Page 154 - Encyclopedia of Nursing Research

DEPRESSion in WoMEn n 121

and entrapment. note that a primary ques- self-care and social engagement (Lafrance &
tion underlying all of these studies is how Stoppard, 2007; Stoppard, 1998; Ussher, 2010).
DD in women is different from DD in men. Randomized controlled trials that estab- D
in contrast, feminist and other postmod- lish the evidence base for treatment largely
ern scholars assert that the search for gen- neglect the role of gender in treatment design,
der differences inspired by the biomedical response, or outcome. The national institute
model of DD disavows and decontextualizes of Mental health Treatment of Depression
women’s experience of DD and the sociocul- Collaborative Research program, for example,
tural circumstances in which it is embed- examined treatment differences in outcome
ded (Lafrance, 2007; Marecek, 2006; Metzl & among those treated with medication and
Angel, 2004; Stoppard, 1998). Social construc- different types of psychotherapy; none of the
tionists and critical social theorists (Burr, treatments tested were specifically modified
2003; Fleming & Moloney, 1996; o’Grady, to address factors that may contribute to DD
2005), for example, contend that women’s in women (Elkin et al., 1989). Still, follow-up
identity is centered in and shaped through studies showed that were no gender-related
their relationships with others, and these differences in outcomes from treatment, even
relationships are constrained by social and when several gender-related factors were
cultural norms about women that are rein- examined (Zlotnick, Shea, Pilkonis, Elkin,
forced by moral judgments made by the self & Ryan, 1996). Similarly, the Treatment for
and by others (Gilligan, 1982; Ridgeway & Adolescents with Depression Study tested
Smith-Lovin, 1999; West & Zimmerman, medication and cognitive-behavioral ther-
1987). Women’s choices in those relationships apy without regard to gender (Domino et al.,
are further compromised by gendered work- 2009). no published accounts of the effects
place and social institutions that contribute of gender in this study were noted. Gender-
to economic deprivation and other resource sensitive treatments also were not used in
limitations (Belle & Doucet, 2003; Chen, several randomized trials conducted in pri-
Subramanian, Cevedo-Garcia, & Kawachi, mary care settings examining collaborative
2005; Gray, 2005). numerous studies on the care for DD; gender differences in outcomes,
basis of women’s accounts of DD validate a when reported, were not found (Bush et al.,
gendered view of depression showing that 2004). The Sequenced Treatment Alternatives
identity loss, gender-based interpersonal to Relieve Depression study is the most recent
demands including caregiving, and moral of the randomized controlled trials to estab-
judgments about the proper role of women lish evidence-based treatment for DD, again
all contribute to the profound sadness and using treatments unmodified for gender con-
despair women experience, characterized as cerns or based on women-centered theoret-
depression in biomedical models (Beck, 1993; ical approaches (Fava et al., 2003). Although
hurst, 2003; Jack, 1991; Lewis, 1987; McMullen, specific gender differences in the anteced-
2003; Scattolon & Stoppard, 1999; Schreiber, ents and course of MDD were evident in the
2001). Such woman-centered perspectives on Sequenced Treatment Alternatives to Relieve
DD have been extended to include embodi- Depression study participants, the investiga-
ment as an important concept in under- tors do not discuss the need for interventions
standing women’s experiences of depression that target women’s concerns (Marcus et al.,
(Fuchs & Schlimme, 2009). Such a “material- 2005). it is important to note that although
ist-discursive perspective” of DD is a begin- no gender differences in outcome are noted
ning attempt to explain how the physical and among the evidence-based treatments used
emotional demands associated with fulfilling in these major treatment studies, the primary
gender expectations leaves women with so outcome of number and severity of depres-
few resources that they become incapable of sive symptoms used in these studies may be