DEPRESSIONthem, including artists like Jackson Pollock and
Mark Rothko, suffered from varying degrees of
depression (Schildkraut and Aurora 1996). Many
of these artists eventually committed suicide, which
is perhaps one of the most significant and danger-
ous results of depression. At least 15 percent of
people with depression complete the act of sui-
cide, but an even higher proportion will attempt it.
Consequently, individuals with severe cases of de-
pression may experience many suicide-related
thoughts and sometimes need constant surveillance.
Depression is often seen in patients with chronic
or terminal illnesses and in patients who are close
to dying. For example, depression is a common
experience of AIDS patients, and is related to a
range of factors such as physical symptomatology,
number of days spent in bed, and in the perceived
sufficiency of social support. Depression has also
been linked to factors that influence mortality and
morbidity. Higher depressed mood has been sig-
nificantly associated with immune parameters per-
tinent to HIV activity and progression: lower levels
of CD4 T cells, immune activation, and a lower
proliferative response to PHA (a natural biological
reaction that is essential to good health). Depres-
sion is also a critical variable with respect to com-
pliance with treatment, especially in HIV-positive
women of low-socioeconomic status.
Depression is strongly related to the number
and duration of stressors experienced, or chronic
burden. Chronic burden, defined by Leonard
Pearlin and Carmi Schooler (1978) as ongoing
difficulties in major social roles, including difficul-
ties in employment, marriage, finances, parenting,
ethnic relations, and being single/separated/di-
vorced contributes to depression and increases
vulnerability to health problems by reducing the
ability of the body to respond to a physiological
challenge, such as mounting an immune response
to a virus. Related to chronic burden, many as-
pects of depression are concomitants of low-so-
cioeconomic status, traditionally measured by edu-
cation, income, and occupation. Research showing
clear social-class differences in depression also
suggest the contribution of the stress of poverty,
exposure to crime, and other chronic stressors
that vary with social class. Jay Turner, Blair Whea-
ton, and David Lloyd (1995) found that individuals
of low-socioeconomic status were exposed to more
chronic strain in the form of life difficulties in
seven domains (e.g., parenting, relationships, and
financial matters) than individuals of high-socioe-
conomic status, which could account for higher
levels of depression.The influence of culture is one factor that has
not been sufficiently studied in the context of
depression. To date, most clinical-disorder classifi-
cation systems do not sufficiently acknowledge the
role played by cultural factors in mental disorders.
The experience of depression has very different
meanings and forms of expression in different
societies. Most cases of depression worldwide are
experienced and expressed in bodily terms of
aching backs, headaches, fatigue, and a wide as-
sortment of symptoms that lead patients to regard
this condition as a physical problem (Sarason and
Sarason 1999). Only in contemporary Western
societies is depression seen principally as an inter-
nal psychological experience. For example, many
cultures tend to view their mental health problems
in terms of physical bodily problems. That is, they
tend to manifest their worries, guilt feelings, and
strong negative emotions (such as depression) as
physical complaints. This could be because bodily
complaints do not carry the stigma or negative
social consequences that psychological problems
do, and are correspondingly easier to talk about.Although not an essential part of aging, many
people over age sixty-five develop clinical depres-
sion. Surveys suggest that only about 5 percent of
healthy elderly people living independently suffer
depression at any given moment, but more than
15 percent experience depression at some point
during their elderly years, and the condition tends
to be more chronic than in younger people. In
addition, some 25 percent of elderly individuals
experience periods of persistent sadness that last
two weeks or longer, and more than 20 percent
report persistent thoughts of death and dying. The
likelihood of depression varies with the situation
the person is in, and is more likely when the elderly
person is away from his or her family in a novel
setting. For example, some 20 percent of nursing
home residents are depressed. Depression is also
antagonized by serious medical conditions that
elderly men and women may have. Correspond-
ingly, depression is commonly associated with ill-
nesses like cancer, heart attack, and stroke. De-
pression often goes undiagnosed and untreated in
the elderly and is something that caregivers (spouse,