Chapter 33 Affective disorders in women with intellectual disabilities
The issue of gender and depression within the general population has been given substantial research attention and an association between female gender and increased risk for depression is established. Adverse childhood experiences, sociocultural roles, and vulnerability to life events are thought to increase the prevalence, incidence, and morbidity risk of depressive disorders in females. Biological factors seem to play a less important role in the emergence of gender differences (Piccinelli et al. 2000).
Affective disorder, and in particular depression, is more common in people with intellectual disabilities (ID). Higher rates of physical illness including epilepsy, socioeconomic adversity, past experience of abuse, and reduced life supports are thought to be relevant risk factors (Richards et al. 2001; Lunsky 2003; De Collishaw and Maughan 2004). When people with ID become depressed, all psychological and somatic symptoms of depression can be observed, but changes are often subtle and develop over time. Depression in this population often remains undiagnosed, atypical symptoms are common, and self-injurious or aggressive behaviour may dominate the clinical picture of people with more severe ID (Gravestock et al. 2005).
In this chapter, we will discuss the presentation of two major disorders, depression and bipolar affective disorder in women with ID. We will highlight epidemiological studies that have taken gender issues into account and explore gender-related risk factors. The assessment of females with ID and affective disorder will be discussed, as well as diagnostic, treatment, and service delivery issues for this highly vulnerable group.
