The Feminine Factor 1

Running head: THE FEMININE FACTOR

The Feminine Factor

Why Depression is More Prevalent in Women than Men

Emily Scott

Bellevue University

Abnormal Psychology PY311-T302

Lee Campbell

August 14, 2015

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Abstract

The paper explores the prevalence of why women are more susceptible than men to various
forms of depression. An overview of depression is given and the basics of treatments are
discussed. The question of prevalence is explored in the factors of gender within the subheadings
of age, genetics, anxiety comorbidity, childbirth, increased victimization and health. All of these
factors have supporting information to show the contribution to this disparity and my theory
includes a combination of both victimization and hormonal changes. No clear answer is derived
but many questions remain to be answered.
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The Feminine Factor

Why Depression is More Prevalent in Women than Men

In this paper we will explore why women are more prone to depression than men. We

will start with the explanation of depression and gain a little more understanding of the science

and treatment available for depression. Next we will look into the possible contributing factors as

to why women are more susceptible to depression then men. Factors to include: age, hormones,

genetics, anxiety, and victimization. We will delve into the prevalence these factors and the

prevalence of depression in women and how it differentiates from men.

Depression in Layman

Every good research paper asks a question, which is the next step in a series of questions

which have been answered before it, to understand my question, therefore, we have to begin with

a previous question; What is depression?

“Mood disorders are defined in terms of emotional, cognitive, behavioral, and somatic
symptoms. In addition to a feeling of pervasive despair or gloom, people experiencing an
episode of major depression are likely to show a variety of symptoms, such as diminished
interest in normal activities, changes in appetite and sleep, fatigue, and problems and
concentration (Oltmanns & Emery, 2015).”
It is hard to define such an extensive condition such as depression as many people

experience depression in many different ways; lethargy, sleeping, insomnia, diminished

enjoyment of activities, non-interaction with people, lack of motivation to leave home, and many

more. In general, therefore, it is feeling down for no real reason. While an episode of major

depression can be set off by a sad or stressful event, it’s not diagnosed major depressive disorder

until it has lasted beyond the scope of the preceding event. This is the dramatically simple

answer to my question; now let’s look at some of the science of depression.

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Moderating Sadness

So what is the science behind depression, or moreover, what is happening in the brain to

induce or prolong depression. The most common theories include the neurotransmitters.

“ Neurochemical messengers in the brain also play a role in the regulation of mood and
the development of mood disorders. Current thinking is focused on serotonin,
norepinephrine, and dopamine, although many other neurotransmitter substances may
also be involved in depression (Oltmanns & Emery, 2015).
These theories involve the absorption or the reuptake of the neurotransmitters. These theories

stem from which medicines are used to treat depression and other mood disorders.

“Evidence that effective treatments for depression inhibit the reuptake of serotonin links a
depletion of that neurotransmitter to mood disorders (see chapter 5). As we discussed in
the appropriate chapters, however, several neurotransmitters are likely to be involved in
these and other mental disorders (Oltmanns & Emery, 2015).”
Scientists have found that there are changes in neurotransmitters, some oversupply, some

undersupply and that the sensitivity of these receptors in the brain could play a role in mood

disorders. With the correlation between the neurotransmitters and mood established, it is no

wonder why the next step has been to look into mood altering drugs.

What are the current treatment for depression? They are pharmaceutical medications and

psychological talk therapies which we will explore further; let’s start with medication. There are

number of medications available to help regulate mood disorders.

“Three types of antidepressant medications are also useful in the treatment of major
depressive disorder: selective serotonin reuptake inhibitors, tricyclic antidepressants, and
monoamine oxidase inhibitors. Medication and psychotherapy are frequently used
together. Outcome studies do not consistently favor either psychological or
psychopharmacological treatment (Oltmanns & Emery, 2015).”
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These are just three of the examples of the available medications on the market for

psychopharmacological treatment. There are other drugs and other procedures such as

electroconvulsive (previously called electroshock) therapy. There are also psychological

therapies such as, talk therapy which has been proven to be effective in the treatment of

depression.

