In addition,
during the development of the strategic plan, the need for research
focused on the particular needs of special segments of the
population—women, children, elderly persons, members of racial and
ethnic minority groups, and persons who simultaneously have a mood
disorder and another general medical illness—became glaringly apparent.
Accordingly, these issues come up repeatedly in both the scientific
reviews and the listing of research priorities and objectives, and
warrant special mention.
Women and Depression —There
is evidence that women are at least twice as likely as men to experience
a depressive episode within a lifetime, a fact that would not only
suggest the need for the development of gender-specific therapies and
prevention strategies, but also may provide important biological
insights into the causes of depression. For example, women are more
likely than men to experience the symptoms of depression on a seasonal
basis. They are also more likely than men to have a prior history of
anxiety disorder and to experience physical symptoms along with
depressive symptoms. Childhood-onset depression appears to confer
similar risk of subsequent depression for girls and boys. However,
earlier onset in boys is associated with comorbidity and suggests a
“purer” form of depressive disorder. Depressed girls report higher
levels of mood disturbance, while boys report more irritability. Since
gender differences in rates of depression emerge in early adolescence,
there are obvious questions about the role of biological factors,
specifically sex hormones, as well as social and cultural influences in
the development of depression. For women, the age of onset of depression
also often coincides with the age period of childbearing, and there is
evidence that pregnancy and the postpartum state are associated with
heightened risk for bipolar depression.
Children —One of the most fundamental advances in mood disorders
research has been to demonstrate that depression and bipolar disorder
are as much illnesses of childhood and adolescence as they are of
adulthood. Now, researchers need to better understand the childhood
precursor forms of depression and bipolar disorder and how and when to
intervene preventively in children who are most at risk of developing
these illnesses. Designing the most effective mental health care
services for children and adolescents is also a critical task for the
future.
Elderly Persons
—Although depression is strikingly prevalent among older people,
its assessment and diagnosis can be especially challenging. The clinical
presentation of depression in older adults may differ from that seen in
young adulthood and midlife. For example, many
older people tend to report to their health care provider
somatic complaints rather than psychological problems, and often do not
present with the full range of symptoms that constitute the threshold
for diagnosis of clinical depression. In addition to the complications
associated with social isolation and loss, detection of depression in
late life can be obscured by other co-occurring general medical
disorders.
Comorbidity
—The occurrence of depression and other mood disorders in the
context of other illnesses is particularly common among elderly people,
yet it is increasingly clear that depression may play a role in both the
cause and progression of many other ailments across the life span.
Research has shown that treatment of co-occurring, or comorbid,
depression can often improve health outcomes for many people with a wide
variety of diseases. Not only may relief from depression help a person
adhere to complex treatment plans and improve his or her quality of
life, but also researchers are tracing the biological aspects of
depression at the physiological and cellular levels that could affect
these other illnesses.
Race, Ethnicity, and Culture —America
draws its strength from its cultural diversity, but the full potential
of our diverse, multicultural society cannot be realized until all
Americans gain access to quality health care that meets their needs,
particularly when those needs include treatment for depression or
bipolar disorder. Unfortunately, there exists a striking disparity in
the quality of mental health services and the underlying knowledge base
as it pertains to Americans who are members of a racial or ethnic
minority group. The U.S. Surgeon General recently found that racial and
ethnic minority groups bear a greater burden from unmet mental health
needs and thus suffer a greater loss to their overall health and
productivity
Addressing this disparity will take equal action in two areas: training
a scientific workforce for research on mood disorders that reflects the
full racial and ethnic diversity of the Nation, and requiring
researchers to conduct investigations using study groups that reflect
the full racial and ethnic diversity of the Nation. Both steps are vital
because culture influences so many aspects of mood disorders, including
how individuals from a given culture communicate and manifest their
symptoms, their style of coping, their family and community supports,
and their willingness to seek treatment. Likewise, the cultures of
researchers, clinicians, and the service system influence diagnosis,
treatment, and service delivery. Cultural and social influences are not
the only determinants of mood disorders and patterns of service use, but
they do play critically important roles.