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WOMAN AND DEPRESSION.
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Discusses factors involved in women suffering more from depression than men.... More...
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Paper Abstract:
Discusses factors involved in women suffering more from depression than men. Gender differences. Prevalence of somatic depression in women. Childhood adversity and sexual abuse and their association with depression, postpartum depression and ethnicity, and depression in elderly women. Examines findings of four research articles on topic including research design of the studies.
Paper Introduction:
Factors Associated With Women and Depression
Introduction
This research paper will critically review four articles from the literature to answer the following research question: What factors are associated with women suffering more from depression than men? The four articles discuss gender differences and the prevalence of somatic depression in women, childhood adversity and its association with depression in women, postpartum depression and ethnicity, and depression in elderly women. This discussion is followed by a conclusion.
Literature Review
One of the factors that may be associated with women suffering more from depression than men, is the tendency for women to suffer from somatic depressive symptoms. Silverstein (2002) stu
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Reliability andvalidity information for the scales was not provided. Factors related to the fact that women suffer more fromdepression than men, are concluded to be: women suffer more from somaticsymptoms; childhood adversity may be the cause of endogenous depressionrather than somatic depression; ethnicity is not a factor in postpartumdepression; and age is not a factor. Beyond depressioncriteria, respondent characteristics remain unclear. Pure depression isdescribed in the literature review to include the absence of these symptomsand the presence of psychomotor disturbance, guilt, and loss of interest.These variables are further operationally defined by the NIMH DiagnosticInterview Schedule, which was used to diagnose subjects regarding thesecriteria. Logistic regression predicted risk for depressive symptoms: bottle-feeding and not living with a spouse or significant other, were associatedwith depression; persistent symptoms were linked with presence of otheryoung children; and severity of initial symptoms predicted ongoingsymptoms. Further, univariate analysis were conducted to examinecorrelations among severity of abuse and depression symptoms. For this article the literature review providedbrief but relevant support for the study. A study weakness for the Yonkers, Ramin, Rush, and Navarrete (2 1)article, is that the sample was limited to an inner-city subject pool andyet findings were concluded to represent a larger population of minorities. Gender differences in the prevalence of somatic versus pure depression: A replication. A survey research design was used for this study, which was anappropriate method of gathering the relevant information. Women remained at a higher risk for depressioneven after adjusting for risk factors such as physical and cognitiveimpairment, fair to poor health, sleep disturbances and use of sleepmedications, and lack of support from social and family networks. The American Journal of Psychiatry, 159(3), 387-394.Minicuci, N., Maggi, S., Pavan, M., Enzi, G., & Crepaldi, G. The sample forthe study consisted of 76 participants. The results of the study were that the overall prevalence rate ofdepressive symptoms was 58% in women and 34% in men but that no significanttrend was found with age. Ethical standards were notmentioned for the original study and were not applicable for this empiricalstudy of archival data. Reliability andvalidity were reported for the Childhood Experience scale only (goodvalidity and interrater reliability kappa from .78 to 1. Men who did have somatic depression tendedto have pain, but were not more likely to have chronic depression oranxiety disorder. Thegeneralizations were valid since the study sample was large and obtainedfrom U.S. Previous studies did demonstrate however, that women tend toreport somatic depression more than men and that this accounts for thehigher prevalence of depression in women. Research questions orhypotheses were not stated or implied. The statistical analysis included chi-square analysis,logistic regression analysis, and univariate analysis. Of this group, 89 were approached and 8 2 agreed to participatein the study. Study limitations and weaknesses for the Minicuci, Maggi, Pavan, Enzi,and Crepaldi (2 2) article include the tendency to form conclusions aboutpossible causes of depression that were not related to the study variables,such as that cultural factors influence depression. Once thesedefinitions are clear, it is recommended that childhood adversity and otherfactors be restudied with regard to somatic complaints versus puredepression. The discussion pointed out that findings were not consistent withprevious research. The authors explained the rationale for using these variables. Study weaknesses of the Silverstein (2 2) article, were the lack ofadequate information regarding previous studies, particularly regarding theECA study and the National Comorbidity Survey. Thus the terms endogenous and nonendogenous aredefined differently for the two studies. The conclusion wasreasonable in view of the data. The study alsopointed out that these rates are higher than for those found in the U.S.,which leads to speculation regarding cultural factors, for all countries. The research objective wasas follows: "Using data from the Epidemiologic Catchment Area [ECA] study,the author attempted to replicate the finding of the National ComorbiditySurvey that the prevalence of depression associated with somatic symptomswas much higher among women than men" (p. Archivaldata was reanalyzed. Poor care