With all of these things going on and being treated the next step and the one I am trying

to explore, is about the prevalence question; which leads me to the heart of my paper. My

question was: why are women more prevalent than men to be diagnosed with depression?

The Gender Factor

It has been proven over and over that women are more likely to suffer depression during

their lifetime than men. This is where we will start to explore the prevalence and the statistics of

just how many more women than men are affected, the age range that is more common, and

possibilities as to why it is more common. Although some people find the increase of depression

in women to be surprising, others relate it to the fact that women will seek help more readily.

“Major depressive disorder is a leading cause of morbidity in the USA. A community

surveys of depression, point prevalence of depression in women varies from 5% to 9%,
and lifetime prevalence from 10% to 25%. Although in clinical and epidemiological
studies, a consistently higher frequency of depression is noted in women than men; this
sex difference has not been explained by the increased tendency of women to report
distress or to seek help more often than men (Wise, Zierier, Krieger, & Harlow, 2001).”
If women are more susceptible to depression, are women more susceptible to other mood

disorders? Studies have shown that women tend to be more susceptible to mono-polar depression

as opposed to bi-polar.

“ Women are two or three times more vulnerable to depression than men are (Kessler,
2006; Van de Velde et al., 2010). This pattern has been reported in study after study,
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using samples of treated patients as well as community surveys, and regardless of the
assessment procedures employed. The increased prevalence of depression among women
is apparently limited to depressive disorders. Gender differences are not typically
observed for bipolar disorders (Oltmanns & Emery, 2015).”
Now that we accept that depression is more common in women and has a little

understanding to what depression is, we will now start to explore to possibility of why women

experience more depression then men.

Sub Category: Age

If we accept that women experience more depression than men we have to look into the

various possible reasons for this and ask some critical defining questions. The first of these

questions is: Could age play a factor in why women are more susceptible to depression? Studies

have shown that depression is actually more common in youth than it is in the elderly. But for

women it seems most likely that they become more vulnerable during they’re midlife.

“Women may be particularly vulnerable to developing depressive disorders during

midlife and the menopausal transition (Kessler etal. 1994; Bijl et al. 2002; Cohen et al.
2006; freeman et al. 2006; Bromberger et al. 2009), during which time significant factors
related to the onset of depressive episodes include fluctuating reproductive hormone
levels, severe premenstrual symptoms, poor sleep, hot flashes and lack of employment
(Accortt et al. 2008) (Kravitz, Schott, Joffe, Cyranowski, & Bromberger, 2014).”
So, if women experience more changing hormones than men, could that explain the

discrepancies in why women are more prone to depression than men? Or is it just one of the

many factors which deal with women and depression.

Sub Category: Genetics

Now we delve into a more scientific question, that of genetics. Asking a second defining

question: Is it possible that women are prone to depression, not due to some outside force but to

the very genetics which they, themselves, have inherited?

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“ Lifetime prevalences were 31% in women and 24% in men for DSM – III – R major
depressive disorder, 22% in women and 16% in men for DSM – IV major depressive
disorder, and 9% in women and 3% in men for severe DSM – IV major depressive
disorder. In women, the simplest model to fit the data implicated genetic factors and
environmental factors unique to the individual in the development of depression, with
heritability estimates ranging from 36% to 44%. In men, depression was only modestly
familial, and the individual environmental factors played a large role in the development
of depression (Bierut et al., 1999).”
If we accept it as being truth that depression is more heritable for women than for men,

then we must ask if that means women are more vulnerable to the environmental factors which

allow the acquisition of depression throughout their lifetime. To me, the idea that women’s genes

are prone to depression is one of the most fascinating options for why women are more

susceptible than men. This reality while interesting proves to be double-edged however as, if

genes are to blame, we must ask: does that really help in the future treatment of depression?

