Why depression is more common in women? – and, how do we break the cycle
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Depression is a silent disorder that is widely swept under the carpet. The reluctance to talk about the condition means that the struggle often goes unnoticed. Mental issues are not confined to a selected few, it can happen to the best of us at any stages in life. But studies have shown that women tend to be more prone to suffer from depression than men. We talk to Mayture Yap, a clinical psychologist from InPsych Psychological & Counselling Services on why this is so and the steps we can take to get out of this gloomy state.
1) Hi Mayture. Women are reportedly to be more prone to depression than men. Can you explain why this is?
Yes, women are found to be twice at risk of developing depression than men. These risk factors are commonly found to begin during adolescence years when puberty hits. Puberty involves hormonal and physical changes, which are often negatively evaluated by girls due to their growing body fats, which resulted in poor body image. On the other hand, boys are likely to appreciate the increase of their body muscles.
Other hormonal issues that are associated with depression that affect women are such as pre-menstruation syndrome, pre/postpartum, and menopause. There are also psychosocial factors to consider such as social pressure that expects women to bear childcare duties in addition to working. They also have higher risks of becoming victim to sexual and domestic violence, which may cause them to feel depressed. Researches have also found that women tend to be more in tune with their emotion, which leads them to seek help and verbalise their problems. On the other hand, depression in men usually goes unidentified.
2) How does depression affect men and women then?
Well, there could be differences in how depression is manifested between men and women. Men tend to externalise their symptoms such as through anger outburst, risk-taking behaviour, substance abuse and constantly finding distractions. On the other hand, women tend to internalise their emotion, leading them to ruminate more often and express sense of helplessness.
3) Depression often feels like we're stuck in an unhealthy thought pattern. Can you share some tips on how to break this cycle?
– Be aware of your thoughts, not just your emotion. People with depression tend to have a mental framework (schema) that reflects negatively about themselves. This will cause them to be bias with information that does not confirm their existing view of themselves, hence discounting any positive encounter with or feedback from others.
– Do not get trap in the 'all-or-nothing thinking', believing that everything has to be a perfect 100 or 0, be it your achievements, social acceptance or appreciation. Instead, see the in-between of things. Measure success or failure within a scale, whether is 20 percent, 50 percent or 80 percent. Not every negative encounter means a 100 percent failure.
– Stop the comparison. Although social comparison does have its usefulness in driving us to do better, it is almost always fuelled by our own sense of insecurity and could be discouraging. Instead of setting other's achievement as our benchmark, we can compare ourselves by thinking about where we are today and where we were in the past.
– Entertain the positive 'what-ifs'. Depression will often caused us to readily assume the worst to happen and take a negative outlook. Whenever you think about "what if I can't", stop and imagine "what if I can".
– Reward even the smallest achievements. Do acknowledge and give credit to every of your achievements, whether it is about doing 5 minutes of physical exercise or completing a task in your to-do list. These recognitions reinforce positive sense of self, which in turn encourages productivity.
– Don't be afraid of change. A depressed individual may reinforce their maladaptive way of coping due to the sense of familiarity and safety. To break away, we need to recognise that change is necessary and it brings new opportunity. Start by changing your interpretation of things. Reframe problems as challenges, mistakes as opportunity to learn.
– Focus on what you have instead of what's missing/lost. Depression will cause us to focus on our past guilt and regrets associated with certain lost. It is important to remind ourselves of what we have and could potentially gain in the present instead of what is missing.
READ MORE: How to support a friend who is depressed
4) The term 'smiling depression' seems to be on the rise this year. Can a supposedly happy person actually be depressed?
Yes. Very likely. Usually people who are depressed find it difficult to express their feelings (or seek help for that matter) due to their fear of being judged or perceived negatively by others including themselves. They might not even acknowledge their own depressed feelings, as a way to cope with the unwanted emotion. They may also carry a strong sense of responsibility to meet others' expectation, believing that they need to please others or not to worry them. Hence, they will put on a cheerful external façade to hide away these internal vulnerabilities, which often goes undetected until it becomes too late. We have witnessed this condition through suicide cases by high profile individuals who were perceived as 'normal' or 'not depressed' when they were alive.
5) As a mental health practitioner, what signs do you look out for in a depressed individual? What behaviour raises the alarm?
Common signs that usually raise the alarm is when an individual begin to withdraw socially and shows little to no interest in people, things or activities that they used to enjoy. There could also be a drop in their activity level and productivity as they find it difficult to get off the bed to start their day. They may also consistently exhibit sad expression and is sensitive to negative news or events (or overly happy which contradicts how they feel). Other more serious symptoms involve signs of self-harm (e.g. cutting or starving). They may also actively express thoughts of dying although some may be less obvious, such as wishing they did not wake up in the morning. Other signs may involve neglecting their own wellbeing (e.g. hygiene, sleep quality, hunger), as well as the engagement in impulsive and destructive behaviour such as substance abuse, reckless driving, or binging.
6) What drives a person to consider suicide?
Individuals with suicidal ideation whom I have encountered consistently expressed a lost of sense of purpose in life, believing that they do not have any meaning to live for. They also tend to feel disconnected from the world and others around them, feeling rejected or unimportant. There are also those who think that they have exhausted all of their coping mechanism, believing that there is no other way to deal with that one particular or many stressors in their life. These individuals often went through stressful life events such as grief, trauma, lost of a relationship or physical function. However, not everyone who experience stressful events will consider suicide, as genetic factors may also be responsible for causing someone to be more susceptible to depression.
7) If we suspect our friend is depressed and suicidal, what is the right way to help? Any positive or negative words/phrases to avoid?
- DO listen & empathise with their struggles. DON'T minimise their pain and assume you know how it feels. Say "It must be difficult to be dealing with this right now" instead of "I know exactly how you feel" or "Don't worry, I was in a worst situation".
- DO check-in regularly without being intrusive. DON'T keep your distance, thinking that you might 'trigger' them.
- DO ask what they need to cope. DON'T tell them what you think they need and expect them to follow.
- DO talk about suicide openly. DON'T avoid the topic or brush it off when the depressed person brings it up. In fact, check with them to encourage them to talk about it.
- DO point out his/her strengths and resources. DON'T judge or blame them for their weaknesses.
- DO encourage them to seek help or share their problems. DON'T expect them to suppress it or 'man up'.
8) What is the prevalence of depression and suicide in Malaysia currently? What resources are available for sufferers and caregivers?
The rate of depression in Malaysia is found to be on a rise at present. According to the Malaysian Psychiatric Association (MPA), the 2017 National Health and Morbidity Survey found that there are 29% of Malaysians had depression and anxiety disorder, compared with 12% in 2011.
The treatment of depression involves psychiatric and psychological intervention. Many may also find healing through spiritual guidance such as faith-based intervention. There is currently an increase in mental health services within the private and non-government sectors. These centres offer face-to-face psychotherapy/counselling, phone counselling as well as therapy through phone application (e.g. Teleme). While the details of these centres can be readily found online, it is important to check the credentials and qualification of the mental health professionals who are providing the services prior to engaging them. For suicidal individuals, hotline services such as Befrienders may help.
Mayture Yap is a practising clinical psychologist focusing on positive humanistic, cognitive, emotional and behavioural development for both teenagers and adults. Click here for more information on InPsych Psychological & Counselling Services.