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.75 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.71 From genetic research data, the influence from multiple genes linking with a combination of factors has suggested risk for depression.55 Children in households with adults suffering depressive disorders represent an increased risk of attention-deficit/ hyperactivity disorders (ADHD) or anxiety disorders.49
According to Burt,78 “trauma suffered by a woman early in childhood places her at risk for depression later in life.” Any history of domestic violence, abuse, victim of incest or the loss of a parent during childhood can influence depression in later years.71
Women are more likely to suffer from psychosocial stressors than men; increasing their likelihood for depression.78 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.78 Studies have provided no explanation as to why some women faced with similar challenges experience no depressive disorders.
Hormonal factors unique to women have been researched as probable risks linking women to higher rates of depression. 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.79,80,83 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).57 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.79,80
Postpartum depression is common for many women. 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 colleagues81 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.76,77 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.82
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.83 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 histories84,85 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.70