Abnormal Psychology

Mood Disorders and Suicide 207

3.Anxious-ambivalent attachment, or alternating between seeking support from

the caregiver and withdrawing, often displaying anger. (Adults with this style

chronically worry about their relationships.)

Adults who are characterized by the two insecure forms of attachment are more

vulnerable to depression: Those with anxious-ambivalent attachment are the most

likely to experience episodes of depression, followed by those with avoidant attach-

ment. Adults with secure attachment are least likely to do so (Bifulco et al., 2002;

Cooper, Shaver, & Collins, 1998; Fonagy et al., 1996).

Culture

A person’s culture and context can infl uence how the person experiences and ex-

presses depressive symptoms (Lam, Marra, & Salzinger, 2005). For instance, in

Asian or Latin cultures, people with depression may not mention mood, but talk

about “nerves” or describe headaches. Similarly, depressed people in Zimbabwe

tend to complain about fatigue and headaches (Patel et al., 2001). In contrast, some

depressed people from Middle Eastern cultures may describe problems with their

heart, and depressed Native Americans of the Hopi people may report feeling heart-

broken (American Psychiatric Association, 2000).

The infl uence of culture doesn’t end with the way symp-

toms are described. Each culture—and subculture—also leads

its members to take particular symptoms more or less seri-

ously. For instance, in cultures that have strong prohibitions

against suicide, having suicidal thoughts is a key symptom;

in cultures that emphasize being productive at work, having

diffi culty functioning well at work is considered to be a key

symptom (Young, 2001).

A particular culture can also be infl uenced by another cul-

ture and change accordingly. Consider that depressed people

in China have typically reported mostly physical symptoms of

depression, but these reports are changing as China becomes

increasingly exposed to Western views of depression (Parker,

Gladstone, & Chee, 2001).

Gender Difference

In North America, women are about twice as likely as men to be diagnosed

with depression (American Psychiatric Association, 2000; Marcus et al., 2005),

and studies in Europe find a similar gender difference (Angst et al., 2002; Dal-

gard et al., 2006). Research results indicate that the gender difference arises

at puberty and continues into adulthood (Alloy & Abramson, 2007; Jose &

Brown, 2008).

What might cause the gender difference? One explanation focuses on a rumina-

tive response to stress: women are more likely than men to mull over a stressful situ-

ation, whereas men more often respond by distracting themselves and taking action

(Nolen-Hoeksema, 1987; Nolen-Hoeksema & Morrow, 1993; Vajk et al., 1997).

A ruminative pattern can be unlearned: College students who learned to use distrac-

tion more and rumination less improved their depressed mood ( Nolen-Hoeksema &

Morrow, 1993).

Another explanation for the gender difference in rates of depression is that girls’

socialization into female roles can lead them to experience more body dissatisfac-

tion, which in turn can make them more vulnerable to automatic negative thoughts

that lead to depression (Cyranowski et al., 2000; Nolen-Hoeksema & Girgus,

1994). Another consideration is that women may be more likely than men toreport

symptoms of depression, although not necessarily to experiencemore of these

symptoms (Sigmon et al., 2005). Such a bias in reporting symptoms isn’t limited

to self-reports: Family members are more likely to report female relatives as seem-

ing depressed, even when the females themselves did not report feeling depressed

(Brommelhoff et al., 2004).

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Culture infl uences which symptoms of

depression people experience, express, and

worry about most.

David Young-Wolff/Photo Edit