Educationals

Factors contributing to depression in women

A variety of factors unique to a woman's life are suspected to play a role in developing depression. The following areas are being studied for depression in women.

The issues of adolescence

The higher incidence of depression in females begins in adolescence, when roles and expectations change dramatically. The stresses of adolescence include forming an identity, confronting sexuality, separating from parents, and making decisions for the first time, along with other physical, intellectual, and hormonal changes. Puberty leads to various physical changes with development characteristics of primary and secondary sex. Girls are more sensitive to early physical manifestations of puberty than boys. For example tall girls feel more self-conscious about their height than do tall boys where they compare themselves with their peers. Sex hormones show changes and decreased levels of estrogen may predispose girls to depression. In adolescence, sexual behaviour and experimentation are common. A strict religious upbringing may engender strong feelings of guilt. These adolescents may require counseling at this period regarding development of normal sexual identity. The onset of menarche is also one of the changes occurring during this period. Cultural attitudes towards the menarche vary, and in some parts of India, it is still considered to be shameful or a curse. Most adolescent girls still do not receive information on the menses from the parents. They rely on information from peers, schools and the media. Support from parents and family during this period could help girls counter the shame associated with onset of menarche. Cognitive and personality development during this period vary commonly leads to adolescent turmoil characterized by identity confusion rebelliousness, mood swings and impulsiveness.

Teenage pregnancies are becoming increasingly common in India. These lead to use of unsafe abortion techniques. The adolescent girl who is depressed, insecure about her attractiveness, or the child of a conflicted or divorced couple is more likely to become pregnant than the adolescent from a stable background.

Suicide

Intentional self-inflicted death (suicide) is becoming increasingly common in the Indian population especially among adolescent females. Attempted suicide is three times more common in females than males. There are various causes like severe untreated depression, personality changes, and various psychosocial factors. A suicidal threat or attempt should not be disregarded as it signifies a "Cry for help"

Issues of Adulthood

Relationship and work rules

It is known that stress in general can contribute to depression in persons biologically vulnerable to the illness. These stress include major responsibilities at home and work, single parenthood, and caring for children and aging parents. Rejection by employers on the basis of age, lack of recent experience, or insufficient training can cause dysphoria and depression.

The "super women" of today trying to play the balancing act of managing the home and work responsibilities presents an ideal prototype for stress induced depression. Support encouragement and empathy from the spouse and family would go a long way in alleviating this disease.

As against this, a housewife usually presents with depression, due to the need for a sense of identity and purpose in life. Marital conflicts usually result in stress and depression and more so in women forced to make difficult decisions in India.

Sexual disorders like vaginismus and frigidity are also an important cause of depression. Sexual dysfunction in partners, too leads to stress in women as this aspect is not easily discussed in our society.

Reproductive Events

Women's reproductive events include the menstrual cycle, pregnancy, the post pregnancy period, infertility and sometimes, the decision not to have children.

Premenstrual Syndrome

This term denotes a group of distressing psychological and physical symptoms starting a few days before and ending shortly after the onset of a menstrual period. Although the prevalence of this syndrome is not known with certainty, it probably occurs in about 40 to 50% of menstruating females. The psychological symptoms include anxiety, irritability, and depression. There may
be uncontrollable crying and a sense of feeling "out of control". There is fatigue, lethargy, loss of interest in work and sexual activities. Appetite may increase. Sleep disturbance is common. Physical symptoms include breast tenderness, abdominal discomfort, bloating, swelling of hands and feet, nausea or constipation. Various explanations for the disorder include excess of estrogen, lack of progesterone, pituitary hormones, disturbed fluid and electrolyte imbalances.

Antidepressants, can prevent the episodes or dampen the symptoms. Diuretics, pyridoxine, bromocriptine, progesterone treatments are not very effective. Psychological support and encouragement may be useful.