Women's Mental Health in Primary Care

By Kathryn J. Zerbe | Go to book overview

Chapter 2
Depression

Depression is a major mental health concern for women. Occurring two to three times more commonly in women than in men, the spectrum of mild-to‐ severe forms takes an enormous toll on family life and productivity. Unipolar depression and seasonal affective disorder (SAD), or winter depression, which is related to a change in daylight hours, predominate in females. In recent generations, there apparently have been earlier onset and increased incidence of depression in younger age groups. The postpartum period is the most likely time for a woman to become depressed (see Chapter 11).

Although major strides have been made over the past 25 years in diagnosing and treating affective disorders, the stigma of having an emotional problem impedes many people from seeking help early. One national poll found that 54% of the United States population view depression as a personal weakness and that 62% do not view depression as the health problem it truly is. Strikingly, 13% of those interviewed saw themselves as "really depressed" (National Mental Health Association, 1996). As these public opinion findings demonstrate, there are literally millions of people who fail to seek treatment because of shame, embarrassment, and limited understanding of the illness. Even in primary care, one half of all patients with depression remain unrecognized (Tylee, 1996) and hence untreated. It is estimated that 10% of patients in primary care have major depression, and that 20% to 30% of all those seen in this setting have depressive symptoms (Klerman and Weissman, 1992; Wells et al., 1992).

Both the varying definitions of the disorder and the standard measurement instruments that can be helpful in primary care as well as psychiatric practice (e.g., Beck Depression Inventory, Hamilton Rating Scale for Depression, Zung Self-Rating Depression Scale) may fail to gauge the depth of suffering of many patients who are inadequately treated. The diagnosis, treatment, and synthesis of relevant literature on depression are therefore more difficult than they appear.

First introduced in 1972, the term "major depression" continues in use today, although it is relatively nonspecific and means different things to different professionals (Parker, 1993). The majority of patients presenting to general medical practitioners do not meet the full diagnostic criteria listed in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (1994), yet the adverse outcome for so-called subthreshold or subclinical depression is as high or higher than for major depression (Olfson et al., 1996). Morbidity in both groups is comparable: One fourth of patients make suicide attempts, about 20% lose at least 1 week of work per year, 15% use minor tranquilizers, and many subjectively report having had "the worst depression of my life" (Johnson et al., 1992; Olfson et al., 1996).

Two thirds of the estimated 6 million women with major depression or dysthymia remain undiagnosed. The annual cost in the United States is more

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Women's Mental Health in Primary Care
Table of contents

Table of contents

  • Women's Mental Health in Primary Care *
  • Preface vii
  • Acknowledgments xi
  • Contents *
  • Chapter 1 - Anxiety Disorders 1
  • Chapter 2 - Depression 31
  • Chapter 3 - Bipolar Disorder 55
  • Chapter 4 - Misuse of Substances 73
  • Chapter 5 - Eating Disorders 109
  • Chapter 6 - Trauma and Violence 139
  • Chapter 7 - Insomnia 165
  • Chapter 8 - Somatization 181
  • Chapter 9 - Catastrophic Loss and Bereavement 199
  • Chapter 10 - Major Medical Illness 219
  • Chapter 11 - Menstruation, Pregnancy, and Menopause 247
  • Chapter 12 - Psychosis 273
  • Chapter 13 - Sexuality and Intimacy 291
  • Chapter 14 - The Older Patient 319
  • Afterword 347
  • General Resources for Patients 350
  • Index 353
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