Kristy dealt with untreated depression herself for almost 20 years. She thought she could ignore her feelings. She prevailed – even during her first divorce when she wondered if her family would be better off without her.
It was only after she retired 15 years later, when she was struggling to lose the nurse career that she loved so much, that she finally turned to a mental health professional. “I would just cry and cry,” said Kristy. “I’ve decided I have to do something.”
While views about mental illness in the United States have improved over the years, the stigma persists. Like Kristy, women may be reluctant to seek treatment for depression. But depression is one of the most common mental disorders, especially during vacations, which can be a time of added stress and loneliness. This year, the COVID-19 pandemic is likely to exacerbate this problem as depression rates have skyrocketed since the pandemic began.
Major depression, commonly known as depression, is more than sadness. People may feel hopeless, irritable, tired, or have physical symptoms such as headaches. During the winter months, more people experience depression when the days get shorter. This phenomenon is known as seasonal affective disorder (SAD).
The holidays that coincide with the onset of winter can also make symptoms of depression worse. The cultural expectation is that this time of year is a time for families and friends to get together, but that’s not an option for everyone, especially during the pandemic.
“The opportunity to spend time with others is limited for women who are alone or single, have no close family members, or are physically removed from their family members, making it difficult to get together,” said Ivy Alexander, Ph.D. , Clinical Professor and Director of the Adult-Gerontological Primary Care Nurse Practitioner Track at the University of Connecticut and a member of the HealthyWomen’s Women’s Health Advisory Council.
Regardless of its cause, depression is a disease that, despite the opinion of some, cannot be poached.
Alexander compares depression to other common medical conditions. “It’s not something that you can decide on. You have to address it like you would deal with high blood pressure,” she said.
Growing up, Kristy, 63, was encouraged to accept what she had to work with in life rather than asking for help. There was no talk of mental illness. “When I was growing up, mental health issues were covered up. They didn’t want anyone to know,” she said.
But stigma can prevent women from tackling depression or benefiting from treatment, and it can even make symptoms worse. In a study of adults over 60 with depression, those who felt strongly that others had stigmatizing beliefs about the disorder also had more severe depression.
In particular, women’s expectations can make them hesitate to seek help, even now that mental health issues are more openly discussed and on the path to destigma. “There’s so much pressure to be the perfect mother or partner,” said Nicole Christian-Brathwaite, a psychiatrist who serves as senior vice president and medical director of telepsychiatry organization InSight + Regroup.
This pressure extends to professional life as well. “Often in the workplace there is a fear of being perceived as vulnerable or weak,” said Christian-Brathwaite.
For women of color, cultural expectations can stand in the way of treating their depression. “Stigma in color communities in mental health has been evident for a very long time,” said Christian-Brathwaite, a black woman.
Stereotypical expectations create further obstacles, especially for black women. “There’s this unfortunate stereotype of the strong black woman or the aggressive black woman,” said Christian-Brathwaite. “Because of the stereotype, people will assume that you don’t need help because you’re that strong woman and you don’t ask for help.”
Barriers persist even when black women seek treatment, which can heighten negative perceptions of depression and treatment. “African American women are less likely to be treated for postpartum depression,” said Christian-Brathwaite. “Because of the delay in diagnosis and improper treatment, they are more likely to develop more severe symptoms of postpartum depression.”
However, Christian-Brathwaite hopes that the increased attention the pandemic has paid to mental health may alleviate some of the stigma in all communities. “People are more willing to discuss mental illness and acknowledge the need for mental treatment,” she said.
Get help when you’re ready
For women with situational or mild depression who are concerned about stigma, there are alternatives to traditional treatments such as medication or therapy. In addition to consulting a doctor, there are other effective ways to reduce symptoms of mild depression outside of a doctor’s office. “There are other ways you might be able to deal with your depression, such as sunlight or exercise,” said Christian-Brathwaite.
Kristy has found that a combination of antidepressants and a therapist will help her, but finding the right therapist can take time and research. “You may not find the right therapist the first time,” she said.
It is important for black and colored women to find a culturally competent therapist, but who can mean more research.
“The percentage of mental health providers who are colored people is very low,” said Christian-Brathwaite. “It can be difficult for an African American woman to find a provider that she can identify with.”
The National Alliance on Mental Illness recommends consulting friends, family members, or cultural organizations for recommendations and asking potential providers whether they have experience dealing with others of their race or ethnicity and whether they have received training in cultural literacy.
Women who are still cautious about therapy may not need to see a therapist at all. “Things like depression and anxiety, which are very common, can be effectively treated in primary care,” said Alexander.
The most important thing is to get treatment. “You may be able to step on water by yourself for a while, but eventually your head will go under,” said Kristy. It is important to take the time to find the right treatment.
“It was an absolute lifesaver.”
Kristy asked us not to use her last name to protect her privacy.
National Institute of Mental Health
National lifeline for suicide prevention
Substance Abuse and Mental Health Administration (SAMSA)