The surprising rates of depression among MENA’s women

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Recently I attended a health strategy meeting, where indicators of health risks showed depression to be the top disease affecting women in the Middle East and North Africa (MENA) but not men (where it was on average 7th place). In one sense, this is not too surprising because depression affects women more than men everywhere. On average, globally, depression ranks 6th for women and 16th for men. 

Still, MENA is unique. The table below shows the average rank of major depressive disorder in terms of a standard measure of health costs, disability adjusted life years (DALY), using data from the  Institute for Health Metrics and Evaluation (IHME). Depression is ranked more highly among MENA’s women than any other region. While MENA’s men are also more prone to depression, the percentage gap between men and women is higher in MENA than all other regions, with the notable exception of Latin America and Caribbean (LAC).  This suggests that men in MENA look more like their counterparts in the rest of the world than women in MENA look like their global sisters.



The map below from IHME shows the ranking of depression across countries. Darker red indicates closer to top rank. Seven of the top 10 countries in the world by rank of depression in women are in MENA (2 of the other 3 are in Latin America and 1 in Europe).



What could explain the prevalence of depression in MENA’s women? One possibility is lack of agency — the capacity to act and make choices. Agency depends to a great extent on income, which provides people with a means to decide where and how to live and what to purchase.

To examine this relationship, I looked at the correlation between women’s labor force participation and the rank of depression. Labor force participation is defined by the share of working age women employed or seeking work. The chart below shows a scatter plot of the two variables. There is a strong positive correlation, indicating that as labor force participation rises the ranking of depression tends to fall (move farther from one). On average, a ten percentage point rise in participation is associated with a drop in the rank of depression by nearly one full spot. 



Of course this is a correlation not a causal indicator. But it could suggest that as women work they are less prone to depression. Indeed, there is a large body of evidence that shows a strong relationship between unemployment and depression.

There are other potential explanations, however, which also warrant further investigation.

Other country specific factors, might affect both women participation in the labor force and depression. For example, social norms that exclude women from participating equally in society might lead to low female participation and more depression. This would generate a correlation between labor force participation and depression, but would not point to women’s participation in the labor force as the culprit. Alternatively, general economic woes could lead to more depression and low labor force participation (after all periods of slow growth and high unemployment are themselves dubbed depressions). Indeed this could explain MENA’s relatively high rate of depression in both men and women, but it does not explain the relatively high cost to women as compared with men in the region, especially given men are the main breadwinners.

Finally, women’s relatively higher rates of depression might cause them to stay out of the labor market.This however seems less likely because there are many countries that rank depression near the top and yet attain high rates of labor force participation.  What is far less common are countries with relatively happy women when labor force participation is low.

In any case this relationship deserves more exploration. If limited employment opportunities for women in MENA are creating serious health risks, expanding them is that much more critical.  Our newly released report “Opening Doors: Gender Equality in the Middle East and North Africa” explores determinants of the low labor force participation in MENA, linking it closely with social norms, and offers policies for change.

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