At the PSI conference, UCLA's Dr. Vivien Burtspoke in a really interesting sessionabout depression and why women are more likely to experiencethis "illness of the brain," as she called it,than men.

First, she discussed theWorld Health Organization's (WHO) Global Burden of Disease Project, whichlooks at the most disabling conditions across the world and the impact they have on global health. She stated that in 2000, the top 5 most disabling conditions were:

1. Lower respiratory infections (pneumonia)
2. Perinatal conditions
3. HIV/AIDS
4. Major depression
5. Diarrheal diseases

I checked the WHO website, and found that their report has been updatedwith data from2004. Depression has actually moved up to the third most disabling condition worldwide. What I found quite interesting is this paragraph in their report:

"Unipolar depression makes a large contribution to the burden of disease, being at third place worldwide and eighth place in low-income countries but at first place in middle- and high-income countries. Effective treatments for depression are available, suggesting that this burden could be reduced."

I often hear those who don't believe that depression is a real illness state that it is purely a Westernphenomenon and doesn't exist in other places. Clearly that is not the case, if even in low-income countries it is the eighth most disabling conditionamong the 135 illnesses that were studied. For your clarification, here's a sampling of which countries are listed in each category:

High-Income: US, Canada, Australia, France, Germany, Greece, Japan, Kuwait, Saudi Arabia, Singapore, Spain, Israel, Finland, Iceland, UK, Aruba, Puerto Rico

Middle-Income: Argentina, Chile, Czech Republic, Hungary, Mexico, Poland, South Africa, Turkey, Brazil, Egypt, Ecuador, Indonesia, Iraq, Thailand, Ukraine

Low-Income: Afghanistan, Bangladesh, Cambodia, Congo, Ethiopia, India, Kenya, Mongolia, Nicaragua, Pakistan, Sudan, Vietnam

In the year 2030, the WHO estimates that depression will move into #1 as THE most disabling condition across the globe. Ischemic heart disease will be second, traffic accidents third andcerebrovascular disease [stroke] fourth.

Depression is not just disabling. The awesome Dr. Ruta Nonacs of the MGH Center for Women's Mental Health sent me a studyappearing in the August issue of the British Journal of Psychiatrystating that depression and smoking create the same increased risks for mortality! From Medscape:

"'We were a bit surprised to find that depression — and not necessarily at a severe level — is associated with mortality at the same strength as smoking,' lead author Arnstein Mykletun, PhD, from the University of Bergen, Norway, told Medscape Psychiatry. 'Perhaps one of the more important new findings is that depression is that strong, even taking into account a lot of potential confounding factors including health status,' he added."

In the same article, Dr. Peter Kramer from Brown Universitycommented that this study, which was large and very thorough, is worth paying attention to. "Depression, he said, is a multisystem disease that involves changes not only in the brain but also in blood vessels, heart, and bones. 'Of the major common mental illnesses, depression really stands out as looking like ordinary disease across a number of body systems.'"

So now we turn to women. When it comes to women, the WHO states:

"Mental disorders are an important source of lost years of healthy life for women aged 15-44 years. They make up 3 of the 10 leading causes of disease burden in low- and middle-income countries, and 4 of the leading 10 in high-income countries; self-inflicted injuries are also in the leading 10 causes for low- and middle-income countries. [Those disorders include depression, bipolar disorder, schizophrenia and panic disorder.]"

What does this have to do with postpartum depression? Women are more likey to have theirfirst psychiatric admission in the first year postpartum than at any other time in their lives.

Dr. Burt explained that there are two major buckets contributing to why women are more likely to suffer from depression than men. The first is biological. We are sensitive to hormonal changes that are happening all of the time in our bodiesand can affect mood. We have quite a few major reproductive-related transitions in our bodies, includingthe timing of puberty, our prementrual days each month, miscarriage, pregnancy and perimenopause. (Constant hormonal turmoil!) The second is psychosocial. A traumatic history such as parental loss, divorce, marital discord, illness, assault and other such traumas can impact the likelihood of depression, as can childhood developmental issues like poor parental attachment. Childbearing responsibilities and a young maternal age, as well as negative self image, also raise the risk of depression in women.

Depression is real, no matter where you are on the planet, and women are at the greatest risk. Don't ignore it. Get help.