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Women - Risk Factors for Depression

 

Women at Greater Risk for Depression than Men

Major depression and dysthymia affect twice as many women as men. This two-to-one ratio exists regardless of racial and ethnic background or economic status. The same ratio has been reported in eleven other countries all over the world. Men and women have about the same rate of bipolar disorder (manic depression), though its course in women typically has more depressive and fewer manic episodes. Also, a greater number of women have the rapid cycling form of bipolar disorder, which may be more resistant to standard treatments. 

Many factors unique to women are suspected to play a role in developing depression. Research is focused on understanding these factors, including: reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics. But, the specific causes of depression in women remain unclear. Many women exposed to these stress factors do not develop depression. Remember, depression is a treatable psychological problem, and treatment is effective for most women

Factors Affecting Depression in Women

Adolescence 

Studies show that the higher incidence of depression in females begins in adolescence, when roles and expectations change dramatically. The stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. These stresses are generally different for boys and girls, and may be associated more often with depression in females. Some researchers have suggested that men and women differ in their expression of emotional problems. In adolescence, boys are more likely to develop behavioral and substance abuse problems, while girls are more likely to become depressed

Adulthood: relationships and work roles

Stress can contribute to depression in many people.  The higher incidence of depression in women may not be due to greater vulnerability, but to the particular stresses that many women face. These stresses include major responsibilities at home and work, single parenthood, and caring for children and aging parents. Social expectations play a role here as well. In two career families, women are more likely to have responsibility for a greater share of child care and household responsibilities. Role conflict is also an issue, as debate continues regarding whether women need to choose between family and work responsibilities, and about which choice is the "proper" one.

Reproductive events 

Women's reproductive events include the menstrual cycle, pregnancy, the post pregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood that for some women include depression. Researchers have confirmed that hormones have an effect on brain chemistry. Changes in emotions and mood often result. The specific biological mechanism explaining hormonal involvement in depression is not known. 

Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. Called premenstrual syndrome, its relation to depressive disorders is not yet understood. Some have questioned whether it is, in fact, a disorder. Further research will eventually add to our understanding of this condition. 

Postpartum depressions can range from transient "blues" following childbirth to severe, incapacitating, psychotic depressions. Studies suggest that women who experience depression after childbirth very often have had prior depressive episodes. However, for most women, postpartum depressions are transient, with no adverse consequences.

Pregnancy (if it is desired) seldom contributes to depression, and having an abortion does not appear to lead to a higher incidence of depression. Women with infertility problems may be subject to extreme anxiety or sadness, though it is unclear if this contributes to a higher rate of depressive illness. In addition, young motherhood may be a time of heightened risk for depression, due to the increased stress.

Personality and psychology

Studies show that individuals with certain characteristics-- pessimistic thinking, low self-esteem, a sense of having little control over life events, and proneness to excessive worrying-- are more likely to develop depression. These attributes may heighten the effect of stressful events or interfere with taking action to cope with them. Some experts have suggested that the traditional upbringing of girls might foster these traits and that may be a factor in the higher rate of depression in women. 

Other researchers have suggested that women are not more vulnerable to depression than men, but simply express or label their symptoms differently. Women may be more likely to admit feelings of depression, brood about their feelings, or seek professional assistance. Men, on the other hand, may be socially conditioned to deny such feelings or to bury them.  Men also have a greater tendency to "act out" when they are under stress.  This results in higher rates of alcoholism in men, and higher rates of physical violence.

Victimization 

Studies show that women molested as children are more likely to have clinical depression at some time in their lives than those with no such history. In addition, several studies show a higher incidence of depression among women who were raped as adults. Since far more women than men were sexually abused as children, these findings are relevant. Women who experience other commonly occurring forms of abuse, such as physical abuse and sexual harassment on the job, also may experience higher rates of depression. Abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. At present, more research is needed to understand whether victimization is connected specifically to depression. 

Poverty 

Women and children represent seventy-five percent of the US. population considered poor. Some researchers are exploring the possibility that poverty is one of the "pathways to depression." Low economic status brings with it many stresses, including isolation, uncertainty, frequent negative events, and poor access to helpful resources. Sadness and low morale are more common among persons with low incomes and those lacking social supports. But research has not yet established whether depression is more prevalent among those facing environmental stressors such as these. One very large study has shown that depression tends to equally effect the poor and the rich. 

Depression in later adulthood

Once, depression at menopause was considered a unique illness known as "involutional melancholia." Research has shown, however, that depressive illnesses are no different, and no more likely to occur, at menopause than at other ages. In fact, the women most vulnerable to change-of-life depression are those with a history of past depressive episodes. An old theory, the "empty nest syndrome", stated that when children leave home, women may experience a profound loss of purpose and identity that leads to depression. However, studies show no increase in depressive illness among women at this stage of life.

As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Despite this, depression should not be dismissed as a normal consequence of the physical, social and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.

About 800,000 persons are widowed each year, most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or psychotherapy. Remarkably, a third of widows/widowers meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to psychotherapy and standard antidepressant medications.

 


Women: Depression and Bipolar Disorder