Women and Midlife Depression: Is Everything You 'Know' Wrong?

Empty nests. Menopause. Midlife crisis. Those are some of the reasons midlife is supposed to cause depression in women.

But as with so much information about midlife, that is at best only part of the story.

While depression is more common in women than men, recent research emphasizes what academics -- but not the general public -- have known for years: for most women, midlife is a positive time in their lives. Depression is more common in younger women, and for most, menopause and children leaving home are not psychologically traumatic.

"Predicting First Depressive Episodes in Middle-Aged Women," a study just presented at the 2007 American Psychological Association annual meeting, tracked 42 to 52 year old women for ten years. The researchers found that many factors were tied to midlife depression in women. A primary one was stressful life events such as loss of work, a death of a spouse or someone close, divorce, and the like. Health problems and a history of anxiety were also tied to episodes of depression. Menopause was one factor of many.

This ties to other recent studies that led the U.S. Surgeon General to conclude that "Menopause ... has little bearing on gender differences in depression. Contrary to popular beliefs, menopause does not appear to be associated with increased rates of depression in women ... menopause by itself is not a risk factor for depression."

In fact, an early 1990 study in Pittsburgh concluded that "natural menopause is a benign event for the majority of middle-aged healthy women." A later study in Boston and a large nationwide survey backed up that conclusion.

What about those women who do get thrown for a loop by the onset of menopause? The Boston and Pittsburgh studies indicate that it may be a matter of predisposition: if you expect menopause to be bad, it will be. Compared to women who had a neutral or positive attitude toward menopause before going through it, women who had a negative view were far more likely to report the experience left them depressed, irritable, and bothered by hot flashes or insomnia.

That expectation may be linked to other psychological factors. Women's health site DrDonnica,com says "Menopause is a risk factor for depression in certain women: women who have had a previous history of depression (including postpartum depression), women with any other psychiatric illness, women with a family history of menopausal depression, and women with a history of premenstrual dysphoric disorder (PMDD, otherwise known as “PMS”)."

This is remarkably similar to most people's experience with midlife crisis: for many, it doesn't exist. People who do go through what they think of as a midlife crisis are often battling a crisis that happens in midlife, such as divorce. And the worst affected tend to be people with a psychological history of neuroticism or depression.

That coincides with the recognition that, for many, midlife is a good period of their lives. The incidence of depression in women is highest in the 30's. And midlife is getting better. Stephanie Kasen and Patricia Cohen of Columbia University found that depression seems to be increasing in younger women, but at the same time it's decreasing in the middle aged. That follows a long-term trend: women used to get more depressed as they aged, but now the opposite occurs.

This is further evidence that life experience, social norms, socio-economic status, stress, and other non-genetic factors play a large role in triggering depression. The good news for middle-aged women is that these forces, in some combination, are trending their way and reducing their risk for midlife depression.

It's also good news that attitude and expectations can help prevent depression. If you want to avoid feeling depressed at menopause, or when the kids head off to college -- make yourself expect that it won't!

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Other sources than the links above:

"Mental Health: A Report of the Surgeon General," Chapter 4: Adults and Mental Health.

"The Menopausal Transition and the Aging Process" in "How Healthy Are We," University of Chicago Press.

"Depression in Adult Women: Age Changes and Cohort Effects," American Journal of Public Health v93(12), December 2003.

"Depression: What Every Woman Should Know," at the National Institutes of Mental Health website.

"Taking the Long View of Depression," in Focus: News from Harvard Medical, Dental, and Public Health Schools.