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Why is depression more common in women than in men
- 4. 罹患抑鬱症的風險性 20 ％〜 26 ％ 8 ％〜 12 ％
- 6. 抑鬱症 (Depression) 生物學的解釋 (Biological explanations) 心理學的解釋 (Psychological explanations) 社會文化的解釋 (Sociocultural explanations)
- 8. 荷爾蒙的性別差異
- 9. 鑑於抑鬱症發病的高峰 與婦女的生育年齡 (25 至 44 歲之間 ) 重 合， 荷爾蒙的風險因素可能會起到一定的作 用。
- 10. 雌二醇 (Estradiol) 孕酮 (progesterone) 雌激素 (estrogen) 和孕激素 (progesterone) 已被證明會影響神經遞質、神經內分泌和晝夜系統， 這些都與心境障礙有關。
- 13. 15 ％的婦女 經歷產後抑鬱症。
- 14. 雖然更年期 (menopause) 是婦女罹患抑鬱症的的風險下降的一段時間， 但是圍絕經期 (periomenopausal period) 對 那些有抑鬱症病史的人是風險增加的時間。
- 15. 其它可能會導致女性抑鬱症的內分泌風險因素 是下丘腦 - 垂體 - 腎上腺（ HPA ）軸 和甲狀腺功能的性別差異。
- 16. 抑鬱症遺傳傾向
- 19. 在因應方式的性別差異
- 23. 對情感投入的性別差異
- 26. 社會的角色和文化的影響
- 36. 諮詢醫生的性別差異
- 39. 在社會中的性別差異
- 42. 季節性情緒失調
- 43. 季節性情緒失調 (Seasonal Affective Disorder ， SAD) 也叫做「冬季憂鬱症」 (Winter depression) ， 是一種感情的，或者情緒的失調。
- 45. 在熱帶， SAD 即便存在也很少見。 但在北緯 30 度以北或者南緯 30 度以南， SAD 顯著存在。
- 46. 在一般人口當中，有百分之一點五左右的盛行率， 在成年人中較常見。好發年齡在二十至三十歲之間。 SAD 的主要症狀是︰憂鬱、渾身無力、疲倦、 沒精神、暴食的傾向 ( 特別是吃碳水化合物 ) 、 嗜睡、體重增加等。
- 48. 女性較男性易患憂鬱症
Editor's Notes
- 為什麼女性罹患抑鬱症比男性更常見？ Why Is Depression More Common in Women Than in Men?
- It has been widely documented that there are gender differences in depression prevalence, with women experiencing major depression about twice as often as men. The lifetime risk of major depression in women is about 20% to 26%, compared to about 8% to 12% for men. This risk exists independent of race or ethnicity. 抑鬱症的患病率存在有性別差異，它已被廣泛證明，女性經歷嚴重抑鬱症的機率往往是男性的兩倍。 女性終身罹患抑鬱症的危險性為20％〜26％，而男性約為8％至12％。這種風險與種族或族裔無關。
- 女性終身罹患抑鬱症的危險性為20％〜26％，而男性約為8％至12％。這種風險與種族或族裔無關。
- Several risk factors have been studied which might account for gender differences in depression prevalence: 專家們針對幾個風險因素進行研究，這些可能解釋了抑鬱症患病率的性別差異： ============================================================================== 風險因素（Risk factors） 風險因素是指引起或增加風險事故發生的機會或擴大損失幅度的原因和條件。構成風險因素的條件越多，發生損失的可能性就越大，損失就會越嚴重。 風險因素是風險事故發生的潛在原因，是造成損失的內在的或間接的原因。
- Biological explanations 生物學的解釋 1. Compared to men, women may have a stronger genetic predisposition to developing depression. 2. Compared to men, women are much more subjected to fluctuating hormone levels. This is especially the case around the time of childbirth and at the menopause, both of which are associated with an increased risk of developing depression.
