Women have long been thought to have much higher rates of
depression than men, but when alternative and traditional symptoms of
depression are considered, these sex disparities disappear, new research shows.
"The sex differences framework is rooted in the idea that
the construct of depression is the same in men and women and seeks to
investigate sex differences in a range of related variables, including
symptoms," investigators led by Lisa A. Martin, PhD, from the University
of Michigan, Dearborn, write.
"Although this has been a popular approach to date, it is
often critiqued for relying on oppositional binaries that understand 'male
depression' only as it is contrasted with 'female depression,' which fails to
acknowledge the heterogeneity that exists within these groups."
The study was published online August 28 in JAMA
Psychiatry.
More Anger, Aggression in Men
The aim of the study was to explore whether sex disparities in
depression rates disappear when other symptoms besides conventional depression
symptoms are considered.
The researchers used data from the National Comorbidity Survey
Replication (NCS-R), a nationally representative survey of the incidence and
prevalence of mental disorders among English-speaking adults in the United
States.
The survey included 3310 women and 2382 men. Their mean age was
45.2 years, 73.4% were non-Hispanic white, and 51.6% had some education beyond
high school. The mean annual household income was $59,575. The mean income for
men was $63,365, and for women, it was $49,327.
The researchers developed 2 scales. The first, the Male Symptoms
Scale (MSS), included alternative male-type symptoms of depression, including
irritability, anger attacks/aggression, sleep disturbance, alcohol or drug
abuse, risk-taking behavior, hyperactivity, stress, and loss of interest in
pleasurable activities.
The second scale, the Gender Inclusive Depression Scale (GIDS),
included all of the MSS symptoms, plus 7 traditional symptoms of depression,
including sad/depressed mood, loss of vitality, tiredness, ambivalence,
anxiety/uneasiness, and complaintiveness or feeling pathetic.
Using the MSS scale that included alternative, male-type
symptoms of depression, the researchers found a higher prevalence of depression
in men (26.3%) than in women (21.9%) (P = .007).
The researchers also found that men reported significantly
higher rates of anger attacks/aggression, substance abuse, and risk-taking
behavior compared with women.
More Stress, Irritability in Women
Women, on the other hand, reported significantly greater rates
of stress, irritability, sleep problems, and loss of interest in things they
usually enjoyed, such as work, hobbies, and personal relationships.
No sex difference in the prevalence of depression as assessed by
the GIDS that included alternative and traditional depression symptoms was
found. According to that scale, 30.6% of men and 33.3% of women met criteria
for depression.
In terms of severity of depression, the researchers found that
63.2% of men and 62.0% of women fell into the mild category, meaning that they
had 1 to 4 symptoms; 28.3% of men and 28.9% of women fell into the moderate
category, with 5 to 9 symptoms; and 8.5% of men and 9.1% of women fell into the
severe category, with 10 to 15 symptoms. No significant sex differences were
demonstrated at any severity level, they report.
"These results suggest that relying only on men's
disclosure of traditional symptoms could lead to an underdiagnosis of
depression in men and that clinicians should consider other clues when
assessing depression in men," the authors write.
They also point out that "despite the significant findings
reported in this study, there are noteworthy limitations."
One limitation was that the study did not include symptoms among
men such as overworking, overexercising, changing their sexual behavior, or
gambling. Also, items that assessed taking chances or reckless behavior were
not linked to an emotional condition. Future studies should include items that
assess the excluded behaviors, the authors suggest.
They conclude that the results of their study have the potential
to bring "significant advances to the field in terms of the perception and
measurement of depression. These findings could lead to important changes in
the way depression is conceptualized and measured."
By Fran Lowry for Medscape
on Aug 29, 2013
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