The Lived Experience of Women with Depression: A Meta-Synthesis

Background and Purpose: Depression continues to be one of the leading causes of disease burden for 
women. Prevalence rates consistently indicate women are diagnosed with depression twice as often as males, beginning in adolescence and persisting across the lifespan. Various explanations have been posited for this gender discrepancy, including biological factors (i.e., hormonal changes); psychological (i.e., rumination); and social (i.e., higher rates of sexual abuse, greater interpersonal stress, lower appreciation 
and pay for women’s work, and role overload).

Qualitative research may further 
illuminate women’s experience of depression and provide insights into how 
women cope and recover, and what is helpful about treatment. 
 Meta-synthesis, embedded within a systematic review, is a way to comprehensively review the qualitative literature in this area, and add to understanding of evidence-based treatment for depression in women. 

Methods: Applying the search process and terms with the assistance of a reference 
librarian to relevant academic databases, inclusion criteria produced a total of 28 studies with 574 participants, who tended to be white, African-American, or Latina.  Most of the studies were 
unpublished as dissertations in the USA and involved individual interviews as the data collection 
method.  The methodological framework provided by Noblit and Hare (1988), which they call “meta-ethnography,” was used for the synthesis.

Results: The themes that were formulated from the 25 studies involved the following: 
1) experience of depression as a biopsychosocial phenomenon; 2) attributions about depression as having emerged from life events or situations; (3) coping 
efforts involving spiritual or religious coping were helpful; 4) psychotherapy was preferred to medication, with downsides as well as advantages; and 5) barriers to treatment involved prior negative experiences and stigma.

Conclusion and Implications: A number of implications emerged from this meta-synthesis. First, the interrelationship between depression and physical conditions implies that medical practitioners should be screening routinely for depression in women.  Environmental events, especially trauma, were often given as reasons for depression.  An implication, therefore, is that treating trauma and its aftermath is important for helping depressed women with such a history.  Further, interpersonal psychotherapy might be an approach that women with depression find amenable given the fact that they have often suffered from abuse, loss, and abandonment in their relationships and because they feel so socially isolated.  Providers can sensitively explore women’s belief systems and practices in order to find out whether a spiritual connection can be part of the approach.

In treatment-seeking, women’s preferences should be elicited.  Psychotherapy can be helpful for validation and support, but there are also disadvantages that need to be addressed. Medication was often used, but there were concerns about lack of information and side effects. Although medical providers should make more efforts to provide education, mental health and social service providers can also do so, exploring concerns about medication, and act as an advocate and broker to those that prescribe.