andsexual abuse were identified as significant predictors for endogenousdepression. The sample procedure for this study was to select all women who camefor an initial postpartum appointment at four inner-city maternal healthclinics. Survey research was used for this study; this design was appropriatefor the study since the goal was to assess patient reports after the birthhad taken place. Results also showed that for theHamilton scale, those with endogenous depression scored higher than thosewith nonendogenous depression. L., & Monroe, S. Thus the hypothesis thatwomen in this study would demonstrate greater somatic depression indicatorsthan men, was implied by the research objective and supported by theliterature. The statisticalanalysis was appropriate for this study because it allowed for examinationof the variables. Findings were however, consistent with the researchobjective stated in the article. The size of the remaining sampledid not lend itself to further randomization procedures. The instruments used for this study were questionnaires and interviewsregarding demographic and other information, the Edinburgh PostnatalDepression Scale, the Inventory of Depressive Symptomatology, the Qualityof Life in Depression Scale, and the SCID for diagnoses. The Journals of Gerontology, 57A(3). 1 51). It was briefly noted that the sample was random and included27 noninstitutionalized individuals, ages 65 years and older; theyresided in rural and urban areas of Veneto, Italy. The results were correctly interpreted and properlyreported. (2 2). communities, conducted between 198 and 1984; data was fromnoninstitutionalized community subjects. The statistical analysis included chi square analysis, whichwas appropriate for this study because it allowed for the observedfrequency to be compared to the expected frequency for statisticalsignificance. There were no differences found between ethnic groups; thus thefirst hypothesis was not supported, which was not expected from theresearch design since previous similar studies found the opposite. The information regarding reliability and validity of themeasure was not stated; there was no description of the instruments. The statistical analysis included chi-square,independent t tests, and a multivariate logistic regression model withdepression as the dependent variable. Those who failed to meet major depression criteria, had chronicdepression, or had a comorbid diagnosis, were not included. A. The hypotheses are based onearlier findings and are clearly stated in the article: the rate ofdepression would be higher among Latina and African American women; womenliving with extended families would be at greater risk; and women with moresevere depressive symptoms following delivery would be more likely to havesymptoms later. Thisdesign was appropriate for the study because it provided a large data basewith a random sample. M155-M162.Silverstein, B. Tables and figures were not provided. (2 2). Somatic depressionis described in the literature review to include symptoms of appetite andsleep disturbances, fatigue, pain, and anxiety. Ethical standards were not addressed. Childhood adversity and the endogenous versus nonendogenous distinction in women with major depression. For this study, endogenous is referred to as a distinctpattern of symptoms, a presumed biogenetic etiology, and absence ofprecipitating stressors; nonendogenous is defined as a reaction toenvironmental adversity. Minicuci, Maggi, Pavan,Enzi, and Crepaldi (2 2) studied prevalence rates and correlates ofdepression in the Italian elderly. While studies show that women suffer more from depression than men, itis not clear if this remains true at all ages. The instruments used for this study were the Structured ClinicalInterview for DSM-IV Axis I Disorders (SCID), the 17-item HamiltonDepression Rating Scale, the Childhood Experience of Care and Abuse scale,and the Childhood Experience of Care and Abuse interview. The instruments used for the original study were the DSM-III fordiagnoses and the NIMH Diagnostic Interview Schedule, used to assess forthe diagnoses. While the study of types of depression in women continues, withinconsistent findings, additional factors related to women suffering morefrom depression than men, are postpartum depression and possibly, ethnicfactors. The discussion was consistent with the research objective, and itcompared findings to previous results. Study strengths were that factors associated with depression were found.For example: ethnicity was not a factor, living with a spouse orsignificant other was preferable to living with extended family, anddepression was linked to other young children at home. Yonkers, Ramin, Rush, and Navarrete (2 1) studied AfricanAmerican and Hispanic subjects attending postpartum appointments atmaternal health clinics. It is recommended that to improve these studies, endogenous andnonendogenous depression must have consistent operational definitions andmethods of measurement. The authors explained the rationale for using thesevariables. Silverstein (2 2) studied gender differences withregard to somatic versus pure depression. For this article the literaturereview provided support for the study, however, while it was mentioned thatmany studies existed, the previous findings reported were cryptic in theirdescription. Thus a systematic sample of 13% of the postpartum patientswas used. An initial phone screening evaluation was done for245 women. However, the conclusion that cultural factors such as socialdisadvantages of women in Italy, may lead to depression, was not supportedby data. Results of this analysis showedthat age and sexual abuse was significantly related to younger subjectsreporting a history of sexual abuse. 