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العنوان
Depressive Disorders In Women /
المؤلف
Naama,Ahmed EL-Sayed Hamed.
هيئة الاعداد
باحث / Ahmed EL-Sayed Hamed Naama
مشرف / Afaf Hamed Khalil
مشرف / Nivert Zaki Hashim
تاريخ النشر
2012
عدد الصفحات
205p.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الطب النفسي والصحة العقلية
تاريخ الإجازة
1/1/2012
مكان الإجازة
جامعة عين شمس - كلية الطب - الأمراض النفسية و العصبية
الفهرس
Only 14 pages are availabe for public view

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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).