Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales ( ). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women ( ) and financial stresses by men ( ) though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration ( ). Men had more impairment in social and occupational functioning compared to females ( ). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis. 1. Introduction Major depressive disorder (MDD) is a common and treatable psychiatric disorder with high morbidity and mortality. Complex interplay between mind, body, society, and culture has been implicated in the incompletely understood pathophysiology of depression [1]. Antecedent stresses and resulting disabilities interact with each other to worsen the depression, which in itself becomes additional stress. Patients’ reports of stresses and adjustment problems frequently do not get due importance in understanding and managing depression, which may explain partial or delayed treatment response and frequent relapses. Very few differences in the course of depression have been detected across gender. Factors like time taken for recovery, time for first occurrence, and number and severity of recurrences did not differ [2]. Background social contexts and support systems are important for understanding the contributing determinants of disease and for planning of treatment [3]. Depression has been identified as significant cause of morbidity and mortality [4]. Ferreira et al. (2013) [5] showed how rural India may be topping the list for depression and disability following
References
[1]
L. Eisenberg, “Psychiatry and society. A sociobiologic synthesis,” The New England Journal of Medicine, vol. 296, no. 16, pp. 903–910, 1977.
[2]
H. B. Simpson, J. C. Nee, and J. Endicott, “First-episode major depression: few sex differences in course,” Archives of General Psychiatry, vol. 54, no. 7, pp. 633–639, 1997.
[3]
G. L. Engel, “The need for a new medical model: a challenge for biomedicine,” Science, vol. 196, no. 4286, pp. 129–136, 1977.
[4]
P. Y. Collins, V. Patel, S. S. Joesti, D. March, T. R. Insel, and A. S. Daar, “Grand challenges in global mental health: a consortium of researchers, advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment,” Nature, vol. 475, no. 7354, pp. 27–30.
[5]
L. Ferreira , R. Ferreira Santos-Galduróz , C. P. Ferri, and J. C. Fernandes Galduróz, “Rate of cognitive decline in relation to sex after 60 years-of-age: a systematic review,” Geriatrics & Gerontology International, 2013.
[6]
E. Bromet, L. H. Andrade, I. Hwang et al., “Cross-national epidemiology of DSM-IV major depressive episode,” BMC Medicine, vol. 9, article 90, 2011.
[7]
S. Seedat, K. M. Scott, M. C. Angermeyer et al., “Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys,” Archives of General Psychiatry, vol. 66, no. 7, pp. 785–795, 2009.
[8]
K. G. Manton, “The global impact of noncommunicable diseases: estimates and projections,” World Health Statistics Quarterly, vol. 41, no. 3-4, pp. 255–266, 1988.
[9]
B. Maire, S. Lioret, A. Gartner, and F. Delpeuch, “Nutritional transition and non-communicable diet-related chronic diseases in developing countries,” Sante, vol. 12, no. 1, pp. 45–55, 2002.
[10]
D. Vlahov, S. Galea, E. Gibble, and N. Freudenberg, “Perspectives on urban conditions and population health,” Cadernos de Saúde Pública, vol. 21, no. 3, pp. 949–957, 2005.
[11]
C. Bottomley, I. Nazareth, F. Torres-González et al., “Comparison of risk factors for the onset and maintenance of depression,” The British Journal of Psychiatry, vol. 196, no. 1, pp. 13–17, 2010.
[12]
S. S. Deshpande, P. Patil, B. Kalmegh, and M. R. Ghate, “Untreated major depressive disorder with and without atypical features: a clinical comparative study,” Asian Journal of Psychiatry, no. 6, pp. 338–343, 2013.
[13]
M. B. First, M. Gibbon, R. L. Spitze, and J. B. W. Williams:, User’s Guide for the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Research Version-(SCID-I for DSM IV TR, November 2002 Revision), Biometrics Research, New York, NY, USA, 2002.
[14]
M. Hamilton, “A rating scale for depression,” Journal of Neurology, Neurosurgery, and Psychiatry, vol. 23, pp. 56–62, 1960.
[15]
E. S. Paykel, J. K. Myers, J. J. Lindenthal, and J. Tanner, “Suicidal feelings in the general population: a prevalence study,” British Journal of Psychiatry, vol. 124, no. 5, pp. 460–469, 1974.
[16]
American Psychiatric Association publication, “Mood disorders,” in Quick Reference to the Diagnostic Criteria From DSM-IV TR, 2000, pp. 203–204, Jaypee Brothers, 1st edition, 2005.
