In this article, we summarize research indicating that women experience depression more frequently than men, and that this difference emerges during the adolescent years. There are several reasons girls may be at higher risk for depression than boys, but researchers still do not fully understand this. We are currently testing whether we can prevent depression in adolescents using a Cognitive Behavior Therapy (CBT) prevention program. We are testing this among girls and boys but hope to examine whether girls respond differently to the intervention. In future research, we hope to tailor interventions that can target female-specific vulnerabilities.
The lifetime prevalence rate of Major Depressive Disorder (MDD) is 1.7 to 2.7 times greater in women than in men (Weissman et al., 1993), with 21.3% of women between the ages of 15 and 54 years old having experienced a depressive episode at some point in their lives, compared to 12.7% of men (Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993). Depression in adolescents is more common than was once believed. It is estimated that the one-year prevalence rate of depression in adolescents is between 1.6% and 8.9% (Angold & Costello, 2001). In fact, half of all individuals who have a mental illness during their lifetime report that the onset occurred by age 14, and three quarters report onset by age 24 (Keuhn, 2005). Mid to late adolescence is the most commonly reported age of first onset for depression or significant symptoms (e.g., Burke, Burke, Regier, & Rae, 1990), which has also been demonstrated across diverse cultures (Cross-National Collaborative Group, 1992).
Adolescents are vulnerable to depression for many reasons. Depressed youth expect rejection from peers and lack problem solving skills, instead mulling over their problems without coming to helpful solutions. Adolescents expect that trying to solve problems will be unsuccessful, so they might avoid the problem, or they approach the problem impulsively. In addition, perfectionistic standards and a negative attributional style (blaming oneself for losses or failures) tend to decrease an adolescent’s sense of self-esteem (Reinecke & Jacobs, 2008).
Before adolescence, girls and boys experience depression at about the same rate (Bebbington et al., 2003). However, by early adolescence (about age 13), rates of depression in girls increases sharply while boys’ rates remain low, and may even decrease. By late adolescence, girls are twice as likely as boys to be depressed (Nolen-Hoeksema, 2001), and there are multiple reasons for this that range from the biological and hormonal changes that occur during puberty, to the cognitive vulnerabilities typically experienced by girls that perpetuate depressive thoughts and feelings (Hankin & Abramson, 2001). For example, one consistent difference has been found in the self-concepts of males and females, more specifically their interpersonal orientations. Defined as the tendency to be concerned with the status of one’s relationships and the opinions others hold of oneself, as early as childhood, girls appear more interpersonally oriented than boys, and this gender difference increases in adolescence (Zahn-Waxler, 2000). When interpersonal orientation leads girls to value their own needs below those of others, they can become excessively dependent, and need a higher degree of approval and success to feel secure than boys (Cyranowski, Frank, Young, & Shear, 2000; Calvete & Cardenoso, 2005).Girls also tend to doubt themselves, doubt their problem-solving abilities and view their problems as unsolvable more so than boys (Calvete & Cardenoso, 2005). Furthermore, by adolescence, girls appear to be more likely than boys to respond to stress and distress with rumination—focusing inward on feelings of distress and personal concerns rather than taking action to relieve their distress (Nolen-Hoeksema, 2001).
Finally, girls are more likely to undergo more hardships and stressful life events, such as poverty, poor education, and traumas (Cyranowski, Frank, Young, & Shear, 2000). Traumas may contribute directly to depression, by making women feel they are helpless to control their lives, and may also contribute indirectly, by increasing their reactivity to stress (Nolen-Hoeksema, 2001). Furthermore, sexual assault during childhood has been more consistently linked with the gender difference in depression than sexual assault that first occurs during adulthood, and rates of childhood sexual assault are significantly higher for girls (between 7 and 19%) than they are for boys (between 3 and 7%) (Cutler & Nolen-Hoeksema, 1991).
While researchers do not yet understand why girls experience depression more than boys, it has been found that young people with an untreated mental illness may suffer debilitating symptoms during their most productive years, including problems with educational attainment and career and family building (Kessler, Avenevoli, & Merikangas, 2001). Despite these detrimental consequences, depressed adolescents are a largely underserved population that faces multiple barriers to receiving treatment (Mufson, Dorta, Olfson, Weissman, & Hoagwood, 2004; Flaherty, Weist, & Warner, 1996).
We are currently conducting a study to evaluate the effectiveness of a preventive Cognitive Behavior Therapy (PCBT) program among teenage girls and boys who may be vulnerable to depression (due to the fact that a parent has experienced depression) at Columbia University/New York State Psychiatric Institute. CBT is a psychological therapy that has been found to be helpful in treating depressed children and adolescents. CBT is designed to address unhelpful thinking patterns and ways of behaving that contribute to depression. If you are interested in participating in the study (HAPPY Study: Helping Adolescents stay Positive and Prevent depression in their Youth), we are looking for adolescents ages 12 to 18 who have a parent who has experienced depression. We are comparing PCBT to study skills training. Adolescents will have a free depression screening, participate in a MRI scan, and will be randomized to participate in either 12 weeks of PCBT or 12 weeks of study skills.
In sum, we are currently studying how to prevent depression in adolescence as well as how to prevent depression from continuing across generations in families. This research is particularly important for adolescent girls given what we know about depression. For more information about the study, or if your family is interested in participating, please contact the HAPPY study: Dr. Rachel Jacobs and Dr. Karen Shoum at 212-543-5187 or jacobsr@childpsych.columbia.edu and shoumk@childpsych.columbia.edu.
References
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