[Study Finds Aftercare Lacking]
[Violence And The Mentally Ill]
HIGHER RATES OF DEPRESSION IN WOMEN[Return to Top]
Higher rates of depression observed in women may be linked to differences in biochemistry and childhood socialization that render some women more vulnerable than men to the illness, according to the National Institute of Mental Health (NIMH). The NIMH study and other research was reported in a special November 1993 issue of the Journal of Affective Disorders devoted to women and depression.
"Research into the biological and psychological underpinnings of depression is beginning to yield findings that help to explain why women are twice as likely to develop depression," said former NIMH Director Frederick K. Goodwin, M.D. "As we learn more about gender-specific factors in the development of depression, we will be better able to design specialized and more effective treatments for both women and men with the disorder.
Findings reported in this issue of the Journal of Affective Disorders are reported below.
Dr. Myrna M. Weissman of Columbia University's New York State Psychiatric Institute and colleagues examined sex differences in the rates of depressive illnesses in the United States, Canada, Germany, and New Zealand.
Across the four countries, they found almost the same rates of bipolar (manic-depressive) disorder in men and women, but higher rates of major depression and dysthymia in women. Major depression first strikes in the mid- to late-20s for both sexes, and while the rate of depression in the United States in men born since 1945 has been rising, it appears to have stabilized in women.
In research on biological mechanisms underlying depression, Dr. Uriel Halbreich and Lucille A. Lumley, M.S., both of the State University of New York at Buffalo, compared neurochemical and neuroendocrine function in men and women.
They found gender differences in several functions of the norepinephrine and serotonin neurotransmitter systems, in activities of dopamine and acetylcholine, and in certain operations of the hypothalamic-pituitary-adrenal system.
These findings suggest that vulnerability to depression, as well as its actual expression, might be related to short- and long-term effects of gonadal hormones. These hormones probably play an important role in the multi-faceted and multi-dimensional mechanisms underlying mood and behavior.
Dr. Diane N. Ruble of the New York University and colleagues, in a literature review of socialization processes in childhood, discussed various social factors that may lead to girls' greater vulnerability to depression. For example, girls are usually more closely watched and protected than boys, making them less likely to develop an independent sense of mastery.
This low sense of self-efficacy, the researchers reported, may lead to feelings of little control, pessimism, and hopelessness. Theorists of learned helplessness believe all of these are related to the development of depression. This review also suggested that pre-pubertal girls sometimes have more depressive symptoms than boys.
This finding supports the view that women's higher rates of depression cannot be solely explained by hormone-related changes associated with the onset of puberty. This is important because it suggests that prevention and intervention efforts should be directed at socialization processes during the early school years.
Dr. Ronald Kessler of the University of Michigan at Ann Arbor and colleagues reported that there is no difference between the sexes in the overall course of depression once it occurs. Men and women who had a history of depression were equally likely to have been chronically depressed or to have experienced an acute recurrence of a depressive episode in the past year.
This finding comes from the National Comorbidity Survey, which was conducted in the United States from 1990 to 1992 and involved nearly 8,100 respondents.
Title and authors of some of the other articles in this special journal issue include: "Do gonadal steroids regulate circadian rhythms in humans," by Dr. Ellen Leibenluft, NIMH; "Gender differences in depression: perspectives from neuropsychology," by Dr. Wendy Heller, University of Illinois; "Puberty onset of gender differences in rates of depression:
A developmental, epidemiologic and neuroendocrine perspective," by Dr. Adrian Angold, Duke University Medical Center, and Dr. Carol W. Worthman, Emory University; "The menstrual cycle and mood disorders," by Dr. Jean Endicott, New York State Psychiatric Institute.
"Depression and weight gain: the serotonin connection," by Dr. Judith J. Wurtman, Massachusetts Institute of Technology; and "Thyroid and adrenal measures during late pregnancy and the puerperium in women who have been major depressed or who become dysphoric postpartum," by Dr. Cort A. Pedersen, et al, University of North Carolina at Chapel Hill. For more information, contact Sophia P. Glezos of NIMH, 301-443-4536.
from Innovations & Research, Vol.3, #1 (1994)
Note: To subscribe to Innovations & Research, write or call Innovations & Research, 730 Commonwealth Avenue, Boston, MA 02215 (617/353-3549). Subscription prices vary, but NAMI members can subscribe for a special rate of $22.
