Womanhood at the Crossroads: Depression in Middle Aged-Women

By: Advika Bagmar

Illustration: Seher Chawla

Depression in middle-aged women mirrors the experience in men in many ways. It includes continuous feelings of sadness, anxiety, and emptiness, along with a loss of interest in previously enjoyable activities, including sexual life. Restlessness, irritability, guilt, and pessimism are common emotional challenges too.

Key findings in the National Center for Health Statistics (NCHS) Data Brief show that more than 8% of women (10.4%) were almost twice as likely as men (5.5%) to have had depression. Recent studies also report that with increasing age, there is an increasing trend in the prevalence of depression in middle-aged Indian women, and that moderate type of depression occurred more frequently in married women (50.0%), whereas the severe type was more frequent amongst widows (27.8%).

These findings pose the question - why are middle-aged women more vulnerable to depression? While juggling many responsibilities, like taking care of their kids and ageing parents, managing work and home duties, or facing financial difficulties are all valid causes for an increased prevalence of depression in women, there are also biological elements, specifically reproductive factors, that constitute the answer to this question.

Menopause is an important event in a woman’s life, associated with hormonal changes that play a substantial role in the functioning of her body. A decline in the level of estrogen contributes to depressive symptoms and mood disorders during this period. Although menopause is the normal, natural transition in life, it substantially contributes to problems related to physical functioning, as well as mood disorders, including depressive symptoms

Premenstrual Dysphoric Disorder (PMDD) often colloquially referred to as premenstrual syndrome (PMS), can be a real rollercoaster for many women. Dealing with recurring physical and emotional symptoms like clockwork, but only during the late luteal phase of your menstrual cycle, takes a strain on one’s health.

Aside from menopause, pregnancy has also been linked with depression. Studies have reported that roughly 9.18% of pregnant women in Mumbai were found to be grappling with depression. This isn't just about feeling blue; it's about the ripple effects that depression during pregnancy can have. Issues like inadequate prenatal care, compromised nutrition for both mom and baby, an increased risk of postpartum depression, even a higher chance of preterm deliveries, and babies born small for their gestational age often arise.

Up to 85% of new moms go through what's known as postpartum blues. Picture this: you've just given birth, and your emotions are on a wild ride. It typically starts in the first few days after childbirth, peaks between days 5 and 7, and then gradually eases up by the end of the second postpartum week. During this time, you might find yourself tearing up for no apparent reason, feeling incredibly impatient, and even sensing a strange detachment from your precious newborn. The physical effect can take a toll on your health – insomnia, difficulty focusing, abrupt weight loss, and an unusual lack of thirst are all part of the package. It's not uncommon for new moms to feel like they're falling short as mothers accompanied by a nagging sense of helplessness. This emotional rollercoaster is especially intense for first-time moms.

Rural and urban non-metro backgrounds appear to bear comparable burdens when it comes to depression. A recent study from Central India revealed that depression affects rural women at a rate of 22%, which is almost twice the national estimate of 12.3%. One out of every six rural women in our study reported symptoms suggestive of depression. Several risk factors were identified, including lower educational status, separation or divorce, and exposure to domestic violence, all of which increased the likelihood of depression.

Based on the above, it is clear that rural women experience a higher severity of depression. Therefore, it is imperative for healthcare providers in primary care settings to go beyond routine healthcare and actively inquire about these risk factors among rural women. By doing so, we can better screen for and provide timely treatment for depression, ultimately improving the mental well-being of this vulnerable population.

The social and psychological stressors confronted by immigrants contribute to elevated depressive and anxiety symptoms; however, the effects of these stressors differ by gender. When one is expected to pack up their entire life and move to a different country to start a new life, it undeniably takes a toll on one’s mental and physical health.

"I am alone, worried, and angry—This is not me."

Studies revealed that women experienced a deep sense of loneliness; they were worried about themselves and their children and some felt anger at their situation. The loneliness and isolation were described by one participant as “I have nobody, it’s just like you are an island on your own. I have got nobody to help me.” Women described feeling irritable, exhausted, becoming over-emotional and crying easily: “I snapped all the time, unnecessary things would just get to me and I would just fly up”. Some women felt angry and concerned that their anger was directed at their children.

Women also worried constantly about many aspects of their lives, particularly their baby and family, “I felt lonely, I felt like it's scary to have these two kids to be looked after all by myself and do everything for them.” This worry made some women unsure of their mental state: “It’s like your head/mind becomes crazy because I worry all the time.”

Depression's impact extends beyond the sufferer, affecting family members too. It can lead to strained relationships, including constant complaints, criticism, emotional distance, and diminished enjoyment together. Spouses or partners may feel hurt, isolated, or even blame themselves for the loved one's symptoms. Unfortunately, family dynamics can further worsen depressive symptoms.

By acknowledging the unique challenges faced by women and providing them with the support, resources, and destigmatized environment they need, we can work towards a society where mental health issues are met with empathy, compassion, and effective solutions. To create a transformative future for Indian women's mental health, we must empower them with the agency to prioritize their well-being, destigmatize mental health conversations in communities, and ensure that mental health resources are not just available but easily accessible. This holistic approach can unlock a brighter, more fulfilling future where women thrive in their emotional and psychological well-being, and in turn, contribute more vibrantly to society.

Bibliography:

Schmied, Virginia, et al. “Migrant Women’s Experiences, Meanings and Ways of Dealing With Postnatal Depression: A Meta-ethnographic Study.” PLOS ONE, vol. e0172385, no. 3, Public Library of Science, 15 Mar. 2017, 10.1371/journal.pone.0172385.

Hiott, Ann E., et al. “Gender Differences in Anxiety and Depression Among Immigrants.” Families, Systems, & Health, vol. 137–146, no. 2, American Psychological Association, 1 Jan. 2006, doi:10.1037/1091-7527.24.2.137.

Women and Depression | Anxiety and Depression Association of America, ADAA. adaa.org/find-help-for/women/depression.

Cybulska, Anna Maria, et al. “Depressive Symptoms Among Middle-Aged Women—Understanding the Cause.” Brain Sciences, vol. 26, no. 1, Multidisciplinary Digital Publishing Institute, 28 Dec. 2020, doi:10.3390/brainsci11010026