Other Risk Factors

Family histories of depression may place a woman at greater risk for developing disorders; however, depression can also exist in women where no genetic links have been identified.⁹⁹ Those with relatives suffering from major depressive illnesses are likely to have a 1.5 to 3.0 times greater chance of developing depression than the general census.¹⁰⁰ A large genome-wide association study genetic and health records of 1.2 million people identified 178 gene variants linked to major depression, a disorder that will affect as many as one in every five people during their lifetimes.⁹⁹ Children in households with adults suffering depressive disorders represent an increased risk of attention-deficit/ hyperactivity disorders (ADHD) or anxiety disorders.¹⁰⁰

Past physical, sexual, or emotional abuse has been associated with depression later in life among people who may be biologically predisposed to depression.¹⁰¹ Any history of domestic violence, abuse, victim of incest or the loss of a parent during childhood can influence depression in later years.¹⁰¹ Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse.¹⁰² Although the exact prevalence is unknown, it is estimated that 12–40% of children in the United States experience some form of childhood sexual abuse.¹⁰²

Women are more likely to suffer from psychosocial stressors than men; increasing their likelihood for depression.¹⁰¹ Stress encountered from work, family or marital relationships has triggered depressive episodes, as well as divorce, death and personal trauma. Caring for aging parents and children along with additional household or work responsibilities can create stressful situations eliciting depression. It has been reported women respond differently to stressful events than men, and for unknown reasons their prolonged responses to the stress actually place them at higher risk for depression than men.¹⁰² A 2025 University of Florida animal study found that acute stress triggers a sex-specific change in brain enzyme activity. In male rats, stress increases levels of 5α-reductase type 2 (5αR2). In contrast, female rats showed no such enzyme change, suggesting a different molecular pathway for stress adaptation. Women are more likely to internalize stress rather than act out, a pattern linked to higher rates of anxiety and depression. Hormones, behavioral and coping styles, and developmental and in-utero factors all have an effect on behavior.¹⁰²

Hormonal factors unique to women have been researched as probable risks linking women to higher rates of depression. Hormonal fluctuations during menstrual cycles, pregnancy, and menopause can significantly impact anxiety levels, making anxiety conditions more common and often more severe in women. Also, women have greater social pressures related to appearance, career, and family roles, which contribute to heightened stress and anxiety. Since hormones directly affect the brain’s ability to control moods and emotions, scientists have examined the influence of hormones during specific times in a woman’s lifecycle; puberty, menses, pregnancy, postpartum, pre and post-menopause.¹⁰¹ One week prior to menstruation, anxiety, mood swings, irritability and depression have each been observed in women suffering from a severe type of premenstrual syndrome known as premenstrual dysphoric disorder (PMDD).¹⁰³ Those debilitated with PMDD exhibit different responses to hormonal changes; demonstrating greater sensitivity possibly linked to histories of mood disorders, or unidentified differences in brain chemistry. Researchers are currently examining the cyclical periods of estrogen affecting the brain that potentially have associations with depression.¹⁰⁴ As sex hormones, estrogens profoundly impact the nervous system, acting on cognitive, affective, and behavioral functions. During periods of estrogen fluctuations, females exhibit increased prevalence of affective disorders.¹⁰⁴

Postpartum depression is common for many women. The statistics regarding maternal mental health are alarming. Approximately one in five mothers suffers from mood and anxiety disorders during the perinatal period, which extends from pregnancy through one year postpartum. From the numerous physical and hormonal changes occurring during and after pregnancy, episodes of depression can exist. While for many they will be temporary, other women may suffer serious conditions requiring emotional support and therapy. Munk and colleagues¹⁰⁶ have noted an increased risk for mental disorders to occur and last several months postpartum. Others have suggested women suffering postpartum depression possibly suffered depression during pregnancy which was undiagnosed. Studies have concluded with recommendations indicating women should be screened for depression during pregnancy as well as during the postpartum period. Everyone receiving well-woman, prepregnancy, prenatal, and postpartum care be screened for depression and anxiety using standardized, validated instruments. Screening for perinatal depression and anxiety occur at the initial prenatal visit, later in pregnancy, and at postpartum visits.¹⁰⁷

If not treated, these disorders can lead to serious health outcomes for the mother, weaken the parent-child bond, and negatively impact the child’s long-term mental health and development. Death by suicide is also a leading cause of maternal mortality.¹⁰⁸ To address this situation in California, the California Health Care Foundation (CHCF) funded the Los Angeles County Maternal Mental Health Access (LAMMHA) project, a five-year initiative (2022-2026) to teach Los Angeles County Federally Qualified Health Centers (FQHCs) how to implement an evidence-based approach known as the Collaborative Care Model (CoCM) to better identify and treat mothers with perinatal mental health problems. The initiative is a collaborative effort involving multiple partners, including the Community Clinic Association of Los Angeles County, Elevation Health Partners, Maternal Mental Health Now, Concert Health, and leadership from the University of Washington’s Department of Psychiatry and Behavioral Sciences.¹⁰⁸ Perhaps this can become a model for the USA.

The U.S. Food and Drug Administration approved a drug March 20, 2019 specifically meant to treat postpartum depression. It is an intravenous infusion of the drug brexanolone, sold as Zulresso. In two placebo-controlled studies, Zulresso demonstrated superiority to placebo in improvement of depressive symptoms at the end of the first infusion. The improvement in depression was also observed at the end of the 30-day follow-up period.¹⁰⁹

Depression has not been associated with the normal aging process; however, evidence suggests older women experience more depression than older men; even though rates decrease in women after menopause.¹¹⁰ The transitioning phases between pre-menopause and menopause indicate fluctuations in hormonal changes; mood changes may not be experienced by all women, while others may demonstrate increased risks for depression. These depressive illnesses have been noted without prior histories while other studies have shown depression in post-menopausal women occurring in those with prior histories of depressive disorders. Older women tend not to express or discuss feelings of sadness and demonstrate less than obvious symptoms resulting in physicians being less likely to diagnose a depressive disorder.¹¹¹ Evaluation of depression prevalence over the life-course confirmed than women's higher odds of major depressive episodes was especially large at ages sixty-five and older.¹¹¹