Depression and women

National Women's Health Report, August, 2003

Women in the Lead

As noted earlier, women have the dubious distinction of being significantly more likely to experience an episode of severe depression to their lifetime than men, although the JAMA study shows the gender gap is closing. Ten years ago, the first national study of depression found women were twice as likely to experience depression as men; in the study published in June, they were just 1.7 times more likely.

"There is a real gender difference," says Carolyn M. Mazure, PhD, professor of psychiatry at the Yale University School of Medicine and Director of Women's Health Research at Yale. No one knows the exact reason for the disparity, nor why men seem to be catching up to women. But there are numerous theories for the higher rates in women. One, of course, has to do with the ways in which women's hormones affect certain brain chemicals that regulate mood. (See Ages and Stages on page 6 for more information.)

Another has to do with the way severe stress, like the death of a spouse or loss of a job or divorce, affects women. Dr. Mazure has conducted considerable research into this area, finding that while such stress can lead to depression for both men and women, it is three times more likely to send women into depression than men. (5)

It seems that when it comes to stress, women may be more sensitive to a wider range of events than men, including moving, a physical attack, or life-threatening illness or injury, as well as the death of a close friend or relative. Part of the reason has to do with the larger networks women have. Although these networks can provide a protective benefit against stress, they are a double-edged sword, says Dr. Mazure: if something happens to someone in the network, or to a woman's place within the network, it may trigger a depressive episode.

New research published in the July 18, 2003 issue of the journal Science also suggests that whether or not stress pushes you into depression may rest a least partly on a gene that determines how you react to the stresses of life. (6)

For Sherry Ingleside *, of central Pennsylvania, the trigger was the economic downslide in 2001. Not only had she taken early retirement from her job as a teacher, but her husband had switched jobs and was earning less. Plus, their retirement portfolio was shrinking faster than a wool sweater in the dryer. "I knew I was feeling things were worse than they were, but I couldn't shake it," she recalls.

Ms. Ingleside exhibited another characteristic of women that may explain their propensity for depression: ruminative thinking. Women are more likely than men to think distressing thoughts, and go over and over their possible causes and consequences without trying to do anything about them. (7)

Additionally, women who score high on a written test designed to rate their "concern about disapproval," were three times more likely to be depressed than men, (8) Dr. Mazure's research finds.

"Many aspects of our social interactions are really based on a sense that we want people to say we've done a good job," she explains. "And there's also a long list of literature suggesting that feeling a sense of control or mastery is really critically important to our functioning. But if you're always being told you haven't handled it well, you're never good enough, you've done it the wrong way, you start to incorporate it into your own thinking."