Page 153 - Encyclopedia of Nursing Research

120 n DEPRESSion in WoMEn

(hendrick, Altshuler, Gitlin, Delrahim, & in the etiology of DD (Abramson & Alloy,
hammen, 2000). MDD is defined as the pres- 2006; Bromberger et al., 2010; Brummelte &
D ence of five or more symptoms (weight sleep, Galea, 2010; hammen, 2003; noble, 2005;
motoric, and cognitive changes) co-occurring Stone, Gibb, & Coles, 2010).
nearly every day over a 2-week period Similarly, the preponderance of gender-
(American Psychiatric Association, 2000). At specific theories of MDD and DYS are derived
least one of the symptoms experienced must from the biomedical model and focus on the
include depressed mood or a loss of inter- type and amount of stressors women expe-
est or pleasure in usually enjoyed activities. rience and factors that mediate and moder-
DYS is diagnosed when depressed mood is ate stress perception. Several investigators
present nearly all of the time for two or more have determined, for example, that women
years and other depressive symptoms are also have higher rates of interpersonal distress
present (American Psychiatric Association, than do men, and these stressors contribute
2000). Rates of DD in women ranges from to their risk for depression (Brown, 2002;
7% to 15%, 1.5 to 2 times higher than rates hammen, 2003; hammen, Brennan, & Shih,
obtained for men in developed countries 2004; Kendler, Thornton, & Prescott, 2001;
(Seedat et al., 2009; Van de Velde, Bracke, & Sanathara, Gardner, Prescott, & Kendler,
Levecque, 2010; Wang et al., 2010; Williams 2003; Zlotnick, Kohn, Keitner, & la Grotta,
et al., 2010); in low- and middle-income coun- 2000). The most specific of these models is
tries, rates of DD are considerably higher based on two decades of empirical work by
(World health organization, 2008). Brown (2002) and Kendler, hettema, Butera,
Although gender disparities in DD Gardner, and Prescott (2003), which shows
have long been recognized, the role gender that when stressors are central to a woman’s
plays in its development and maintenance identity and contain elements of entrapment,
is still evolving and remains hotly contested humiliation, or loss, DD is likely to follow in
(hammarstrom, Lehti, Danielsson, Bengs, & the subsequent year. Cognitive vulnerability
Johansson, 2009; Piccinelli & Wilkinson, 2000; models that propose alterations in stress per-
Ussher, 2010; Wittchen, 2010; World health ception also have been proposed to account
organization, 2009). The most dominant for gender disparities in DD (Brown, 2002;
framework for understanding DD is the bio- hyde, Mezulis, & Abramson, 2008; Kendler,
medical model (hammarstrom et al., 2009), Gardner, & Prescott, 2002; nolenhoeksema,
organized around the concepts of allostasis 1994; Stone et al., 2010). Perceived hopeless-
and hypothalamic–pituitary–adrenal dysreg- ness, neuroticism, brooding rumination, and
ulation in individuals (Brummelte & Galea, negative self-evaluations are cognitive vul-
2010; Mcewen, 2003; Sterner & Kalynchuk, nerabilities that have been shown to contrib-
2010). in broad strokes, it contends that DD ute to risk for DD in women (Abramson &
is attributable to uncontrolled stressors, the Alloy, 2006; Brown, 2002; Crane, Barnhofer, &
perception of stressors as threats, and conse- Williams, 2007; hyde et al., 2008; Kendler
quent excessive physiological response. The et al., 2002; nolen-hoeksema, 1994; Treynor,
resulting wear and tear on stress regulatory Gonzalez, & nolen-hoeksema, 2003). Social
organs in the central nervous system and support also has been shown to be a key
periphery eventually leads to neurotrans- variable in moderating the effects of stress-
mitter disarray, hypothalamic–pituitary– ful events (Agrawal, Jacobson, Prescott, &
adrenal dysregulation, and subsequently Kendler, 2002; Brown, 2002; Kendler, Myers,
depressive symptoms. For women, uncon- & Prescott, 2005). Brown (2002), for example,
trolled and/or excessive stressors, cognitive has shown that having a confident or other
schemas that alter stress perception, and key relationship reduces the likelihood of a
gonadal hormones all have been implicated depressive outcome following humiliation