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Single, Depressed Female

Here's a sad fact: One out of three women between the ages of 18 and 23 have significant symptoms of depression. Depression in women used to be associated with a mid-life event, says Ann Peden, associate professor in the UK College of Nursing. "We attributed women's depression to children leaving home or the onset of menopause—but that's no longer true. We're seeing it occurring in younger and younger women," she says.

Ranked as the number one mental illness in the world by the World Health Organization, depression affects twice as many women as men. The most common symptoms of depression include not sleeping well, feeling hopeless, excessive feelings of guilt, weight loss, poor concentration, and negative thinking—the symptom on which Peden and her colleagues in nursing are focusing.

"'Everything I do is a mistake.' 'People are looking at me; I don't fit in.' 'I'm really stupid.' We all have these thoughts from time to time but they move quickly through our thought processes. But with depressed people, these thoughts get caught and are repeated over and over," Peden says. "We can help you sleep better, make your appetite better and, with our drugs, we can help you concentrate; but negative thinking isn't as easily treated."

Photo of Mary Kay Rayens, Lynne Hall and Ann PedenMary Kay Rayens (left), Lynne Hall and Ann Peden are focusing their study of depression in women on how to combat negative thinking.

Why are so many college-age women depressed? "You have low self-esteem, a pessimistic bent and a tendency toward thinking negatively, and then on top of that things like failed romances, separating from your parents, roommate problems, and not doing well in school—the kinds of things that happen when you are trying to be independent—push you too far," says Peden, who was named the 1999 Psychiatric Nurse of the Year by the Kentucky Nurses Association.

Peden along with her College of Nursing colleagues Lynne Hall, assistant dean for research and doctoral studies, and Mary Kay Rayens, research assistant professor, conducted a three-year study titled "Prevention of Depression in College Women: A Pilot Test," funded by the National Institute of Nursing Research, National Institutes of Health.

"In August of 1996, we recruited 246 women attending UK who had never been diagnosed or treated for depression. And we found 35 percent of them—one out of three—had high depressive symptoms," Peden says. Those 92 women were invited to take part in the intervention portion of the study, and were divided into experimental and control groups. The experimental group was broken into groups of six to eight women, who met for intervention one hour a week for six weeks.

"The focus of the intervention is to help people recognize that they are thinking negatively. We emphasize that it is a habit that they can change," Peden says. "We use affirmations—positive self statements—and we teach the 'Stop' technique. The Stop technique is a cognitive-behavioral strategy that actually helps people change their thinking style. We use cassette tapes of the women speaking affirmations to replace their negative thoughts and practicing the Stop technique."

Peden and her team taught the women a number of affirmations, such as "Take a deep breath, in an hour it won't matter," "A mistake is only wrong if I label it that way," "I am as worthwhile as I allow myself to feel," and "You're strong enough to handle criticism," but the women also wrote their own. "Their affirmations are often much better than ours," says Peden. "Affirmations have been used for years in pop psychology, but, as far as I know, they've not been empirically tested. Our study supports their effectiveness."

Women involved in the intervention had improved self-esteem and fewer negative thoughts and depressive symptoms compared to the women who did not take part in the intervention. The study subjects were surveyed at one, six and 18 months after intervention, and the decrease in negative thoughts was maintained over time. One month after the intervention, only 25 percent of the women had a high level of depressive symptoms compared to 58 percent of those who did not receive the training. At 18 months after the intervention, only 15 percent of the students in the experimental group had a high level of depressive symptoms in contrast to 29 percent of those in the control group. The researchers' findings suggest that interventions that reduce negative thinking may be one key to preventing depression in college women.

Peden, Hall and Rayens are embarking on a new study to test the effects of their intervention on depressed low-income single mothers, thanks to another grant from the National Institute of Nursing Research. This $648,980 grant is the largest NIH research grant ever received by the UK College of Nursing.

"Moms with young children are, in general, at risk for depression, particularly moms with preschool-age children, six and under," says Hall. "And the risk increases for low-income single mothers; many of these women get by on as little as $300 a month." This study will include 160 single mothers taking part in a one-hour group session for six weeks.

Alicia P. Gregory