Women are being diagnosed with major depression at twice the rate of men, and Spokane women are being diagnosed at a rate higher than the national average, according to a recent report.

The report released by the Blue Cross Blue Shield Association, major depression diagnoses are steadily increasing nationwide across all age groupings and have risen 33 percent since 2013. The report notes that women in Spokane have a diagnosis rate of 7.3 percent, which is higher than the 6 percent national average for women.

Spokane psychologist Kim Chupurdia, of MultiCare Rockwood, says those figures might not tell the whole story, however.

“I think the main thing that pops out at me is that this is a study based on people who have commercial health insurance and are seeking treatment, which probably isn’t representative of the population as a whole,” Chupurdia says. “There’s certainly a number of people who have Medicaid or Medicare or no health insurance at all and that could be a totally different number set.”

Chupurdia concurs with the report’s claim, though, that women are diagnosed with major depression at double the rate of men. Major depression is characterized by symptoms that last at least two weeks, including persistent sadness, decreased energy, feelings of hopelessness, changes in appetite or sleep, and thoughts of death or suicide.

“It’s historically true that women have more depression than men,” Chupurdia says. “The statistics I normally see are about two (women) to one (man).”

Dr. Mia Wise, a medical director at Premera Blue Cross, says experts haven’t yet discovered why this is. 

“I think the answer is as variable as the disease itself,” Wise says. As to why women in Spokane have a higher diagnosis rate than the national average, Wise says there’s no clear answer there, either.

The National Institutes of Mental Health estimate some 16.2 million adults in the U.S. had at least one major depressive episode in 2016.

Chupurdia says a number of factors can contribute to depression in women.

“Biology certainly is a factor,” Chupurdia says. “As women, we have different hormones than men. Hormones don’t cause depression, but fluctuations can contribute. From a social standpoint, there are different pressures on women than men. If a woman works, for example, she’s also likely to be taking care of the household and the children. Women are more likely to have a history of abuse, which would be another risk factor. Women are more likely to be single, raising children.”

Katie Morris, family therapist supervisor at Providence Sacred Heart Medical Center, notes that women might be more likely to be diagnosed with depression simply because they’re in contact with health care providers more often.

“Women are typically more likely to report symptoms not only of mental health issues but medical issues as well, so I think that could be part of the reason why we’ve seen an increase (in major depression diagnoses) in women,” Morris says.

She says awareness might be contributing to increased rates of diagnoses, particularly among adolescents and young adults.

“I feel like we, as a society, have really worked on talking about how important it is to discuss mental health issues with our kids, and I think that that’s probably why we’re seeing an increase in it, because we as a society are getting more comfortable talking about mental health,” Morris says.

However, Chupurdia says many women still take a stoic attitude toward their health.

“I think, as women, we have a tendency to feel like we can push through or maybe we don’t have it as bad as somebody else, but that doesn’t mean it isn’t worth treating, that we can’t have a higher quality of life and be more functional,” she says.

Chupurdia adds that “it doesn’t hurt” to seek care if one notices depression symptoms that last for two or more weeks. 

The report also claims that 80 percent of those diagnosed with major depression are also facing additional chronic health conditions. 

“What we do know for sure is mental illness is related to how somebody experiences health issues,” Wise says. “That’s true no matter where you are in the country, no matter whether you’re male or female. We do know that when you have depression and another disease, the outcomes are negatively impacted. And all those lifestyle choices you make in that depressed state have negative consequences on your physical health.”

One approach to diagnosing mental illnesses involves integrating behavioral health care into physical health care, Chupurdia says.

“More than half of primary care visits are about somatic complaints, like headaches for example, that could be related to depression,” she says. “So, women end up talking to their OB (obstetrician) or their family practice doctor about their (depression) symptoms, because they’ve gone in for something else.” 

In the integration approach, a mental health provider is available on-site within a clinic or other setting.

A medical provider potentially could pull a mental health provider into the exam room right then, if the patient has a concern. Another option would be for the primary provider to help the patient schedule a visit with the colleague down the hall.

“People are more likely to follow through with that referral if it’s within their medical clinic,” Chupurdia says.

She says MultiCare Rockwood is discussing implementing such a strategy.

“It’s a totally different way of practicing medicine, so it doesn’t happen overnight,” she says. “I’ve worked in some settings like that before, and I’d say that the difficulty is getting everybody to accept that this is the new normal. It helps the physicians be able to focus more on what they do best, which is medical care, and gives the patient more of a specialist to talk to about mental health issues, so it’s much more direct access to care.”

Chupurdia says she’s seen studies that assert depression is treated more successfully in the integrated approach.

“A team approach or an integrated approach to care definitely has higher success,” Chupurdia claims. “There’s just more follow-up, more eyes on the patient.”