Women's Health Surveillance Report

Depression

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Donna E. Stewart, MD, FRCPC (University of Toronto); Enza Gucciardi, MHSc; and Sherry L. Grace, PhD (University Health Network)

Health Issue

Depression is a disorder the symptoms of which cause clinically significant distress or impairment in physical, social, occupational, and other key areas of functioning. Women are approximately twice as likely as men to experience depression. The average major depressive episode persists approximately nine months in the absence of treatment, and about 50% of individuals who have one episode will experience a recurrence. Psychosocial factors likely mediate the risks for depression incurred by biological influences. The effects of stress, violence, poverty, inequality, and low self-esteem likely increase women's vulnerability to depression.

Key Findings

Data from the National Population Health Survey (NPHS) show that depression is common in Canadian women, with a self-reported incidence of 5.7% per year compared with 2.9% in men in 1999. Geographically, the highest rates of depression among women are found in Nova Scotia and New Brunswick, while women in PEI have the highest rates of hospitalization for depression. The highest rates of depression are seen among women of reproductive age. Predictive factors for depression include previous depression (OR = 2.97 feelings of being out of control or overwhelmed (OR = 1.80), chronic health problems (OR = 1.77), traumatic events in childhood or young adulthood (OR = 1.69), lack of emotional support (OR = 1.47), and low sense of mastery (OR = 1.32). Women who are lone parents are more likely (15%) to experience depression than women generally (7%). Greater severity of chronic pain increases the prevalence of depression among women more than men. Being overweight (i.e. body mass index 25.27) and daily smoking are also associated with depression in Canadian women. Although depression is treatable, in 1998-1999, 67.6% of depressed Canadian women were not taking antidepressant medication. Only 43% of those reporting a major depressive episode had consulted a health professional about the problem. People with lower education, inadequate income, and fewer contacts with a health professional are less likely to receive treatment for their depression.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• Commission research to gain a better understanding of the factors that increase or decrease vulnerability and resilience to depression and begin to conduct surveillance on these factors.
• As 8% of 12-to-13-year-old girls report contemplating suicide in the previous year (NPHS), collect and analyze data to gain an understanding of the contributing factors to this situation and how to improve self-esteem in early adolescent girls.
• Collect and analyze national data on the prevalence of clinical depression and anxiety.
• Collect and analyze data on current treatments for depression and their efficacy in depressed women at different life stages to determine what treatments and services are optimal.
• Conduct further research to better understand interprovincial variations in depression rates and hospitalization rates for women to develop the best possible practices for prevention and treatment strategies.
• Collect data on the impact of depression on work and family life and the costs to individuals, families, and society.
• Collect and analyze data on depression at 6 and 12 months after childbirth to determine depression's prevalence and the factors that increase or decrease vulnerability to it.

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