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Title: Why Depression Is More Common In Women Than Men
According to WHO, Heath is defined as a state of complete mental, social and physical wellbeing and not just the absence of disease and illness. Depression is defined as a mood disorder with persistent feelings of sadness. Depression affects how people think, behave and feel. It can lead to a variety of physical and emotional problems. People with depression have trouble doing daily activities and sometimes they may feel their life worthless. Depression is a highly prevalent chronic illness and is the second leading cause of disability in the United States, Canada and globally. By 2030, it is predicted that depression will be the leading cause of disease burden, especially among women. Between 1990 to 2010, depression showed a 76% increase in disability-adjusted life years in Canada and 43% in the United States. Education, socioeconomic status, income and abuse are factors that contribute to the high rate of depression in women.
The prevalence of depression is higher in females than males with an annual prevalence of 5.6% and 3.3% respectively. In 2010, in the United States prevalence of depression was 5% in women and 3 % in men which increased to 6% and 3.7% respectively in 2012. No clear evidence is present that shows that the depression rate is more in countries where women have lower socioeconomic status than men. According to different studies, it is shown that the reason for the high prevalence of depression in females can be attributed to biological sex differences than culture, diet, race and education. Depression is twice more prevalent in young women than men but the ration decreases with age. Globally young women are at an increased risk of mental disorders and depression at the start of puberty ADDIN EN.CITE <EndNote><Cite><Author>Whiteford</Author><Year>2013</Year><RecNum>289</RecNum><DisplayText>(Whiteford et al.)</DisplayText><record><rec-number>289</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574061939">289</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Whiteford, Harvey A</author><author>Degenhardt, Louisa</author><author>Rehm, Jürgen</author><author>Baxter, Amanda J</author><author>Ferrari, Alize J</author><author>Erskine, Holly E</author><author>Charlson, Fiona J</author><author>Norman, Rosana E</author><author>Flaxman, Abraham D</author><author>Johns, Nicole</author></authors></contributors><titles><title>Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1575-1586</pages><volume>382</volume><number>9904</number><dates><year>2013</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>(Whiteford et al.).
Why is depression more prevalent among women? It is found in one study that women showed more sensitivity to interpersonal relationships, whereas, men showed more sensitivity to goal-oriented and career factors. Women also face specific forms of depression such as postpartum depression, premenstrual dysphoric disorder, postmenopausal anxiety and depression linked with the changes in hormones. Increased prevalence of depression can be correlated with hormonal changes particularly before menstruation, during puberty, following pregnancy and menopause. This suggests that hormonal fluctuation in females can trigger depression ADDIN EN.CITE <EndNote><Cite><Author>Albert</Author><Year>2015</Year><RecNum>287</RecNum><DisplayText>(Albert)</DisplayText><record><rec-number>287</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574061651">287</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Albert, Paul R</author></authors></contributors><titles><title>Why is depression more prevalent in women?</title><secondary-title>Journal of psychiatry & neuroscience: JPN</secondary-title></titles><periodical><full-title>Journal of psychiatry & neuroscience: JPN</full-title></periodical><pages>219</pages><volume>40</volume><number>4</number><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>(Albert).
Gender is one of the critical determinants of health which influences control and power, individuals have over health determinants such as roles, social status, socioeconomic position access to treatment and resources. Gender is very important in defining the exposure and susceptibility to a large number of mental health risks. It is not possible to determine the gender impact on mental health status without studying gender-based disparity in depression prevalence. The high prevalence of depression in women than men has been consistently observed in the general population. Some genetic, psychological, social and biological factors have been investigated to explain this association. According to different studies, sexual harassment, poverty, chronic strain and child abuse contribute to the high prevalence of depression among women than men. From a psychological perspective, the two main variables contributing to the gender differences in major depression are rumination and interpersonal orientation. According to different studies, the higher level of these constructs is associated with depression among women. Although these explanations have empirical support in epidemiological, clinical and laboratory studies, the mechanism underlying the gender difference in major depression remains unclear. Recently studies have been conducted in which it is shown that personality traits contribute to the high prevalence of depression in women.
There are many different theories that give an explanation of depression causes within the psychological domain. One of the psychological theories for depression is that of psychological susceptibility. This theory argues that women are more susceptible to depression due to personality traits and type. According to this theory, it is believed that some personalities are less flexible. This is a reason which explains their struggle to adapt and cope with adversity and change, whereas, on the other hand, some personalities are more accommodating and can deal with different events and stressors of life. Studies have found that before puberty, prevalence of depression is the same among girls and boys. A similar rate of depression is also seen in men and women who are older than 65 years of age.
Another psychological theory on the women depression revolves around rumination and cognitive negative self-talk. According to Beck and Alford, some people are more vulnerable to depression because of their negative self-talk constellation about the world, themselves and the future. Rumination is defined as thinking over and over again about events and situations in one's life. Cognitive-behavioral therapy is a psychological approach that helps in preventing depression. This theory has been implemented as a psychological intervention for those people who lived with depression for many years. Another theory explains the psychological stressor of depression. According to this theory, economic and psychological stress may develop from the experience of women of their social roles such as domestic responsibilities of women, gender-based violence, stereotyped role expectations and poverty. This theory is based on the assumption that life stressors such as divorce, death, trauma and poverty increase the chance to not cope with the challenges of life. This makes them more susceptible to depression especially when these negative events are persistent and ongoing. According to this theory, different life stressors and hardships hinder the ability of a person to cope which leads to depression. In addition, the way women understand and interpret these negative events influences the level of depression. For example, women may blame themselves for living in oppression, poverty, and abusive situation. This theory acknowledged that some life stressors has an impact on the everyday lives of women.
Freud was the first to create a systematic theory to compare the mental health of men and women. According to this theory, men are psychologically superior to women. Different epidemiological studies have been carried out to assess the mental health problems among men and women. According to these studies, women are more prone to internalizing problems such as depression and anxiety. These include both severe and milder forms of depression as well as phobias and generalized anxiety disorders. Most of the women lives with feelings of profound loss, sadness, guilt, self-blame, self-reproach and great energy loss. Women experience a great loss of interest in life, motivation, and energy more than men. Women as compared to men feel more helplessness in improving their circumstances. As compared to men, women often have trouble in concentration and sleeping. Women also suffer from more panic attacks and random thoughts. Among the most prominent social division is the one we form by gender. The interest in the role of gender difference in depression is relatively a new concept. According to different studies, women have a higher risk of developing a depressive disorder as compared to men. Although the reasons for these differences in mental health among men and women are not known exactly, it is predicted that psychological and hormonal influences have an indirect and direct effect on mood. Some of the reasons are an unhappy marriage, increased likelihood of abuse and victimization and more help-seeking behavior. Not only women are at more risk of developing depression, but once they develop, depression symptoms presentation may also differ from men. Women are more likely to be presented with a typical symptom such as weight gain and increased appetite and tend to report more somatic and anxiety symptoms whereas, men exhibit classical symptoms such as weight loss and insomnia.
There is one unresolved controversy regarding the relationship between suicide and depression. Depression is a major precursor of suicide and it is more common in women. However, suicide is three times more common in men. Other than this, men use more violent suicide methods. The depression in males is characterized by alcohol abuse, lowered stress tolerance and aggressiveness. In general, overrepresentation of major depression in women is just an artifact because of antisocial behavior and alcoholism mask depression in men. In terms of comorbidity, it is found that depressed women have higher rates of comorbid disorder and most common is eating disorder and anxiety ADDIN EN.CITE <EndNote><Cite><Author>Ferrari</Author><Year>2014</Year><RecNum>288</RecNum><DisplayText>(Ferrari et al.)</DisplayText><record><rec-number>288</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574061717">288</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ferrari, Alize J</author><author>Norman, Rosana E</author><author>Freedman, Greg</author><author>Baxter, Amanda J</author><author>Pirkis, Jane E</author><author>Harris, Meredith G</author><author>Page, Andrew</author><author>Carnahan, Emily</author><author>Degenhardt, Louisa</author><author>Vos, Theo</author></authors></contributors><titles><title>The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010</title><secondary-title>PloS one</secondary-title></titles><periodical><full-title>PloS one</full-title></periodical><pages>e91936</pages><volume>9</volume><number>4</number><dates><year>2014</year></dates><isbn>1932-6203</isbn><urls></urls></record></Cite></EndNote>(Ferrari et al.). On the other hand, depressed men have a higher rate of comorbid substance abuse and alcohol dependence. In some studies, the duration of illness has also been evaluated. According to these studies, women develop depression at a younger age and tend to have a longer duration of episodes. Women also have a higher risk of recurrence and chronicity.
One study was conducted in which the influence of the reproductive cycle on depression was evaluated. Results showed that the premenstrual period, menopausal years and postpartum period triggers depressive episodes in those women who have a previous history of depression. About 82% of the depressed women reported worsening of depression before the menstrual period. Pregnancy is usually considered a time of emotional wellbeing. however, it is found that the risk of depression increases to 10-25% in pregnancy. Depression on pregnancy is also associated with preterm delivery. The marked gender differences in the prevalence of depression that started with puberty suggest that hormonal changes are associated with this difference. In puberty, the brain of the female is exposed to estrogen which is a major reason for depression in women.
Studies have been conducted in which it is hypothesized that a higher rate of depression among women is due to poverty, sexual harassment and chronic strain due to the limitation in social status and power. As discussed above, depression is a multilevel phenomenon. Different theories explained the causes of depression. For example, some biological factors (biochemistry, temperament and genetic), psychological factors (familial history, personality, and personal history) and sociocultural factors (social isolation, inequities, and cultural diversity). Worldwide depression is one of the leading cause of disability affecting more than 360 million people. In European countries more than 8% of the population suffers from major depression every year, this mental health problem has a significant impact on economic and global health.
Depression is a chronic disease. Its treatment usually lasts for about 6 to 12 months. Pharmacology therapy is a first-line treatment therapy for depression. In recent years the use of antidepressants has increased significantly. A study was conducted in Sweden and it was found that approximately 9% of the population in Sweden was prescribed with antidepressants and 65% of these antidepressants were prescribed for women. Similar results were found in other countries. Despite the widespread use of antidepressants, this disease has repeatedly shown to be inadequately treated. The most commonly prescribed antidepressants are serotonin reuptake inhibitors, monoamine oxidase inhibitors, and tricyclic antidepressants. All of these are prescribed depending on the severity of illness, adverse drug reaction, and patient age. The impact of gender is not only on the number of antidepressants prescribed but also on the type. It is found in different studies that SSRIs are prescribed more in women than men. Women are more likely to be clinically diagnosed with depression as compared to men because they are more likely to seek healthcare which increases their chance of diagnosis ADDIN EN.CITE <EndNote><Cite><Author>Falicov</Author><Year>2003</Year><RecNum>291</RecNum><DisplayText>(Falicov)</DisplayText><record><rec-number>291</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574062091">291</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Falicov, Celia Jaes</author></authors></contributors><titles><title>Culture, society and gender in depression</title><secondary-title>Journal of Family Therapy</secondary-title></titles><periodical><full-title>Journal of Family Therapy</full-title></periodical><pages>371-387</pages><volume>25</volume><number>4</number><dates><year>2003</year></dates><isbn>0163-4445</isbn><urls></urls></record></Cite></EndNote>(Falicov). According to the 'social role' theory of gender differences in depression, the traditional roles of women are more stressful and less rewarding than men leading to higher depression rates in women. According to different studies married women experience higher depression as compared to married men. Different studies were conducted and it was found that difference in social roles in marriage contributes to the high rate of depression among women. These studies have determined that gender-specific demand imposed on married women such as not participating in the workforce, looking after children, homemaking are linked to depression in women. A study was conducted and found that as men and women entered adulthood, due to unequal social status based on family and work roles the gender gap in depression increases.
Patriarchy is an ideological and social construct that considers men superior to women. Many studies have been conducted and found that inadequate social support and a combination of life stressors makes women more susceptible to depressive symptoms. Women are more likely to admit mental health problems than men. Gender role socialization paradigm started with the assumption that women and men learn stereotyped gender behavior and attitudes from ideologies, cultural norms and values. According to traditional gender role stereotypes, men are physically tough, strong and aggressive and have the power to control their emotions. Men are also concerned with assertiveness, independence and self-esteem ADDIN EN.CITE <EndNote><Cite><Author>Baxter</Author><Year>2014</Year><RecNum>290</RecNum><DisplayText>(Baxter et al.)</DisplayText><record><rec-number>290</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574061993">290</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baxter, Amanda J</author><author>Scott, Kate M</author><author>Ferrari, Alize J</author><author>Norman, Rosana E</author><author>Vos, Theo</author><author>Whiteford, Harvey A</author></authors></contributors><titles><title>Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010</title><secondary-title>Depression and anxiety</secondary-title></titles><periodical><full-title>Depression and anxiety</full-title></periodical><pages>506-516</pages><volume>31</volume><number>6</number><dates><year>2014</year></dates><isbn>1091-4269</isbn><urls></urls></record></Cite></EndNote>(Baxter et al.).
Bibliography
ADDIN EN.REFLIST Albert, Paul R. "Why Is Depression More Prevalent in Women?" Journal of psychiatry & neuroscience: JPN 40.4 (2015): 219. Print.
Baxter, Amanda J, et al. "Challenging the Myth of an “Epidemic” of Common Mental Disorders: Trends in the Global Prevalence of Anxiety and Depression between 1990 and 2010." Depression and anxiety 31.6 (2014): 506-16. Print.
Falicov, Celia Jaes. "Culture, Society and Gender in Depression." Journal of Family Therapy 25.4 (2003): 371-87. Print.
Ferrari, Alize J, et al. "The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010." PloS one 9.4 (2014): e91936. Print.
Whiteford, Harvey A, et al. "Global Burden of Disease Attributable to Mental and Substance Use Disorders: Findings from the Global Burden of Disease Study 2010." The Lancet 382.9904 (2013): 1575-86. Print.
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