Depression - Gender Differences.

DEPRESSION: GENDER DIFFERENCES

Among the myriad differences between men and women is the manner in which they are influenced by and respond to depression. From environmental to social and cultural to chemical, the divergent factors that categorize depression as having separate indicators and consequences. Among other methods, organizational therapy employs the use of clarification between people and events in order to ascertain a basis of the depression; as a means by which to establish a relationship between the issues and the individuals who bring them to light, organizational therapy is a way to correlate the association between "life cycle events and the onset of problems" (Stanton, 1992, p. 331). As well, the fact that depression manifests itself differently between men and women draws upon research for such conclusions, which clearly demonstrate the physical variances.

Chemical imbalance in the brain has long been thought to be the cause for depression. But researchers at Washington University have discovered possible structural abnormalities in the brain as well. The prefrontal cortex has been found to be smaller in the brains of the depressed person. In fact, depressed patients have been found to have a drastically smaller volume of a section of the left PFC that sits behind the bridge of the nose. In some cases this section is up to forty percent smaller in depressed persons. When researchers looked into what might cause this shrinkage, it was found that it could be the result of having loss of glia, which are small cells that do important or even critical housekeeping of the brain. The glia might also play a part in the development of serontonin in the system. Additionally, it may be that a defect in the neural development of the prefrontal cortex could be the initial abnormality in depression. "People who suffer from either major depression or manic depression and who also have family members with these mood disturbances display strikingly low numbers of glial cells--but not neurons--in a brain area implicated in emotional behavior and stress responses" (Anonymous, 1998, p. 296).

The entire subject of depression and gender is one that is widely misunderstood by the public. Depression is often thought of as simply a sad mood, or as a problem that people should be able to 'snap out of"; on the contrary, depression is now known to be a physical malady. Antidepressant medication is sometimes compared to being a mood elevator that it definitely is not. The medication only serves to remove the bleakness or hopelessness that may be felt by the patient in his or her illness. And while the physical needs may be met by an antidepressant medication in most cases, the truth is that the whole body is affected by depression in significantly divergent ways depending upon gender.

I. DIFFERENT GENDERS, DIFFERENT PERCEPTION

John Gray understands the vast separation between the male and female gender. His best-selling book, Men Are From Mars, Women Are From Venus, has helped countless people to overcome the inherent friction that exists between men and women due to their uniquely opposite characteristics. However, emotional relationships do not represent the only differing aspect between the genders, inasmuch as virtually everything about the male/female mind hinges upon contrary viewpoints. Depression is among this contrary. Research has shown the incidence of this difference to begin in childhood; without realizing it, parents address their male children differently than they do their female counterparts, which serves to establish a significant disparity in the manner each gender ultimately views his or her social and emotional environment. Experts in the field of child development have consistently found that this incongruous approach parents have toward their children begins at quite a young age, insofar as the mother and father -- individually as well as collectively -- "communicate one way to baby girls and a different way to baby boys" (Anonymous, 1996, p. PG). As the child grows older and is continually addressed in a contrary fashion, this helps to greatly influence how that particular child develops lifelong impressions.

"Now, just how this difference between boys and girls evolves is a nature-nurture contest. Part of the reason why parents talk differently to girls than boys...is the tendency to adhere to social conventions and gender stereotyping. But the other part...is that the biology of a baby boy or baby girl may propel parents toward gender biasing from birth" (Anonymous, 1996, p. PG).

The social aspects of being either male or female also play an integral role in how depression manifests itself in each respective gender. For example, men and women handle work-related stress in significantly different ways, inasmuch as women become more outwardly and emotionally distressed, while men often internalize their dissatisfaction. As an antagonist for depression, Dugan et al (1996) notes that "occupational stress and its causes and effects have been areas of research interest for many years" (p. 46). Yet another example is that a gender-based mentality has been found when examining the fear of crime and the measurement of crime against particular gender. While a crime may be the same, it affects each gender differently. This is based on societal nuances as well as the different fear of crime phenomena as interpreted by each gender.

