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Depression and women
December 11, 2000
11:05 am
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Cici
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Taking the Long View of Depression
Fifty-year Study Reveals Rise in the Illness Among Younger Women

You would not find Stirling County on a map of Atlantic Canada, but it is a real place. It was given this protective pseudonym by Alexander Leighton, HSPH professor emeritus of social psychiatry, back in 1948 when he first picked the location for an unprecedented longitudinal study of mental illness. Since the first interviewers took the field in 1952, Stirling County has mirrored nearly all the social changes that have transformed daily life in metropolitan centers across North America. Stirling County has become more suburban and less rural, the local economy less industrial and, for that matter, less local. It has seen living standards rise, educational opportunities widen, and health care delivery expand. It has also seen more crime, more drug abuse, more media saturation, frailer families, and weaker religious values. What Stirling County has not seen is a general increase of depression.

The longitudinal study on mental illness begun by Jane Murphy and Alexander Leighton 50 years ago is showing some surprising results today. Photo by Liza Green, HMS Media Services

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The rate of depression in the general population remained virtually constant at about 5 percent from 1952 to 1992, according to a flurry of new papers from the Stirling County Study published in recent months by Jane Murphy, HMS professor of psychiatry at Massachusetts General Hospital; Nan Laird, HSPH professor of biostatistics; Richard Monson, HSPH professor of epidemiology; Art Sobol, HSPH programmer analyst; and Leighton. As reported in the March Archives of General Psychiatry and the May Psychological Medicine, what changed over 40 years is the demographics of depression. Compared to 1952, younger women are now at twice the risk for the disorder.
These new results from the study, based on the third harvest of data ending in 1996, fly in the face of other epidemiological studies of community mental health that reported significant increases based on one-time surveys asking subjects to recall their lifetime experiences with depression. The Stirling County Study findings also contradict the conventional wisdom that modern life is so overwhelming that we live in an age of depression, according to Murphy, who has been the project director since 1975. "What we're able to report is that the overall prevalence rate is steady at 5 percent, but the way it's distributed in the population is different between 1970 and 1992, and it's largely influenced by this twofold increase among women under 45."

Murphy continued, "Now when I'm asked how our findings fit with what other people are talking about in terms of an increase in depression, well, it's difficult to explain, but it both refutes and corroborates. They refute it in terms of saying it doesn't look as if there's an overall increase. But the increase among young women under 45 fits very well with the other studies because they have suggested that something began to happen among people born after World War II." The overall rate remained constant because the sharp increase in depression among younger women was offset by smaller reductions in the rates among younger men, older men, and older women.

Banking Data
Longitudinal studies create large cohorts of subjects who can be followed over time and re-interviewed. Thus the original Stirling County sample of 1952 was tracked down as a cohort at the time a new sample was identified in 1970. Both of these cohorts were re-interviewed as a third sample was added in 1992.
The result is a richly detailed data trove that can be re-analyzed in new ways to get at novel questions. This round of papers, Murphy explained, scrutinized the depression rate in two separate ways—by prevalence and by incidence. The prevalence study was based on the three samples, but the incidence study was based on following up the first two samples.

Tracking down these older cohorts is time-consuming. But for an incidence study, the focus is on people who are well at the beginning of the period of interest. "Incidence is theoretically a more important rate, but there are fewer opportunities to calculate it because it takes all this tracking over time," Murphy said.

The annual incidence rate for depression (new cases) was about four per 1,000 for both cohorts, which is quite consistent with the overall prevalence rate of roughly 5 percent, given that many depressions are chronic, said Murphy. There was, however, a contrast between the incidence and prevalence trends. There was no change over time in the distribution of incidence by age and gender as there was for prevalence. The incidence study was based solely on the two earlier cohorts in which none of the women in 1952 and only a few in 1970 were born after 1945. "This difference seems to highlight an important feature of our findings," Murphy said. "Only the younger women in the new sample of 1992 had been born so recently, and they are the ones whose rate markedly increased.

