Epidemiology of women and depression.
BACKGROUND
Depression is the leading cause of disease-related disability among women in the world today. Depression is much more common among women than men, with female/male risk ratios roughly 2:1.


OBJECTIVE
Recent epidemiological research is reviewed. Implications are suggested for needed future research.


RESULTS
The higher prevalence of depression among women than men is due to higher risk of first onset, not to differential persistence or recurrence. Although the gender difference first emerges in puberty, other experiences related to changes in sex hormones (pregnancy, menopause, use of oral contraceptives, and use of hormone replacement therapy) do not significantly influence major depression. These observations suggest that the key to understanding the higher rates of depression among women than men lies in an investigation of the joint effects of biological vulnerabilities and environmental provoking experiences.


CONCLUSIONS
Advancing understanding of female depression will require future epidemiologic research to focus on first onsets and to follow incident cohorts of young people through the pubertal transition into young adulthood with fine-grained measures of both sex hormones and gender-related environmental experiences. Experimental interventions aimed at primary prevention by jointly manipulating putative biological and environmental risk factors will likely be needed to adjudicate between contending causal hypotheses regarding the separate and joint effects of interrelated risk factors.
Kessler
Ronald C
RC
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Suite 215, Boston, MA 02115-5899, USA. kessler@hcp.med.harvard.edu
D000293:Adolescent; D002648:Child; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D003937:Diagnosis, Differential; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors