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Träffad av blixten eller långsam kvävning: genuskodade uttryck för depression i en primärvårdskontext
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. (Challenging gender)
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Struck by lightning or slowly suffocating : gendered expressions of depression in a primary health care context (English)
Abstract [en]

Depression is a common mental health problem in primary health care. One third of the Swedish population is expected to experience depression at some point in their lives. The understanding of depression has expanded, both from a lay and primary health care perspective. The number of persons considering themselves as depressed, receiving the diagnosis, and getting treatment for it has increased steadily over the last decades.

Unchanged, however, is that depression is diagnosed twice as often in women as in men, while twice as many men as women commit suicide. These gender differences appear in adolescence. In earlier research biomedical, psychological, and social-cultural explanations of gender differences have been discussed. Patient’s own perspectives have more seldom stood in focus, and men’s narratives in particular are still scarce. In this thesis, gender, i.e. how to be a woman or a man, is considered as a construct, formed and negotiated in social interaction.

The aim of the study is to explore the gendered face of depression from a patient perspective: How is depression expressed and explained by patients in primary health care, by women and men, adults and adolescents? How are depressed women and men portrayed in the media? How do patient and media accounts of depression compare with the perspective offered in medical research articles?

Method and material The analyses are based on data from three different sources: patient narratives, newspaper portrayals and scientific medical articles.

– 37 in-depth interviews were undertaken with primary health care patients diagnosed with depression. Informants were chosen to include both men and women, grown-ups (Studies I + II) and young adults (Study V) of varying occupational and social class backgrounds. Data were analyzed according to grounded theory.

– 26 articles portraying lay informants with depression (Study III) were drawn from three major Swedish daily newspapers by a search of database Mediearkivet 2002. The articles were analyzed by qualitative content analysis.

–82 scientific articles concerning depression in relation to gender were identified in a PubMed search 2002. The understanding of depression in these articles was explored and compared with findings in the grown-up patient narratives and in the media portrayals by means of discourse analysis (Study IV).

Findings Study I captured women’s and men’s formulations of their experiences of depression. To be marked with demands constituted a central experience for both women and men, but the outward manifestations differed in relation to gender as well as to class. Home and work had different priority. Men talked more about physical distress (often chest pain) than about emotions. Women readily verbalized emotional distress – shame and guilt – while physical symptoms were vague and secondary (often about the stomach). Men dealt with insecurity by aggrandizing their previous competence, women by self-effacement.

Study II disclosed gendered trajectories into depression. Four symbolic illness narratives were identified: struck by lightning, nagging darkness, blackout and slowly suffocating. Most of the men considered their bodies suddenly “struck” by external circumstances beyond their control. The stories of women in the study were more diverse, reflecting all four illness narratives. However, the women had a tendency to blame their own personality and to describe depression as insidious and originating from the inside. The women expressed feelings of guilt and shame but also conveyed a personal responsibility and concern with relationships.

Study III identified four themes in media portrayals of depression: displaying a successful facade, experiencing a cracking facade, losing and regaining control and explaining the illness. The mediated image of depression both upheld and challenged traditional gender stereotypes. The women’s stories were more detailed, relational, emotionally oriented and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression.

Study IV revealed gaps in how depression in relation to gender is understood by the patients, the media, and the medical research establishment. There were differences in recognition, in understanding of the reasons, and in contextualization of depression. Although women and men described different symptoms and reasons for falling ill, in scientific articles these gendered differences were conceptualized mainly in terms of hormones and other biological markers.

Study V elucidated the impact of gender on adolescent depression. The young women and men were all striving to be normal, influenced by demanding media images, confronted by identity trouble, and overwhelmed by feelings. They had dreams of an ordinary family and described normative expectations. Getting a safety net of friends and other adults was a way out. Both the young women and men were eager to communicate their distress when given the opportunity. This seemed especially important to some of the young men, who in talking about their emotional problems transgressed gender norms.

Conclusions Patient perspectives enrich the understanding of gendered expressions of depression by making visible transgressions of and breaks with stereotype gender norms. Gender awareness is an important key in clinical consultation. To recognize gendered narratives of illness might have a salutary potential, making depression more visible among men, and relieving self-blame among women. By re-evaluating restrictive gender patterns, the clinician might encourage development of healthier practices of how to be a man or a woman, a development especially important for adolescents.

