Women and Depression:What’s Culture Got To Do

With It?Connie Marsh MD

University of Kansas School of Medicine-Wichita

Importance of topic

By 2020, depression will be the second greatest cause of disability world wide

Women and Depression

In any given year, what percentage of individuals will have depression?a. 2%b. 5%c. 10%

Women and Depression

True or FalseWomen and men have the same rates of depression.

Women and Depression

What percentage of women, over a life time, will have depression?a. 7%b. 13%c. 21%

Women and Depression

Importance◦ impact

Women and Depression

Impact◦ Isolation◦ Work problems◦ Family problems◦ Worsening medical problems◦ Suicide attempt and completion

15%

Women and Depression

Importance◦ Impact on illness

Greater disability and impairment Diabetes Lung disease High blood pressure Back problems Heart disease

Women and Depression

For most women, depression usually first occurs

a. Age 15-24b. Age 25-44c. Age 45-55

Women and Depression

Neglected◦ 60% detection by primary care doctor◦ Less than 2/3 of people with depression seek

treatment Inadequate treatment is common

Women and Depression

What does depression look like?

Women and Depression

Mood Sleep Appetite Energy Interests Guilt Concentration Slowed down Thoughts of suicide

Depression

Women more likely ◦ Seasonal component◦ Excess eating◦ Excess sleeping

Depression and Women

What does depression look like?

What’s Culture Got To Do With It?

Perception of mental illness Stigma Willingness to accept treatment Compliance to treatment Role expectations Immigration

What’s Culture Got To Do With It?

Rates of depression across races/ethnic groups◦ Globally◦ Within US culture

900 young women 21% of whites 28% of African Americans 29% of Hispanics

What’s Culture Got To Do With It?

Male/female disparity

What’s Culture Got To Do With It?

Social◦ Introspection encouraged in girls

Socioeconomic◦ Single parent◦ Social isolation

Psychological◦ Increased rates of sexual/physical abuse in

females

What’s Culture Got To Do With It?

Male/female disparity◦ ENDOCRINE/neurotransmittors

ESTROGEN

What’s Culture Got To Do With It?

Puberty Premenstrual Pregnancy/lactation Postpartum Perimenopause

When?

Estrogen

What are risk factors for depression?

Risk Factors

For males and females◦ Family history◦ Personal history◦ Serious medical illness◦ Decreased social support◦ Serious life stress◦ Substance abuse, including alcohol, MJ, cigarettes

Risk Factors

For females◦ Loss of parent before age 10◦ Childhood sexual/physical abuse◦ History of depression after pregnancy◦ Single parent◦ Unhappy/abusive marriage◦ Presence of young children in home

Risk Factors

Psychotherapy Antidepressant medication Life style changes

◦ Exercise◦ Nutrition◦ Socialization

Treatment

If risk factors◦ Recognize susceptibility◦ Don’t ignore symptoms, including irritability◦ Get therapy

Stay healthy◦ Exercise◦ Avoid substances—drugs, alcohol, MJ, smoking

Prevention?Modification?

Get help early◦ More treatable◦ Less impact on job/family/relationships

Vicious cycle◦ Recognize stressful times as susceptible times

Increase social support network◦ ASK for help◦ If young children in home, especially important

Prevention?Modification?