The American Psychological Association has issued a report sharply challenging the comfortable old assumptions about why twice as many women suffer from major depressions as men. Turns out it isn't all hormones, after all.
Quite the contrary. After a three-year study, the Task Force on Women and Depression has pointed the finger at a whole range of social conditions that denigrate and victimize women as being substantial contributors to women's depression.
On one level, one could say that you don't have to be a psychologist to figure out that a class of people who are underpaid in the workplace, beaten up at home and raped almost routinely on college campuses are going to suffer much more from depression than people who aren't victimized. What is important about the study, however, is that it bears the stamp of authority of the APA and marks the first time it has linked cultural causes to depression in a formal task force report.
While it does not discount biological causes of depression, the panel said that mental health professsionals need to "develop ways of thinking about women's depression in a biopsychological context. Understanding the complexities of women's higher risk for depression requires understanding the interaction of women's biology with their environment. It requires clear definitions of depression and of the biological, psychological and social variables used to predict it."
The panel recommended that a great deal more research be done in the whole area of women and depression and how they differ from men in causes and treatment. The panel also found that depression was misdiagnosed in women 30 to 50 percent of the time. It cautioned that anti-depressant drugs, 70 percent of which are prescribed for women, are often misprescribed and improperly monitored. "Prescription drug misuse is a very real danger for women," the report warned.
About 7 million women suffer from diagnosable depression, and the researchers put the overall cost to society at $16 billion a year. They were particularly concerned about the lack of access to mental health care by the 37 million people who have no health insurance, as well as those whose policies don't cover mental health care. Sixty-seven percent of employer policies don't have mental health benefits. Fully 8.5 million American women -- 15 percent of the female population -- live in poverty, and the numbers are increasing yearly. "The hopelessness and crisis-oriented nature of living in poverty not only contribute to depression and related responses, but also provide significant barriers to receiving appropriate mental health treatment and care," the panel advised.
One of its most striking findings had to do with violence against women. "The rate of sexual and physical abuse of females is much higher than previously suspected and is a major factor in women's depression. One study estimated that 37 percent of women have a significant experience of physical or sexual abuse before the age of 21. Several task force members felt . . . the real numbers may be as high as 50 percent," according to the report. The panel suggested that for those women depression may be the result of post-traumatic stress syndrome.
Sexual harassment at work, which one study found could happen to as many as 71 percent of all working women, often results in job loss and other traumas, and the panel suggested that because of the high incidence of sexual harassment it should be considered as a possible trigger for depression in women.
Women's experiences in trying to balance work and family life, and the support they get from their husbands, affect depression. One study found that mothers who had no trouble finding child care, and whose husbands shared child-care responsibilities, had low rates of depression, as low as husbands and employed women with no children. The employed mothers who shouldered all of the child-care responsibilities had high rates of depression. Higher rates were found among women caring for aging parents.
And the panel cited other studies that found an elevated rate of suicide among women professionals who are in fields traditionally dominated by men. Another study found an elevated rate of suicide among male nurses, who are operating in an environment dominated traditionally by women.
The workplace and home clearly have an impact on women's mental health, as well as physical health. Those concerned with rising health care costs ought to ponder the implications of the task force report very carefully. It has debunked the notion that women's mental health is an immutable product of hormones. The culture is leading to depression, too -- and that can be changed.