Now we have some notion of how women become depressed we can turn to the question of social class. The circumstances associated with the aetiology of depression might well be expected to occur more commonly among working-class women, and yet there is a widespread belief that it is more common among middle-class women. A sociologist, Pauline Bart, in a recent review asserts that 'Middle-aged, middle-class, married, never divorced housewives, those women who assumed the traditional roles of wife and mother have a higher rate of depression than working women or women who have been divorced' (Bart, 1974: 144). A psychiatrist, Ernest Becker, states that depression is more common among middle-class women: 'high expectations leave a middle-class woman particularly vulnerable to feelings of disappointment with attendant feelings of guilt, low self-esteem and depression. Since she is less able than a working-class woman to explain her disappointment in terms of social deprivation she does so in terms of personal failure' (Becker, 1964). In an equally stimulating discussion of depression Charles Costello, a psychologist, also suggests that upper-and middle-class women have more depression and that this may be due to the expectation that is 'developed that one is individually responsible for one's position in life - that things are under one's control' (Costello, 1976: 71). But although commonly asserted, systematic epidemiological research gives no support. There have been a number of surveys of psychiatric disorder in whole populations: in an earlier chapter we discussed those in Manhattan and Nova Scotia. Barbara and Bruce Dohrenwend in a valuable review note that of eleven studies examining social class and psychiatric disorder in urban communities eight report the highest rate in lower social class groups.! This has been confirmed by Michael Rutter and his colleagues
at the Institute of Psychiatry using a clinical-type interview in an Inner London Borough and also by Naomi Richman who carried out a psychiatric interview with the mothers of children under five living on a council estate in a working-class district in North London (Rutter et al., 1975; Rutter and Quinton, 1977; Richman 1974). Since most psychiatric disorder among women is likely to be some form of affective condition, these results are indirect evidence, at least, that lower-class groups have a higher rate of depression. Other than our own there have been two recent direct population studies of depressive symptomatology. The first by Warheit, Holzer, and Schwab (1973) used an eighteen-item questionnaire on a random sample of adults in a city of 75,000 in the south-eastern United States. The questionnaire was not validated but had grown out of research with psychiatric patients. Twenty-one per cent of the white women were considered to have a high score (this is double that of white men, the same as black men, and one third less than black women). Using a five-fold measure of social class there was a seven-fold difference between the top and bottom categories, the higher the class the lower the rate. Comstock and Helsing (1976) recently surveyed a large city and a semi-rural area in the United States using a similar questionnaire. The patterns of differences according to socio-economic indicators (income and years of schooling) were comparable but not quite so large.