Doctoral Thesis: Battling the black dog: an exploration of the strategies used by
young Australian women coping with depression

Supervisors: Professor Christina Lee & Dr. Sue Outram

University: Research Centre for Gender, Health and Ageing, University of Newcastle, Australia.

Purpose of the study:
The overall aim of the project is to bridge the gap between coping research and clinical application by creating a model which identifies strategies which women use to pass successfully through periods of depressed mood, in order to make recommendations for treatment.
The project plans:
1. to explore the cross-sectional and longitudinal correlates of depressed mood among the Younger cohort
2. to identify those coping styles and strategies associated with successfully passing through periods of depressed mood.

Data collection
The first part of the project has been addressed through analyses of the main survey data collected in 2000 and 2003. The second aim was addressed through a substudy (Coping Survey) sent to 1200 participants in July 2004.

Cross-sectional results
In the cross-sectional analysis, approximately 30% of young women indicated that they were experiencing depressive symptoms, as indicated by the CES-D 10. The following demographic variables were related to depressed symptoms: low income, low educational qualifications, a history of unemployment, not being in a relationship, and living arrangements other than living with a partner. Those health-related variables which were significantly associated with depressive symptoms included frequent visits to doctors and medical specialists, and a higher number of physical symptoms experienced and diagnoses made. More illicit drug use, higher use of Cigarette and alcohol, and lower exercise status were also significantly associated with depressive symptoms.

Longitudinal results
Data from Survey 3, completed three years later, showed that approximately 25% of young women scored 10 or over on the CES-D 10. Comparing data from 2000 and 2003, four ‘depressed’ transition status categories were determined: ‘never depressed’; ‘no longer depressed’; ‘became depressed’; ‘remained depressed’. The specific research questions for the analyses were: “What changes are associated with becoming ‘depressed’?” and “What changes are associated with recovery from ‘depression’?”

After adjusting for all the transition variables in the model, compared with those who were ‘never depressed’, women were more likely to be categorised as ‘became depressed’ if they reported the following: becoming unpartnered, having an increase in the number of major life events, having a decrease in social support, and becoming less physically active. They were also more likely to be in this group if they reported an increase in the number of physical symptoms, and if they had any change in the number of physical diagnoses they have received, compared with Survey 2. The only transition variable significantly associated with lower likelihood of ‘becoming depressed’ in the adjusted model, was reporting a change in income in either direction. After taking all transition variables into account, compared with those who ‘remained depressed’, women were more likely to be ‘no longer depressed’ if they reported: decreases in income, number of life events and physical symptoms experienced. The only significant variables in the adjusted model for a reduced likelihood of being ‘no longer depressed’ were the reporting of a decrease in social support, and a change – increase or decrease – in the number of visits to medical specialists.

Conclusion from cross-sectional and longitudinal analyses
These results support the view that depression is one aspect of a multifactorial cluster of negative conditions across several domains of functioning, including physical illhealth, risky behaviours, and marginal social status. The complex interactions between these conditions, of which depression is only one, underscore the difficulties which arise in the treatment of depression and support the value of preventive interventions as an important public health strategy.

Styles and strategies used by women with depressive symptoms
The second part of the project has been addressed through analyses of the Coping Survey. 1200 surveys were sent to women, randomly selected from each of the four ‘depressed’ transition groups: 300 for each group. The data collection phase ended in February 2005.

Preliminary results indicate that these women are highly resourceful and employ a wide variety of strategies to cope with depressive symptoms. By far the most commonly recommended strategy made by these women is to “talk with others”, and other strategies include distraction activities and being proactive in focussing on the ‘depression’ itself, by diarising, and taking time to work out what situational factors are maintaining the depressed mood. Taking to professionals and taking antidepressant medication are rarely recommended by women across any of the four groups. The overall implication for practice, at this point, is that many younger women are searching for non-pharmacological treatments, despite the fact that they view depression as a medical condition.

Results from scales used to measure coping styles will be integrated with identified strategies and recommendations to create a model of practical interventions which younger women have found helpful when coping with depressive symptoms.

To contact Cate:
Cate France
Women's Health Australia
Research Centre for Gender Health and Ageing
University of Newcastle
University Drive
Callaghan
NSW 2308
Australia

Email: Cate.France@newcastle.edu.au