The rate of depression among women is twice that of men, and the higher incidence is mainly related to the experience of being female in contemporary culture, an expert panel of the American Psychological Association said yesterday.
In a report, the association's Task Force on Women and Depression rebutted earlier work that had suggested that a higher reported rate of depression among women could be attributed to their being more inclined to admit emotional distress or to use mental health services.
The report, based on a review of recent studies, said the factors placing women at greater risk for depression included physical and sexual abuse, poverty, bias that persisted in such forms as ** lower wages than those paid to men, unhappy marriages, hormonal changes over the menstrual cycle and childbirth, and a tendency to focus on depressed feelings rather than taking steps to master them.
Psychotherapists should look for such underlying factors and take them into account in treating depression in women, the report urged.
More than 7 million American women have a diagnosable depression, and most of them go untreated, the report said. The report said one in four women would experience clinical depression at some time in life, compared with one in eight men.
The report cited violence against women as a major factor making them especially prone to depression. The report said 37 percent of women had suffered significant physical or sexual abuse by the age of 21.
Unhappy marriages lead to depression in women more often than in men, the panel's report said.
"An unhappy or tension-filled marriage makes women three times more likely to get depressed than it does men in similar relationships," said Dr. Ellen McGrath, a psychologist in Brooklyn Heights, N.Y., who was chairwoman of the panel.
Women's reproductive problems are another cause of depression. Up to 40 percent of women studied said the inability to conceive was "the most upsetting experience of their lives." Dr. Bonnie Strickland, a University of Massachusetts psychologist who formed the panel when she was president of the association in 1987, said about 10 percent of women "have serious postpartum depression."
Women may inadvertently worsen their own depression, the report said. "Men usually distract themselves from depressed feelings, while women tend to dwell on those feelings," Dr. Strickland said.
"But at least in the short term, distracting yourself is better than brooding and ruminating. There are gender styles in how men and women handle these feelings, and the male approach, in this case, helps cut short the depression."
Dr. McGrath said the panel concluded that a more effective approach was for a depressed woman to take some positive step, even if a small symbolic one, toward changing the circumstances that were leading to the depression. "You still have to process the feelings of depression or you'll stay vulnerable to them all over again later on. But it's a matter of timing. It's better to do that after you're out of the pit of depression."
The report said that anti-depressants were effective and necessary in treating certain kinds of depression and noted that 70 percent of anti-depressant prescriptions were given to women, but often without proper diagnosis or monitoring.
The good news, said Dr. Strickland, is that "depression, if treated, begins to lift in three to four months for more than 80 percent of women, whether they are in therapy or getting medication."