Women outnumber men for depression

Women outnumber men, two to one, in the prevalence of depressive illness.

A large body of evidence exists with regard to the prevalence of depressive illness being markedly higher in women than men. Although the reasons for this distribution are not entirely clear, the reasons based on research are thought to be multifaceted. The factors that have been researched to indicate contributory causing including biological such as genetics, reproductive events, personality types, psychological, gender (identity and role) family roles and partner relationships, work roles, victimization and poverty. In this article I shall examine the research and key components of the research providing some personal and critical commentary on the basis of research.

The key biological explanations provided suggest that their maybe a genetic predisposition to developing depression. In addition, because of women’s changing hormone level around childbirth and menopause increase the risk of depression (Mule,2004) suggests that during these events depression outcome is of a higher risk. A biological link is also reinforced in that Women are more prone to depression following puberty. Gender specific events including birth, PMT and menopause existentially these reflect a “direct” stresses that lead to women being depressed including postnatal depression.

It is thought that “gender differences in depressive symptoms appear to emerge in early adolescence and then remains throughout the adult life span” (Nolen-Hoeksema, Larson, & Grayson, 1999). Consistent Research also indicates that adolescent girls develop depressive symptoms at an earlier age than do adolescent boys (Nolen-Hoeksema, Larson, & Grayson, 1999). However, these emerging gender differences can be caused by individual vulnerability, life stress, and pubertal transitional challenge indicative of the gender and gender identity. It is clear that girls are more susceptible to depression even in adolescence, but there is no concrete evidence to prove why. (Mule, 2004).

Hereditarily speaking genetic transmission may cause women to be more susceptible to depression. In support of genetic transmission as an explanation for the sex differences there is reasonable evidence from twin and family studies that genetic factors are operating in the genesis of depression and affective disorders (Nazroo & Edwards, 1998). Two explanations are theorized to support hereditary theory one that there is within the x chromosomes where the gene for depression exists within females and thus not males. The other explanation is the phenotype (the expression of an organism’s genes as well as the influence on environmental factors and the interactions between the two) such that the phenotype is more likely to be effected by being in an environment where the parents are also depressed. Phenotypes affects men as well; however its affects are stronger in women (Mule, 2004). This is thought to occur more because women have a higher tendency of awareness of their surroundings and are typically closely interconnected with their family members (Mule, 2004).

There is also considerable evidence that suggests women’s bodies respond to stress very differently than men’s. They pour out higher levels of stress hormones, and they fail to shut off production of the stress hormones readily (Mule, 2004). The female sex hormone progesterone blocks the normal ability of the stress hormone system to turn itself off. Sustained exposure to glucocorticoids kills brain cells, especially the hippocampus, crucial to memory (Mule, 2004). Thus females stress system are set up biologically to amplify internally their negative life experiences.

New research is also emerging in the field. An interesting study indicates that certain biological markers such as MCP-1 become inflamed that these elevations in inflammatory markers found in depressive subjects may be partially the result of disturbances of sleep initiation found in this population. Increased levels of MCP-1 have been found in major depression patients, suggesting that MCP-1 may be linked with an increased susceptibility to depression. Other studies found that increased levels of MCP-1 are much more common place in women than men, not only that but women sustain the increase for longer periods of time. These findings suggest that women are more likely to become depressed than men because of the substantial increased levels of MCP-1 that women are subject to (Motivala, 2005).

It is also thought that from an evolutionary perspective women needed to be more sensitive to the relationship so to avoid abandonment when raising children. In addition, feelings of lack of attractiveness for mate and feelings of becoming elderly and not being able rear children caused feelings of dissatisfaction more with women. It is though that this additional perspective led women to be more ruminative and reassurance seeking than men. There are two strands to such a psychological explanation. Firstly, that women ruminative more than men, which may also predispose them to developing depression. In contrast, men are more likely to react to difficult times with stoicicism, anger, or substance misuse. Second, that women are generally more invested in relationships than men. Therefore relationship problems are likely to affect them more, and so they are more likely to develop depression.

One explanation of depression variations are that women come under more stress than men. For example go work just like men, looking after the home, families, children as well. Daniel and Jason Freeman (Apter, 2003) have written about “The Stressed Sex” (OUP) arguing that higher rates of depression in women (20 to 40%) result from increasing pressure on women “to function as carer, homemaker and breadwinner.”. This theory is supported by Kenneth S. Kendler (2014), who was able to research opposite sex twins showing that there is a significant difference between men and women in their response to adversity. He states that “Women seem to have the capacity to be precipitated into depressive episodes at lower levels of stress.” He even states this variation eloquently “I spend four hours a day with my kids and I feel guilty as hell, you spend two hours a day and feel like you’re a great father. It’s not fair.” I can see based on my own work with depressed female clients at least anecdotally with women that are trying to fulfill all these roles multiple roles – emotional and financial provider and filling the role of the female being a primary stress. Also as women live longer than men, the related stresses of bereavement, loneliness, poor physical health, and security link to a rise in depression. It is well known that women are more likely to seek out medical treatment than men and thus express their feelings with a doctor. As such doctors are more likely to make a depression diagnosis.

