ORIGINAL ARTICLE/ ARTÍCULO ORIGINAL/ ARTIGO ORIGINAL

Depression in women. Concept analysis from the nursing perspective

Depressão em mulheres. Análise do conceito desde a perspectiva da enfermagem

Nora Angélica Armendáriz García¹; María Magdalena Alonso Castillo²; Karla Selene López García³; Bertha Alicia Alonso Castillo⁴

¹RN, Ph.D. Professor, Universidad Autónoma de Nuevo León (UANL), México. email: nordariz@hotmail.com.

²RN, Ph.D. Professor, UANL, México. email: magdalena_alonso@hotmail.com.

³RN, Ph.D. Professor, UANL, México. email: kslg@hotmail.com.

⁴RN, Ph.D. Professor, UANL, México. email: balonso_mx@yahoo.com.mx.

Receipt date: July 24, 2012. Approval date: May 8, 2013.

Article linked to research: Depresión en mujeres: Análisis de concepto.

Subventions: none.

Conflicts of interest: none.

How to cite this article: Armendáriz- García NA, Alonso-Castillo MM, López- García KS, Alonso-Castillo BA. Depression in women. Concept analysis from the nursing perspective. Invest Educ Enferm. 2013;31(2): 270-276.

ABSTRACT

Objective. To identify the elements characterizing the concept of depression in women through the revision of the definitions and uses of the concept in literature, as well as identify its attributes, antecedents, and consequential events. Methodology. Some steps were used from the methodology of the concept's analysis by Walker and Avant. Results. Through the analysis performed, we managed to identify that depression is a complex concept associated to other similar concepts (sadness, melancholy, among others); however, upon elaborating the present analysis it was considered that the main attribute of depression in women was the presence of inhibition or delay of motor functions, as well as the presence of altered frame of mind. Likewise, hormonal alteration was identified as the principal antecedent for its presence. The consequence identified most frequently was that of suicidal thoughts. Conclusion. The study managed to introduce primordial aspects of the concept of depression in women. The use of this concept must be adapted and applied in the daily nursing practice.

Key words: depression; depressive disorder; women.

RESUMO

Objetivo. Identificar os elementos que caracterizam o conceito de depressão em mulheres através da revisão das definições e usos do conceito na literatura, bem como da identificação dos atributos, antecedentes e consequentes do conceito. Metodologia. Empregaram-se alguns passos da metodologia de análise do conceito de Walker e Avant. Resultados. Mediante a análise realizada se conseguiu identificar que a depressão é um conceito complexo que está sócio a múltiplos conceitos similares (tristeza, melancolia, entre outros), no entanto ao realizar a presente análise se considerou que o principal atributo na depressão na mulher foi a presença de inibição ou atraso das funções motoras, bem como a presença de alteração do estado de ânimo. Assim mesmo se identificou a alteração hormonal como o principal antecedente de que a mulher presente depressão. A consequência que se identifico com mais frequência foi o pensamento suicida. Conclusão. O estudo conseguiu apresentar aspectos primordiais do conceito de depressão em mulheres. O uso deste conceito deve adaptar-se e aplicá-lo na prática diária de enfermagem.

Palavras chaves: depressão; trastorno depressivo; mulheres.

INTRODUCTION

During recent years it has been observed globally that depression is a public health problem affecting close to 340-million people, which are mostly women.^1,2 It is estimated that by 2020 depression will become the second cause of disease burden, attributed with 5.7% of the disability-adjusted life years, placed immediately after ischemic heart disease in both sexes.³ In 2001, los depressive disorders were the second cause of years lost due to premature mortality or due to disability-adjusted life years in the category of 15 to 44 years of age.¹ In Latin America, it was noted that depression revealed a disease burden of 8.7%,⁴ presenting almost double the risk of occurring in women (11.1%) than in men (6.0%). Additionally, it was identified that in the general population depression has high lifetime prevalence, given that at least half the population has suffered it.⁵

Although depression is an important health problem, which especially affects the female population, no sole definition exists to conceptualize it, thus, complicating planning of strategies of promotion, prevention, detection, and treatment of this disorder. The term depression is used in diverse ways, from its implementation in a daily manner as synonymous with sadness to its classification as an affective disorder. This originates complications in the health status of women who most often present this disease, which can lead to irreparable damages and to more regrettable consequences, like death, due to the combination with other problems like drug use.^6,7

