The Experience of Symptoms of Depression in Men vs Women: Analysis of the National Comorbidity Survey Replication
TL;DR: Whether sex disparities in depression rates disappear when alternative symptoms are considered in the place of, or in addition to, more conventional depression symptoms is explored.
Abstract: RESULTS Men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a higher proportion of men (26.3%) than women (21.9%) (P = .007) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in equal proportions: 30.6% of men and 33.3% of women (P =. 57).
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TL;DR: Findings suggest conformity to traditional masculine norms has a threefold effect on men experiencing depression, impacting their symptoms and expression of symptoms, their attitudes to, intention, and, actual help-seeking behaviour, and their symptom management.
482 citations
TL;DR: Clinical studies that identify sex differences within the activity of these circuits, as well as preclinical studies that demonstrate cellular and molecular sex differences in stress responses systems, reveal sex differences from the molecular to the systems level that increase endocrine, emotional, and arousal responses to stress in females.
464 citations
TL;DR: It is reported that exposure to subchronic variable stress (SCVS) induces depression-associated behaviors in female mice, whereas males are resilient as they do not develop these behavioral abnormalities, and transcriptional analysis of nucleus accumbens revealed markedly different patterns of stress regulation of gene expression between the sexes.
Abstract: Depression and anxiety disorders are more prevalent in females, but the majority of research in animal models, the first step in finding new treatments, has focused predominantly on males. Here we report that exposure to subchronic variable stress (SCVS) induces depression-associated behaviors in female mice, whereas males are resilient as they do not develop these behavioral abnormalities. In concert with these different behavioral responses, transcriptional analysis of nucleus accumbens (NAc), a major brain reward region, by use of RNA sequencing (RNA-seq) revealed markedly different patterns of stress regulation of gene expression between the sexes. Among the genes displaying sex differences was DNA methyltransferase 3a (Dnmt3a), which shows a greater induction in females after SCVS. Interestingly, Dnmt3a expression levels were increased in the NAc of depressed humans, an effect seen in both males and females. Local overexpression of Dnmt3a in NAc rendered male mice more susceptible to SCVS, whereas Dnmt3a knock-out in this region rendered females more resilient, directly implicating this gene in stress responses. Associated with this enhanced resilience of female mice upon NAc knock-out of Dnmt3a was a partial shift of the NAc female transcriptome toward the male pattern after SCVS. These data indicate that males and females undergo different patterns of transcriptional regulation in response to stress and that a DNA methyltransferase in NAc contributes to sex differences in stress vulnerability. SIGNIFICANCE STATEMENT Women have a higher incidence of depression than men. However, preclinical models, the first step in developing new diagnostics and therapeutics, have been performed mainly on male subjects. Using a stress-based animal model of depression that causes behavioral effects in females but not males, we demonstrate a sex-specific transcriptional profile in brain reward circuitry. This transcriptional profile can be altered by removal of an epigenetic mechanism, which normally suppresses DNA transcription, creating a hybrid male/female transcriptional pattern. Removal of this epigenetic mechanism also induces behavioral resilience to stress in females. These findings shed new light onto molecular factors controlling sex differences in stress response.
290 citations
Cites background from "The Experience of Symptoms of Depre..."
...Men and women manifest different symptoms and coping responses to episodes of depression (Martin et al., 2013); and based on current diagnostic schemes, women have twice the incidence of depression and anxiety disorders (Kessler et al....
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...Men and women manifest different symptoms and coping responses to episodes of depression (Martin et al., 2013); and based on current diagnostic schemes, women have twice the incidence of depression and anxiety disorders (Kessler et al., 1994)....
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TL;DR: The mechanisms by which peripheral and central immune cells act on the brain to affect stress-related neurobiological and neuroendocrine responses are discussed, including the roles of pro-inflammatory cytokine signaling, peripheral monocyte infiltration, microglial activation, and hypothalamic-pituitary-adrenal axis hyperactivity in stress vulnerability.
238 citations
Cites background from "The Experience of Symptoms of Depre..."
...Clinical findings paint a more complicated picture, suggesting gender-specific HPA axis dysfunction in human patients and supporting hypotheses that the experience and symptoms of depression are different in men and women (Martin et al, 2013)....
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TL;DR: It is concluded that alexithymia, as assessed by the TAS-20 and its subscales DIF and DDF, is closely related to depression.
Abstract: Patients with depression exhibit high rates of alexithymia, representing a major public health concern. We sought to examine relationships between depression severity and alexithymia as assessed by the Toronto Alexithymia Scale (TAS-20) and the TAS-20 subscales of difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT). Potentially relevant studies were obtained independently by two reviewers. Chi-square statistics based on the Q -test and I 2 index assessed statistical heterogeneity between studies. Subgroup analyses were mainly used to explore sources of heterogeneity. Begg׳s test and Duval and Tweedie' trim and fill were used to assess potential publication bias. Altogether, 3572 subjects from 20 study groups across 19 studies were included. Medium relationships were observed between depression and TAS-total score (TAS-TS), DIF, and DDF. There was also a weak relationship between EOT and depression. Subgroup analyses showed a stronger correlation between TAS-TS and depression assessed by self-reported tools than that assessed by the Hamilton Rating Scale for Depression. The heterogeneity significantly decreased only in the subgroup analysis by depression tool. We conclude that alexithymia, as assessed by the TAS-20 and its subscales DIF and DDF, is closely related to depression. These relationships were affected by depression measurement tools.