Daniel and Jason Freeman (Apter, 2003) also cite that association with depression may exist due to feedback from the external world. For example, in terms of reward and recognition women are paid less than men and find it more difficult to advance the career ladder so that this lack of social and relational feedback (or appreciation) makes women more vulnerable to depression. Certainly Brown and Harris (2012) do cite the lack of options to do more in life due to role stressors and not being challenged enough. Such life characteristics include having to stay at home and relational deprivation. The right amount of juggling e.g. roles can be useful for mental health. However, also not being able to do things because of wealth of choice can cause regret. Although this may not relate to depression directly but whether than energy of having to juggling come intrinsically or extrinsically (Apter, 2003).

However, Apter (2013) argued that it is the commitment to unreal and impossible standards and importantly someone else’s standard that “dulls” women’s own needs and wishes that could be a factor to the depression variation that is increased External Locus of control. Jack (1991) identified the “Over Eye” that comments and assesses actions and feelings and their compliance to standards. These ideals may entrap e.g. envy of other women’s perfect lives, being the perfect girl. Therefore the argument is not the stress of juggling that is the factor in depression but more the idealised compulsion too. In today’s age the emphasis of the media on image, sexuality and what an ideal is may put additional pressure on women who already have more external judgements. Jack (1991) argues that it is the self that through internalisation of the external bringing to light the “activity required to be passive” in relationships. These internalisations include cultural expectations about feminine goodness, gender roles and identity.

Evidence also indicates that limitations placed upon women (Silberstein & Lynch, 1998) play a significant factor in differences. These explanations include social status, learned helpless ness, and demographic challenges (Mule, 2004). Gender related limitations beliefs include countless stereotypes (for example, feminine, nurturing). Mule (2004) argues “Women are conflicted to live up to these stereotypical roles and expectations of perfection every day, no matter how many roles they take on in their everyday life.”. Through socialization women become more emotional and achievements are in relation to men. In contrast for men who come from assertiveness and individuality make this generalization of inferiority appears viable.

In one study for example the quality of marriage is more strongly related to home life satisfaction for women compared to men (Denmark & Paludi, 1993) which indicates that women invest emotionally to these roles more while men see the instrumental gains such as housekeeping. Thus women may feel more like a role or servant. A research paper (Wilhelm & Roy, 2002) states that women who reported higher rates of their partners as less caring and as more likely to be a depression causing stressor. Similarly with parental roles very few men are the primary caretaker and in even where they are employed they are more involved with children than men. However employed women are more dissatisfaction with the amount of time they have with children and spouse, tending to complain less while men were more satisfied when the partner spent more time on child care tasks (Denmark & Paludi, 1993). All these factors indicate more emphasis self and external expectations for on female fulfilment.

Through the analysis of these two gender roles, it is evident that women are less satisfied with their gender responsibilities. Also with changing individual value systems, smaller family size, increasing longevity, and increased self-expectation, these pressures to be all these things increases. With regard to gender identities in modern times the idea that “thin is beautiful” has become the socially accepted norm. The media publicizes what is beautiful; and more often than not women don’t seem to relate to these looks. Mule (2004) suggest that these contributing factors if internalized can result in dangerous feelings and habits, such as depression and eating disorders (comorbid in women).

Reflecting on this internalisation how is it then possible to be in a state of emptiness and disconnected from the inner self and well as the outside world caused by depression and how this must then add to low self-worth in that that the ideals cannot  be fulfilled in that state of disconnect. Such as need must be at the detriment to wellbeing regardless of depression.

Of additional interest in the differences in depression rates within subgroups of women including culture, socio-economics, abuse, location. Depression is linked to economic problems, less educated and lower socioeconomic status. Since women are more represented than men as being within these categories this is another factor for the variation. In addition, women of color are also more at likely in comparison with Caucasian women. The rate of sexual and physical abuse is much higher in women and is a major factor in women’s depression. Depressive symptoms may be long-standing effects of post-traumatic stress disorder for many women (McGrath et al., 1990).

It has been shown that “Depressive disorders show substantial comorbidity with other psychiatric disorder, especially anxiety, externalizing, and eating disorders” (Hankin & Abramson, 2001). The disorders that largely affect women are eating disorders and anxiety. Therefore a hypothesis is that since women suffer more that also contributes to women suffering more from depression. For example, the ruminative “depressive” thoughts may lead to having obsessive thoughts of “have to be beautiful” which in turn could result in excessive dieting and eating disorders. This is supported by Kimberling & Ouimette (2002) who found women are diagnosed with comorbidity of anxiety disorders and depression twice as often as men.

Another worthy consideration is the hypothesis of depression differences is reoccurrence studies of depression. That is that women’s reoccurrence of depression occurs more often than men. Although a counter study (Mule, 2004) seemed to indicate this was not the case it was noted that this study was based on a small population size.

Given a summary of the available hypothesis and contributor factors it is recognised widely that there is no single factor know yet that there is a consensus on that answers why depression is so much more prevalent in women. However, it can be said that there are multiple reasons as discussed across evolutionary, sociocultural, physiological and psychologically oriented.

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