- Sex Differences in Hormones: •激素的性別差異：
- Given that the peak onset of depressive disorders in women coincides with their reproductive years (between the ages of 25 to 44 years of age), hormonal risk factors may play a role. 鑑於抑鬱症發病的高峰與婦女的生育年齡（25至44歲之間的年齡）重合，荷爾蒙的風險因素可能會起到一定的作用。
- Estrogen and progesterone have been shown to affect neurotransmitter, neuroendocrine and circadian systems that have been implicated in mood disorders. 雌激素和孕激素已被證明會影響神經遞質、神經內分泌和晝夜系統，這些都與心境障礙有關。 ========================================================================== Estrogen ['estrədʒən] 雌激素 雌激素（estrogen）是一類主要的女性荷爾蒙，包括雌酮、雌二醇等。雌二醇是最重要的雌激素。雌激素主要由卵巢分泌，少量由肝，腎上腺皮質，乳房分泌。懷孕時，胎盤也可大量分泌。男性的睾丸也會分泌少量。卵巢分泌的主要是β-雌二醇，其他雌激素的重要性較小。 ============================================================================ progesterone [prəu'dʒestərəun] 孕酮 孕酮（progesterone，亦稱為黃體酮、孕甾酮、黃體甾酮、黃體激素、助孕激素、助孕素或助孕酮）是一種涉及女性月經週期、妊娠和對人類還又其他動物的胚胎有影響的類固醇。孕酮是一種女性荷爾蒙，參與人類與其他動物的雌性月經週期，支援懷孕與胚胎形成。孕酮是屬於一類稱為孕激素（progestogen）的荷爾蒙，也是人類最重要的孕激素。 未懷孕的女性，其孕酮只在每次月經週期的後半段才由卵巢黃體大量分泌。腦、肝與腎上腺也會分泌。懷孕時（第三個月開始），胎盤也可大量分泌。
- The fact that women often undergo mood disorders associated with their menstrual cycle, like premenstrual dysphoric disorder, also points to a relationship between female sex hormones and mood. 事實上女性在她們的月經週期往往會經歷情緒障礙，像經前煩躁症，也道出了女性的性激素和情緒之間的關係。
- In addition, the hormonal fluctuations associated with childbirth are a common trigger for mood disorders. 除此之外，分娩所引起的激素的波動是情緒障礙一個常見的觸發因素。
- In addition to premenstrual dysphoric disorder, up to 15% experience postpartum depression. 除了月經前焦慮障礙，15％的婦女經歷產後抑鬱症。 ========================================================================== One recent study indicated that as many as 25 percent of women suffer from depression during either pregnancy or postpartum period. Yet, in most of these women, the illness goes unrecognized and untreated.
- Although menopause is a time when a woman's risk of depression declines, the periomenopausal period is a time of increased risk for those with a history of major depression. 雖然更年期是婦女罹患抑鬱症的的風險下降的一段時間，但是圍絕經期對那些有抑鬱症病史的人是風險增加的時間。 =================================================== Menopause [‘menəpɔ:z] 絕經期 圍絕經期（perimenopausal period)是指婦女40歲後出現的卵巢功能逐漸衰退，生殖器官開始萎縮向衰退過渡的時期，是一個逐步變化的過程。一般發生在45-55歲之間，平均持續4年，可以分為絕經前期、絕經期以及絕經後期。
- Other hormonal factors that may contribute to a woman's risk for depression are sex differences related to the hypothalmic-pituitary-adrenal (HPA) axis and to thyroid function. 其它可能會導致女性抑鬱症的內分泌風險因素是下丘腦 - 垂體 - 腎上腺軸（HPA）軸和甲狀腺功能的性別差異。 ================================================================================= 下丘腦-垂體-腎上腺軸 (HPA或HTPA軸)，也被叫做 邊緣系統-下丘腦-垂體-腎上腺軸（LHPA軸），是一個直接作用和回饋互動的複雜集合，包括 下丘腦（腦內的一個中空漏斗狀區域）,腦垂體（下丘腦下部的一個豌豆狀結構），以及腎上腺（腎臟上部的一個小圓椎狀器官）。這三者之間的互動構成了HPA軸。HPA軸是神經內分泌系統的重要部分，參與控制應激的反應，並調節許多身體活動，如消化，免疫系統，心情和情緒，性行為，以及能量貯存和消耗。從最原始的有機體到人類，許多物種，都有HPA軸。它是一個協調腺體，激素和部分中腦（特別是參與介導一般適應綜合征 (GAS)的中腦區域）相互作用的機制。
- 2. Women have a stronger genetic predisposition for depression than men based on identical and fraternal twin studies, as well as documented and detailed family history records. 2.比起男性，女性有較強的抑鬱症遺傳傾向，根據同卵和異卵雙胞胎的研究，以及記錄和詳細的家族病史記錄。 ================================================================================== 1. Compared to men, women may have a stronger genetic predisposition to developing depression.
