520 Women’s Health Psychology
the highest prevalence rates for women between 18 and
44 years (Kessler, McGonagle, Swartz, Blazer, & Nelson,
1993). Pregnancy and postpartum are also high-risk times
for depression, with postpartum depression occurring in
about 10% to 16% of women in the “rst six months after
they have given birth (Llewellyn, Stowe, & Nemeroff,
1997). Kathol, Broadhead, and Kroenke (1997) report that
depression is more prevalent among primary care patients
with certain mental disorders (e.g., 30% of patients with an
anxiety disorder, 15% to 25% of patients with substance
abuse disorders, 28% of patients with schizophrenia, 30%
to 40% of patients with dementia and 75% of individuals
with obsessive-compulsive disorder). Likewise, Rouchell,
Pounds, and Tierney (1999), indicate that prevalence rates
for depression are higher for individuals with certain physi-
cal illnesses (e.g., 16% to 19% of individuals with CHD,
20% to 38% of individuals with cancer, 27% of individuals
with stroke, and 30% of individuals with HIV/AIDS). These
statistics highlight the importance of examining the inter-
action between mental and physical health to increase the
quality of women•s lives.
Risk factors for the occurrence of an episode of major de-
pression include family history of psychiatric illness, adverse
childhood experiences, personality characteristics, isolation,
and stressful life events (see Kessler, 2000, for a review). For
women, such stressful life events can be associated with
marital and reproductive status (e.g., divorce, death of a
spouse, birth, and miscarriage). Women who assume a care-
taker role for an ill spouse, parent, or child are also at higher
risk for major depression (Kessler & McLeod, 1984;
McCormick, 1995; Rosenthal, Sulman, & Marshall, 1993).
However, many studies do not control for history of depres-
sion and inappropriately conclude that certain risk factors are
associated with the onset of a depressive episode when, in ac-
tuality, history of depression accounts for the association
(Kessler, 2000). The etiology of depression in women re-
mains a conundrum in the research community. Studies that
have examined gender differences in reporting symptoms
conclude that reporting differences does not account for the
higher rates of depression in women (see Kessler, 2000). As
discussed later in this chapter, many theories (e.g., multiple
roles theory) have been presented to explain why women are
twice as likely as men to suffer from major depression. How-
ever, research is still needed in this area to explore risk fac-
tors for the onset of depression, its chronicity, and relapse to
inform prevention interventions and treatment implementa-
tion. Finally, the prevalence of depression is high among
women with speci“c physical illnesses. This highlights the
importance of health psychologists routinely screening for
depression, particularly among those diagnosed with the top
“ve disease killers of women.Anxiety DisordersAnxiety disorders, characterized by panic attacks, worrying,
and fear, are the most common of all mental disorders.
Neugebauer, Dohrenwend, and Dohrenwend (1980) reported
higher rates of anxiety in women than men in the 18 studies
they reviewed, with an average female-to-male ratio of 2.9.
The NCS estimates that the lifetime prevalence rate for all
anxiety disorders is 19.2% for men and 30.5% for women
(Kessler et al., 1994). In examination of speci“c anxiety
disorders, women demonstrated lifetime prevalence rates
of 10.4% for posttraumatic stress disorder as compared to
5.0% for men (Kessler, Sonnega, & Bromet, 1995), and 6.6%
for generalized anxiety disorder (GAD) compared to 3.6%
for men (Kessler et al., 1994). Women are also twice as likely
as men to develop panic disorder and simple phobia (Kessler
et al., 1994; Robins et al., 1984).
Not only are women more prone to experience anxiety
disorders, but also they are more likely to have a comorbid
anxiety condition or other psychiatric disorders. Pigott (1999)
reported that women with panic disorder often have an addi-
tional diagnosis of GAD, simple phobia, or alcohol abuse.
Similarly, anxiety disorders frequently are comorbid with de-
pression (see C. Brown & Schulberg, 1997). Research has
identi“ed physical disorders that often mimic symptoms of
anxiety, including cardiac conditions, pulmonary conditions,
and gastrointestinal conditions (see Henry, 2000); however,
less attention has been given to the actual co-occurrence of
anxiety and various physical illnesses.
As with depression, theories have been postulated as to
why women experience higher rates of anxiety disorders, and
gender-speci“c risk factors have been suggested. However,
research examining gender differences in the etiology of anx-
iety is sparse. Research has not yet offered an explanation as
to why women experience anxiety disorders more often than
men. Further investigation is warranted to create effective
prevention, intervention, and treatment strategies. Health
psychologists also can assist with routine screening for anxi-
ety in medical settings to provide insight into the comorbid-
ity of anxiety with various physical illnesses.Eating DisordersThis section addresses the three primary eating disorders of
anorexia nervosa (AN), bulimia nervosa (BN), and binge
eating disorder (BED). It has been reported that females