An integrated model for understanding biological, gender and cultural aspects of depression has yet to be developed. As general practitioners we have a unique possibility to see and to study the whole individual in her social and cultural context.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 59 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1325
Keyword [en]
depression, gender, class, shame, adolescents, media, primary health care, consultation, grounded theory, qualitative research
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-30910ISBN: 978-91-7264-935-4 (print)OAI: oai:DiVA.org:umu-30910DiVA: diva2:288701
Public defence
2010-02-12, Betula, NUS, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-01-22 Created: 2010-01-21 Last updated: 2011-04-18Bibliographically approved
List of papers
1. Beyond weeping and crying: a gender analysis of expressions of depression
Open this publication in new window or tab >>Beyond weeping and crying: a gender analysis of expressions of depression
2005 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 3, 171-177 p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Depression/complications/diagnosis/*psychology, Female, Follow-Up Studies, Humans, Interviews as Topic, Male, Middle Aged, Psychophysiologic Disorders/etiology/psychology, Questionnaires, Self Efficacy, Sex Factors, Social Class, Socioeconomic Factors
Identifiers
urn:nbn:se:umu:diva-6135 (URN)10.1080/02813430510031315 (DOI)16162470 (PubMedID)
Available from: 2007-12-06 Created: 2007-12-06 Last updated: 2017-12-14Bibliographically approved
2. Struck by lightning or slowly suffocating: gendered trajectories into depression
Open this publication in new window or tab >>Struck by lightning or slowly suffocating: gendered trajectories into depression
Show others...
2009 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, no 1, 56- p.Article in journal (Refereed) Published
Abstract [en]

Background: In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression.

Methods: Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory.

Results: The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified – "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" – and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships.

Conclusion: Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.

Place, publisher, year, edition, pages
London: , 2009
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-30888 (URN)10.1186/1471-2296-10-56 (DOI)
Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2017-12-12Bibliographically approved
3. Gendered portraits of depression in Swedish newspapers
Open this publication in new window or tab >>Gendered portraits of depression in Swedish newspapers
Show others...
2008 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 18, no 7, 962-973 p.Article in journal (Refereed) Published
Abstract [en]

Mass media are influential mediators of information, knowledge, and narratives of health and illness. In this article, we report on an examination of personal accounts of illness as presented in three Swedish newspapers, focusing on the gendered representation of laypersons' experiences of depression. A database search identified all articles mentioning depression during the year 2002. Twenty six articles focusing on personal experiences of depression were then subjected to a qualitative content analysis. We identified four themes: displaying a successful facade, experiencing a cracking facade, losing and regaining control, and explaining the illness. We found both similarities and differences with regard to gendered experiences. The mediated accounts of depression both upheld and challenged traditional gender stereotypes. The women's stories were more detailed, relational, emotionally oriented, and embodied. The portrayal of men was less emotional and expressive, and described a more dramatic onset of depression, reflecting hegemonic patterns of masculinity.

Place, publisher, year, edition, pages
Newbury Park, Calif.: Sage Publications, 2008
Keyword
depression, experiences, gender, illness and disease, media
Identifiers
urn:nbn:se:umu:diva-10126 (URN)10.1177/1049732308319825 (DOI)
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2017-12-14Bibliographically approved
4. Gaps between patients, media and academic medicine in discourses on gender and depression: a metasynthesis
Open this publication in new window or tab >>Gaps between patients, media and academic medicine in discourses on gender and depression: a metasynthesis
2009 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 5, 633-644 p.Article in journal (Refereed) Published
Keyword
depression, discourse analysis, gender, medical/health care discourse, metasynthesis
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-22950 (URN)10.1177/1049732309333920 (DOI)
Available from: 2009-05-20 Created: 2009-05-20 Last updated: 2017-12-13Bibliographically approved
5. "My greatest dream is to be normal": the impact of gender on depression narratives of young Swedish women and men
Open this publication in new window or tab >>"My greatest dream is to be normal": the impact of gender on depression narratives of young Swedish women and men
2011 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 21, no 5, 612-624 p.Article in journal (Refereed) Published
Abstract [en]

Depression is common among young people. Gender differences in diagnosing depression appear during adolescence. The study aim was to explore the impact of gender on depression in young Swedish men and women. Grounded theory was used to analyze interviews with 23 young people aged 17 to 25 years who had been diagnosed with depression. Their narratives were marked by a striving to be normal and disclosed strong gender stereotypes, constructed in interaction with parents, friends, and the media. Gender norms were upheld by feelings of shame, and restricted the acting space of our informants. However, we also found transgressions of these gender norms. Primary health care workers could encourage young men to open up emotionally and communicate their personal distress, and young women to be daring and assertive of their own strengths, so that both genders might gain access to the positive coping strategies practiced respectively by each.

Place, publisher, year, edition, pages
Sage Publications, 2011
National Category
Psychiatry Family Medicine
Identifiers
urn:nbn:se:umu:diva-30889 (URN)10.1177/1049732310391272 (DOI)21149850 (PubMedID)
Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2017-12-12Bibliographically approved

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