- Psychological explanations 心理學的解釋 3. Women are more ruminative(沉思的，默想的，愛反復思考的) than men, that is, they tend to think about things more—which, though a very good thing, may also predispose them to developing depression. In contrast, men are more likely to react to difficult times with stoicicism(禁欲主義； 堅忍； 淡泊； (S-)斯多葛學派 ), anger, or substance misuse. 4. Women are generally more invested in relationships than men. Relationship problems are likely to affect them more, and so they are more likely to develop depression. 4.婦女一般都比男性更投入關係。感情問題會影響到她們更多，所以她們更容易患抑鬱症。
- Gender Differences in Coping Style: 在應對方式的性別差異
- Coping style is a person's characteristic strategies used in response to life problems or traumas. These can include thoughts, emotions or behaviors. 應對方式是一個人為了應對生活中的問題或創傷用的特殊策略。這些可以包括思想、情感或行為。
- Studies show that women tend to use a more emotion-focused, ruminative coping style, mulling their problems over in their minds, while men tend to use a more problem-focused, distracting coping style to help them forget their troubles. 研究表明，女性傾向於使用更多的情緒為中心的、沉思的應對方式，在她們心中思索自己的問題，而男性傾向於使用更多以問題為中心、分散注意力的應對方式，幫助他們忘記他們的麻煩。
- It has been hypothesized that this ruminative coping style could lead to longer and more severe episodes of depression and contribute to women's greater vulnerability to depression. 據推測，這種沉思的應對方式可能會導致更長、更嚴重的抑鬱症的發作，導致女性對抑鬱症的脆弱性更大。
- 4. Women are generally more invested in relationships than men. Relationship problems are likely to affect them more, and so they are more likely to develop depression. 4. 女性一般都比男性更投入關係。感情問題會影響到她們更多，所以她們更容易患抑鬱症。
- Sociocultural explanations 社會文化的解釋 5. Women come under more stress than men. Not only do they have to go work just like men, but they may also be expected to bear the brunt of maintaining a home, bringing up children, caring for older relatives, and putting up with all the sexism! 6. Women live longer than men. Extreme old age is often associated with bereavement(親人喪亡，喪失親人，喪親之痛), loneliness, poor physical health, and precarity(不穩定)—and so with depression. 7. Women are more likely to seek out a diagnosis of depression. They are more likely to consult a physician and more likely to discuss their feelings with the physician. Conversely, physicians (whether male or female) may be more likely to make a diagnosis of depression in a woman.