[17]
R. Gaikwad, S. Deshpande, S. Raje, D. V. Dhamdhere, and M. R. Ghate, “Evaluation of functional impairment in psoriasis,” Indian Journal of Dermatology, Venereology and Leprology, vol. 72, no. 1, pp. 37–40, 2006.
[18]
M. J. Hilsenroth, S. J. Ackerman, M. D. Blagys, et al., “Reliability and validity of DSM-IV axis V,” The American Journal of Psychiatry, vol. 157, pp. 1858–1863, 2000.
[19]
L. Vijaykumar, “Indian research on suicide,” Indian Journal of Psychiatry, vol. 52, pp. S291–S296, 2010.
[20]
A. Venkoba Rao, N. Mahendran, C. Gopalakrishnan et al., “One hundred female burn cases: a study in suicidology,” Indian Journal of Psychiatry, vol. 31, no. 1, pp. 43–50, 1989.
[21]
S. Jena and T. Siddhartha, “Non-fatal suicidal behavior in adolescents,” Indian Journal of Psychiatry, vol. 46, pp. 310–318, 2004.
[22]
C. T. Sudhir Kumar, R. Mohan, G. Ranjith, and R. Chandrasekaran, “Gender differences in medically serious suicide attempts: a study from South India,” Psychiatry Research, vol. 144, no. 1, pp. 79–86, 2006.
[23]
C. Zlotnick, M. T. Shea, P. A. Pilkonis, I. Elkin, and C. Ryan, “Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up,” American Journal of Psychiatry, vol. 153, no. 8, pp. 1021–1027, 1996.
[24]
P.-C. Wu, “Measurement invariance and latent mean differences of the beck depression inventory ii across gender groups,” Journal of Psychoeducational Assessment, vol. 28, no. 6, pp. 551–563, 2010.
[25]
S. Nolen-Hoeksema, “Gender differences in depression,” Current Directions in Psychological Science, vol. 10, no. 5, pp. 173–176, 2001.
[26]
A. Feijo Mello, L. S. Blay, and R. Kohn, “Global assessment of relational functioning scale (GARF): a validity study in patients with recurrent major depression in Brazil,” Transcultural Psychiatry, vol. 44, no. 1, pp. 55–64, 2007.
[27]
T. J. Shors, C. Chua, and J. Falduto, “Sex differences and opposite effects of stress on dendritic spine density in the male versus female hippocampus,” Journal of Neuroscience, vol. 21, no. 16, pp. 6292–6297, 2001.
[28]
V. Paralikar, M. Agashe, S. Sarmukaddam, S. Deshpande, V. Goyal, and M. G. Weiss, “Cultural epidemiology of neurasthenia spectrum disorders in four general hospital outpatient clinics of urban Pune, India,” Transcultural Psychiatry, vol. 48, no. 3, pp. 257–283, 2011.
[29]
T. A. Furukawa, H. Azuma, H. Takeuchi, T. Kitamura, and K. Takahashi, “10-year course of social adjustment in major depression,” International Journal of Social Psychiatry, vol. 57, no. 5, pp. 501–508, 2011.
[30]
N. M. Rice, M. A. Grealy, A. Javaid, and R. Millan Serrano, “Understanding the social interaction difficulties of women with unipolar depression,” Qualitative Health Research, vol. 21, no. 10, pp. 1388–1399, 2011.
[31]
M. Fava, “Introduction: optimizing treatment outcome in depression,” The Journal of Clinical Psychiatry, vol. 61, supplement 2, p. 4, 2000.
[32]
J. Guidi, G. A. Fava, M. Fava, and G. I. Papakostas, “Efficacy of the sequential integration of psychotherapy and pharmacotherapy in major depressive disorder: a preliminary meta-analysis,” Psychological Medicine, vol. 41, no. 2, pp. 321–331, 2011.
[33]
L. Gottlieb, H. Waitzkin, and J. Miranda, “Depressive symptoms and their social contexts: a qualitative systematic literature review of contextual interventions,” International Journal of Social Psychiatry, vol. 57, no. 4, pp. 402–417, 2011.
[34]
J. Leff, S. Vearnals, C. R. Brewin et al., “The London depression intervention trial. Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: clinical outcome and costs,” British Journal of Psychiatry, vol. 177, pp. 95–100, 2000.
