Reading: Depression & Suicide Among Women in Midlife

On Tuesday morning we were awakened by the news of fashion designer Kate Spade’s suicide. We were physically awake by then, of course, but we’re not talking about that kind of awake. Kate seemed to have what many of us covet: career success, wealth, family, fame. Her persona was one of bright colors, simplicity, and a sense of humor. She had a reputation of being kind and generous. So why? Why would anyone who seemingly had it all do this? The day after news broke of Kate’s death, her husband, Andy Spade, released a statement to the press revealing his wife had suffered from anxiety and depression for years.

In 2016, the Centers for Disease Control released the results of a study that found the rate at which women aged 45-64 committed suicide in 2014 had increased by 63% from 1999. Furthermore, the study found the rate at which women are committing suicide is growing faster than men in every age group, the greatest among middle-aged women. In 2014, the CDC also published a report stating women between the ages of 40 – 59 have the highest rate of depression.

We talked to Dr. Cecilia Dintino, a clinical psychologist, a psychology professor at Columbia University, and co-creator of Twisting the Plot, a therapy workshop for women over 50. Here she explains why midlife women are most at risk for depression and what we can do about it.

What are common misconceptions about who’s most at risk for committing suicide?
The main misconception is that it couldn’t happen to me or people like me.

What makes women in midlife specifically vulnerable to depression?
First of all, there is the biology part — women in the menopausal transition are 14% more likely to have an incidence of depression. Women who have a history of premenstrual dysphoric disorder or any other depression are three times more likely to have depression during the menopausal transition. Then of course psychologically there’s a lot going on: women suffer changes to their bodies, their role in life, their status; divorce rate among people over 50 has doubled since the 1990s. And then what I think is the biggest issue: ageism. It’s really, really, really insidious and has a huge hold on our culture. Studies have revealed implicit ageism bias in people who don’t think they’re ageist. We’re not even aware of it; we breathe it like air. This affects your feeling of being relevant, your sense of purpose, and your sense of potency in the world. I think it’s the combination of all these things that make women really vulnerable. Interestingly, the number of middle-aged white women dying annually from opiate overdoses has increased by 400%.

What are the common life factors that lead to depression at this stage in life?
Most of my clients who do my workshops at Twisting the Plot have been pushed out of fields like fashion and design. Even a few years before they’re asked to leave, they’re made to feel irrelevant and that their ideas are not as serious. Another thing I see in my practice, it’s like an epidemic, are women whose husbands have left them after 30-plus-year marriages. It’s shocking to most of them. So, the women are asking themselves, “who am I now?” There’s also illness and the care-taking of parents and what that does to your sense of stability in the world. Another thing I see is first-time eating disorders because of the effect of body changes. Then there’s empty nest syndrome, which is the sense that my kids don’t need me anymore or they don’t live nearby. To me, the issue is a lack of imagination in our culture; maybe there’s another way to be. This stage of life is not even dealt with. I’ve had this happen so many times: women will sit at a dinner party saying 60 is great and then corner me in the bathroom and ask, “what do I do? Help me!” It affects career women just as much as non-career women. We just have to think of new ways of being. There’s something beyond 50 [we] can grow into.

What are the biological and physical factors that make women more susceptible to depression?
In some ways it parallels adolescence. There are hormonal changes, body changes, skin changes … It’s just that there isn’t a lot of status attached to [aging]. Perimenopause can start as early as 30 and last as long as 15 years — it’s not just six months of icky feelings. For many people, it is truly hell. But you know what? We can survive this. Women have survived much worse. It’s just that we don’t [yet] know why we’re surviving it. To me, that’s the biggest problem. It’s like a bunch of horrible symptoms without a story.

