Gender, Culture & Age Variations

Depression is always personal and contextual. The individual experience of depression, as well as the symptoms observed by others, are shaped by biology, age, cultural and sociological expectations.

Men and women often experience depression differently. Each experiences different neurohormonal influences and the two genders tend to employ different coping mechanisms and defenses. In general, men tend to externalize symptoms; whereas, women tend to internalize symptoms. Let’s look at more specific distinctions…

While men in today’s culture are more inclined towards emotional expressiveness than their ancestors, they still have a tendency to mask their pain, and resort to self-defeating ways of managing their emotions. Most have been socialized to believe that “big boys don’t cry.”

When depressed, men tend to engage in more destructive behaviors than women, involving anger, irritability, and addiction.

Men are more likely than women to engage in destructive, often addictive, behaviors when they’re depressed, such as turning to alcohol or drugs, or becoming frustrated, discouraged, irritable, angry and even abusive. Many have trouble managing anger so they hold it in until they can’t take it anymore and explode. They may even neglect and abuse spouses and children. Many walk around with a vast hurt inside and a longing for someone to heal it. But they’re also ashamed of those feelings, so they can’t bear to tell anyone.

Men are often ashamed of the symptoms of depression.

Some men are always expecting rejection, so they “reject first” as a defense. Some become “workaholics” to avoid feeling and discussing their feelings with others. Others engage in reckless, risky behavior, such as illicit love affairs, gambling or substance abuse. Overt, observable signs of depression may only emerge when the man’s defenses have been unmasked and the compulsive behaviors can no longer relieve the emotional pain. Rather than acknowledging painful feelings, men are more likely to acknowledge having symptoms such as fatigue, irritability, loss of interest in once-pleasurable activities, or sleep disturbances.

Men are at a higher risk of completing suicide than women, even though women more frequently attempt.

While more women attempt suicide, a greater percentage of men actually complete suicide. In fact, almost four times as many males die by suicide. While women often commit suicide as a result of a relationship breakdown, men are more likely to commit suicide because they lack goals and purpose in their lives, or cannot “fix the problem.”

Women are more likely than men to admit to symptoms of depression such as feelings of sadness, worthlessness and excessive guilt and they are naturally more inclined and more willing to discuss their feelings with family and friends. While such support may be helpful, women are more prone than men to harmfully excessive co-rumination with friends and more likely to become trapped in a cycle of despair, helplessness and passivity. This is particularly true of women who perceive that they have less social power and control over their lives than men.

Women are more comfortable talking about their symptoms of depression than men.

Women more frequently report feeling unappreciated by their partners. Many working mothers bear the greater burden for housework and childcare, in addition to occupational stress. They’re also more likely to be responsible for caring for aging parents, and are more likely candidates for abuse and poverty.

Women are more prone to ruminating, persistently revisiting negative thoughts and feelings.

NIMH surveys have found that this sense of powerlessness and the “grinding annoyances and burdens that come with women’s lower social power” causes chronic stress. Chronic stress provokes chronic rumination — the churning of feelings over and over again. Rumination, in turn, perpetuates chronic stress because it depletes the reservoir of motivation, perseverance, and problem-solving skills that we must have in order to facilitate positive change.

More women suffer from depression than men.

The majority of the population with Major Depression is comprised of women between the ages of 18 and 45. In the United States, Major Depressive Disorder is twice a common in adolescent and adult females as in adolescent and adult males, a differential that emerges during adolescence, often coinciding with the onset of puberty.

While hormones are certainly not the only cause of depression, they can play a significant role.

Hormones are part of the brain chemistry that controls emotions and mood. So while biology alone does not account for the higher rate of depression in women, biological, life cycle, hormonal and psychosocial factors unique to women certainly contribute to it. For example, many women experience worsening of depression symptoms a few days before the onset of menses. Some women are susceptible to a severe form of premenstrual syndrome (PMS), sometimes called Premenstrual Dysphoric Disorder (PMDD). PMDD results from hormonal changes that typically occur around ovulation, and before menstruation begins. The cyclical rise and fall of estrogen and other hormones are known to influence the brain chemistry associated with depression, which may help explain why the risk for depression increases during the transition into menopause.

