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Global Burden of Depression on Women

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Global Burden of Depression on Women

There are various definitions for depression and the symptoms associated with this condition. The DSM-IV TR is the generally accepted classification for depression level differentiating between states of moderate (single episode) and severe (recurring) feelings of depression (American Psychiatric Association [DSM-IV-TR], 2000). The Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV TR) is used by clinicians and psychiatrists to diagnose psychiatric illnesses. The DSM-IV TR is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children. Some symptoms of depression according to the DSM is a mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). (3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (4) Insomnia or hypersomnia nearly every day. (5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down), and (6) fatigue or loss of energy nearly every day. In order to be diagnosed with depression patients must be experiencing at least two symptoms out of the six listed above (American Psychiatric Association [DSM-IV], 1994).

The Global Burden of Disease report issued by the World Health Organization makes various claims about depressive disorders and the effect it has on the world. According to the report depression is the number one cause of disease affected life years in woman age 15-44, and is the third leading cause of DALYS overall and the number one neuropsychiatric disorder worldwide (Global Burden of Disease Report, 2004). DALY'S are defined as the sum of years of potential life lost due to premature mortality and the years of productive life lost due to disability. The report also makes a prediction that in 2030 depression will jump to the number one leading cause of DALY'S resulting in disease or injury (Global Burden of Disease Report, 2004). Depression is a plausible area of concern when it comes to the burden this disease presents not only nationwide but globally.

Depression accounts for productivity loss of over $44 billion a year in the United States (Wang, Simon, & Kessler, 2003) and is also associated with elevated rates of suicide and over 30,000 deaths each year in the United States (Centers for Disease Control and Prevention, 2006). Prevalence rates for depressive disorders vary across cultures and nations. In the United States, the lifetime prevalence rate for depression has been estimated at 5.2%-9.6% in Canada, 1.5% in Taiwan, and 19 % in Lebanon. Prevalence rates tend to be higher in developing countries 19.9, Thailand, 40% in Cuba, 39% in Dominican Republic and 19% in Mexico (Bolton, Wilk, & Ndogoni, 2003).

There are prevalence rate disparities between gender and socio-economic status with those who have low income encountering a higher prevalence rate of depression and women having a twice as likely chance of being diagnosed with depression as men (Colman, & Ataullahjan, 2010). Although the use of SSRI's (serotonin reuptake inhibitors) coupled with psychotherapy have been proven to help treat depression, the burden of depression has not been combated and is instead projected to be on the rise.

While considering this burden on the world one may look into the cause of the disease in order to assess what can be done to reduce this impact. The diathesis-stress model is a psychological theory that explains behavior as both a result of biological, genetic factors and life experiences (Eberhardt & Hannan, 2010). The diathesis-stress model is a psychological theory that explains behavior as both a result of biological and genetic factors ("nature"), and life experiences ("nurture"). The term "diathesis" is used to refer to a genetic predisposition toward an abnormal or diseased condition. According to the model, this predisposition, in combination with certain kinds of environmental stress, results in abnormal behavior (Eberhardt et. al, 2010). There are various types of diathesis stress models and this paper will be focusing on the model for depression. The diathesis-stress model for depression suggests that people have, to a certain degrees, vulnerabilities or predispositions for developing stressors in life that can trigger a depressive disorder (Eberhardt et. al, 2010). This model has stimulated research and treatment on how to mitigate the stress, and therefore reduce the expression of the diathesis, by developing protective factors. Some protective factors include pharmacological medicines, psychotherapy, and the development of support systems. Even more importantly, the stress-vulnerability-protective factors model has allowed mental health workers to create a patient profile of what happens when the person is doing poorly (the diathesis), what hurts (the stressors), and what helps (the protective factors) (Eberhardt et. al, 2010).

The thesis of this paper is that the diathesis-stress model can be used to explain why depression is widely more prevalent in women than in men. Also by using the model, health care professionals can find protective factors that can help to reduce the impact of this burden not only domestically but internationality as well.

A person's interpersonal relationships may make them more susceptible to depression because research has shown that a lack of social support increases stress which can lead to one developing depressive symptoms. The concept of loss and its relation to depression has been established to have a relationship; interpersonal loss has been shown to be predictive of depression (Colman et. al, 2010). Women are more likely than men to define themselves in terms of their relationships with others which can explain why they are more predisposed to develop stressors when their relationships are not what they consider ideal (Cambron, Acitelli, & Pettit, 2009). Men are usually socially expected to go out and be the bread winners while women are expected to stay in the house and take care of the kids and the home, and this practice is seen globally around the world. Women whose job was to be the nurturer and the care giver of the home have been reported to feel increase of stress if their partner was deemed uncaring and if they felt like their role in the marriage was that of being the house servant rather than



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