Depression

Social Stigmatization and Societal Expectations
as Factors of Health Inequalities Illustrated by
the Example of Depression
Psychotherapists report their experiences
Health Inequalities V:
Verhältnisse für Gesundheit
11./12. Juni Bielefeld
Lena Hünefeld, M.A.
Research Questions
1.
2.
3.
4.
5.
6.
7.
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Depression – Definition and Forms
Prevalence Rate of Depression
Causes of Depression
Research Question
Methods
Results
Conclusion
Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Depression - Definition (Müller-Rörich 2007)
The word „depression“ covers a broad spectrum of behavior and
mood states, from normal mood swings to severe impairments
requiring treatment
Depressive moods can be defined as disease
1. when they last longer than average
more than two weeks
2. when these causes and effects are
disproportionate
3. when they are of strong intensity
impairment of daily routine
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Depression – Types and Symptoms
(ICD-10)
• Types:
Core Symptoms:
1. Depressive episode
2. Recurrent depressive disorder
3. Persistent mood disorders
a. Dysthymia
b. Cyclothymia
a.
b.
c.
d.
e.
•
Severity:
1.
2.
3.
Mild
Moderate
Severe
a. without psychotic symptoms
b. with psychotic symptoms
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depressed mood
loss of interest and enjoyment
reduced energy
increased fatiguability
marked tiredness after only slight
efforts
f. reduced self-esteem and
selfconfidence
g. somatic disorders (e.g. disturbed
sleep, diminished appetite)
h. ideas or acts of self-harm or suicide
Sociology with the Specialty Gender and Life Course Research
Prevalence Rate of Depression
(Culbertson 1997, WHO 2010)
• Current situation:
− 121 million people are affected by depression worldwide
− 4 millions are affected by depression in Germany
• Lifetime prevalence:
− Women: 20-25%
− Men: 7-12%
• Ratio of women to men in industrial societies:
5
Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
2:1
Sociology with the Specialty Gender and Life Course Research
Causes of Depression
• Biological / Genetic Approach
− Neurotransmitters: Male organisms produce more serotonin, men have less
serotonin receptors (Schäfer 2007)
− Hormones: e.g. premenstrual syndrome, pregnancy, menopause (e.g. Dinner
2005)
• Social Psychological Approach
− Family status (Hautzinger 1984/85, Hecht 1990)
− Limited role repertoire vs. role plurality (e.g. Gove 1972, Hecht 1990)
− Lower social status and discrimination against women (ILO 2003)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Causes of Depression
• Artefact Approach: Different vulnerability of depression is an
artefact and women and men are affected by depression to a
similar extent
− males show different symptoms than women (male depression) (Rutz 1997,
Real 1999, Dinner 2005, Kogler & Kaiser-Kaplaner 2007)
− males show less symptoms or describe more somatic symptoms (Ernst &
Angst 1992, Kessler et al. 1993, Wittchen 2000)
− sex differences in perception of symptoms (Gijsbers van Wijk & Kolk 1997,
Wolfersdorf 2006)
− males seek help in a different manner (Briscoe 1987, Rickwood & Braithwaite
1994, Möller-Leimkühler 2000)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Research Question
How do social expectations influence the health
behaviour and the therapy of depressive men?
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Qualitative Study
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
Gender specific handling of depression
• 5 of 6 psychotherapist reported a male specific handling of
depression:
−
−
−
−
−
Men externalize the reasons of the depression
Men show a lower acceptance of depression than women
Men disclaim the depression
Men try to treat the depression themselves
Women came more often to the therapist for themselves
„Men describe their complaints rather briefly while women elucidate their
descriptions more. And they are more accessible. Men are more emotionally
reserved.“ (No.2/w)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
Gender specific (reporting of) symptoms of depression
• All psychotherapists reported gender specific symptoms:
−
−
−
−
Men report more somatic symptoms
Women report more about emotions and sadness
Men disclaim the symptoms or trivialize the symptoms
Men have more severe symptoms than women
„So, for men it is difficult to speak about themselves as a depressed patient. So, I
think it is consistent with the stereotype that a man speaks more about physical
symptoms rather than about classic depressive symptoms.“ (No. 4/m)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
Social expectations as parameter
• 3 of 6 psychotherapist specify the social expectations as one
parameter why the proportion of women in the statistics of
depression is higher:
− Men have to be strong
− Men are more afraid of disadvantages at the workplace
− Women are allowed to show their suffering
„Men need to last longer, they compare themselves with their own sex and men
must be strong. While women are free to show their suffering“ (No.2/w)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
Gender specific treatment of depression
• 5 of 6 psychotherapist reported that gender influences the therapy
of depression:
− The access to female patients and their emotions is easier than it is to men
− Implementation of different therapy approaches for male and female patients
(men: Progressive muscle relaxation, pragmatic approach, women:
Interoceptive exercises, imaginary journey)
„ With women it is easier to get to the core of the matter.“ (No. 6/m)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Results
Sex vs. Gender
• 4 of 6 psychotherapist report that sex is not a reason for the higher
proportion of depressed women
− Men do not allow the diagnosis of depression
− Women and men are equally affected by depression
„That's a social requirement for men. Depression fits more in the self-concept of
women.“ (No.4/m)
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Conclusion
• Women are twice as likely as men to be affected by depression
• Previous studies and the expert interviews show evidence that the
depression statistics are an artefact
• Men and women deal differently with symptoms and depression
• Gender influences the therapy of patients with depression
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Questions
• How can we inform and sensitize society about depression?
• How can we help men to handle depression in a healthier way?
• Do we need a gender sensitive training about diseases in general
and depression in particular?
• How can we develop diagnosis criteria without gender bias?
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Health Inequalities V: Verhältnisse für Gesundheit 11./12. Juni Bielefeld
Sociology with the Specialty Gender and Life Course Research
Sociology with the
Specialty Gender and
Life Course Research
Lena Hünefeld, M.A.
Phone +49 241 80 93977
E-Mail [email protected]

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