Women are two to three times as likely as men to suffer from depression, according to the American Psychological Association. Yet only about one-fifth will get the treatment they need.
That women suffer from depression is not news. But the underlying reasons for it are beginning to surface in a direction that may surprise many.
For years, researchers blamed sex hormones for women's depression. The common phrases were "menopausal" or "premenstrual." Indeed, oestrogen is still a factor in some areas of depression, according to Dr Elizabeth Young.
But hormone regulation doesn't account for much of the picture. Instead, researchers are beginning to focus on the quality of women's lives and the choices they make.
In a recent article in the Journal of Personality and Social Psychology," Susan Nolen-Hoeksema, a national expert on women and depression, described a cycle of three factors that synergistically feed on one another to create symptoms of depression in women.
Stress is one culprit
The cycle starts with stress.
"Women face a number of situations in their lives that make them feel out of control and helpless," says Nolen-Hoeksema. "Even when there are things they can do, they feel so out of control and helpless that they don't do what they can."
It's no surprise to most women that their lives are stressful. Many wear many hats in their households. And few are willing to speak on the record if they are suffering any kind of depression.
Many women work the same number of hours each day as their husbands and at the end of the work day, clean the house, prepare for company, care for pets and run errands. There often doesn't feel as though there is enough time in the day to successfully complete obligations.
The second part of the cycle, called "loss of mastery," is the sense many women have that they have no control over their lives. For some, it's a vague awareness that society has parcelled out power, and women are on the short end. For others, it's the day-to-day knowledge that your life is subject to the whims of everyone from your boss to your babies.
Add to all this the third part of the cycle - the fatal habit many women have of rumination. Unlike men, women tend not to take action, not to distract themselves. Instead, they dwell on their problems, sometimes endlessly, which only heightens their sense of despair and powerlessness, Nolen-Hoksema says.
Many women typically describe their blues as: You don't feel as though you're happy - ever. You have no motivation. It's not 'I feel sad,' it's, 'I just don't feel anything anymore.'
The need to take action
Twenty years ago, most psychologists would have talked a woman through her past, to determine the roots of her depression - and probably add to her natural tendency to ruminate, says University of Massachusetts psychologist Bonnie Strickland. That's less common now, she says.
Today, psychologists may recommend an anti-depressant to start with, simply to pull the woman out of her torpor so she can function and begin to make changes.
And change is the key, says Eva Stubits, a clinical psychologist.
Psychologists try to help women sense that they can change their circumstances, Stubits says. Women can be shown some of the unhealthy ways they've been perceiving their lives - that they've been too exclusively the caretaking members of the family.
Often, Strickland says, that helps them to understand their relationships better, "to think about what are sources of happiness and pleasure."
Concrete activities like exercise, reading, taking a class, meditation, or talking to a friend are all recommended steps to well-being.
The goal, Nolen-Hoeksema says, is to break the cycle of despair. Women need to establish the sense that they can change their lives in positive ways, or, as Nolen-Hoeksema puts it, opt for "action and taking control."
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Depression and women