OCT 1162Y (Psychosocial Perspectives) Due Date: Week 3, Jan. 19 & 21

Women with Depression: The Importance of Social, Psychological and Occupational Factors in Illness and Recovery (Authors: Whitney, Kusznir, & Dixie)

Introduction

  • The essential feature of depression disorders (DD) includes a “period of at least two weeks during which there is either a depressed mood or loss of interest or pleasure in nearly all activities”
  • Depression is almost twice as common in women as men
  • This gender difference could be a result of
  • Artifact theories emphasize the diagnostic bias that can arise with sex differences in help-seeking behaviour. Women seek medical help more often than men and are more diagnosed with a DD
  • Biological theories emphasize gender differences in brain structure and function, genetic transmission of mental illness, reproductive function and gonadal hormones
  • Psychosocial factors affecting occupational roles and behaviours are related to depression in women (in most societies, occupational roles traditionally assumed by women are not as highly valued)

Unique feature of depression in women

  • Refer to case example, pg. 24
  • DD tends to be more severe and associated with more functional impairment in women than men, women may have longer periods of depression
  • Disruption of engagement in meaningful occupations for women with depression could be of great significance
  • Women are more likely to experience a stressful life event in the 6 months prior to the onset of a depressive episode
  • Presence of young children is a risk factor especially if the women works and has difficulty with childcare
  • Abuse and victimization is strongly correlated with depression

The Differences in Physical and Biological Subsystem

  • Recent studies have shown that women have higher plasma levels of antidepressants, more side effects, and more frequent drug toxicity than men
  • Women appear to respond better to some treatments (e.g. SSRI’s & MAOIs)

Differences in Information Processing Subsystem

  • There appears to be a difference in responsivity to various types of psychotherapy that could suggest a gender difference in info processing. Women compared to men in psychotherapy do better in: group therapy, problem solving individual therapy, cognitive behavioural therapy, and interpersonal therapy

Understanding the Social Context of Depression

  • Social isolation and a range of social barriers (e.g. lack of money for medication, transportation for appointments, social and recreational activities, etc.) can impact treatmentas well as the meaningful activities and roles eroded by depression
  • Women are more likely to be victimized and live in poverty which are social factors that contribute to depression
  • Mental illness, especially DD, is the leading health cost and cause of disability facing business in Canada and around the world

Understanding Occupational Disruption and Recovery

  • Functional impairment in paid employment due to depression most frequently manifests as missed time, decreased productivity, and interpersonal problems
  • An analysis of occupational involvement and competencies is needed to establish a realistic return to work timetable, and avoid failure of return to work too early or without environmental modifications

Women in the Work Force

  • Growing involvement of women in the paid labour force is one of the most significant demographic trends in Canadian society
  • Some studies suggest a difference in stress response between genders (women tend to exhibit emotional symptoms such as depression whereas men tend to manifest physiological disease such as heart disease)
  • Women are experiencing more stress and demands at work and home in recent years

Work-Life Conflict

  • Work-life conflict has been used to describe the conflicting demands of work and non-work life occupations. The 2 major components of work-life conflict include 1) time crunches and scheduling conflicts & 2)feeling overwhelmed or over loaded
  • A study found that 35% of employees reported high work-life conflict, 1/3 reported high levels of depressed mood, 50% felt ‘burned’ out
  • Women report more work-life conflict than men do regardless of job type or dependent care status
  • Costs associated with high-work-life conflict include decreased wellness, reduced job satisfaction and organizational commitment, greater use of medical system, increased absence from work
  • In Canada, advocacy at a national level has provided a 12 step plan to defeat depression in the workplace and strategies that focus on healthy work environments
  • Understanding the relationship between the engagement in occupation and depression provides a basis for enabling occupational performance for women with DD.
  • The process of enabling occupational performance requires the development of an empathetic relationship, appreciation or nature an impact of depression on functions, and the importance of goal setting in therapeutic rapport

Conclusion

  • Enabling optimal occupational performance in recovery of women with depression requires careful attention to the various factors impacting a woman’s life stages, but also working with the client to discover the purpose of engaging in occupation