Women are clearly at greater risk for developing depression than men. This may be due to two factors. First, women are physiologically different, which may explain some of the variance. More importantly, women are psychologically different, and this psychology is shaped by both their different physiology and the different cultural expectations placed on them. They are expected to express their feelings more, and it is more socially accept-able for them to admit to being depressed, although for-mal studies have demonstrated that men and women are equally likely to report their depressive symptoms.
Depression often leads to withdrawal, which can be interpreted as passivity in women, which is also more culturally acceptable. Withdrawal in men is generally interpreted as a sign of weakness. When men withdraw they usually describe it as a choice without any change in mood. Thus it is interpreted more as an independent act and is recharacterized in more socially acceptable terms such as stoicism. Social factors likely play a large roll in the higher rates of depression in women as well.Certain ethnic groups are more susceptible.
A correlation appears to exist between latitude and susceptibility to depression. Northern Europeans are the most susceptible, with Scandinavians suffering from the highest rates and Mediterraneans suffering from the lowest rates. Certain races also appear to be more susceptible, with whites suffering greater rates than blacks. Recently, a cultural shift has occurred in Japan as a result of the introduction of safe and effective antidepressants used to treat milder forms of depression. Because Buddhism has heavily influenced Japanese society, the notion that life is filled primarily with suffering has been the accepted paradigm.
In contrast, Western culture tends to be more positive and hopeful. Thus feeling sad about one’s lot in life in Japan was considered the norm, whereas in Western culture it is considered abnormal. As Japan has become more Westernized and Buddhism less valued, the notion of treatable depression has become more accepted. Obesity plays a role in the development of depression, counteracting the myth of Falstaff or “Jolly Old St. Nick.”
Studies are beginning to demonstrate that significant weight loss in patients with clinical obesity can lead to remission of their depression. Depression appears to be linked with obesity in a manner similar to hypertension, heart disease, sleep apnea, joint pain, and diabetes. There may be some correlation with obesity, female gender, and suffering higher rates of depression. Females have, on average, higher percent-ages of body fat than males, and body fat has higher estrogen levels, the hormone involved in female development.
Certain personality styles are more susceptible to depression, with shy, reserved, or dependent people at higher risk than outgoing, sociable, or independent people. This is truer for males than females, again because being shy, reserved, or dependent is more culturally acceptable in females than males. Body fat and personality style have a significant biologic basis, although both are clearly shaped by environmental factors.