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There are clear general statements that can be made about the relationship between age and depression. First, the propensity for depression is rare before adolescence (Birmaher et al., 1996). Secondly, the prevalence of depression declines in late middle age or early old age (e.g., Figure 1.2). Thirdly, the female to male sex ratio for depression is not constant over the lifespan, being around unity in childhood, rising during adulthood, and declining once again in elderly groups (Jorm, 1987).

The relationship between sex differences and age is of interest, as it may be linked to explanations for the former. The onset of the difference in adolescence may be related to the emergence of adult hormonal status. However, adolescence is both a biological and a social transformation. Some authors have argued that the social process of 'gender intensification' may be responsible for additional stresses on girls. Others adhere to the idea that hormonal changes increase female vulnerability. Until recently, the burden of evidence favoured the social hypothesis, as the sex ratio appeared to be related to chronological age

Percentage with 3 depressive episode

Percentage with 3 depressive episode

35-44 45-54

Figure 1.2 Prevalence of depressive episode by age in 1993 and 2000 for all adults. Data taken from Meltzer et al. (1995) and Singleton et al. (2001)

35-44 45-54

Figure 1.2 Prevalence of depressive episode by age in 1993 and 2000 for all adults. Data taken from Meltzer et al. (1995) and Singleton et al. (2001)

rather than to hormonal development (Bebbington, 1996). However, two very good, recent epidemiological studies (Angold et al., 1999; Patton et al., 1996) are both in favour of a relationship with menarche rather than social transition.

The issue nevertheless remains unresolved, as does the age at which the sex ratio once again tends towards unity. One possibility is that the rate of depression in women declines (thus reducing the sex ratio) after the menopause. This would be interesting, in view of the idea that in women the hormonal status of the child-rearing years is particularly associated with vulnerability to depression. Because the menopause coincides with a number of social transitions, and is in any case an event of psychological significance, it is necessary to try to control for confounding by social variables that serve to mark these transitions. Using data from the first British National Survey, Bebbington and his colleagues (1998) found that the decline in prevalence rates of depression after age 55 could not be accounted for by obvious social factors, such as the end of involvement in childcare or changes in marital or employment status. This would be consistent with a possible hormonal influence. However, in the second national survey, the decline in female depression occurred to a greater degree after age 65. Such a shift is easier to explain in (unspecified) social terms.

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