Struck by lightning or slowly suffocating - gendered trajectories into depression.
BACKGROUND
In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression.


METHODS
Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory.


RESULTS
The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified - "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" - and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships.


CONCLUSIONS
Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.
Danielsson
Ulla
U
Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden. ulla.danielsson@fammed.umu.se
Bengs
Carita
C
Lehti
Arja
A
Hammarström
Anne
A
Johansson
Eva E
EE
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003142:Communication; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D005783:Gender Identity; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D033262:Narration; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires