Why is depression more prevalent in women?

Paul R. Albert

doi:10.1503/jpn.150205

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RE: Response to 2015 editorial
Paul R. Albert [PhD]

Posted on: 24 March 2023
The Impact of Sociocultural Factors on Depression in Women: A Psychiatrist's Perspective on Traditional Chinese Culture
Lien-Chung Wei [M.P.H.]

Posted on: 18 March 2023

Posted on: (24 March 2023)
Page navigation anchor for RE: Response to 2015 editorial
RE: Response to 2015 editorial
Paul R. Albert [PhD], Ottawa Health Research Institute (Neuroscience), University of Ottawa
I thank Dr. Wei for his perspective on the 2015 JPN editorial (https://www.jpn.ca/content/40/4/219) entitled “Why is depression more prevalent in women?”. Dr. Wei discusses the potential impact on depression of transition to the workforce in women in traditional Chinese culture. In this editorial, we noted that across global burden of disease there was no clear difference in the prevalence of depressive illness comparing countries where a majority of women participate in the workforce or do not. This implies that being in the workforce may not be a major contributor to depression in women. Thus, I argue that biological differences may have a primary role in driving the gender differences in MDD, as opposed to psychosocial or cultural differences. Thus, the focus of the editorial is on animal and clinical studies addressing underlying biological mechanisms that could explain in part the gender difference in MDD.

However, comparing different populations in different countries is not the best way to assess the impact of outside-the-home work on women’s mental health. A much more sensitive measure would be to follow depression rates over time in countries where there is a transition in women’s role from strictly home care to also participate in the workforce. This type of study could provide evidence that change in roles of women can impact their mental health. Furthermore, transition to workplace is just one so...
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I thank Dr. Wei for his perspective on the 2015 JPN editorial (https://www.jpn.ca/content/40/4/219) entitled “Why is depression more prevalent in women?”. Dr. Wei discusses the potential impact on depression of transition to the workforce in women in traditional Chinese culture. In this editorial, we noted that across global burden of disease there was no clear difference in the prevalence of depressive illness comparing countries where a majority of women participate in the workforce or do not. This implies that being in the workforce may not be a major contributor to depression in women. Thus, I argue that biological differences may have a primary role in driving the gender differences in MDD, as opposed to psychosocial or cultural differences. Thus, the focus of the editorial is on animal and clinical studies addressing underlying biological mechanisms that could explain in part the gender difference in MDD.

However, comparing different populations in different countries is not the best way to assess the impact of outside-the-home work on women’s mental health. A much more sensitive measure would be to follow depression rates over time in countries where there is a transition in women’s role from strictly home care to also participate in the workforce. This type of study could provide evidence that change in roles of women can impact their mental health. Furthermore, transition to workplace is just one social issue that may affect the gender ratio in MDD. Addressing the importance psychosocial and cultural conditions for this gender difference may provide important insights to develop and implement more effective treatments for women.
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Competing Interests: None declared.
Posted on: (18 March 2023)
Page navigation anchor for The Impact of Sociocultural Factors on Depression in Women: A Psychiatrist's Perspective on Traditional Chinese Culture
The Impact of Sociocultural Factors on Depression in Women: A Psychiatrist's Perspective on Traditional Chinese Culture
Lien-Chung Wei [M.P.H.], Psychiatrist, Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taiwan (Republic of China).
In response to the original article by Paul Albert on the prevalence of depression in women and its focus on biological explanations for gender differences in MDD (1), I would like to provide a perspective on the sociocultural factors that may contribute to this disparity, particularly in the context of traditional Chinese culture.

In traditional Chinese culture, women are often expected to prioritize their roles as wives and mothers above all else. The concept of "男主外，女主內" ("men are responsible for the outside world, women are responsible for the inside world") has long been a pervasive cultural norm in Chinese society. Women are expected to take care of the home, raise children, and support their husbands' careers, while men are expected to be the primary breadwinners.

However, in modern society, more and more women are entering the workforce and taking on leadership roles outside the home. While this represents an important step towards gender equality, it also creates significant pressure for women to balance their professional and personal responsibilities. Many women continue to shoulder the majority of the caregiving responsibilities at home, in addition to their work obligations, leading to high levels of stress and burnout. This issue could also apply to many North American women as well as Chinese women.

This pressure to excel in multiple roles can lead to depression and other mental health conditions. As mental healt...
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In response to the original article by Paul Albert on the prevalence of depression in women and its focus on biological explanations for gender differences in MDD (1), I would like to provide a perspective on the sociocultural factors that may contribute to this disparity, particularly in the context of traditional Chinese culture.

In traditional Chinese culture, women are often expected to prioritize their roles as wives and mothers above all else. The concept of "男主外，女主內" ("men are responsible for the outside world, women are responsible for the inside world") has long been a pervasive cultural norm in Chinese society. Women are expected to take care of the home, raise children, and support their husbands' careers, while men are expected to be the primary breadwinners.

However, in modern society, more and more women are entering the workforce and taking on leadership roles outside the home. While this represents an important step towards gender equality, it also creates significant pressure for women to balance their professional and personal responsibilities. Many women continue to shoulder the majority of the caregiving responsibilities at home, in addition to their work obligations, leading to high levels of stress and burnout. This issue could also apply to many North American women as well as Chinese women.

This pressure to excel in multiple roles can lead to depression and other mental health conditions. As mental health professionals, it is essential that we recognize the impact of these sociocultural factors on women's mental health and work towards developing strategies to support women in both their personal and professional lives.

In conclusion, while Albert's article focused on the biological explanations for gender differences in MDD, it is crucial to consider the psychosocial and cultural factors that may contribute to the higher prevalence of depression in women. By taking into account the impact of cultural norms and expectations, we can better understand the factors contributing to depression in women and develop more effective strategies to prevent and treat this condition.

Sincerely,

Lien-Chung Wei, MD, Psychiatrist
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Competing Interests: None declared.
References
Albert PR. Why is depression more prevalent in women? Journal of psychiatry & neuroscience: JPN. 2015;40(4):219-21. doi: 10.1503/jpn.150205. PubMed PMID: 26107348; PubMed Central PMCID: PMC4478054.

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