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In looking carefully at the combined literature on fear of crime and risk of victimization, one is left with a curious gap in this consideration. Men, by and large, continue to report significantly less fear of crime than women do. Yet it has been found that in most instances while men report physical assaults to police and seek emergency medical attention for injury, there is almost never a sense of how they feel about these experiences of assault. Nor do is there an understanding about how different men, with their varying relationships to and engagement with hegemonic masculinity and with the state, respond to violent victimization (Stanko, 1993). In other words, while men do report crimes conducted against themselves, rarely do they give more than the facts relating to the crime. They do not go into detail involving their feelings about the crime; however, neither do the law enforcement agencies tend to request information regarding such. With the instance of many men who might be perceived to be gay or are in fact homosexual, they prefer to not release information regarding inner feelings inasmuch as this tends to mark them as weaker. This is an unfortunate causation of society's outlook on gender related factors.

Jefferson (1996) notes that fear of crime is comprised of two distinct elements: personal fear and the use of a public 'fear of crime' discourse. The latter could be variably invested, and could be more about crime than fear of crime. It was sometimes inflected more with anger. Some were invested in other discourses, such as neighborhood decline. It has been found that personal fears were normally of particular crimes, notably burglary or sexual assault, and could vary: inside and outside the home; and within and beyond familiar, local territory. Women are found to be more likely to express personal fear and men are more likely to reproduce the public discourse, especially older men (Jefferson, 1996).

In discerning the distinction between the two genders and how each is affected by the fear of crime phenomenon, it was found that sex as such was not predictive of fear of crime; however, the effects of gender increased fears of victimization among women and sense of safety among men. While women feared for physical safety, men were in fear only as far as crime against them, not necessarily that of physical endangerment. Age was influential and found to be especially true for men. Anxieties about declining health and strength were sometimes expressed and are perceived to be in direct relation with a male's concern of aging and becoming unable to protect himself in the event of a crime. Age did not appear to affect women in the same level as it was apparent that women of all ages are concerned about being unable to protect themselves against the possibility of physical crime. While older women were more likely to experience this type of fear, it was in no way peculiar to an age group among women. Findings help to establish the "means to derive a more complete view of a given social environment" (Koehly et al, 1998, p. 3).

Research findings have helped to explain the measurement problems of crime and the fear of crime phenomena as it relates to gender depression. In two groups of mostly local, young or middle-aged, low-crime women, levels of fear and anxiety exceeded very low risk. Three of these women (married with children) worried excessively about burglary, or physical and sexual assault, and were hence judged depressively anxious. Their anxieties centered on their children but also included other members of the family, as well, revealing a core anxiety expressed as traditional, caring femininity. The lack of identity beyond that of being wife or mother combines with projection of protective agency onto the men in their families, leaving them with excess vulnerability that manifests in fears of burglary and/or assault. For two women in the study, fear of crime centered on fear of male sexual violence linked to violent, alcoholic fathers (Jefferson, 1996).

II. SIDE EFFECTS OF DEPRESSION

During the past decade the prevalence of eating disorders has increased among teenage and college-age American women. This increase is probably caused in part by society's idea of the ideal woman as being overly thin in order to be beautiful. Research has shown that anorexia nervosa consists of several psychopathological components as well as the physical components, and that the psychopathological characteristics often include such things as depression, anxiety, and difficulty in social situations, as well as low self-esteem (Wilcox, 1996). Adolescence is an intense time and is normally a time of physical changes as well as psychological changes. Females in particular seem to experience stress that is not experienced by their male peers. Females commonly experience depression during adolescence and other characteristics such as obsessiveness, compulsion and general reticence are quite common. While most anorexics have co-occurring clinical depression there are others suffering from anxiety, substance abuse or personality problems as well as an increased risk of suicide. Parks et al (1997) notes that "within nonclinical samples, body image distortions have been associated with lowered self-esteem, depression, and chronic dieting" (p. 593).

The vicious cycle that exists with depression and female eating disorders serves to perpetuate the mental imbalance. Indeed, the consequences are far greater than just being overweight. Obesity, in and of itself, leads to a number of other diseases and complications that can significantly shorten a person's life. Of the long list of ailments, those at the top include heart disease, some cancers, diabetes, high cholesterol and blood pressure, and gallbladder disease. However, the mental distress such behavior causes is a significant concern, for a poor emotional outlook also takes its toll on the body. A common denominator among women with eating disorders is the overwhelming feeling of inadequacy they experience. Attempts to control their problem usually prove futile, which serves to plummet them even further and further into the depths of shame and depression.