- Social Roles and Cultural Influences
- 5. Women come under more stress than men. Not only do they have to go work just like men, but they may also be expected to bear the brunt of maintaining a home, bringing up children, caring for older relatives, and putting up with all the sexism! 5.婦女受到比男性更多的壓力。她們不僅像男人一樣必須去工作，而且她們也被期望承擔維持家庭、撫養子女、照顧老年親屬，同時要忍受所有的性別歧視！
- It has also been theorized that women who become housewives and mothers may find their roles devalued by society while women who pursue a career outside the home may face discrimination and job inequality or may feel conflicts between their role as a wife and mother and their work. 也有人推測，女性成為家庭主婦和母親之後可能會發現自己的角色被社會貶低，而追求家庭以外的職業婦女可能面臨歧視和工作的不平等或可能會覺得他們作為一個妻子和母親角色與她們的工作之間存有衝突。
- Due to their social circumstances, adverse life events associated with children, housing or reproduction may hit women especially hard because they perceive these areas as important to their definition of themselves and may feel they have no alternative ways to define themselves when these areas are threatened. 由於她們的社會環境，與兒童、住房或生殖相關不利的生活事件可能會造成女性更嚴重的困擾，因為她們認為這些領域對她們自己是相對重要的，所以當這些領域受到威脅而且沒有解決方法時，她們將會不知所措。
- Differences in Frequency of and Reaction to Stressful Life Events: 在生活中面對壓力事件的頻率和反應方式的差異：
- Evidence suggests that, throughout their lifetimes, women may experience more stressful life events and have a greater sensitivity to them than men. 有證據表明，在整個生命週期，女性可能會遇到更多的生活壓力事件，並且對這些事件比男性有更高的敏感性。
- Adolescent girls tend to report more negative life events than boys, usually related to their relationships with their parents and peers, and to experience higher levels of distress related to them. 青春期少女比男生經歷更多的負面生活事件，通常與她們的父母和同齡人有關，並體驗到更高度的痛苦。
- Studies of adult women have found that women are more likely than men to become depressed in response to a stressful life event and to have experienced a stressful event within six months prior to a major depressive episode. 對成年婦女的研究發現，面對生活壓力事件，女性比男性更容易變得抑鬱，並在抑鬱發病之前六個月內有經歷過壓力事件。
- 4. Women live longer than men and extreme old age is often associated with bereavement, loneliness, poor physical health, and other factors that predispose to depression. 4.女性壽命較男性長，而老年往往與喪親之痛、孤獨、不健康的身體等因素有關，更容易罹患抑鬱症。
- 5. Women are more likely than men to consult a physician if they do not feel well or have symptoms of depression, and are therefore more likely to be diagnosed. There is also some evidence that both male as well as female physicians are more apt to make a diagnosis of depression in women than men with identical complaints. 5.女性比男性更容易諮詢醫生，如果他們不舒服或有抑鬱症的症狀，因此更容易被診斷。也有一些證據表明，男性和女性的醫生更容易使抑鬱症的女性診斷比男性具有相同投訴。
- There is also some evidence that both male as well as female physicians are more apt to make a diagnosis of depression in women than men with identical complaints. 也有一些證據表明，男性和女性的醫生更容易使抑鬱症的女性診斷比男性具有相同投訴。
- Gender Differences in Socialization: •在社會中的性別差異：
- Researchers have found that gender differences in socialization could play a role as well. Little girls are socialized by their parents and teachers to be more nurturing and sensitive to the opinions of others, while little boys are encouraged to develop a greater sense of mastery and independence in their lives. This type of socialization is theorized to lead to greater depression in women, who must look outside themselves for validation. 研究人員發現，在社會的性別差異也有影響。小女孩從小被父母和老師教導對別人的意見要更包容和敏感，而小男孩卻被鼓勵要發展更強的掌握和獨立生活的意識。這種型態的社會化理論讓女性更須尋求外部的認可，而導致女性更容易罹患抑鬱症。
- 6. Seasonal Affective Disorder (SAD syndrome) is four times more common in women than men, and its incidence increases the farther away you live from the Equator. For example, Tromso, a city in Norway 200 miles north of the Arctic Circle, has close to 50 days during the winter when the sun is never seen. This period is referred to as morketi den (murky time) and as one psychiatrist noted, “The whole city slows down, people’s concentration and work capacity are reduced and they are always tired. There is a definite increase in depression, particularly in women.” Sales of sleeping pills, tranquilizers as well as “pep” pills rise sharply as do accidents. The sun’s return after 7 weeks is celebrated as Soldag (Sunday), and the first rays are greeted with tears, prayers and special wishes, children are sent home early from school and everyone stops working.
- Seasonal Affective Disorder (SAD syndrome) is four times more common in women than men, and its incidence increases the farther away you live from the Equator. 罹患季節性情緒失調，女性是男性的4倍，居住在離赤道越遠其發病率越高。