203 citations
References
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11 Jun 2013
113,134 citations
TL;DR: Notably, major depressive disorder is a common disorder, widely distributed in the population, and usually associated with substantial symptom severity and role impairment, and while the recent increase in treatment is encouraging, inadequate treatment is a serious concern.
Abstract: ContextUncertainties exist about prevalence and correlates of major depressive
disorder (MDD).ObjectiveTo present nationally representative data on prevalence and correlates
of MDD by Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) criteria, and on study
patterns and correlates of treatment and treatment adequacy from the recently
completed National Comorbidity Survey Replication (NCS-R).DesignFace-to-face household survey conducted from February 2001 to December
2002.SettingThe 48 contiguous United States.ParticipantsHousehold residents ages 18 years or older (N = 9090) who responded
to the NCS-R survey.Main Outcome MeasuresPrevalence and correlates of MDD using the World Health Organization's
(WHO) Composite International Diagnostic Interview (CIDI), 12-month severity
with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR),
the Sheehan Disability Scale (SDS), and the WHO disability assessment scale
(WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.ResultsThe prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval
[CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95%
CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases
were independently classified as clinically significant using the QIDS-SR,
with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean
episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured
by SDS was substantial as indicated by 59.3% of 12-month cases with severe
or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%)
cases had comorbid CIDI/DSM-IV disorders, with MDD
only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases
received health care treatment for MDD, treatment was adequate in only 41.9%
(95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2)
of 12-month MDD being adequately treated. Sociodemographic correlates of treatment
were far less numerous than those of prevalence.ConclusionsMajor depressive disorder is a common disorder, widely distributed in
the population, and usually associated with substantial symptom severity and
role impairment. While the recent increase in treatment is encouraging, inadequate
treatment is a serious concern. Emphasis on screening and expansion of treatment
needs to be accompanied by a parallel emphasis on treatment quality improvement.
7,706 citations
TL;DR: A review of the Social Sciences Citations Index for the literature from 1966 to 1990 revealed that Cronbach's (1951) article had been cited approximately 60 times per year and in a total of 278 different journals.
Abstract: Coefficient alpha (Cronbach, 1951) is certainly one of the most important and pervasive statistics in research involving test construction and use. A review of the Social Sciences Citations Index for the literature from 1966 to 1990 revealed that Cronbach's (1951) article had been cited approximately 60 times per year and in a total of 278 different journals. In addition to the areas of psychology in which one may expect to see alpha used, such as educational, industrial, social, clinical, child, community, and abnormal psychology, this list of journals included representatives from experimental psychology, sociology, statistics, medicine, counseling, nursing, economics, political science, criminology, gerontology, broadcasting, anthropology, and accounting. In spite of its widespread use, however, there is some confusion as to the true meaning and proper interpretation of the statistic. In this article I address this confusion in two ways. First, a theoretical discussion of alpha is presented. This includes some of the many statements that have been made about alpha and an attempt to integrate these statements. Second, I take a more practical approach in which the interpretation of alpha is examined by observing the changes in alpha as the number of items and interitem correlations are manipulated.
7,137 citations
TL;DR: Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s and means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset.
2,113 citations
"The Experience of Symptoms of Depre..." refers background in this paper
...Addis7 proposes 4 conceptual frameworks within the existing literature that address how gender shapes men’s experiences, expressions, and reactions to depression: (1) the sex differences framework, (2) the masked depression framework, (3) the masculine depression framework, and (4) the gendered response framework....
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...It assesses 8 constructs that have been proposed in the literature as externalizing symptoms of depression in men: (1) irritability, (2) anger attacks/aggression, (3) sleep disturbance, (4) alcohol/other drug abuse, (5) risk-taking behavior, (6) hyperactivity, (7) stress, and (8) loss of interest in pleasurable activities....
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...Symptoms were excluded from the scales for one of 3 possible reasons: (1) symptoms were deemed inappropriate, (2) equivalent items were not available, or (3) the number of people for whom data were available for a symptom was too small to be useful for the analysis (ie, <250 people)....
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Book•
01 Jan 1995
TL;DR: Background, aims and coverage of the survey Measurement and classification of psychiatric disorders Sampling and interviewing procedures Distribution of CIS-R scores Prevalence of neurotic symptoms and prevalent psychiatric disorders.
Abstract: Background, aims and coverage of the survey Measurement and classification of psychiatric disorders Sampling and interviewing procedures Distribution of CIS-R scores Prevalence of neurotic symptoms Prevalence of psychiatric disorders.
614 citations
"The Experience of Symptoms of Depre..." refers background in this paper
...Addis7 proposes 4 conceptual frameworks within the existing literature that address how gender shapes men’s experiences, expressions, and reactions to depression: (1) the sex differences framework, (2) the masked depression framework, (3) the masculine depression framework, and (4) the gendered response framework....
[...]
...It assesses 8 constructs that have been proposed in the literature as externalizing symptoms of depression in men: (1) irritability, (2) anger attacks/aggression, (3) sleep disturbance, (4) alcohol/other drug abuse, (5) risk-taking behavior, (6) hyperactivity, (7) stress, and (8) loss of interest in pleasurable activities....
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