"This suggests that a portion of the prevalence rate is under social influences," said Murphy. "We have tried to emphasize that depression is a very complex disorder. There's no doubt from evidence other than in our study that there is a genetic component, but it's by no means a genetic disorder. Depression has never shown anything like a genetic heavy loading. So some portion of it would relate to experience, and with this suggestion that women born after the Second World War are at increased risk, it makes you think that maybe the proportion of depressions that are socially related is on the rise."

Depression's Effect
Depression is a debilitating, persistent, and deadly disease. It is especially dangerous for men, said Murphy, and the Stirling County data bear that out. Excluding alcohol abusers, the men identified as depressed in 1952 had twice the expected mortality rate over the next 16 years. By 1970, 83 percent of them were either dead or had been chronically or recurrently depressed with persistent impairment. Depressed women fared better, perhaps because they were twice as likely as men to seek help.
"Our next task is to look at everything we have that might provide some clues about why younger women still in their childbearing years would have this high rate. We have economic information we can look at, marital history, childbearing history. We have information that goes right back to the first 1952 study on attitudes—whether a woman should work outside the home, for example. The most immediate thing that's different from 1952 to 1970 to 1992 is the number of women who are contributing to the household income by regular well-recognized work. You would think that would be a blessing in some regards, but it may be a disadvantage in others. Whether we're going to be able to tease any of that out, I don't know, but we're extremely anxious to see what the results will be."

In his commentary on Stirling County, Psychological Medicine editor E.S. Paykel hailed the study as "one of the classics of epidemiology." He also noted that "these studies are very difficult to carry out, requiring remarkable persistence and devotion." Leighton and Murphy, who are husband and wife, have shown both. They brought the Stirling County Study with them from Cornell when they came to Harvard in 1966. Since 1982, the study has been based at MGH. At 92, Leighton still remains an active consultant on the project. It was Murphy who actually made the first "cold call" in 1952, driving up to a randomly selected farmhouse in Stirling County and knocking on the door. Her task was to convince a total stranger that she was for real, that confidentiality would be ironclad, and that answering an hour and 45 minutes of questions would advance our knowledge of mental health. That's how the Stirling County Study has proceeded ever since.

—John Fleischman

December 11, 2000
7:40 pm
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Molly
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See happiness, I fit in the study, born in 53, and starting to contribute to the household in 86. I would have been happier, if I had followed what I was taught, to be a wife and mom, vs inept because I didn't have a career too, and shouldn't just go with the flow, of the husband. What a pandora's box that was opened.

December 12, 2000
9:35 am
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janes
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Would you Molly? We need to be able to evaluate what we were taught as children vs what WE as adult people want from OUR OWN LIVES which are just as valuable and contributing as those of the husbands.

Women thoughout history have often been viewed as chattel, property, "less-than" individuals. This is the myth that male dominated societies have wished to promote.

Being a stay at home mom and wife is one of the greatest callings and a tough tough job. It is not the "less-than" role society has assigned it.

It is only when we feel it is less than something else that it is. Unfortunately, the Wife/mom role often leaves a women without a means of financial support if and when the "bread winner dies unexpectedly or decides to move on.

Expectations for women should come from within each woman...as an individual choice. That is how daughters should be raised...be what YOU want to be and hopefully life will fall into place.

The role of the media and societal expectations on women's roles (and men's) has had a great effect. It is only recently that we have started to talk about codependence and other systems that allow us to not think of ourselves and be unhapppy

Be happier if we had done it another way? The road not taken? We can all make that assumption. We make choices and then later think..."shit..I shoulda done ___________." But tough as it is we now have the luxury of change if we want and so forth.

Just some personal thoughts

j

December 12, 2000
12:45 pm
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Cici
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It was an intersting tidbit for me because I have always felt frustrated with the women's lib movement. although the movement is a mere shadow today of what it once was, it seems to have succeeded in making women feel guilty about whatever life choices they make.

You stay at home, you are denegrated for not being a "contributing member of society" (as if rasing children were as easy as that). If you go to work, you are overwhelmed with "mother-guilt" and suppress it, making that aggression and turmoil ruin other close relationships.

