Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, January 14, 1992 TAG: 9201140119
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Long
RECOGNIZING DEPRESSION IS FIRST STEP TO CURING IT
Depression has long been considered primarily a women's disease. The rate for women being treated, as shown by community surveys, is two to six times as high as for men.Now it looks as if men could be starting to catch up.
Economic and social pressures and a greater willingness by men and doctors to recognize and discuss emotional problems may eventually whittle away the statistical difference.
According to a recent analysis involving more than 23,000 patients and 500 medical practitioners, many more mistakes are made in recognizing depression in men than in women.
The study, published in the journal Psychological Assessment, found that clinicians outside the mental health field failed to recognize symptoms of depression in two-thirds of the men as against half the women who were found to be suffering from it using standardized tests.
Furthermore, the clinicians in the study were more likely to diagnose de- pression in women when in fact they were not suffering from it, according to thetest results.
Historically, it has been considered "unmanly" to admit to suffering from emotional problems. Rather than seek medical help for depression or even acknowledge that they may have such a problem, many men have traditionally handled their feelings by drinking too much alcohol, taking mood-altering drugs, being cranky and irritable or falsely cheerful, abusing their wives or children, becoming workaholics or exercise addicts or, with little or no warning, committing suicide.
On top of this, many doctors have been reluctant to delve into the emotions with their male patients or even to ask "embarrassing" questions that might reveal alcohol or drug abuse. Another obstacle to detecting depression in men is that men are only half as likely as women to visit a doctor.
Women, on the other hand, see doctors far more regularly. Facing less social stigma about emotional problems, women generally feel more comfortable than men in talking about their bad feelings and are more inclined to confront them rather than to try to drown them in pills and alcohol.
Doctors, too, have been less reluctant to quiz female patients about their emotional health and more likely to conclude that women with certain hallmark symptoms are in fact depressed.
To be sure, even when diagnostic errors are taken into account, depression is still considered to be a more common affliction among women. Dr. Myrna Weissman, professor of epidemiology in psychiatry at Columbia University, and her husband, Dr. Gerald Klerman, professor of psychiatry at Cornell University Medical Center, have analyzed scores of studies in the United States and many other countries.
They find that while depression affects young boys and girls with equal frequency, after puberty girls and women are about twice as susceptible.
The distribution is probably related, in part, to hormonal factors; (for example, premenstrual and postpartum depression are common and well recognized.)
But it may also reflect social pressures that affect men and women differently. For example, Klerman said, while the women's movement may have succeeded in raising social awareness about the need for men to participate more in household chores and child-rearing, in most households women with outside jobs still do the lion's share.
"There has been a distinct rise in depression among young women, and a main reason for it is that the promises to women have not been fulfilled," Klerman said.
For both men and women, Weissman said, feeling powerful and in control is a potent antidote to depression. "Maybe different things make men and women feel powerful and in control, though that is likely to be less so as women's and men's roles become more similar," she said.
Rates of depression have been increasing worldwide in both men and women born after World War II. If indeed there has been a disproportionate increase in depression among men, Klerman suggested socioeconomic factors as a prominent cause.
Many men can no longer reinforce their social dominance by holding "macho" jobs. Instead, more men today hold unisex jobs and compete with women.
In the last few years, extensive layoffs and forced retirements have compounded the problem. A disproportionate number of men are out of work, suffering from lost status and battered self-esteem on top of often severe economic pressures, a perfect formula for depression.
Loss of appetite and sleep disturbances - insomnia (especially early-morning awakening) or excessive sleepiness - are common signs of depression. Also common is a general slowing down of mental and physical activities, a phenomenon called psychomotor retardation.
Depressed people often have difficulty concentrating and thinking clearly and doing work they once did easily.
Pastoral counseling or at community mental health centers can help those without enough money or insurance.
If nothing else, try joining a self-help group. There are now many men's groups as well as women's groups in urban areas. Participation in regular physical activity is another valuable antidote to depression.
Above all, do not wait until the demons of depression result in alcohol or drug abuse, spouse or child abuse or, worst of all, suicide. - New York Times News Service
Jane E. Brody writes about health issues for The New York Times.