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UW Daily Guest Editorial

THIRA Health / Partial Hospitalization Program  / UW Daily Guest Editorial

UW Daily Guest Editorial

By Dr. Mehri Moore

Why Women are More Depressed than Men — Understanding Culture, Place, and Time

Originally published in UW Daily

Though many of the afflicted are disinclined to speak about their struggles openly, mental illnesses like depression, anxiety, and related somatic disorders constitute something of a silent epidemic. In established economies, these mental health irregularities affect more than 20% of the population, and preliminary studies suggest that the figure is even higher in developing economies. A World Health Organization (WHO) report asserts that depression accounts for the largest proportion of the burden associated with mental and neurological disorders, and that depression is predicted to be the second leading cause of the global burden of disease by 2020.

Further, organizations like WHO and the Mayo Clinic report that women are nearly twice as likely as men to be diagnosed with a depressive disorder. According to WHO, 21.3% of American women will experience a major depressive episode at some point in her life, a number that is around 12.7% among men. On an annual basis, 12.9% of American women will experience a major episode, meaning that an American woman is slightly more likely to suffer from depression in any given year than an American man is in his lifetime.

While WHO admits that certain gender biases — doctors are more likely to diagnose depression in women than in men, even when scores on standardized measures are similar; women are 48% more likely than men to be prescribed psychotropic drugs; largely because of social stereotyping, women are more likely to disclose struggles with disorders like depression to their health care providers while men are more likely to disclose struggles with alcoholism and other substance abuse — may account for some of the disparities between rates of depression in men and women, its research indicates that a gap remains even once these biases are controlled for. There is no single reason why this is so, but the most convincing explanations consider the confluence of factors physiological, developmental, social, and cultural.

The Roots of Depression in Adolescence

As children, boys and girls operate on a relatively level playing field. In terms of physical strength and capabilities, pre-pubescent boys and girls are fairly equal, and girls’ brains actually tend to mature faster than do boys’. Once children reach adolescence, neurological development levels out, patriarchal socio-cultural structures begin to bear down more formidably, and mental health disparities become more pronounced. Indeed, among adolescents, girls are three times as likely as boys to suffer from a depressive disorder.

During their teenage years, boys are often empowered in everything from socially-sanctioned dating patterns to freedom of choice regarding educational tracks. Where boys are allowed to date around, are valued for their intelligence, and are encouraged to pursue STEM fields, girls are told that promiscuity is unflattering, that their value rests in their physical appearance, and that it’s best to leave science and math to the boys. These are, no doubt, well-worn complaints, and though progress has been made, ongoing movements striving to empower girls and women should be indication enough that these issues persist — no one fights for that which they’ve already achieved.

The Narrowing of Women’s Paths

As boys and girls transition from late adolescence into early adulthood, their brain development tends to diverge: young men are predisposed to think in linear, singularly-focused ways, whereas young women are much more process-oriented, more circular and horizontal in their thinking, taking in and considering multiple factors at once. Unfortunately, at least in the dominant institutions of the West, linear thinking is highly valued, a preference that results in professional women being dismissed simply because their natural approaches to thinking and problem-solving challenge entrenched institutional philandry.

Thus, unless a woman is highly skilled or remarkable in some way, society attempts to winnow down her options, discouraging her from tackling “men’s work” and unceasingly whispering a single word: motherhood. Of course, there is no reason to disparage motherhood as such, but we should take care to only valorize child-rearing when it is a woman’s active, uninhibited choice, not when it is the outcome of a subconscious desire generated by years of furtive patriarchal conditioning.

Regardless of her reasoning, when a woman becomes a mother, her priorities and values necessarily shift. Personal fulfillment is set aside and her focus is redirected toward care-taking and providing, meaning a mother’s social, cultural, and educational opportunities become subordinated to those of her child(ren). Ultimately, depression stems from feeling trapped, from feelings of helplessness. Whether one loses a loved one, undergoes major stress, or, yes, becomes responsible for another human’s well-being, the attendant experience of feeling that one cannot — or should not — affect change on their lot can undermine one’s ability to cope with everyday life and lead to bouts of depression. The joys of motherhood are by no means negated by these considerations, but it’s important to recognize that motherhood can be yet another entry in many women’s long histories of opportunity-depletion at the hands of society, and that these histories make women increasingly prone to depressive disorders.

Of course, this need not be the case. If society valued women — especially in their maternal capacities — it would prioritize their needs instead of relegating them to afterthoughts. Like care-giving in general, child-rearing is often forced to the lowest stratum of the employment hierarchy, if it’s socially recognized as work at all. Guaranteed parental leave and, for further on down the line, mature — and affordable — communal childcare networks are critical components of any social structure striving to be more hospitable than hostile to women’s needs, which is why ongoing political indifference to these issues is so frustrating. Motherhood is not inherently a recipe for depression; it exists as such because American society refuses to provide the support its new mothers require and deserve.

The Diverse Manifestations of Depression (and the Way Forward)

The fact that all patriarchies are not created equally notwithstanding, these gender-based exposures to risk factors of depression predominate anywhere men and women operate within unequal power structures. Distinct cultural determinants influence how a population at large understands and discusses depression — and this undoubtedly shapes the ways different women experience and manifest depression — but comparative studies suggest that similar gendered factors underlie most women’s struggles with mental health.

In Japan and China, for instance, many women suffer somatic ailments stemming from undiagnosed and untreated depression. In my country of origin, Iran, women frequently only report conversion symptoms, complaining that “my eye doesn’t see” or “my arm doesn’t work,” in an effort to tailor — whether consciously or not — their depression to a culture that takes physical symptoms more seriously than emotional ones.

Cultural variations aside, what’s clear is that — in addition to uniquely physiological risk factors like postpartum depression and premenstrual dysphoric disorder — women must contend with numerous socially-constructed risk factors that contribute to their higher rates of depression. Unlike physiological factors, these social factors can be mitigated and, eventually, eliminated, but only with a concerted collective effort. In an attempt to accelerate the at times glacial progress that we have heretofore seen, we should strive to make one thing clear: empowering women — and anyone else disadvantaged by patriarchal power structures — is not only a matter of political probity and social rectitude; it’s a matter of health and mental wellness. WHO has made clear how globally burdensome depression will be in the near future, and the only way to lift that weight is to acknowledge that depression is just as much a matter of social and cultural conditioning as it is a matter of biology or chemistry. We, without question, have the power to help alleviate millions of women’s anguish. The only question is: do we have the will?

Dr. Mehri Moore
Dr. Mehri Moore

Medical Director and Founder | MD, Psychiatrist and Psychotherapist.

Mehri Moore, MD brings over 35 years of work with women and girls to her leadership at THIRA Health. Her vision for THIRA was born out of a desire to address the core issues that women face, rather than simply working through symptomatic challenges.

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