Women's Depression: Before Or After Marriage, When Women Are More Depressed?

Dear Editor

Depression is a widespread mental illness. It is distinguished by persistent sadness and a loss of interest or pleasure in previously rewarding or pleasurable activities. It can also interfere with sleep and appetite. Tiredness and lack of concentration are common symptoms [1]. Depression is a chief reason for the Global Burden of Disease [2]. It is estimated that 3.8% population in the world suffers from depression. Around 280 million people worldwide suffer from depression [3]. According to a new study published in The Lancet, the overall number of mental diseases increased considerably in 2020, with an additional 53.2 million cases of depression [4]. Depression has a high lifetime prevalence; associated disability, chronic course, and recurrence have been noted [5]. In addition, depression has a frequent relationship with other prevalent chronic medical illnesses (e.g., diabetes, angina, asthma, arthritis, etc.), and the incremental worsening of their outcomes has been established [5].

There are gender differences in the rates of prevalent mental diseases, especially depression [6]. For example, a recent study shows women suffer from significant depression more often than their male counterparts [7, 8]. Additionally, women are 1.5 to 3 times more likely than men to experience a major depressive episode at some point in their life, with percentages ranging from 6.0 to 17.0 percent [9]. Furthermore, in 2010 the global prevalence of depression among women and men was reported to be 5.5% and 3.2%, respectively, indicating a 1.7-fold increase in women [10, 11].

A study reported that 15.0% of married women were at risk of depression [12]. Also, another study conducted among married women found that 33.3% of participants were depressed [13]. Furthermore, one recent study revealed that 20.1% of married women suffer from severe depression [14]. On the other hand, another study found that depressive symptoms are 17.0% among unmarried women [15]. Depression status is not the same in different stages in women's life. Married women suffer more depression than unmarried ones [16]. A comparative study conducted on 100 working women (an equal number of married and unmarried) concludes that compared to unmarried women, married women have a higher rate of depression [17]. Also, another comparative study conducted on 320 participants, where 160 were married and 160 were unmarried women, revealed that married women were more depressed than unmarried women [18]. On the contrary, according to one study, married women are less likely than unmarried women to report depressive symptoms [19].

There are several reasons behind women's depression. For example, a previous study showed that age, possession of own vehicle, years of schooling, and recent family deaths were significantly associated with depression among married women [13].

Pregnancy is one of the most challenging times in a woman's life, with significant physical, mental, and sexual well-being [20]. Depression associated with childbearing can occur during pregnancy (prenatal depression), after birth (postnatal depression), or both (perinatal depression) [21]. According to several research studies, common mental disorders (depression and anxiety) during pregnancy range from 4.0% to 25.0% [22, 23]. Prevalence rates of prenatal depression during the early weeks of pregnancy were reported to be 5.19% in one study [24]. According to the findings of another study, the rate of prenatal depression was 35.7% [25]. Over one-third of women worldwide experience physical or sexual violence; the lifetime prevalence of violence ranges from 10.0 to 69.0%, with intimate partner violence accounting for most cases [26]. The presence of domestic violence was found to impose a five times higher and highly significant risk of developing prenatal depression among women [27]. Prenatal depression has been linked to occupation, domestic violence, and a lack of social support [27]. The prevalence of postpartum depression was 15.6% to 39.4% [28-30]. Postpartum depression was linked to being widowed/widower, having limited social support, having a present hospitalized child, having experienced the death of a family member or close relative, having an abortion history, having low birth weight, gestational age below 36 weeks, unplanned pregnancy, relatives' mental illness, had no antenatal and postnatal visit [28, 30]. Postpartum depression was linked with job involvement after child delivery, job loss due to pregnancy, history of miscarriage or stillbirth or child death, unintended pregnancy, management of delivery cost by borrowing, selling, or mortgaging assets, depressive symptoms during pregnancy, and intimate partner violence [30]. The prevalence of peripartum depression was 14.0% [31]. Emergency Caesarean sections and unemployment have been linked to the development of peripartum depression [32].

Additionally, mothers of young children are more likely to develop depression and mental health disorders [33]. One recent study revealed that the rate of depression among mothers of young children is so high as well as pointed out the link between children's lifestyles and behavioral factors, such as child's temperament, television watching, and internet use, with the elevated level of depression among mothers [34]. Besides mother's depression is associated with a child's sickness [34]. Furthermore, lower self-rated health status is one of the causes of feelings of depression among unmarried women [35].

Human being likes to see dreams; women want to see visions more. They dream about future life partners, family, and children. Marriage is the beginning of a new chapter in a women's life. Although unmarried women are worried about their poor health status, they get more depressed after marriage. Intimate partner violence, abortion history, unplanned pregnancy, job loss due to pregnancy, stillbirth, lack of social support, living without a husband, children's harmful lifestyles, recent family member's death, etc., are linked with women's depression after marriage (Fig. 1). Women need mental support, especially after marriage. They need help from their family, particularly their husbands. Moreover, the psychological distress, marital dissatisfaction, and general unhappiness of married women were all adversely correlated with husbands' engagement in housework [36]. So, we strongly recommend that the husband always be by his wife's side, give her more time, and take care of her. We suggest that more studies on mental health care for married women should be done in the future.

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