The age effects confirm the embarrassing situation that we have no clear explanation of the sex difference: we cannot say for sure what weight should be accorded to biological, social, and psychological explanations (Bebbington, 1996, 1998).
Nevertheless, social factors may well be of considerable importance because the sex ratio is not universally maintained across all sociodemographic categories. It is, for instance, much more marked in married than in never-married groups (Bebbington et al., 1981; Lindeman et al., 2000; Weissman & Klerman, 1977). Young married women looking after small children appear to be particularly at risk, at least in some societies (Brown & Harris, 1978; Ensel, 1982). Unsupported mothers appear to be even more at risk (Targosz et al., 2003). However, marital status has different associations with affective disorder in different cultures. Married women are at low risk of disorder in Mediterranean countries (Mavreas et al., 1986; Vazquez-Barquero et al., 1987), in rural New Zealand (Romans-Clarkson et al., 1988), and among British Orthodox Jews (Lowenthal et al., 1995). These societies all accord a high value to the home-making role.
This variation in the impact of marital status on the sex ratio of depression might be taken as merely epiphenomenal, a sort of froth on the central fact that women are inherently vulnerable to depression for biological reasons. Alternatively, it might suggest not only that social variables are important in determining the sex ratio for depression, but also that the association with relatively simple sociodemographic factors is itself affected by more subtle sociocultural influences. The pervasiveness of the sex ratio could then be seen as a reflection of the all-pervading hydra of social disadvantage experienced by women worldwide.
In most Western societies, women are even now less likely to be employed than men. Employment generally has beneficial effects on psychological health: it brings interest, income, fulfilment, social contacts, and status, and provides structure and a sense of control (Jahoda, 1982; Krause & Geyer-Pestello, 1985). The availability of these benefits is likely to differ both among women, and between men and women. The advantages of employment are weaker in married women (Roberts & O'Keefe, 1981; Roberts et al., 1982; Warr & Parry, 1982), more so if they have children (McGee et al., 1983; Parry, 1986), most so when the children are of pre-school age (Haw, 1995). Full-time employment is particularly demanding (Cleary & Mechanic, 1983; Elliott & Huppert, 1991). The most likely explanation for these findings is role conflict and overload. Thus, part of the excess of depressive disorders in women may be related both to their reduced involvement in employment and to the particular strains they are exposed to if they do work.
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