Exploring depression
Exploring depression

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Exploring depression

2.1 Depression can affect people in different ways

Depression affects people in different ways (NIMH, 2015). Some people may experience a few symptoms, others many. The severity, frequency and duration of symptoms (how long they last) will vary depending on the individual. Symptoms may also vary depending on the stage of the illness. Depression is also more common amongst women than men (see Table 1).

Table 1. Age-standardised DALYs (per 100,000) attributable to major depressive disorder and dysthymia, 1990 and 2010 (adapted from Whiteford et al., 2015)

Disorder

1990 Male

 

2010 Male1990 Female2010 Female
Major depressive disordera694.8689.91171.71161.2
Dysthymiab135.3135.8189.7190.0
(a) Major depressive disorder accounted for 63,200,000 DALYs (2.5% of all cause DALYs and 24.5% of DALYs attributed to mental, neurological and substance use disorders) in 2010; (b) Dysthymia accounted for 11,100,000 DALYs (0.4% of all cause DALYs and 4.3% of DALYs attributed to mental, neurological and substance use disorders) in 2010.
  • From the data presented in Table 1, has there been any change in the relative proportion of DALYs attributed to major depressive disorder over the two decades?

  • The relative proportion of DALYs for major depressive disorder and dysthymia have remained relatively constant for both males and females. However, the figure for females was also consistently higher than for males (1.7 fold greater than for males for major depressive disorder, and 1.4 fold greater for dysthymia).

The reasons for the gender disparity are not fully clear but may be linked with biological, psychosocial or other gender-related factors (NIMH, 2015). Women are also vulnerable to depression after giving birth (termed ‘postpartum’ or ‘postnatal’ depression), at a time when physical and psychological changes can be overwhelming. Women with depression describe experiencing feelings of sadness, ‘worthlessness’ or guilt, and men frequently report irritability (anger, or frustration) and insomnia and tend to turn more to alcohol or drugs when depressed. People who suffer from depression may avoid talking with family or friends about their mood or their feelings, and severe depression can turn to suicidal thoughts and suicide attempts.

Children and adolescents may also develop depression. Because typical behaviours associated with transition from childhood to adolescence to adulthood may vary, it can be difficult to identify whether a child or young person is going through a temporary ‘phase’ or suffering with depression (NIMH, 2015). Frequently, chronic mood disorders such as depression can begin as high levels of anxiety in childhood. The teenage years can be particularly difficult, as young people begin to form their identities, deal with social, gender, sexuality and relationship issues, and start making independent decisions. Severe changes in mood, anxiety, eating disorders or substance abuse could also indicate higher risk for depression and suicide among adolescents. Depression often persists, recurs, and continues into adulthood, if left untreated.

Depression in older adults may be difficult to recognise, as it may be less ‘obvious’. Most older adults feel satisfied with their lives, despite living with illness or physical problems, so having depression is not a normal part of growing older (NIMH, 2015). Depressive symptoms may be linked to medical conditions (Alzheimer’s disease, heart disease, stroke or cancer) in older people, and major depression can sometimes be difficult to distinguish from grief (the loss of a loved one). However, grief that is complicated and lasts for a very long time following a loss may require treatment. Older adults who have experienced depression when younger are also at higher risk of developing depression late in life. Factors commonly associated with depression are indicated in Box 4.

Box 4 Factors associated with depression

  • Genetic predisposition

  • Life events − trauma, loss of a loved one, a difficult relationship, an early childhood experience, or any stressful situation.

  • Early onset − often in teenage years or young adulthood (early 20s or 30s); most chronic mood and anxiety disorders in adults begin as high levels of anxiety in children, and could mean high risk of developing depression as an adult.

  • Comorbidity with other medical illnesses − depression can co-occur with diabetes, cancer, heart disease, neurodegenerative disorders such as Parkinson’s, Alzheimer’s or Huntington’s diseases, and can exacerbate these conditions (or vice versa).

  • Medications − often taken for comorbid illnesses, could contribute in some cases to depression.

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