As noted in a recent blog, women are twice as likely to experience major depression than men. They are also up to three times more apt to suffer from anxiety disorders or to attempt suicide. The reasons for these gender differences are not clear, and some believe such statistics are exaggerated because females are more “sensitive” and therefore more likely to report such symptoms. On the other hand, a variety of observations tend to confirm that these disparities are valid, such as the following half dozen.
1. Hormonal differences are usually cited as the major explanation. Compared to men, women experience much more fluctuation in hormone levels that are associated with symptoms of depression. In addition to premenstrual dysphoric disorder, up to 15% experience postpartum depression. Depression is so common during the menopause, that involutional melancholia was an established psychiatric diagnosis up until 1980. Women are also more apt to suffer from hypothyroidism, which is often associated with depression.
2. Women have a stronger genetic predisposition for depression than men based on identical and fraternal twin studies, as well as documented and detailed family history records.
3. Women tend to be more involved in personal relationships than men and suffer more when they are disrupted. More married women and housewives have increasingly entered the workforce and find it difficult to juggle job and family responsibilities, such as caring for an elderly relative. A major European study covering over 30 countries with a combined population of 514 million people recently reported that depression in middle-aged women had doubled in 40 years because of these pressures. Women between the ages of 25 and 40 were three to four times more likely to become depressed than men.
4. Women live longer than men and extreme old age is often associated with bereavement, loneliness, poor physical health, and other factors that predispose to depression.
5. Women are more likely than men to consult a physician if they do not feel well or have symptoms of depression, and are therefore more likely to be diagnosed. There is also some evidence that both male as well as female physicians are more apt to make a diagnosis of depression in women than men with identical complaints.
6. Seasonal Affective Disorder (SAD syndrome) is four times more common in women than men, and its incidence increases the farther away you live from the Equator. For example, Tromso, a city in Norway 200 miles north of the Arctic Circle, has close to 50 days during the winter when the sun is never seen. This period is referred to as morketi den (murky time) and as one psychiatrist noted, “The whole city slows down, people’s concentration and work capacity are reduced and they are always tired. There is a definite increase in depression, particularly in women.” Sales of sleeping pills, tranquilizers as well as “pep” pills rise sharply as do accidents. The sun’s return after 7 weeks is celebrated as Soldag (Sunday), and the first rays are greeted with tears, prayers and special wishes, children are sent home early from school and everyone stops working.
As will be explained in a subsequent blog, career oriented single working women may be at particularly increased risk not only for anxiety, depression and heart disease, but also breast and ovarian cancer, so stay tuned. Additional information on all the above can be found at www.stress.org.
Written by: Paul J. Rosch, MD, FACP