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Abstract By ٢٠٢٠, the World Health Organisation has predicted that depression will be the “second leading cause of global disability burden” and that as many as one in four women will suffer from a mood disorder during their lifetime. Worldwide, major depression is at least twice as common in women as men, accounting for ٤١٫٩٪ of the disability from neuropsychiatric disorders among women compared to ٢٩٫٣٪ among men, these data appear consistent with current UK figures (Office for National Statistics (ONS), ٢٠٠١). At first it is important to establish that the female preponderance is not artefactual. Two major reporting artefacts have been cited as potentially contributing to the reported gender gap in depression; a helpseeking artefact, and a recall artefact. The help-seeking artefact refers to a perceived reticence in males to seek treatment or advice for depressive symptoms, which could explain the preponderance of females reporting for treatment (Kessler et al., ٢٠٠٠). However, in a comparison of data from two worldwide multicentre studies conducted by the Cross National Collaborative group and the World Health Organization, Kuehner (٢٠٠٣) found that the rates of depression identified in community samples were in accord with those reported from primary care settings. The recall artefact postulates that women’s recall is biased in favour of past negative affective states, and thus women report a higher rate of lifetime depression. Kuehner (١٩٩٩) conducted a controlled test of this by comparing men and women’s reports of depressive symptomatology during a depressive episode, and their recall of these symptoms ٦ months later.He found no recall artefact: there was no disparity in the reported severity of symptoms at times one and two, between males and females. Depression in women is associated with specific biological changes that occur during different stressful feminine life events starting from puberty, childbearing, passing through pregnancy and postpartum period and lasting with menopause.At puberty several hormonal changes occur in depressed a dolescent , mainly sex hormones secretion, dysregulation of growth hormone secretion and dysregulation of hypothalamic pituitary adrenal axis (Birmaher and Brent, ٢٠٠٣). Stress is cited as the preceding factor in ٨٥٪ of cases of depression by female chilbearing depressed patients (Parker et al., ٢٠٠٣) . Exposure to stress alters the levels of hormones in the hypothalamus–pituitary–adrenal (HPA) axis, notably cortisol, corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) (Binder et al., ٢٠٠٩). During pregnancy and postpartum period fluctuations in gonadal hormones occur, it is also important to note that the HPA axis also undergoes significant changes during these times. For example, pregnancy-related steroid hormones and peptides, such as oxytocin, dampen the reactivity of the HPA axis during pregnancy. Furthermore, there is evidence that cortisol, ACTH, CRH and corticosterone binding (CBG) levels are altered significantly during pregnancy and postpartum (Yim et al., 2009). Menopause is defined by the permanent cessation of menstruation for ١٢ months secondary to a loss of ovarian activity. The postmenopause is characterized endocrinologically by tonically elevated gonadotropin (follicle stimulating hormone (FSH), luteinizing hormone (LH)) secretion, persistently low levels of ovarian steroids (estradiol, progesterone) and relatively low (٥٠٪ decrease compared to younger age groups) testosterone secretion (Soules et al., ٢٠٠١). The menopause transition and the perimenopause are the transitional periods from reproductive to nonreproductive life (Hall, ٢٠٠٧). The late menopause transition is characterized endocrinologically by tonic elevations of plasma FSH and sustained menstrual cycle irregularity with more prolonged periods of amenorrhea and hypoestrogenism. Results from several studies demonstrate that ovarian steroids influence many of the neuroregulatory systems implicated in the pathophysiology of affective disorders (Rachman et al., ٢٠٠١). Psychosociocultural factors and depression in women: Biology is not the only factor invlved in depression in women, other enviromental factors are involved and are variable from a stage to another. During childhood and adolescence, depression may be associated with cognitive factors (as negative attributional style ), experience of negative life events as failure events, child abuse and sexual identity disorder. Other factors include poverty and parenting considerations (Bruce et al., 2005). Various factors play for the condition of the adult women in developing countries. While, traditional roles of women in these societies expose them to greater stress, they are also less able to change to their stressful environment because of lack of education and support. The factors which further add to the problem are associated poverty, religious factor, hunger, malnutrition, overwork, domestic and sexual violence (Gosh et al., 2002). In developing countries different studies revealed that religious factor has an intimate relation to the view of society to the woman. Ethnic Arab women, particularly in Muslim society, have been viewed as ”powerless, subservient, and submissive”. The male is the leader and highest authority in the household, the economy, and the polity (Al- Krenawi et al., ١٩٩٦). A Muslim woman’s physical symptoms are accepted as legitimate and morally acceptable expressions of pain, as pointed out by Bazzoui (١٩٩٠). Muslim culture condemns suicide, and clients may not divulge suicidal feelings easily. If asked directly about thoughts of killing themselves, most depressed patients reply that they are good people and would never entertain such thoughts. Although the wish to die is not uncommon among people with depression in Muslim cultures, it usually remains at the level of wishing that God would terminate their life, and does not progress to the wish to kill themselves (Fakhr el Islam, ٢٠٠٠).Domestic violence and its impact on depression in women: Physical, emotional, and sexual abuse of women by an intimate partner is strongly associated with depression, anxiety and anxiety disorders, and a variety of other psychiatric problems, including substance abuse, dissociation and dissociative disorders, and posttraumatic stress disorder (PTSD). Intimate partner violence, or domestic violence, affects an estimated one in four women and, along with depression, has been recognised by the World Health Organisation (١٩٩٨) to be a significant public health concern. Domestic violence also affects children, who may themselves be subject to abuse and/or witness the violence. Both girl and boy child victims of abuse have significantly higher rates of childhood mental disorders, anxiety disorders, personality disorders and major affective disorders, and witnessing violence as a child has particularly been associated with anxiety in girls (Spataro et al., ٢٠٠٤). Clinically depression in women may differ in symptoms reporting, depressed females complaint more physical symptoms , sleep disturbances and easy fatigability, during childhood and adolescence the depressed females report different range of symptoms which may appear away from typical depressive symptoms, these include school problems (difficulty concentrating and paying attention in class and during homework periods, and loss of the necessary energy and motivation levels that are required for academic achievement), family conflict (frequent unpleasant interactions with parents or siblings), suicidal crises, increasing illict substance abuse and somatic symptoms (Torros et al., 2004). |