387), but only a few authors were actually cited andcritiques of previous work were not offered. Thestatistical analysis used to reach each result was chi square (one for eachanalysis). The results werefurther represented by tables which were clearly labeled. The discussion was consistent with the research purpose stated in thearticle. Of those eligible, 24 2 remained in the study. Considering the large numbersmentioned regarding previous research, the background section did notadequately represent previous findings. Severesexual abuse was associated with higher scores on endogenous symptoms ofguilt and psychomotor retardation, and severe physical abuse, antipathy,neglect, and high and lax levels of supervision and discipline weresignificantly associated with endogenous depression. Research questionsand hypotheses were not stated or implied. Newspaperadvertisements and television news requests were used to target thesubjects for the study. The research design for this study was not clearly stated. The sample procedure for this study was described as using data fromthe NIMH ECA study. The sample wasrepresentative of the population. For this article the literature reviewprovided very brief support for the study. Childhoodadversity was operationally defined by the Childhood Experience of Care andAbuse interview which had 8 scales: antipathy, neglect, supervision,discipline, discord, physical abuse, sexual abuse, and psychological abuse. The results of the study were that findings did replicate those of theNational Comorbidity Survey. To further study the somatic versus pure (endogenous) depressionfactor, Harkness and Monroe (2 2) investigated women with major depressionto determine links to childhood adversity and to determine differences inendogenous and nonendogenous depression. The generalizations were valid only to asimilar population, which may have been overlooked, since the authorsconcluded that their minority group representation was similar to otherreports in the United States. The fourarticles discuss gender differences and the prevalence of somaticdepression in women, childhood adversity and its association withdepression in women, postpartum depression and ethnicity, and depression inelderly women. The review ofliterature clearly supported the research purpose. A., Ramin, S. The author stated that the goal of this study was to replicatefindings of the National Comorbidity Survey, which showed that women tendto report more somatic depression than pure depression, compared to men;however, an adequate discussion of this previous survey was not provided.Thus a critical evaluation of previous findings was not possible. The conclusion was reasonable in view of the data. Femalesshowed a much smaller difference in prevalence of pure depression and whenthey did have pure depression, they tended to have an anxiety disorder,pain, and chronic depression. communities. A forward stepwise logistic regression was used, which wasappropriate since the authors had no a priori hypotheses. Thestatistical analysis used to reach each result was appropriate and thetables were clearly labeled and accurately presented findings. The authorsexplain the rationale for using these variables; they had been previouslyassociated with depression.Variables were only operationally defined by the assessment instrument. While Silverstein clearly stated the research objective, the researchquestion and hypothesis was not clearly stated. ReferencesHarkness, K. The sample procedure for this study was the use of a conveniencevolunteer sample, recruited from one community. For example, the results of the chi-square analysisshowed comparisons of depressed women with nondepressed women; only 6.5% to8.5% had a major depressive disorder and only 5 % reported onset followingbirth. While this procedure wasappropriate for this study, since the sample is representative of thepopulation and it is a large sample, a more adequate description of thesample could have been provided in the article. This procedure wasappropriate for this study due to the availability of the sample. A research objective,supported by the literature, was clearly stated to include: investigationof the relationship between depression subtype and different levels ofchildhood adversity and examination of relative contributions of differenttypes of childhood adversity to depression subtypes. A study strength wasthat it did report findings that the prevalence of depression in elderlywomen is higher than for men, in Italy, despite age. The American Journal of Psychiatry, 158(11), 1856-1864. Ethical standards were not addressed. The statisticalanalysis included preliminary chi-square tests and independent-sample ttests to examine sample characteristics. This studydemonstrated that one of the factors related to the fact that women tend tosuffer more from depression than men, is the tendency for women to suffermore somatic symptoms. A future study is then recommended to investigatethe possibility that women suffer more from somatic symptoms, which maywarrant a separate diagnostic category from depression. This procedure was appropriate for this study due to theconvenience of the sample and the nature of the study. M. This discussion is followed by a conclusion. A random sample fromeach of five age groups was taken, with over-sampling used to obtain amplenumbers for groups. Somatic depression includessymptoms of appetite and sleep disturbances, fatigue, pain, and anxiety.This is compared to pure depression which includes the absence of thesesymptoms and the presence of psychomotor disturbance, guilt, and loss ofinterest. M., Rush, A. The major variables used to address the hypotheses for the studyincluded depressive symptoms and diagnosis, ethnic group, and livingarrangements. Study strengths were thatthe reanalysis of data from a large survey, assisted in furthersubstantiating the conclusion that women tend to suffer more from somaticdepression, than men. The conclusion that womensuffer more from depression than men, despite age, was reasonable in viewof the data. Conclusions Each of the four studies reviewed, presented findings relevant to theresearch question. Female respondents demonstrated twice theprevalence of somatic depression, compared to male respondents. Study weaknesses of the Harkness and Monroe (2 2) article, were thesmall sample, the use of women only, and the conclusion that severe levelsof childhood adversity were significantly associated with severe endogenousdepression, when the definition of endogenous depression remains unclear.Study strengths were that it pointed out the need to operationally defineboth types of depression. The survey research design for this study was cross-sectional. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. For this article the literaturereview provided brief support for the study. In addition afurther limitation was noted, that the definition of endogenous andnonendogenous differ for each study, as does the measure of thesevariables, which makes conclusions and comparisons of findings difficult.Thus, while Silverstein reported that women tend to suffer more fromnonendogenous depression, this study pointed out that childhood adversity,which has been linked to women and depression, is more related toendogenous depression. The American Journal of Psychiatry, 159(6), 1 51-1 53.Yonkers, K. Tables were clearly labeled and accuratelypresented findings. This study included a survey of psychiatric morbidityin five U.S. Literature Review One of the factors that may be associated with women suffering morefrom depression than men, is the tendency for women to suffer from somaticdepressive symptoms. Factors Associated With Women and Depression Introduction This research paper will critically review four articles from theliterature to answer the following research question: What factors areassociated with women suffering more from depression than men? ). The sample isrepresentative of the population of similar women who have had children. No differences due to age of first exhibiting depressivesymptoms were found for women or men. The variables were operationally defined by the testinstruments. Thisrandom procedure was appropriate for this study. The statistical analysis wasappropriate for this study. Thesample is representative of the population of similar women. The purpose of the study wasclearly stated in the article: to estimate the prevalence of depression inan elderly population and determine associated factors. Study limitations were noted to beretrospective report bias, and a brief time period between assessmentperiods. The major variables used to address the research objectives for thestudy were childhood adversity and endogenous and nonendogenous depression. The major variables used to address the research purpose includedgender, and physical, social, and psychological variables. Prevalence rate and correlates of depressive symptoms in older individuals: The Veneto study. The discussion was consistent with the research hypotheses as statedin the article. The conclusion that women show higher prevalenceof somatic depression was reasonable in view of the data. J., & Navarrete, C. This definition differs from that of Silverstein (2 2).Silverstein described endogenous depression as synonymous with puredepression. The sample procedure for this study was noted as being describedelsewhere. This study did determine factors associated with women anddepression: ethnicity was not a factor, living with a spouse orsignificant other was preferable to living with extended family, anddepression was linked to other young children at home. Study limitations were not noted. The information regarding reliability and validityof the measures was not stated. The article failed toprovide an adequate description of the original methods used to acquire thesample or the data. The authors mentioned thatthere had been a "surge of interest" in the topic, with "methodologicallyrigorous" studies (p. Multivariate analyses were used to examinecontributions of the childhood adversity variables to the different typesof depression. While no formal operational definition section is provided, theoperational definitions of the variables are implied. Theseresults were expected from this research design since previous findingshave shown that more women than men suffer from depression; they wereconcluded to be high, but similar to those found in Spain. Ethical standards were not specificallyaddressed, however it appeared that efforts were made to comply withstandards, since subjects were given a list of treatment referrals andinvited to a free 3-hour cognitive behavior therapy workshop; thus attemptswere made to ensure that no negative effects of the study were experienced. (2 2). The generalizationswere valid since the study limitations were noted to include the limits ofa cross-sectional design and a conveniently located sample. The resultswere correctly interpreted and properly reported. Endogenous andnonendogenous were only loosely defined by a description in a previousstudy. The instruments used for this study were the Italian version of theCenter for Epidemiological Studies-Depression Scale (CES-D Scale) to assessdepression, and a questionnaire to assess social support, health status,and medical conditions. The generalizations were valid since the sample was large andrepresentative of the elderly Italian population. It was alsofound that a poor health status and mild cognitive impairment areassociated with double the risk of depression, which was expected since ithas been previously reported. The depression diagnosis was defined by the DSM-IV. The results werecorrectly interpreted and properly reported however, the use of tables andfigures would have assisted in readability. The authors clearlyexplain the rationale for using these variables with the literature review. This design was appropriate for the study because thedata base was large and representative of the population (U.S.communities). The major variables used to address the research objective for thestudy were somatic depression and pure depression. (2 1). These results were expected fromthis research design since they had been found in previous studies.
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