Concept analysis is an important methodological tool to define what is to be studied -in this case depression, given that it examines its structure and function, through identification of attributes and characteristics that define and identify it. This methodology is important when a given concept has been well defined or when it is applied in diverse disciplines, and it needs to be implemented in others or in one in particular. It also offers alternatives to explain and describe situations of interest for the practice of a discipline, especially if it is new or under construction, as is the case of nursing. Particularly, the concept of depression in women from the nursing perspective is outstanding, given that these professionals offer care related to mental health since depression is one of the diseases manifested with the greatest prevalence.

Because nursing professionals have the closest communication with patients, they can identify the most characteristic signs or symptoms to offer quality care that covers the needs of individual. Because of this, if nursing personnel clearly conceptualizes depression, they could more efficiently and effectively encounter situations that may arise. Coupled to this, clearing up the concept of depression in women is of importance to employ it in clinical practice, in theory, and in research seeking to obtain broader knowledge of this problem. Thus, in the future nursing interventions may be accomplished focused on reducing or avoiding the onset of this public health problem. The aim of this study was to identify the elements that characterize the concept of depression in women from the nursing perspective, through the revision of definitions and their use in literature, as well as to identify its attributes, antecedents, and consequential events.

METHODOLOGY

To identify depression in women, some steps were used from the methodology of the concept's analysis by Walker and Avant⁸ (selection of the concept of interest; identification of its definitions and uses; determination of its attributes, antecedents and consequential events -in this case, depression).

The study began by selecting the concept of depression; thereafter, a document review was conducted in electronic journals, texts, and dictionaries, focusing on the theme of depression, as well as on information regarding the diagnosis of depression from a psychological and psychiatric approach. An article search was conducted in Spanish and English through electronic databases like Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), MEDLINE, Scientific Electronic Library Online (SciELO), and Google Scholar. Descriptive words were used in Spanish (depresión, síntomas depresivos, and trastorno) and in English (depression, depressive symptoms, and disorder). A search period was established from 2000 to 2011 to select the articles of interest, without limiting by gender, given that publications on the depression concept in women are scarce. The work also employed the International Classification of Diseases version 10 (ICD-10) from the World Health Organization - WHO-⁹ and the Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IVTR) ¹⁰ employed for the diagnosis of depression; dictionaries were also used.

Article inclusion criteria established the appearance of the descriptive terms in the title and abstract to define if it were fitting to continue with the document analysis. Some 31 articles were recovered in the Abstract and Indexing Services (AIS), thus: two in LILACS, two in ScIELO, 12 in MEDLINE, six in Google Scholar, and nine were in three AIS (LILACS, SciELO, and Google Scholar). Thereafter, the articles were read to verify compliance with the selection criteria, as well as their direct relation with the theme being studied and, thus, accomplish analysis of the concept.

RESULTS

Its definition

Definition from dictionaries. The Dorland medical dictionary¹¹ defines depression as sadness, despondency, or melancholy; mental disorder characterized by the presence of one or more major depressive episodes. Roper's nursing dictionary¹² defines it as diminished power or activity; or as a low physical or mental state. Lastly, a medical sciences dictionary offers a precise meaning, thus: the drop in mood that constitutes a clinically discernible state and reduction of functioning levels.

Definition from literature. According to the WHO,⁹ the American Psychiatric Association,¹⁰ Lara et al.,¹³ Pilgrim and Bentall,¹⁴ and Zavala et al.¹⁵ depression is the presence of symptomatology associated to this disease, besides being a clinical disorder, which affects the majority of the population at some point of their lives; this state can be transitory or prolonged. Pérez and García16 state that it is a multifactorial disorder integrated by symptoms usually grouped into affective (low mood, sadness, discouragement), cognitive symptoms (negative thoughts of oneself and of the future, low self esteem, hopelessness y remorse), behavioral symptoms (withdrawal from social activities, reduction of habitual behaviors, slowness in walking and talking, motor agitation) and physical symptoms (related to appetite, sleep, and generally, lack of energy). This disorder can occur in mild, moderate, or severe episodes.^9,16

