Among women in the United States, depression is at epidemic levels: Approximately 12 million women in the U.S. experience clinical depression each year, and more than 12% of women can expect to experience depression in their lifetime. Moreover, many experts believe the numbers are likely higher, given the degree of under-reporting about the condition, the fact that depression in women is often misdiagnosed and the fact that fewer than half of women who experience clinical depression will ever seek care.
The public health implications are undeniable. Beyond the condition's isolated impact, depression can have lasting physical and mental health effects that ripple through an individual's lifetime, with research also indicating that a mother's depression can affect the mental and physical development of her child.
In response to these concerns, Interim Dean Sandra Weiss of the UC San Francisco School of Nursing is leading three major studies aimed at shedding important light on some of the most pressing issues facing American women with depression and the clinicians who treat them.
The first study takes a systematic look at the etiology, triggers, symptoms, comorbidities and treatment of women who experience depression in the hope that a more comprehensive and detailed understanding of the disorder can improve screening in primary care settings and lead to more precisely targeted treatments.
Weiss is co-principal investigator of this nationwide, multisite study that involves nine leading universities. Funded by the National Network of Depression Centers and its participating sites, the study enrolls women ranging from adolescence through old age – primarily women who are not already undergoing treatment with a mental health professional.
"This is not the typical group of women in most depression studies," says Weiss. "Instead, we are trying to understand symptom presentation for depression and comorbid anxiety by screening women at nonpsychiatric settings, such as ob-gyn, primary care or pediatric settings where the women's children receive care."
Some of the questions the study explores are: How many of these women meet the criteria for depression and, of those, how many actually make it to treatment? What types of treatment are most common, and how is treatment linked to the severity and nature of their symptoms?
If the study can offer some definitive answers to these questions, it could modify screening and referral guidelines and, perhaps, make the case for more integrated behavioral and mental health resources in primary and specialty care settings.
Some studies have shown that integrating behavioral health in primary care can be successful in catching mental health problems before they become more severe and, therefore, more difficult to treat.
In addition, Weiss hopes she and her fellow researchers will be able to add to emerging knowledge about how best to target treatment options to a particular set of symptoms, at a particular time in life – a form of precision medicine for women's depression.
The study is using standardised, validated tools to determine, for example, whether there are different symptom clusters that may reflect different subtypes of women's depression, and how symptoms might differ at different times in a woman's life.
The findings that emerge could help create more evidence-based clinical guidelines than current treatment approaches, which tend to rely on the same guidelines for both men and women or an individual provider's clinical wisdom.
She adds that the study could also help clinicians understand potential red flags for depression. "One of the interesting things to me is that it's widely believed that people get more depressed as they get older, but so far we've found that older women are less depressed," says Weiss.
"We also found the importance of a key social determinant: When women are unemployed, they have over twice the odds of experiencing depression. Although there has been evidence of this effect for men, it has often been assumed that employment per se is not particularly salient for women's mental health."
While the study, which began in 2014, will take place over an extended period of time, an initial paper, based on the first wave of participants, has been accepted for publication in the Journal of Women's Health. The paper demonstrates the feasibility of creating a large-scale, multisite infrastructure and managing a complex registry of data from diverse professionals and clinical sites.
"It's very exciting to be creating a pooled data set in collaboration with the country's top experts in depression," says Weiss. "We already have 1,500 participants and plan to increase the number substantially, as well as follow the cohort over time."