A feminist analysis of the theories of etiology of depression in women.

Women in the United States are more likely to be hospitalized for depression than be diagnosed with breast cancer during their lifetime, despite the continued underrecognition and underdiagnosis of depression. According to the DSM-IV, unipolar depression is a severe mood disorder characterized by a loss of pleasure in most activities, along with one or a combination of associated symptoms. Women between the ages of 20 and 45 are most prone to depression, with the incidence declining as they age. The likelihood of a correct diagnosis and the method of treatment of depression, as is true for other conditions and illnesses, is very much dependent upon the belief in its etiology; therefore, the theories of etiology warrant our serious consideration. Depression in women is explained in the literature most recently by biochemical explanations, though Freud's classic "female masochism" theory is still accepted in updated forms. Conflicting social roles and expectations, continued violence against women and children, and extreme disparities in socioeconomic opportunities and conditions between men and women are also cited as reasons for women's very high rates of depression in the U.S. Primary prevention through assessment for the predictors of depression offers the best hope for the promotion of mental health in women. During the course of routine health care interactions, nurses in primary care settings are potentially in the best position to assess each woman encountered for depression risk factors or symptoms. A few important questions asked by the nurse in the course of taking a brief health history or vital signs--such as where and with whom the woman lives; where she works (inside and/or outside the home) and if she finds the work fulfilling; how she supports herself financially; when, how much, and how well she sleeps; and what kinds of emotional support networks she has--may reveal enough to warrant a more detailed and specific assessment or a referral for treatment. Psychoeducation, often administered by psychiatric RNs, includes consciousness raising and self-help groups, women's studies courses, and the establishment of support networks. These, as well as various forms of feminist-based interpersonal psychotherapy, are oft-cited approaches to aiding at-risk women clients. Given the willingness of many women clients to discuss their mental health status with a caring and interested nurse, perhaps the most positive intervention nurses can make is to listen, be supportive, and take seriously the pressures on women to be at once everything to everyone and no one at all.