Depression is also identified as the alteration of the frame of mind associated to secondary phenomena conducive to it^17,18 and it is characterized by loss of interest and enjoyment of things and life, diminished vitality that leads to reduced levels of activity and to exaggerated fatigue, which is even present almost daily upon minimum effort, during two or more consecutive weeks.^19,20 For its detection, at least two of the following symptoms should be present: diminished attention and concentration, loss of self confidence, sense of inferiority, ideas of guilt or of being useless, somber perspective of the future, suicidal thoughts and/or actions, besides sleep and appetite disorders.^9,10 The concept of depression in the health field is related to a set of symptoms for its detection, diagnosis, and treatment. In psychology, the diagnosis is mainly done through the ICD-10;⁹ psychiatry uses the DSM-IV-TR.¹⁰

Attributes of the concept

For Walker and Avant,⁸ the attributes are all the necessary characteristics that make up the concept being analyzed. It was identified that the most characteristic essential attribute to refer to depression in women was inhibition or delay of psychomotor functions, followed by altered frame of mind, profound sadness, despondency, unhappiness, guilt, negative view of oneself, and hopelessness (Table 1).

Based on the analysis of the attributes identified in this study, depression was considered a state of inhibition or delay of psychomotor functions, which is reflected in a mood alteration represented by profound sadness, feelings of dejection, in addition to the presence of a series of affective, cognitive, behavioral, and physical symptoms in women.

Antecedents of the concept

This refers to all those situations, events, or phenomena preceding the concept of interest. It seeks to improve understanding the context within which it is used; in turn, helping its refinement through knowing the causes that favor the onset of depression in women.To manage to identify these antecedents, a review was carried out of selected articles related to the theme in which some events were observed that occur with greater frequency upon the presence of depression in women. Among the antecedents cited most frequently by diverse authors (Table 1), we found hormonal or biochemical alterations in the brain, as well as the presence of stressful events in the lives of people, history of abuse, alcohol use, low income, and diminished support or social networks, among others. Gender differences in the socialization processes lead to discrepancies in one's own assessment and vulnerability to depression. Different expectations for boys and girls may originate in that women become more fearful and may present depression during adulthood.²³

Consequential events of the concept

These are events that emerge as a result of the presence of depression in women. Knowing these consequential events requires identifying the situations that come after the depression. For this purpose, a review was conducted of previously selected articles to establish the situation that occurs most frequently in women with depression (Table 1). According to the authors consulted, these are: in the first place, suicidal thoughts; in the second place, alcohol intake; and, finally, weight loss or increase.^7,10

DISCUSSION

The analysis performed using Walker and Avant's methodology⁸ offers us a conceptualization of depression in women from a nursing perspective. Thus, we manage to identify that depression is a complex concept associated to other similar concepts (among them, sadness and melancholy). However, upon conducting the current analysis, it was considered that the principal attribute observed in depression in women was the presence of inhibition or delay of the motor functions, as well as the presence of altered mood. Additionally, based on the bibliography reviewed, diverse approaches were distinguished from medical perspectives regarding the concept of depression. Also, its conceptualization was not noted focused on women, who ultimately present this disease to a greater measure, which is why it became a viable proposal of the concept analysis from the nursing perspective.

During the course of the analysis of the information, some situations were identified anteceding the onset of depression in women, among which there are hormonal and biochemical alterations, as well as life stressing events; currently, this last issue is considered with much weight. As specific situations that emerge after the depression in women, we identified suicidal thoughts and use of psychoactive substances. Performing the analysis especially on the concept of depression is important because the attributes presented can overlap with other health problems in women, which originate, in the first place, a deficit in the development of scientific knowledge on this topic, reducing the possibility of offering preventive care to those at risk of suffering from depression; and, in the second place, the likelihood of increasing the risk of presenting negative consequences in personal, family, and community health.

Due to the aforementioned, it may be concluded that the study managed to present primordial aspects of the concept of depression in women from the nursing perspective, which are fundamental for detection, diagnosis, and treatment of this severe health problem. In turn, it may be considered that the current work is the first step to clarify and promote the use of this concept focused on the nursing discipline, seeking to adopt it and apply it in daily practice. Coupled to this, further scientific studies are required to clarify and employ this concept from this discipline's perspective, seeking to improve scientific knowledge in this area and manage to transfer it to the practice and favor women's state of health.

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