First of two parts
We all have episodes of sadness. But when these episodes interfere with getting on with the business of life, this condition is called depression.
Q: What is depression?
A: Depression is an emotional response to troubles that includes sadness, discouragement and persistent hopelessness.
Depression comes in degrees more than kinds. A recent study led by Dr. Alan Romanoski at Johns Hopkins has divided the disorder into "major depression" and less severe forms known as "non-major depression." Dr. Romanoski explains, however, that non-major depression can be as serious as major depression, because of its persistent nature.
The interesting result of this redefinition is that while men and women seem to have equal risks of major depression, women have 10 times the risk of men for non-major depression. About 8 percent of all women have signs of depression.
Q: How do you separate the forms of depression?
A: Both major and non-major depression can be brought on by tragic or troubling life events. Major depression makes it harder to do everyday tasks, and it produces changes in eating habits, sleep patterns, sexual drive and ability to concentrate. People with major depression suffer from intense guilt and self-blame. At least one in four have hallucinations.
Non-major depression is a lot more common and describes three out of four cases of depression. Often, it is triggered by an acute life event such as a death, divorce or unemployment, and it is short-lived. Chronic non-major depression usually comes and goes and involves mild symptoms. These repeated episodes eventually wear a person down and interfere with health.
Q: Who is likely to become depressed?
A: Women are two to three times more likely than men to become depressed. Surprisingly, the new study did not suggest a difference in risk by race, education or income. However, both men and women who are unemployed were more likely to be depressed.
The two forms of depression differ by age. Major depression has a peak occurrence in middle age. Non-major depression increases with age. In fact, one of every 12 people over 65 will have this disorder.
The living arrangements of households play a major role in the risk for depression. People in married-couple households have only half the risk of any other type of living arrangement. Widowed and divorced people are more likely to be depressed. A number of studies indicate that marriage is more likely to protect men than women against depression.
Q: What factors bring on depression?
A: Factors which bring on depression can be divided into two types. Acute life changes can precipitate the onset of depression. Precipitating factors include:
* Life events, such as a loss of a loved one or a job.
* Physical changes, such as serious illness, major surgery or the hormonal shifts that can bring on depression before a woman's period or after a woman has given birth.
* Larger-than-life events, such as natural or man-made disasters.
Continuously stressful factors can predispose or increase the chance of getting depression whenever a troubling event occurs. Predisposing factors include:
* A family tendency to become depressed, due in part to family patterns or biology.
* Having a close relative, particularly a mother, who was depressedwhen you were growing up.
* The day-to-day stress of life, including daily hassles, abusive situations, family discord, poverty or work stress.
Dr. Romanoski points out that a combination of factors, like loss of a loved one and a stressful work situation, increases the likelihood of depression.
Q: Is there a way to prevent depression?
A: Knowing who gets depression and when it occurs can help prevent the disorder or at least reduce its impact.
For more information about depression, you can request "Let's Talk Facts About Depression" from the American Psychiatric Association by calling (202) 682-6220 or writing to 1400 K St. N.W., Department JH, Washington, D.C. 20005.
In Baltimore, the Depression and Related Affective Disorders Association provides information, support groups and seminars. Write or call Sally Mink, DRADA, Meyer 3-181, 600 N. Wolfe St. Baltimore 21287-7381. Call (410) 955-4647.
Next week: Prevention and treatment.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.