Symptoms of Major Depression in Women Apply Across Cultures

Posted on December 9th, 2015

New findings from a multinational research team indicate that the core symptoms of major depression found in American women are highly similar to the core symptoms found in Chinese women.

American women have a much higher level of lifetime exposure to major depression than men. The standard criteria for diagnosing the disorder in the U.S. come from an organization called the American Psychiatric Association (APA). In a study published in March 2015 in the journal Psychological Medicine, researchers from the U.S., the United Kingdom and the Netherlands compared the accuracy of the APA major depression diagnosis in American women to the accuracy of the same standard of diagnosis for women in China, as well as women in Europe.

Defining Major Depression

Major depression (known formally as major depressive disorder) is acknowledged among mental health professionals as the most severe example of a group of conditions known in the U.S. as depressive disorders. People affected by this condition experience serious, potentially debilitating changes in mood characterized by feelings such as hopelessness, sadness and/or emptiness. As a rule, these damaging mood changes occur in bouts or episodes of varying length. At a minimum, an individual with major depression must have one episode of severe mood alteration lasting at least two weeks in order to qualify for a major depression diagnosis. Some people experience only a single episode, while others experience recurring episodes over time.

According to the criteria established by the American Psychiatric Association, a bout of major depression is defined by the simultaneous or overlapping presence of at least five out of a possible nine total symptoms. In addition to dysfunctional changes in baseline daily mood, these symptoms include altered sleeping patterns, unexplained changes in body weight, fatigue, a decreased ability to feel pleasure, reduced mental clarity and suicidal thinking, suicidal planning and/or active suicidal behavior. All affected individuals must experience a clear drop in their day-to-day ability to function. The APA made some changes to the criteria for diagnosing major depression in 2013; however, the core components of the diagnosis remain intact.

Major Depression in Women

In America, the average woman receives a major depression diagnosis far more often than the average man (roughly 17 women for every 10 men). There are biological and non-biological explanations for this gender disparity. On the biological front, women have increased depression risks associated with altered sex hormone levels during menstruation, pregnancy, the postpartum period following pregnancy and menopause. Non-biological influences on women’s depression susceptibility include heightened stress levels attributable to dual responsibilities at work and at home, as well as women’s relative lack of socioeconomic standing in comparison to men. In addition, doctors tend to diagnose major depression more often in women than in men who have essentially the same indicators of illness.

Women’s Depression in Different Cultures

In the study published in Psychological Medicine, researchers from Virginia Commonwealth University, the United Kingdom’s Wellcome Trust Centre for Human Genetics and King’s College London and the Netherlands’ VU University compared the accuracy of the American Psychiatric Association definition of major depression for American women, European women and Chinese women of Han descent. (Fully 90 percent of all people living in China share this racial/ethnic background; Han Chinese make up an even larger percentage of the population of Taiwan.) Data for American and European women came from four separate studies conducted on American and European population groups. Data for Han Chinese women came from detailed interviews conducted during a project known as CONVERGE. All of the women from each part of the globe had a history of recurring depression symptoms. Because of the start date of their study, the American, British and Dutch researchers used the APA’s pre-2013 definition of major depression.

After completing their comparisons, the researchers concluded that the nine core diagnosable symptoms of major depression recognized by the American Psychiatric Association are “very similar” among American women, Chinese women and European women. They also reached the same conclusion when they looked at the additional criteria the APA uses to define the disorder.

The study’s authors believe their findings indicate that the American Psychiatric Association’s definition of major depression is largely immune to any problems associated with the cultural background, language or racial/ethnic ancestry of the population of women under consideration. They also believe their findings underscore the usefulness of cross-cultural comparisons of depressive illness.

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