The Harvard Psychiatry Brain Collection has been specifically trying to collect brain tissue from families with serious mental illness. There has been a special focus on the membership of the National Alliance for the Mentally Ill (NAMI), the organization for families with brain disorders. Our "Brain Bank" functions as a repository for brain tissue that is used for scientific investigations of the underlying causes of neuropsychiatric brain disorders. Toward this end, we distribute donated tissue to qualified investigators throughout the country.
For research purposes, it is important that we collect tissue from: A. Individuals with a psychiatric diagnosis (schizophrenia, manic-depression, obsessive-compulsive disorder); B. First degree relatives (parents, siblings, offspring) of individuals with a psychiatric diagnosis; and C. "Normal Control" individuals who have no family history of mental illness.
The Harvard "Brain Bank", which is centered at McLean Hospital, is federally funded to undertake the processing and distribution of donated brain specimens. Unfortunately, the government does not provide sufficient funding to cover the costs associated with brain removal which, may in some cases be as much as $200-300. In the past, these costs have generally been assumed by the family members interested in brain donation. However, because of the severe shortage of brain tissue donated by individuals with a serious psychiatric illness, we have established a special fund in order to cover the costs of brain removal for individuals with a psychiatric diagnosis (category A above). In addition, as long as there is adequate funding available, we will also cover such costs for the donation of brains from first degree relatives (parents, sibling, offspring) of individuals with schizophrenia, manic-depression or obsessive-compulsive disorder (category B above). The spouse of an individual with a serious mental illness, who has no other blood relatives with a serious mental illness, can donate brain tissue in the category of "Normal Control" (category C above), and as long as there is adequate funding available, we will agree to cover the associated costs of donation.
Pre-registration for brain donation is encouraged, but not necessary. When an individual dies, the surviving family members make the decision to donate. We do, however, encourage families to openly plan for brain donation and to pre-register with the Brain Bank.
Brain donation is a personal decision that is made by the surviving family at the time of death. In the event of a death, or an impending death, just dial 1-800-BRAIN BANK any time of the day or night and our staff will assist you in the donation process.
For more information about brain donation, please call 1-800-BRAIN BANK (1-800-272-4622) and request our "Brain Donation Information" brochures for your Local Affiliate meeting or a copy of our free video interview with Dr. Jill Bolte Taylor titled "LifeSpan: Research Takes Brains".
Remember: From Knowledge Will Come A Cure!
Jill Bolte Taylor, Ph.D. firstname.lastname@example.org
- Co-Director Harvard Psychiatry Brain Collection; McLean Hospital; 115 Mill Street; Belmont, MA 02178
- Board Member of the National Alliance for the Mentally Ill (NAMI)
- "The Singin' Scientist!"
A national study of psychiatric aftercare has found that patients leaving psychiatric hospitals often receive inadequate or uneven transitional services. "Because psychiatric care has increasingly been provided in community-based settings rather than in hospitals, there must be greater coordination between hospitals discharging patients and the local mental health centers and clinics providing care after they leave," said Dr. Robert Dorwart, a co-author of the study published in the August 1994 issue of the American Journal of Public Health.
"Right now they are falling through the cracks," he continued. The Harvard-based study funded by the National Institute of Mental Health found that half of the facilities surveyed provided patient follow-up of one week or less. While nine out of ten hospitals reported making discharge plans for patients leaving the hospital, 75 percent provided no case-management services, the most intensive form of aftercare.
And although 60 percent of hospitals said they arranged a follow-up appointment for patients leaving the hospital, just 10 percent made telephone calls to see if the appointment was kept. For more information, contact Dr. Dorwart at 617/495-0868.
"The perceived association between violent behavior and serious mental illness was explored to determine the validity of claims by mental health advocates that individuals with serious mental illness are no more dangerous than members of the general population," wrote E. Fuller Torrey, M.D., in conjunction with his article, "Violent Behavior by Individuals with Serious Mental Illness," published in the July 1994 issue of Hospital and Community Psychiatry.
Torrey reviewed recent studies and media accounts of violent behavior by individuals with serious mental illness and found that "although the vast majority of [such individuals] are not more dangerous than members of the general population, recent findings suggest the existence of a subgroup that is more dangerous.
A history of violent behavior, noncompliance with medications, and substance abuse are important predictors of violent behavior in this subgroup....Until the problem of violence by this subgroup is addressed, it will be difficult to substantially decrease the stigma associated with serious mental illness," concluded Torrey.