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research provides insight into gender differences in depression More than 19 million Americans suffer from depression yearly and women are twice as likely as men to experience a major depressive episode. Depression may occur at any age during a woman's life, and individual risk may be increased with events such as puberty, pregnancy, and perimenopause, as well as trauma, substance abuse, and quality of relationships, according to a report published recently by the American Psychological Association. The report, entitled "Summit on Women and Depression: Proceedings and Recommendations," includes research contributed by 35 international experts in an attempt to summarize current research and suggest ways in which recent findings can be incorporated into health policy and health-care practice. In addition to the individual research cited, the report notes that a World Health Organization report on "The Global Burden of Disease" found that "depression presents the greatest disease burden for women when compared with other diseases." The report lists a number of factors that may play a role in the high incidence and prevalence of depression among women, including genetic factors, influence of sex hormones, and life stress and trauma such as abuse during childhood or by an adult partner. Although results from family or twin studies have not been definitive in showing the exact contribution of genetics to depression, the growing mass of evidence suggests that there is a genetic risk that may be different for women and men. Researchers are exploring the interaction of genetic, hormonal, and experiential factors as a possible contributor to women's heightened risk for depression. The link between increased rates of depression and puberty, mood and the menstrual cycle, as well as mood and pregnancy suggests a role of gonadal hormones in depression. Specifically, changes in gonadal hormones, disturbances in the hypothalamic-pituitary-gonadal axis and attendant effects on neuromodulators such as serotonin may all be key mechanisms in the initiation of depression. Case-control and community-based studies have shown that more than 80 percent of major depression cases are preceded by a serious adverse life event. Initial research has suggested that early trauma has a greater impact on risk for depression than later occurring trauma. Research has also indicated that women may be more likely than men to experience depression in response to a stressful event. Common treatments for depression in women include psychotherapy and antidepressants. Both psychotherapy and antidepressant treatments are equally effective for mild to moderate depression. Controlled clinical trials provide evidence for the efficacy of interpersonal and cognitive behavioral interventions as psychotherapy. Other evidence suggests that some structured behavioral marital and family therapies are effective in treating depression. There is also some evidence that psychotherapy is useful in preventing relapse or recurrence in patients who have successfully been treated with antidepressants. The contributors to the report recommend more effort to develop, evaluate, and implement interventions that will prevent the recurrence of major depression in women at risk by virtue of a prior episode. Targeted prevention is also recommended, focusing on times of heightened risk for depression such as adolescence. Preventive strategies in women about to become mothers are seen as needed particularly for women who are at risk by virtue of previous depression, especially previous postpartum depression. Lastly, the report authors stress the importance of public education campaigns to inform both the general public and non-mental health medical professionals about the incidence and morbidity of depression among girls and women. Copies of the report
are available from at http://www.apa.org/pi/wpo/women&depression.pdf |