Dr Deborah Loxton
Ms Jennifer Byrne
Ms Jane Rich
Professor Julie Byles
University of Newcastle
Project completion year
beyondblue commissioned the Priority Research Centre for Gender, Health, and Ageing (PRCGHA) at the University of Newcastle to undertake a review of Australian literature that pertained to women and depression. Specifically, the systematic literature review aimed to gauge the prevalence and correlates of depression, including postnatal depression, among women living in Australia across the life span. In addition to examining research pertaining to prevalence and correlates of depression in general, the review focuses on age span, women from Indigenous and culturally and linguistically diverse backgrounds, geographic location and rurality.
The research team developed inclusion and exclusion criteria in order to determine the articles that would be reviewed. Keyword searching of six databases and hand searching for pertinent author names yielded 1,271 articles. After applying exclusion criteria, 528 articles were excluded as being irrelevant based on their abstract content. A further 417 articles were excluded based on their total content. This left a total of 111 articles that were reviewed for the report.
The 111 articles that comprise this review were read and, according to the aims of the project, were placed into seven categories: prevalence and correlates of depression; prevalence and correlates of depression at different ages and life stages including depression among young women; postnatal depression; depression among middle-aged women; older women; depression among Indigenous and culturally and linguistically diverse women; and rurality and depression. As would be expected, some articles covered more than one topic area, so some articles are covered in more than one section.
In this review, the point prevalence rates of depression among women ranged from 4.3 per cent to 43.9 per cent. This large range of estimates may be due to variations in the methods used to determine the presence of depression or degree of depressogenic symptomatology, as well as differences in the populations and samples included in the different studies. Higher rates were reported for studies involving younger women, or specific population groups. Studies reporting higher rates also tended to report the prevalence of depressive symptomatology rather than a clinical diagnosis of depression.
Prevalence of depression tended to decrease with age, with older women being less likely to be identified as depressed in most prevalence studies in this review. However, it is unclear whether these age differences occur because of a reduced susceptibility to depression in older age, or whether the differences are due to cohort effects. The triggers or risk factors for depression do appear to vary across the life course, and the postnatal period and the period around menopause are times of particular risk of depression among women.
Among all age groups, traumatic and stressful life events were consistently associated with depression. Violence and abuse, either as a child or as an adult, were particular risk factors. Women also had a higher risk of depression if they experienced separation or divorce, or if they were sole mothers. By contrast, moving into a relationship was protective against depression. Other factors associated with depression included financial stress and socioeconomic disadvantage, reflected in association between depression and educational qualifications and unemployment.
Depression has also been associated with a number of health risk behaviours including use of alcohol, tobacco and illicit drugs, and is more common among women who are overweight or obese. Physical activity has been found to be protective of depression in some studies. Depression is often co-morbid with other mental health and physical conditions such as arthritis, angina and heart disease, and incontinence. The condition is also likely to be recurrent, with previous depression or anxiety being a strong predictor of prevalent depression.
Some correlates of depression were specific to particular age groups. For young women, depression was associated with the later stages of puberty, interpersonal conflict, scholastic failure, skin problems, illicit drug use, transitioning into motherhood and being single. Postnatal depression was correlated with many of the same factors as non-postnatal depression; additional factors included a family history of mental health problems, infant temperament, aspects of the mother’s psychology and interactions with the mother’s partner. In middle-age, surgical menopause was associated with depression. Also noteworthy was the finding that women aged 45-49 years were the most likely of all age groups to be hospitalised for depression. For older women, dental health issues, dependence on others, falls, injuries and pain were associated with depression.
Depression is more common among women who were born in countries other than Australia, although few studies that assessed prevalence of depression among women from different cultural backgrounds were available. Depression is also likely to be higher among Indigenous women; however, the prevalence in this population is unknown.