Sub Category: Anxiety Comorbidity

Another avenue worth exploring is the comorbidity rate of anxiety with depression. Are

women more likely to have anxiety disorders and thus be more vulnerable to depression?

Unfortunately, with the high comorbidity rate of anxiety and depression it seems difficult to

discern which came first or which maybe causal and the other effect.

“Anxiety symptoms often precede MDD and may increase the vulnerability of midlife
women to depressive episodes, particularly recurrences. Women with anxiety symptoms
should be monitored clinically during the ensuing year for the development of an MDD
episode (Kravitz et al., 2014).”
So women with anxiety symptoms seem to have more recurrent episodes of depression

but not the initial onset of depression.

“Numerous studies using both clinical and community samples have documented high
rates of co-morbidity between major depressive disorder (MDD) and the anxiety
disorders (ANX) in adults, adolescents and children(Maser & Cloninger, 1990;
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Merkangas et al., 1996; Mineka et al. 1998; Angold etal. 1999) (Klein, Lewinsohn,
Rohde, Seeley, & Shankman, 2003).”
Anxiety doesn’t seem to have any age markers; although it does seem to be higher in the

midlife of women, at least for the recurrences of depression. Maybe this could explain why we

see higher depression in the midlife women; if their hormones are elevated and out of sync,

perhaps this leads to more anxiety and increased episodes of depression. Here is another study

about the comorbidity of anxiety and depression.

“Our preliminary study has shown only a non-significantly higher rate of anxious
depression in women, compared with men (48% and 43% respectively) (16); however, in
our replication study sample, the difference between sexes became statistically significant
(47.7% compared with 40.7%). This is certainly consistent with the findings of the
previous multicentre study (9,33), which had shown a higher rate for women of anxious
depression (65%) then of nonanxious depression (56%) (Fava et al., 2006).”
This study shows that women tend to have anxious depression; could that be a factor in

increased risk?

Sub Category: Childbirth

Weighing in with another interesting and unique factor is to look at the time surrounding

childbirth. There are a lot of increased hormones and then, of course, a lot more worry and

excitement to go along with the new child. Could this be a factor, in why women are more prone

to depression and men?

“ The rate of first hospital admission for depressive disorders decrease during pregnancy
and increased markedly in the first three months after birth (peeking in the second month
with a rate of 10.74 /1,000 person year and rate ratio of 12.56) compared with the 6
months prior to pregnancy. Admission remained elevated in the second postpartum year
(Xu, Austin, Reilly, Hilder, & Sullivan, 2012).”
Postpartum is such a difficult disorder, and cannot be readily explained. Postpartum is

dangerous for the new mother and for their child. During this critical development phase,
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rejection from the mother can have lifelong effects. For the mother to feel responsible for those

effects and the guilt that goes along with the disorder can be very dangerous for the new mother,

with marked increase in the rate of suicide in women experiencing postpartum depression.

“A comprehensive meta-analysis by Gaynes and colleagues found that as many as 18.4%

of pregnant women were depressed during the pregnancy (Gaynes et al., 2005). Eleven
percent of women had new episode of major or minor depression in the first trimester of
pregnancy (8.5% in the second and third trimesters), 4.9% of which was major depressive
disorder (MDD) (Gaynes et al., 2005) (Xu et al., 2012).”
This time surrounding pregnancy is perhaps the most critical time of a woman’s life and

experiencing postpartum can add so much more to the severity that it becomes imperative that

the woman seek help. I find it a very compelling argument that these critical stages of a woman’s

life; pregnancy, postpartum, and midlife, during which there are large hormonal fluctuations,

could help explain the increased likelihood of women’s susceptibility to depression.

Sub Category: Increased Victimization

Of the many factors looking into depression, one which stands out for me is the

likelihood of increased victimization. As a former victim myself, I keenly know the power that

this particular force can exert upon a balanced mind. I was most surprised by the specific

numbers of victimized women and this, for me, is a powerful factor.