We carry children, and giving birth is still the #1 reason for death among women worldwide. We are more prone to STDs, blamed for infertility, have a hgiher incidence of depression and anxiety mood disorders. We are more prone to migranes. We get PMS and mood swings, and are run through the ringer by medical professionals who give us birth control pills at 15 without warning of side-effects. Then, horomone replacement therapy after menopause, which can cause the digestive disease I have.

Even if you don't take horomones, the majority of reproductive responsibilty falls on your shoulders, from birth to contraception. We are exposed to xeno-estrogens in the environment from plastics and alminum manufacturing plumes, which can exacerbate PMS and cause mood swings, as well as debilitate the body (bone density, weight gain, skin problems, low sex drive).

Men get to pee standing up. They still get more money for doing the same job. We get discriminated against even with health insurance because as long as you have your period you can still get pregnant. Pregnancy is treated like a disease tha thas to be cured, not a natural process.

On top of all this, we are held up to standards of beauty that are nearly impossible to replicate.

If you have 3 kids, a job, and a home, you have to take care of all that plus work out every day to keep in shape, plus cook nutritious yet appetizing meals that thechildren will try to eat, plus take critcism for "not being there" (be it at work or with your children).

We are expected to schedule every minute of our day to cater to everyone else but ourselves. And that's the NORM?!?!?!?!?

December 12, 2000
12:55 pm
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gingerleigh
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Damn straight Cici.

And so many of us wonder why we wander around vaguely pi**ed off and/or sad, and can't verbalize why we feel this way to ourselves or to anyone else. We're labeled melancholy, bi*chy, cold, selfish, or sometimes even crazy. And then when we do try to "help ourselves", we are seen as "Acting out" or indulging in that "self-help crap". What's a woman to do?

No kidding. How does one possibly stay "sane" in these circumstances? Perhaps acting "sane" under these conditions is a sign of true insanity?

December 12, 2000
2:31 pm
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Anonymous
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You guys dont have to buy into that sh*T. I mean, sure society has great expectations of us and women with less compensation in comparison to the man, but it is up to us as individuals to live up to our own standards. Raising psychologically and physically healthy children is the most challenging and rewarding career in the world and the women who do it are goddesses and all the men, worth their salt secretly know this.
We are the ultimate creators of life, we are better business people, organisers, administrators and truth be told, we are the true leaders of the family and I believe eventually society. We may not be up there in a suit with the boys, mentally masturbating our next conquest, but we are the true drivers behind the machine.....hehe
Its important that WE know this, outside praise and reinforcment is a bonus, but not necessary to our self esteem .......or for that matter our eventual global domination...( joke..hehe )

December 12, 2000
2:34 pm
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there is truth in the global domination thingy, I do believe that females will be running the show sooner than we think. Statistics show we are better with money, business, leadership, administration, politics etc....
I personally believe I was a warrior woman in my past life, I certainly am one today.
Hail Zena! lol