What are the solutions?
What helps us survive and get through things is a sense of purpose and meaning. So our kid may be going through the terrible twos and it’s hell but we know the story — they’re inserting their independence and it’s just something you go through and you talk to other people about it and the culture agrees this is the story of having a two-year-old. The same thing with having an adolescent or having an ailing parent — there’s a cultural narrative [around it]. The same thing with the pain of childbirth, there’s a story arc there — you get a child at the end of it. Brandeis psychology professor, Margie Lachman touches upon this in her research on lifespan development: there’s absolutely no status attached to [menopausal] symptoms. There’s no story arc [for midlife]: I’m going to go through this [pain] and become this powerful, wise leader. There’s nothing. As women say to me, “and then I’m going to wait to die.” The solution is to create new ideas and new ways of being and getting groups of women together to support each other and try on these new identities. With Twisting the Plot we’ve been doing repurposing workshops, helping women think about what they can do. I get them to do a life review where they pull out all the things that are special and unique about them that they’re going to take forward. Up until the day we die, we should be reinventing ourselves. Longevity is not a curse, it’s a gift.

What prevents women from getting help?
The stigma. It’s the stigma that keeps women from admitting to their husbands and colleagues at the dinner table that they’re struggling with aging but then corners me in the bathroom. There’s a stigma about the old, crazy lady. It’s something we don’t challenge enough in our culture — it’s the intersection of sexism and ageism. I think a lot of women feel that. Women shouldn’t have to claim themselves as mentally ill because they don’t feel like they fit in anymore.

What does the stigma look like for women?
It washes away all the powerful things they’ve done and they take on the persona of a slow-walking, over-medicated, forgetful, confused person with mental illness and ailments. How many celebrities do we know who went to the hospital for mental illness? Once a celebrity’s mental health issues are made public, they can’t overcome it. Look at Catherine Zeta-Jones — whatever you read about her now, the byline is always there, ‘who was hospitalized for bipolar disorder.’

What can women do to help themselves?
We need to defy this stigma by getting help and talking about it. The only way to combat stigma is to take it out of its secret hiding places and erase the taboo. One in eight women have major depression — why are we keeping quiet about this?

Do you believe there’s a double standard in terms of how we perceive mental health issues in men vs. women?
There’s a bias in our culture that women are crazy anyway. There’s more to lose [for women]. For a man it’s called stress, for a woman, it’s called crazy.

What are some key signs that someone is at risk for suicide?
The problem is there are no absolutes. You can’t ignore it when people talk about committing suicide, but the scary thing is it seems to me that the ones that are really serious about doing it know not to tell people. Extreme self-loathing and a strong point of view that their life has no value are also very concerning.

What can we do if we sense someone we love needs help?
Having even one person to talk to can make such a huge difference. I’ve talked to people who were on rooftops, who were ready to do it. But because I’m talking to them, they [don’t]. Suicidality is a state, not a trait. We can come out of things. The most important thing is to have connection, to have someone to talk to. One of the main signs that someone is in danger is they disconnect from people.

Why are we so surprised when someone commits suicide?
We’re especially surprised when someone had what looks to us as a good life. We’re not as surprised when it’s a junkie on the street. And really we’re all vulnerable. There’s this myth that if you have money or education or status that you’re not going to be susceptible to mental illness. It’s not a special thing that only happens to people who don’t take care of themselves.

Does the method in which someone commits suicide mean anything?
Hanging and jumping are very significant because it has a high completion rate. With other methods like taking pills, there’s some leeway, there’s a little space when people can call for help.

What about the decision to leave a note?
[Leaving] a note implies very serious intent. Taking the time to think about somebody, like your child, is [usually] a deterrent.

How have the psychological demands and opportunities for midlife and late midlife women changed over the past decades?
Demands and opportunities go hand-in-hand. I feel the demand to make something of myself, to create a runway that my nieces and my grandchildren can claim because I’ve been given the opportunity. I know a lot of women who have died, mostly from cancer in their late 50s and 60s and I owe it to them — if I’m going to live to 100 I need to make it worth something.

What appeals to you personally about your line of work?
It’s the storyteller in me — I like twisting the plot for people. I like getting them to tell a whole new story and have a whole new ending.

This interview has been edited for clarity and length.

If you need help or know someone who needs help, here are Dr. Dinton’s recommended resources:

• National Suicide Prevention Lifeline at 1-800-273-8255 | You will be connected to a skilled, trained counselor at a crisis center in your area. This service is available 24/7. You can also chat with someone online.

• SAMHSA National Helpline at 1-800-622-4357 | SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals and families facing mental health and/or substance use disorders. Services are available in English and Spanish.

• Dialectical Behavior Therapy resources (treatment designed for individuals suffering from suicidal urges)

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