“ One factor that might contribute to the high prevalence of depression in women is sex-
based violence. During the past decade, violence against girls and women has
increasingly been recognized as a public-health issue. In the USA, women experience
violence ten times more frequently than men, whether in the form of incest, rape, sexual
assault, or battering. National surveys have shown that 27% of women report a history of
childhood sexual abuse, and 15% report having been raped at some time in their life. In a
review of seven north-American community-based studies, women who reported
histories of childhood sexual abuse had a significantly higher risk of depression than
women who did not report such history (Wise et al., 2001).”
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Could the increased risk of depression be linked to the increased risk of victimization for

women? I find it interesting that the percentage of violence against women is high enough to be a

good possibility for the increase susceptibility of depression in women. I believe that

victimization is a very likely contributor to depression. After experiencing something as stressful

and violent as rape, it seems only natural that it may begin a depressive episode. As the

definition of major depressive disorder is at least one episode of depression without any history

of mania, that violence could change the numbers in the commonality of depression rather easily.

Sub Category: Health

The last, but not least, factor that we will explore is health in women and any contributing

factors in depression. It should be no surprise that health could play a role in depression. If

someone is diagnosed with something like a major illness or other life altering condition, of

course this could lead to an episode of depression; especially any chronic disease.

“Both the 1-year prevalence of diabetes in MDD patients without antipsychotic use or
with antipsychotic use were also higher than that of the general population (11.33% vs
6.53%, and13.40% vs 6.53%). Compared with the general population, diabetes was more
prevalent in patients with MDD in all age groups, except age 18 to 29 years;… In
addition, women with MDD also had a higher prevalence of diabetes then did women in
the general population. Women comprised a larger proportion of patients with MDD than
did men (Chien et al., 2012 ).”
In this example diabetes was more common in patients with major depressive disorder

(MDD); does this mean that people are depressed over having diabetes or does depression affect

our health that drastically? Everyone knows that diabetes has a genetic component and so does

depression, could those genes be somehow linked?

“The prevalence of major depressive disorder was higher in younger adults, women,
those with income <124% of federal poverty level, unmarried individuals, and those who
reported worsening of their health status. In addition, smokers, those with duration of
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diabetes <5 years, and those with major complications had a higher prevalence of major
depressive disorder ( Egede & Zheng, 2003).”
This study is very interesting; not only is the prevalence of major depressive disorder

higher in women but also those with low income and younger adults. Perhaps this could lead us

to a possible answer, two-fold, anxiety and hormonal changes. People of lower income have to

be experiencing anxiety and younger adults are going through hormonal changes.

Seeking Answers

Throughout this paper we have looked at the definition of depression, prevalence of

depression in women the science and treatment. We have explored some of the possible factors

in explaining why women experience depression more than men. We have looked at genetic

options, age factors, victimization, anxiety, child birth, and health. In my opinion, the two best

contributing factors in explaining the increased risk of depression in women are the hormonal

changes during the mid-life and childbirth, and victimization. To me, these two factors make the

most sense and have the largest gap between men and women. There are still plenty of possible

factors to explore, including gender roles and social expectations, among many others. I believe

exploring these factors may aid in the future treatment of depression. Finding any anomaly could

be key to finding a more perfect cure for depression disorders.

Fortunately for me, every good paper does not require a definitive answer to be good; and

while we have begun to scratch the surface of depression, the morass is deep and no single

answer is the cure-all to every form of depression. In the end we have to realize that depression

is more multifaceted than the most intricate diamond and more complex than the Gordian knot.

While no easy answer is in sight, we can take comfort in the fact that these questions are being

sought out and the search for tomorrows cure is being researched today.
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Chien, I., Wu, E., Lin, C., Chou, Y., & Chou, P. (2012). Prevalence of diabetes in patients with

major depressive disorder: A population-based study. Comprehensive Psychiatry, 53(5),

569-755. doi: http://dx.doi.org/10.1016/j.comppsych.2011.06.004

Egede, L.E., & Zheng, D. (2003). Independent factors associated with major depressive disorder

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