Beat+the+Blues!+Depression+in+Women

Name: Sunnya Khawaja, n8876835 Tutor: Judith Meiklejohn

media type="custom" key="24286920"

**Artefact** The artefact is a video developed by ‘Beyond Blue’, an organisation that provides information and raises awareness about depression and anxiety in Australia. Beyond Blue aims to reduce the stigma associated with depression. The video called ‘Briony’s Story’ shows a young woman who was suffering from postnatal depression. Briony shares her experience of depression. Her depression prevented her from getting out of the bed, her coping became poor and she could not fulfil her role as a wife and mother. Subsequently, she was guilt ridden and felt like a failure. She urges all women to speak out and reach out for help if they are experiencing depression. Briony explains that after seeking help and taking medication she has overcome her depression and is able to resume her normal life.

**Public Health Issue** This artefact depicts the topic ‘women and depression’. As shown by the graph below, the prevalence of depression is almost twice as common in women (21.3%) than men (12.7%) (Noble, 2005). This trend is observed across several ethnicities and socioeconomic and geographical groups (Noble, 2005; Abiodun, 2006).Therefore, it is a major concern nationally and internationally (Belfer, 2008). In Australia approximately 20% of people suffer from depression at some stage in their life (Australian Psychological Society, 2013). Presently depression is in the top ten global burden of disease (World Health Organisation, 2001). It is currently ranked as fourth place however; by 2020 it is expected to be the second leading global burden of disease (World Health Organisation, 2001). Depression is a serious women’s health issue that needs to be urgently addressed.



**Literature Review** According to 2011 statistics there are 3439 427 037 women in the world (Worldstat Info, 2011). Depression is the leading cause of morbidity for women (Noble, 2005). One in every five women in Australia is likely to suffer from depression in her lifetime (Beyond Blue, 2013). Depression is a mental health concern which is marked by affective, behavioural, thought and physiological symptoms. The affective symptoms consist of feelings of sadness and unhappiness (Beyond Blue, 2013). Behavioural symptoms comprise of apathy, withdrawal from family and friends, disinterest in daily activities (Better Health Channel, 2013). Thoughts are negative and are associated with ideas of helplessness, hopelessness, worthlessness, guilt, loss and failure (Beyond Blue, 2013). Concentration is poor and memory can be affected (Women’s Health, 2012). Physically a person has low level of energy and can have low or increased appetite or sleep (Kessler, 2003). If an individual experiences depressive symptoms for more than two weeks then that person may be suffering from clinical depression (Beyond Blue, 2013). Depression impairs a person’s functioning and it is a serious risk factor for self- harm and suicide (Australian Psychological Society, 2013). There are multiple causes of depression. It is caused by genetics, chemical and neurotransmitter imbalance, life stressors and negative thinking. These factors can interact with each other in a complex manner. Scientists have found that families with a history of depression contain genes associated with major/severe depression (Harvard Health Publications Harvard Medical School, 2013). Genetics may contribute to up to 50% more as the risk factors for depression (Harvard Health Publications Harvard Medical School, 2013). However, depression is higher in families where women are depressed compared to families where men are depressed (Harvard Health Publications Harvard Medical School, 2013; Goltser-Dubner, Galili-Weisstub, & Segman, 2010). Therefore, genetic interaction with other factors is different for women compared to men. In the case of women, genetic predisposition is linked with reproductive hormones and other stressful events (Harvard Health Publications Harvard Medical School, 2013). Women are also more susceptible to depression because of the chemical imbalance in the areas of the brain controlling mood, thinking, and behaviour (Women’s Health, 2012). Various neurotransmitters can be responsible for depression. Further, women are different from men because of reproductive functioning. They experience hormonal fluctuations and gynaecological changes in their bodies. These changes take place during the menstrual cycle, pregnancy, miscarriage, postnatal period and menopause (Women’s Health, 2012). Premenstrual dysphoric disorder is a depression experienced by 2-10% of the women just before their period due to the hormonal changes (Noble, 2005). Women are at high risk of developing depression during their child bearing years (Noble, 2005). Depression is also high among pregnancy. Miscarriage, which is perceived as a death of an unborn child can be very painful and can trigger depression (Noble, 2005; Rai & Regan, 2006). The postnatal period is described as the time shortly after child birth. Postnatal depression affects one in seven mothers in Australia (ABC Health and Wellbeing, 2013). It is also prevalent in developing countries (Fisher et al., 2012). Postnatal depression occurs in the first 12 months after giving birth (ABC Health and Wellbeing, 2013; Glazier, Elgar, Goel, & Holzapfel, 2004; Lee, Yip, Leung, & Chung, 2004). Although the birth of a child is an exciting and happy time, mothers often feel very overwhelmed and anxious (ABC Health and Wellbeing, 2013). New mothers may feel incompetent if they believe they will not be good mothers (ABC Health and Wellbeing, 2013). Further, hormonal changes after birth (low oestrogen level) are another common trigger for postnatal depression (Noble, 2005; Studd & Nappi, 2012). Menopause, with is the end of reproductive life is manifested by severe hormonal imbalances and chemical changes in the body. Women during this phase can experience severe depression (Noble, 2005; Studd & Nappi, 2012). Depression is also precipitated by stressful and traumatic events in life. A study highlights that compared to men women are three times more likely to experience depression due to stressful life events (Kendler, Gardner, & Prescott, 2002). Along with the day to day challenges, women have a higher risk of encountering traumatic experiences such as child abuse, sexual assaults and domestic violence (Harvard Health Publications Harvard Medical School, 2013). These severe stressors may produce stress hormones, which interact with reproductive hormone and neurotransmitters leading to depression (Harvard Health Publications Harvard Medical School, 2013). Further, a survey conducted on women in thirty countries indicated that compared to men, women are more likely to say that they are stressed (Garnefski, Teerds, Kraaij, Legerstee, & van den Kommer, 2004). Women are more susceptible for certain diseases such as breast and cervical cancer (Wong‐Kim & Bloom, 2005). Research reveals that these life threatening illnesses can cause secondary depression. Women can be more sensitive emotionally, which can lead to negative thinking (Breast Cancer Network Australia, 2010). Such irrational thoughts can interact with gene, hormones, chemicals and stressors to produce depression. This state of helplessness and hopelessness is a major cause of self harm. Depression is a complex disorder; there are different treatment methods available for women suffering from this condition. Medication such as anti-depressant drugs is used to decrease the chemical imbalance in women (Women’s Health, 2012). Further, cognitive behavioural therapy (psychotherapy) is essential for reducing negative thinking, building coping skills, improving behaviour and actions (Stuart, 2012). Social therapy is important to help women who are lonely and isolated from others (Hollon, Stewart, & Strunk, 2006). Substantial research studies have been conducted to investigate the causes of depression in women (Solomon, Haaga, Arnow, 2001).Most of these studies are cross-sectional in nature. Questionnaires and surveys are commonly used as measures, which can be impacted by retrospective bias. Research studies need to be more controlled. Experimental studies (RCT) are very accurate and can be run over a long period of time (longitudinal) (Dooley, Prause, Ham-Rowbottom, 2000). Longitudinal studies are ideal as they examine participants for a long time. These RCTs should have more emphasis on women gender and their stressors and the affect of hormones on depression. Literature reviews indicated that a combination of quantitative with qualitative is an effective way to study depression, particularly if the women are from a minority or ethnic group (Arnault & Fetters, 2011).There is limited information on depression in non-western ethnic groups, cultures and in women from developing countries. Future research is warranted in this area.

