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RISK FACTORS FOR THE DEVELOPMENT OF DEPRESSION AT WOMEN

Cristina POPESCU

The constant growth of depression frequency along successive generations of this century have made some authors talk about a new "melancholic period". The historic perspective over the depressive phenomenon underlines its proportioning periods of economic, political, moral crisis. The ample spreading of depression in the last decades, up to epidemic proportions according to some was related to a series of phenomena amplified in the transition period in Romania. The growth of the rhythm of social changes over-reclaiming the adaptation capacities of a person and puts to trial the efficiency of individual mechanisms of confronting life problems, shattering some social structures offering personal support, modifying the system of social roles against which they were defined, individual insecurity, unemployment and poverty, loneliness connected with underlying competition and individual interests, relative moral norms, stressing material values, aside demographic and biological factors have made the depressive answer, expressed by discontent, disappointment, non-implication and social withdrawal, self-devaluation, lack of hope going up to suicide, to manifest more and more often. Depression had the fourth place of hospital admissions a decade ago, and it has today the first place among other psychic disorders. Its severe forms have got to represent almost 30 % of the totality of diseases imposing hospitalization and 75 % of the total admissions of males.

Despite all these, depression is more frequent at women, some of its forms showing twice more often at women than at men. Its prevalence varies according to sex and age group. Thus, if in childhood depressive disorders appear more often at boys than at girls, at puberty the sex balance is changed and depression becomes more frequent at women, this tendency maintaining at an adult age too. After 55, a few years after menopause, the frequency of depression starts to decrease at women, so that towards the end the sex differences are reduced.

The frequency of depression at women varies according to their marital, professional, educational, economic status. Depression is more frequent at married women than at married men; on the contrary, its frequency at unmarried or widowed women is not clearly different from that registered at men with the same marital status. The risk of depression increases at mothers, especially if they have pre-school children in their care, at housewives, at those women with a low education level or with low income.

Much research has been done in the attempt of explaining these differences and different theories have been put forward. The role of biological, psychological, social factors has been analysed; the idea is how they interact to determine the above mentioned differences.

As far as genetic factors are involved in marking the differences between sexes, there is no conclusive data yet. The presence of depression at mothers seems to be a better predictor for depression at children, but the risk of its appearance at the boys and girls of a depressive mother is not different. This data is rather compatible with a social mechanism of transmission rather than with a genetic one. In the same way we could say that the variation of the sex balance according to socio-demographic factors functions.

The observation that the sex differences regarding depression frequency is limited to the age interval corresponding the women’s fertile period suggests some neuro-endocrine factors. At puberty a direct relationship between the growth of feminine hormones levels (estrogens) and the depressive symptoms at girls and in inverse relationship between the levels of testosterone and the affective-negative disposition at boys as been underlined. The precocious maturing associates the decrease of depressive disposition at boys and its increase at girls. At an adult age, premenstrual tension and using oral contraceptive is associated with a growth of depression frequency. In the postpartum period depression appears quite often. Menopause seems to be a more reduced risk factor to develop depression than it was traditionally considered. Although hormonal factors doubtlessly influence the risk of depression development at the two sexes, they can fully explain the noticed differences. Those life periods in which the sex balance is modified –puberty, menopause- is marked not only by neuro-endocrine modifications, but also by social ones, and therefore, the noticed changes can be the result of both categories of factors.

Many explanations were based on the analysis of differentiated social roles of the two sexes. Vis-à-vis those roles, the person is self-defined and self-valued. The different social roles of men and women in society in general, and especially in the family are associated with different stress levels, with varied resources and confrontation styles, with different satisfactions.

It was assumed that women, because of their marital roles would be exposed to more stress. The results of studies comparing the two sexes about their level of stress are different: some underlined significant differences, some did not. The frequency of long active stressing situations (disease, disability, conflict) seems to be greater at women, or it was proved that these chronically stressing situations have a greater unfavourable influence on mental health than short time events. They exhaust the person’s confrontation resources and amplify the impact of stressful events intervening at a certain point.

Some types of events can affect women more than men. We are talking about those referring to their affective relations. In a survey on persons confronted with chronically stressing situations, women were as vulnerable as men towards the events affecting their personal life, but more than that they reacted intensely to events affecting those around her, especially the members of her family. Increased sensitivity of women towards other people’s problems make her more exposed to stress.

Men tend to give less attention to events not affecting them directly, thus reducing the level of stress. The reaction of women towards a larger diversity of events has important consequences towards their mental health. They pay for the given or self-assumed role of taking care of others. In this case, the solution would not be the reduction of their preoccupation her those near, but the husband’s careful involvement in family life, which could contribute to preventing depression development.

The risk of depression development after an unpleasant event is big at women with an inferior social status and at those with small children. At women with an inferior social status depression is four times more frequent than at those from middle class. Belonging to an inferior social class is associated with a greater frequency of unpleasant events and with a grown vulnerability towards them. This vulnerability is defined through private attitudes and convictions, as well as through a limited resource access.

It seems that the answer to the same level of stress is greater for women than for men. They respond more affectivity and at the same time continue to be preoccupied by the negative events a longer period of time. On the contrary, more tend to change their focus from such events, getting involved in relaxation activities. They manage to comfort themselves faster, sometimes by using alcohol.

In order to develop depression what matters are not only the events and stressing situations of an adult age. Many times the problems of an early age along the maturing process can have an even more important role: they make the person vulnerable and make the risk of depression at further confrontations bigger, which can have psycho-traumatizing effects. Physical and sexual abuses at an early age increase a lot the probability of developing depression at an adult age, and women are frequently victims of such abuses.

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