Gender

Evidence for gender differences in responses to depression comes from a large number of studies. Women are consistently reported to have greater prevalence of affective disorders than men/l01'i021°3'104 and 105) The reasons for this gender difference are unclear, and are as likely to be social as biological.

Divergences in the number and quality of social and occupational roles have been proposed to explain the greater prevalence of affective disorders among women.(i02) In the context of marital relationship, previous research has indicated that, for men, marriage confers a protection against illness, while it appears to be associated with higher rates of depression for women. (l06) There has been some evidence that within the marriage the traditional female role is limiting, restricting, and even boring, which may lead to depression. (l07'i°8) For example, the role of child caretaker has consistently been shown to be associated with both high levels of stress and a higher incidence of depression for women. {1C9) Women are found to have more depressive symptoms when they have young children in the home, and this tends to increase in an almost linear fashion according to the number of children in the household. (H0) Further, since women who are employed outside the home also tend to be responsible for household chores, (111) the notion that differentiation in occupational roles partially explains the prevalence of depression for women is supported. Bracke(l02) found validity of social role explanations by showing that the gender differences in depression chronicity can partially be explained by differences in employment status, marital status, and educational attainment. However, Weich et al/l05) refute the version of the occupational roles hypothesis, namely that women have a higher prevalence of common mental disorders by virtue of their tendency to be over- or underoccupied compared with men. Specifically, they did not find gender differences in the prevalence of common mental disorders when men and women are adjusted regarding the number or type of roles occupied. In other words, neither the number of social roles, occupancy of traditional 'female' caring and domestic roles, nor socio-economic status explained the gender differences, in their study. In summary, the impact of social and occupational roles as explanation of gender differences in affective disorders is not yet obvious.

Further, to explain why women are more likely than men to manifest depression Nolen-Hoeksema has proposed the ' response style theory'/1°4il2) According to this theory, women are more likely than men to have a ruminative response style, which contributes to the perpetuation of their depressed mood. {i13'll4 and H5) Ruminative responses to depression refer to 'behaviours and thoughts that focus one's attention on one's depressive symptoms and on the implications of these symptoms'. Nolen-Hoeksema argued that, when depressed, women are more likely to engage in these ruminative responses, thereby amplifying their depressive symptoms and extending the depressive episode. On the other hand, men are more likely to distract themselves from depressed mood, thereby dampening their symptoms.

Finally, there is some evidence to suggest that the post-partum and the premenstrual periods, with their associated biological and psychological changes, represent periods of increased risk of depression among women. However, the extent of the risk imparted by endocrine factors has not yet been determined. (116)

In summary, at similar levels of stress women are probably more vulnerable to affective disorders than men. One explanation of this finding is that women may be more willing than men to admit symptoms and/or men may express their symptoms in different ways through alcohol abuse or 'acting out', for example.

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