**Cultural and Social Analysis** Numerous socio-cultural factors are related to women’s depression. In general, in most societies women’s primary role as child bearers is to raise children and to care for their family. Moreover, they are expected by their societies to complete domestic chores (Meagher & Murray, 1997). Majority of societies in the world are dominated by men. Women are usually dependent on men (husband) and may be perceived incompetence without their support. As women have a passive role in many societies, they may not be as highly educated and skilled as men Thus, there are fewer women in the workforce/low levels of employment and low wage. Due to the low level of ‘professional’ jobs among women, they have a low socio-economic status (Stewart, Gucciardi & Grace, 2004). Poverty is a major risk factor for depression (Lund et al., 2011). These issues are more intricate for women in the developing countries where they are usually financially dependent on their husband or a male family member (De Silva, Huttly, Harpham, & Kenward, 2007; De Silva, Mckenzi, Harpham, & Huttly, 2005). During times of war and conflicts, in developing nations, women experience financial hardships when their husband passes away (World Health Organisation, 2013). They are often not permitted to work and survival becomes a challenge. One such serious example in the world is that of Afghanistan. Subsequently, stressful events such as financial strains, feelings of inadequacy and competency, may cause depression (Cardozo, 2004).

In Western society, women have many cultural pressures. Media (e.g. magazine and television) gives young women the message that ‘a thin woman is attractive’. Women with body image issues are usually dissatisfied with their body. This body image issue with an obsession to be thin can lead to depression (Myers & Biocca, 1992). Moreover, women are subjected to distressful events such as abuse, rape and domestic violence. Women are more susceptible to abuse compared to men. Abuse is very traumatic and women can impact women’s mental health seriously by causing depression (Weiss, Longhurst, & Mazure, 1999; Hegarty, Gunn, Chondros, & Small, 2004; Roosa, Reinholtz, & Angelini, 1999; Yama, Tovey, & Fogas, 1993). In the 21st century, a change in the society means that more women are choosing to stay single. Single mothers may experience many hardships. It is at times difficult to raise children, balance family and work commitment without a partner’s support (Brown & Morgan, 1997; Kessler, 2003). Similarly, there are lesbian women present in all societies. In most parts of the world, sexuality is considered a taboo topic and there is stigma associated with sexual orientation other than heterosexuality. Lesbians may be subjected to prejudice and discrimination. Their mental health may be affected which can lead to depression (Ayala & Coleman, 2000). Geographical factors are also associated with depression. In Australia majority of the population live in large capital cities, while some live in rural and remote areas. Overall, rural dwellers experience hardships and harsh life. Women living in remote areas face different types of stressors. There are limited facilities and support (infrastructure/recreation) available in rural areas and people living here are very isolated from the rest of society. Subsequently, women in these areas are more likely to suffer from depression compared to those living in urban areas (Buys, Roberto, Miller, & Blieszner, 2008; Kilkkinen et al., 2007) Australia has a large multicultural society. Approximately 45% of the Australia population were born overseas or have a parent who was born overseas (Khawaja, McCarthy, Braddock, & Dunne, 2013). Migrants and refugees, who are CALD (culturally and linguistically diverse), encounter challenges when relocating to a Western country such as Australia. They may have difficulty finding accommodation/housing, employment, learning English and understanding the new foreign environment (Khawaja et al., 2013). CALD women may experience role changes and intergenerational conflict (Khawaja et al., 2013). These difficulties may lead to depression. Moreover, refugees experience torture and traumatic events in their country of origin prior to resettling. These distressing events, if not managed can lead to depression and post traumatic stress disorder (Australian Psychological Society, 2013).

**Analysis of the Artefact** This video artefact is an excellent representation of depression in women. It provides a snapshot of how depression affects women. The factors that make women susceptible to this mental health condition are also highlighted. Many videos, similar to ‘Briony’s Story’, can be found on the Beyond Blue website. These videos aim to raise awareness about depression and educate the public about the symptoms and the importance of seeking help immediately. This assessment piece has helped me understand why women, compared to men, are more likely to be depressed. I have learnt about the physiological predisposing factors and the socio-cultural and cognitive precipitating factors of depression in women. Subsequently, I have understood the serious nature of depression. However, I have also learned that depression is a disease that can be managed and potentially prevented. It is important for organisations such as Beyond Blue to continue increasing knowledge about depression in society.


 * Reflection**

1) http://healthcultureandsociety2013.wikispaces.com/%27Who+do+you+love+most%27%3F 2) http://healthcultureandsociety2013.wikispaces.com/Advertising%2C+where+do+we+draw+the+line%3F

ABC Health and Wellbeing. (2013). Postnatal depression. Retrieved from []
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