In their January 2016 issue, the journal Social Science and Medicine published Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders, by Jonathan Platt, MPH, Seth Prins, PhD candidate, Lisa Bates, PhD, and Katherine Keyes, PhD, MPH. All the authors work at Columbia’s Department of Public Health.
Here’s the abstract:
“Mood disorders, such as depression and anxiety, are more prevalent among women than men. This disparity may be partially due to the effects of structural gender discrimination in the work force, which acts to perpetuate gender differences in opportunities and resources and may manifest as the gender wage gap. We sought to quantify and operationalize the wage gap in order to explain the gender disparity in depression and anxiety disorders, using data from a 2001-2002 US nationally representative survey of 22,581 working adults ages 30-65. Using established Oaxaca-Blinder decomposition methods to account for gender differences in individual-level productivity, our models reduced the wage gap in our sample by 13.5%, from 54% of men’s pay to 67.5% of men’s pay. We created a propensity-score matched sample of productivity indicators to test if the direction of the wage gap moderated the effects of gender on depression or anxiety. Where female income was less than the matched male counterpart, odds of both disorders were significantly higher among women versus men (major depressive disorder OR: 2.43, 95% CI: 1.95-3.04; generalized anxiety disorder OR: 4.11, 95% CI: 2.80-6.02). Where female income was greater than the matched male, the higher odds ratios for women for both disorders were significantly attenuated (Major Depressive Disorder OR: 1.20; 95% CI: 0.96-1.52) (Generalized Anxiety Disorder OR: 1.5; 95% CI: 1.04-2.29). The test for effect modification by sex and wage gap direction was statistically significant for both disorders. Structural forms of discrimination may explain mental health disparities at the population level. Beyond prohibiting overt gender discrimination, policies must be created to address embedded inequalities in procedures surrounding labor markets and compensation in the workplace.”
In other words, when women were receiving less pay than men for the same work, they were about two and a half times more likely to “have major depressive disorder,” and about four times more likely to “have generalized anxiety disorder” than their male counterparts. But when women were earning more than men, the odds were 1.2 and 1.5 respectively.
The use of psychiatric terminology (“major depressive disorder” and “generalized anxiety disorder”) constitutes something of a barrier to communication here, but the general message is clear: people (in this case women) who are routinely treated unfairly and discriminately are more likely to be depressed and anxious, than those not so treated.
This is hardly surprising. Depression and anxiety are not illnesses. They are adaptive mechanisms – messages from our bodies alerting us to the need to make changes. So, for instance, a person living in a high crime neighborhood might experience depression and anxiety. These feelings are not symptoms of an illness. Rather, they are the normal and appropriate emotional concomitants to the knowledge that one’s living arrangements are not safe, wholesome, or comforting.
The feelings of depression and anxiety are, in effect, a “nudge” from the body to move to safer surroundings, analogous to the urges that animals feel to move to higher ground in time of flooding, or to move to warmer latitudes as winter approaches.
But in a great many cases, the individual is unable to move, either because of family ties, lack of means, or other reasons. So the urge to move lies unrequited, where it grows stronger, and saps the person’s energy and will. The feelings of hopelessness, anhedonia, worthlessness, and guilt, codified in the DSM as “symptoms” of the “illness, major depressive disorder” are in fact the eminently appropriate response to being trapped in an untenable but inescapable situation.
And in this regard, gender wage discrimination is an extremely fast-holding trap. Even if the victim can manage to find another job, there is every likelihood that the wage discrimination will be as strong as it was in her previous position.
Platt et al found that women in a large US nationally representative sample were earning only 54% of men’s pay. This figure, when adjusted for productivity, was increased to 67.5%. But even by the latter reckoning, this is an enormous difference. For every man earning $30,000 per year, his matched female counterpart was earning about $20,000. Over a forty-year working career, this amounts to a $400,000 disparity.
Quoting again from Platt et al:
“In sum, there are robust and long-standing gender disparities in depression and anxiety disorders, in addition to persistent gender disparities in wages. Although the latter are somewhat reflective of differential individual-level attainment of characteristics conducive to productivity, a large proportion of this gap remains after accounting for these factors and is likely the result of discriminatory processes operating at structural, institutional, and individual levels. This ‘unexplained’ portion appears to be increasing.”
So what we’re seeing here is one more piece of evidence that depression is not an illness to which women just happen to be “prone.” Rather, it is an entirely appropriate and realistic response to an intolerable situation. And when the situation can’t be escaped, the depression becomes, understandably, an abiding and persistent sense of joylessness and unfulfillment. And when this kind of discrimination is combined with the fact that many employed women come home to another five or six hours of housework and childcare, the joyless treadmill factor increases enormously.
Psychiatry then enters the picture, proclaiming with its customary unsupported assurance, that episodes of depression and anxiety that cross arbitrary and vaguely-defined thresholds of severity, frequency, and duration, regardless of their source, are illnesses – just like diabetes. These illnesses are caused by deficits of neurochemicals for which, by great good fortune, psychiatry has “very effective” remedies in the form of pills and high voltage electric shocks to the brain.
Psychiatry also has an “explanation” for the gender gap disparity in depression. On the NIMH website you will find a page called Depression in Women. There’s a section headed “What causes depression in women?” Here’s the section quoted in full:
“Several factors may contribute to depression in women.
Genes—women with a family history of depression may be more likely to develop it than those whose families do not have the illness.
Brain chemistry and hormones—people with depression have different brain chemistry than those of people without the illness. Also, the hormones that control emotions and mood can affect brain chemistry.
During certain times of a woman’s life, her hormones may be changing, which may affect her brain chemistry. For example, after having a baby (postpartum period), hormones and physical changes may be overwhelming. Some women experience postpartum depression, a serious form of depression that needs treatment. Other times of hormonal change, such as transition into menopause, may increase a woman’s risk for depression.
Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression in some women.”
So there it is: genes, brain chemicals, hormones, and stress. Stress, of course, is a valid consideration here, but note how the NIMH has worded it: “Stress…may trigger depression…” Trigger is a firearms analogy and denotes a relatively minor event that initiates a major event in a system that is already prepared and primed. So, the loss of a loved one – to use the NIMH’s own example – doesn’t cause feelings of despondency and depression; rather, it triggers these feelings in “some women,” presumably those already primed with “different brain chemistry” and depression-prone genes.
The Platt et al study is thorough and meticulous and was picked up by several mainstream media, including the Wall Street Journal, the New York Times, and the Guardian. But I have not been able to find a single mention of it on any psychiatry-promoting site. This is the same psychiatry that consistently asserts its commitment to a biopsychosocial perspective.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.