December 12, 2000
6:18 pm
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Molly
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I know that the financial thing is a real tough one to argue, part of the sociological changes, can't take that one to the bank ha ha,it used to be that your family would provide, ha ha again, and the media, I often wonder if there wasn't some great conspiracy to destroy America, job creation, look at all the jobs created after women went to work, entire industries, all around cleaning up the mess, or making bigger ones. Look back at women and substance abuse, they used to keep us mellow with opium, the house wife blues, and then when the pharmacy industry was created in the 20's it was to keep the women out of the ghetto's to get the medicine for meloncholy, then tranq's, then diet pills, now prozac. They didn't even test drugs on women until recently, and I still remember my gyn stating that pms was in my head Most of the pill poppers are women, why we were told to take it, and we usually do what we are told. We are more sensitive, and they or we have been isolated from other women. We need each other, we hear us we understand us.
Being a stay at home mom, ment that we worked at the Red Cross, school, PTA, Girl Scouts, church and temple, we had the opportunity for outside interest, and after the kids go to college, we could continue, or take care of the grand kids, or go to school, or use the skills we developed doing community service. Being a Council PTA President, was like running a major corporation, no small task, or a soft ball mom. Can you imagine that they now have games starting at 9pm.? Its true, why moms and dads don't get home till 7. We had power when we controlled the neighborhood, and our children, and our neighbors children, we were the grass roots. Look what has happened since we went to work, and for what a larger tax base for the government services? As far as money, and financial security, I remember grandma took so much out of the grocery money and stashed it for a rainy day vs new shoes, I mean I am guilty and got caught up in the crap that was fed me, not being of value because I stayed at home, but where the hell did that start any how?
Skye, good to hear from you, and yes I believe that we will be in power, I believe the date is supposed to be 2012. But I sure hope that the women are real women and not sudo men, I have seen that, women who have become the female versions of Bill Clinton, older with their boy toys. Its ugly. Janes, we do have a choice today, and due to the rough road we have traveled, know what to tell our daughters, some where in America that got lost, I don't see the problem in other countries, maybe its comming for them, I sure hope not. But today we can start over and over and over if we have the energy, and didn't make to much of a mess with the last choice, its just so hard for women all the way around, not much or as much room for error.

December 12, 2000
6:21 pm
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unhappylc
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Amen sisters.....!!!!

December 13, 2000
1:15 pm
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Cici
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Skye, although I agree whole-heartedly with your stance, I have serious misgivings about the ability for us to "choose our own destiny".

From all my sociology and psychology classes, from my religion classes, what I have gained is a knowledge of teh powerful and almost insidious forces that still linger in our culture. We are still ruled by the Puritannical founders of this country, in legislation, media bias and cultural psychology.

You can live up to your own standards, but show me a woman not affected by cultural bias and I'll show you someone who is either lying to you or to themselves.

No matter what happens, whatever choices we make, it takes a long friggin' tiome to get over the "what-ifs".

I recently got a graduation announcement from a friend who received her doctorate in international law. She is successful, in her early 30s, beautiful. But, insecure. She still believes that her life and work are of less value because she isn't married. She gushes over my up-coming nuptuals and complains about how she still can't find a man. This from an educated woman who chose work over marriage conscienciously.

Besides that, there is the comon cultural emphasis on dividing women. We become jealous and spiteful after we hit puberty, not because of how OUR mothers raised us but because of the social circles and dynamics of the school environment. Statistically speaking, women feel more valued when they have established a close bond with a partner, while me feel more valued if they have a circle of male friends.

Now, this could be attributed to society and culture, which we could then protest with the whiney insitence of the victim. This could also be attributed to strong biological forces that still shape behavior, from sexuality to mothering, because we are animals. Mammals, whatever. our minds don't separate us from our biology. Women still get b*tchy or cry a lot at the onset of our hormonal surges.

What I propose is that we stop holding ourselves up to comparison, thereby separating ourselves into "us" vs. "them". our culture is famous for this. We like to label and separate ourselves. Why can't we just be a group with a common goal.

December 13, 2000
6:14 pm
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Molly
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I agree Cici, but what is the goal? Some one keeps moving my cheese!

December 14, 2000
12:29 am
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Wow!!!! This is a lot to think about! I have felt a lot of these things. I don't think I could put it into words like you all did. I am proud of staying home and raising my children. I just hope it pays off by them succeeding in whatever they choose to do with their lives. I have worked part time jobs here and there. Mainly in the evenings so I caould be home for them when they wake up and come home from school. They are both excellent students and GREAT kids...really they are! I could have had a career...I chose not to. I can persue it later!

December 14, 2000
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Wow!!!! This is a lot to think about! I have felt a lot of these things. I don't think I could put it into words like you all did. I am proud of staying home and raising my children. I just hope it pays off by them succeeding in whatever they choose to do with their lives. I have worked part time jobs here and there. Mainly in the evenings so I caould be home for them when they wake up and come home from school. They are both excellent students and GREAT kids...really they are! I could have had a career...I chose not to. I can persue it later!

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