Contrary to popular belief, depression is not “a normal part of aging.” Many seniors live vibrant, fulfilled lives without ever experiencing serious mood disturbances, despite the fact that their minds and bodies are aging and they are more susceptible to physical illnesses. But others find that the retirement picture is not as rosy as they anticipated. Some find that they suddenly have too much time on her hands, nothing to look forward to, no purpose or direction in life. Some may spend too much time ruminating about the past, bemoaning roads not taken, filled with regrets about “unfulfilled potential.” They may become too focused on their own mortality, anxious about death, rather than living their lives to the fullest and appreciating the valuable years ahead.

Seniors may face unique challenges, involving change, illness, and complex feelings about their pasts.

Depression affects 1 in 5 seniors living in the community; 2 in 5 living in nursing homes. Older adults are more likely to be suffering from more serious medical conditions such as heart disease, stroke or cancer — all of which commonly cause depressive symptoms. They may also be taking more medications whose side effects may contribute to depression.

Some older adults experience ischemia, a condition in which the blood vessels become less flexible and harden over time, constricting the flow of blood to the brain, which can result in vascular depression. In addition to increasing the risk of cardiovascular problems, constricted blood flow contributes to depressed mood and thought disorder. And in a particularly cruel twist, the brain abnormalities resulting from vascular depression can also prevent depressed older patients from responding to antidepressant medication.

Older adults, over the age 55, are 4 times more at risk for suicide.

The suicide rates in people suffering from Major Depression over age 55 are four times higher than that of the general population; in fact, white males, age 85 and older, have the highest suicide rate of any age group. Studies have suggested that many of these suicide victims may have suffered from a depressive disorder that went undiagnosed and untreated, even when they had visited their doctors within one month of their deaths. There are several possible explanations: they visited primary care physicians who were not qualified to diagnose and treat depression; their symptoms may have been overlooked because symptoms in older adults may be less obvious; and they may be less inclined to acknowledge, or even allow themselves to experience feelings of sadness or grief.

Childhood depression often recurs in adulthood, especially when it goes untreated, and childhood depression tends to be a predictor of more severe mental health disorders in adulthood.

Before puberty, boys and girls are equally likely to develop Depressive Disorders. By age 15, however, girls are twice as likely as boys to have experienced a Major Depressive Episode (National Institute of Mental Health, 1999). Adolescence is a period of tumultuous personal change. Adolescents are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and learning to make important decisions.

There may be early warning signs.

A depressed child or adolescent may feign illness to get out of going to school or work, cling to a parent, or worry excessively that a parent may die. Older kids may sulk, get into trouble at school or work, be negative and irritable, and feel “misunderstood.” While these behaviors can be indicative of mood swings that re typical of adolescent developmental stages, consistent patterns of such behaviors bear watching.

Adolescent depression can lead to an increased risk for suicide.

Suicidal ideation or thoughts of suicide can be alarmingly high in adolescents. Some research indicates that as many as one in four 15- to 24-year-olds report suicidal thoughts. Even more alarming, most of their parents did not notice depressive symptoms (Hassad, 2006).

Adolescent depression frequently co-occurs with other disorders such as anxiety, disruptive behaviors, eating disorders or substance abuse.

Culture can influence the symptoms of depression, as well as the way those symptoms are experienced and articulated. In some cultures, depression is described in somatic or physical terms rather than in the context of feelings like sadness or guilt. For example, Hopi Indians may describe the depressive experience as being “heartbroken.” Latino and Mediterranean cultures often describe depression in terms of physical complaints, such as “nerves” and headaches. Chinese and Asian cultures complain of tiredness, “weakness” or “imbalance.” Middle Eastern cultures complain of “problems of the heart.”