Based upon an article from the British Medical Journal entitled "Male Sexual Problems," the findings indicate that male sexual function is so completely interwoven with other factors that there is no one single factor that can be considered the cause of sexual dysfunction. Dysfunction is often the result of factors such as complications from illness, general poor health or even side effects from treatment of other illnesses. Impotence is the major common side effect of many drugs, and it has also been a known side effect of aging, anxiety and depression. Male sexual dysfunction is also a known result of all forms of psychiatric disorder either directly or indirectly, with the side effects of drugs taken in conjunction with psychiatric disorder leading to sexual dysfunction such as depression. As sexual function continues to wane, the incidence of increased depression becomes cyclical in nature (Gregoire, 1999).

III. CHEMICAL ASPECT

Establishing the determinants of depression and gender in relation to the death of astrocytes in the brain, one is compelled to investigate the myriad experiment data that has surfaced since it was first surmised that the two entities had any connection to each other. Indeed, it has been found that the lack of astrocytic activity in the brain is an integral component to the overall concept of depression; it is with this information that the psychological community has become better equipped to address the relationship between astrocytic death and depression.

Considered for decades to be a disease of the insane, depression has finally been recognized for the debilitating and emotionally unbalancing illness it truly is. With an astounding fifteen million Americans suffering from clinical depression -- a full five percent of the entire United States population -- it can no longer be looked upon as nothing more than merely the blues. Additionally, another five percent are victims of occasional despondency, with one of every six people succumbing to a significant depressive episode at some point throughout their lives. Depression often hits the elderly more than any other age group; however, with each passing year the average age of sufferers continues to drop.

The field of psychology utilizes a number of statistical procedures in order to effect the applicable findings. According to Kendall (1991), the typical procedure behind such research is accumulated by way of study reviews, which employ the use of methodological considerations. These include deciding upon outcome measures, regulating therapy quality, as well as "investigating client and therapist characteristics and the therapeutic relationship" (Kendall et al, 1991, p. 78). There exist a number of issues that serve to influence the comparison modes, such as side effects, compliance and quickness of action, which must also be taken into overall consideration when determining the data.

Among the variables that exist within the framework of statistical procedures, defining whether or not there is a difference between gender participation is a significant consideration. One study in particular from the National Institute of Mental Health Treatment of Depression Collaborative Research Program noted the differences between male and female patient statistical findings after a number of procedures were rendered. Zlotnick (1998) notes that depending upon the type of treatment each individual received -- placebo/clinical management; cognitive-behavioral therapy; interpersonal therapy; or imipramine/clinical management -- it was established that the final outcome was not influenced by gender. While the "role of gender was examined in the process and outcome of therapy in the treatment" (Zlotnick et al, 1998, p. 655) by reproducing the same findings in relation to psychotherapeutic treatment methods, it was determined that the second set of findings were the same.

Researchers have been making the connection for some time now between depression and the death of astrocytes, noting that the astrocytes -- being essential for the brain's nerve cells -- have been discovered to have healing properties. Pennisi (1999) notes how neurobiologists are beginning to recognize the regeneration components of astrocytes. "It's going to make [neurobiologists] look at these cells in more detail. It will be interesting to see if they can be purified and used in [brain] repair" (Pennisi 1999, p. PG). Understanding the roles that neurons and astrocytes play in the body helps one to fully comprehend why there may be a strong connection to depression. Astrocytic responsibility includes maintaining the blood brain barrier (BBB), as well as providing structural support, protection and repair of the central nervous system (CNS). Neurons, on the other hand, are the vital links between electrical impulses and the nervous system.

"Repetitive spreading depression (SD) waves, involving depolarization of neurons and astrocytes and up-regulation of glucose consumption, is thought to lower the threshold of neuronal death during and immediately after ischemia" (Miettinen et al, 1997, pp. 6500-6505).

In postulating the hypothesis that the growth or death of astrocytes somehow affects depression, it is relatively easy to recognize the fact that without the necessary astrocytes in place, conducting the brain-healing processes that they have been discovered to posses, it triggers within the brain the inability to maintain a sense of perspective. "A kind of star-shaped brain cell that helps support surrounding nerve cells plays a much more pivotal role in maintaining the brain's vitality than researchers had thought...astrocytes double as neural stem cells, the source of new nerve cells" (Pennisi, 1999, p. PG). Wineke (1996) notes the importance of ongoing research into the very real possibility that the absence of astrocytes serves to adversely effect brain function. "Twenty years ago, the ideas we are studying were considered eccentric and fanciful. Now, this is really where it's at" (Wineke, 1996, p. 1G).

IV. RESEARCH

The field of psychology utilizes a number of statistical procedures in order to effect the applicable findings. The typical procedure behind such research is accumulated by way of study reviews, which employ the use of methodological considerations. These include deciding upon outcome measures, regulating therapy quality, as well as "investigating client and therapist characteristics and the therapeutic relationship" (Kendall et al, 1991, p. 78). Kendall et al (1991) notes that there exist a number of issues that influence the comparison modes, such as side effects, compliance and quickness of action, all of which must be taken into overall consideration.

Cooper et al (1998) notes that the dynamic psychological composition is that which defines human culture as one with "multiple-worlds theories [that] link individuals with contexts and conceptualize people as agentic in negotiating cultural boundaries" (p. 559). It can readily be argued that the discipline of psychology is integrally related to social change and how that ultimately influences people's perceptions and whether or not that manifests into depression. Inasmuch as culture is looked upon as a "set of universally adaptive tools" (Cooper et al, 1998, p. 559), the function of dynamic interaction is essential in order to comprehend the vast differences -- as well as similarities -- between the genders. Social-group processes rely upon the dynamic approach as a means by which to define cultural diversity, as well as address issues that transcend the boundary lines.

According to Segall et al (1998), the concept of behavioral therapy for the likes of depression takes into consideration the history of cross-cultural gender psychology, in that it assesses culture as an "indispensable component in the understanding of human behavior" (p. 1101). Because there exists myriad contrarieties in the manner in which genders behave from culture to culture, such perspectives as relativism and absolutism are integral components in understanding the association with depression. "When all of psychology finally takes into account the effects of culture on human behavior (and vice versa), terms like cross-cultural and cultural psychology will become unnecessary" (Segall et al, 1998, p. 1101).

Scientists have long questioned the process of collecting and interpreting data in order to "optimize the possibilities for cumulative scientific knowledge" (Schmidt, 1992, p. 1173). Many within the field adopt traditional procedures that base their findings upon statistical findings; this particular method is chosen over others because of its ability to decrease the possibility of sampling errors. Meta-analysis, another data collection procedure where psychologists can obtain research results, is one that experts say can solve problems of "erroneous conclusions" (Schmidt, 1992, p. 1173) that other methods might produce. It is a matter of personal opinion which data collection method a psychologist might prefer for gender-related depression, based primarily upon how accurately that particular procedure produces the desired information. As Wertz (1998) notes: "Unlike physical things, mental life contains no independent elements but different moments mutually implicating each other in the whole" (p. 42).

V. CONCLUSION

While depression may be an equal opportunity disease, the manner by which it is initially cultivated and ultimately manifested is quite different between the genders. Scientific research has suggested that a combination of social, cultural and environmental factors is collectively at work to individualize the often covert and sometimes covert gender responses that trigger depression. Hoyle (1991) notes that these relationships, which have to do with items that "indirectly measure a psychological construct and relations among psychological constructs" (p. 67), are the focus determining variables.

The manner by which depression overtakes each gender is a varied as how the illness is ultimately manifested. While men may internalize their disease, women typically express it through emotional demonstration. There is no concrete equation as to why men react differently than women to the same stimuli, whether that particular motivational factor happens to stem from external forces or internal distress. Indeed, research has more than effectively documented the obvious and contrasting ways in which men and women exist in order to build a foundational basis of fact.

Clearly indicative of how environmental, social and cultural components reflect a gender difference in depression is how men and women have come to deal with various situations that arise. Indeed, research has shown that while genetic consideration is strong with regard to depression, other outside influences have been known to contribute, as well. That men are taught to be strong and fearless adds to their inability to process their emotions, ultimately causing a backup of emotional distress that leads to depression. Women, on the other hand, while able to express themselves, often find that they are up against an emotional brick wall nonetheless. Characteristically speaking, depression may affect men and women in the same general way; however, the manner by which it is first cultivated and then manifested is quite different between genders.

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