Women are more likely to be diagnosed with depression than men. However, significant gender differences in prevalence, symptoms, and treatment also exist.
Understanding the sex-specific mechanisms of depression is essential, as this allows us to develop more effective treatments tailored to the specific needs of patients of different genders.
However, such mechanisms accounting for the gender differences in depression patients are currently not fully understood, but recent research suggests that hormones and neurotransmitters may play a role.
Male–Female Ratio for Depression Is 1:2
According to the World Mental Health Survey Initiative, as of 2011, the average lifetime depression estimates were 14.6 percent and 11.1 percent in 10 high-income and eight low- to middle-income countries, respectively. The same survey also found that the 12-month depression prevalence estimates were 5.5 percent and 5.9 percent in high-income and low- to middle-income countries, respectively.
Additionally, women are diagnosed with depression at twice the rate of men.
According to a systematic review, the global annual prevalence of depression in 2010 for females and males was 5.5 percent and 3.3 percent, respectively, consistent with the aforementioned survey results.
Depression Symptoms Experienced by Men and Women Are Very Different
Across different cultures, female depression patients may experience different symptoms than male patients.
In one study involving 2,541 depression patients, 62.5 percent of the participants were female.
As the study discovered, compared to men, women tend to experience greater symptom severity and greater rates of anxiety disorder, bulimia, hypersomnia, digestive problems, and pain.
Women also tend to have more bodily complaints without an identifiable physical problem and more suicide attempts than men.
In contrast, male patients tend to experience more episodes of major depression, as well as more alcohol and substance abuse.
Furthermore, compared to male patients, women experiencing depression may be more likely to experience the more common symptoms, such as guilt, worthlessness, extreme sadness, and fatigue. On the contrary, instead of feeling sad, many men show anger, irritability, and even aggression when they get depressed.
In addition, men with depression are less likely to seek help or treatment for their condition than women. And some may not even recognize symptoms such as anger and aggression as those of depression, which can delay treatment and exacerbate their condition.
4 Possible Causes of Gender Differences
The aforementioned gender differences in depression prevalence and symptoms are not fully understood. However, they may be related to various factors.
1. Hormonal Factors
Hormonal factors are thought to play a significant role in the gender difference in depression prevalence.
In a new study published in Neuropsychopharmacology, researchers found that chronic dysregulation of the stress hormone cortisol can impair motivation and dopamine system function, leading to depression.
Although chronic cortisol dysregulation impairs the motivation of both male and female mice, it does so through different mechanisms. Specifically, cortisol dysregulation reduces the amount of dopamine, the “feel-good” neurotransmitter, in female mice only, while it impairs the dopamine transporter in male mice.
Research has proposed that there is a direct relationship between sex hormones, which experience a surge at the start of adolescence, and depressed mood in young girls. And some studies link depression among adolescent girls with the interactions between sex hormones and social factors.
In addition to their teenage years, women experience hormonal changes throughout their lives, such as those associated with the menstrual cycle, pregnancy, childbirth, and menopause, which may all contribute to the development of depression.
Specifically, 20 to 40 percent of pregnant women experience depression. If left untreated, depression during pregnancy may lead to miscarriage, preterm birth, low birth weight, infant developmental problems, and postpartum depression.
The rate of postpartum depression among new mothers is even higher than that of pregnancy depression, reaching almost 13 percent. Mothers suffering from untreated postpartum depression may be unable to take good care of their children, leading to their baby’s delayed development. In severe cases, depressed mothers may even think of harming themselves and their children. If untreated, this type of depression can last for months or even longer.
Similar to hormones, neurotransmitters are chemical messengers in the brain that transmit signals between neurons and between neurons and other cells. They can regulate our mood, cognition, and behavior.
Research has shown that women may have altered levels of neurotransmitters, such as serotonin and dopamine, which can contribute to the development or persistence of depression.
For instance, one Canadian study discovered that the average rate of serotonin synthesis in men was 52 percent higher than in women. This may be a factor in the much lower depression prevalence in men.
Furthermore, there exist gender differences in dopamine receptor expression and function. Men may also have altered levels of norepinephrine. Both dopamine and norepinephrine are associated with mood regulation, and they can contribute to the development of depression. This may also explain why men are more likely than women to engage in substance abuse and addiction, as these activities can also be linked to differences in neurotransmitter function and production.
3. Socioeconomic and Cultural Factors
According to a UK study, in terms of country differences, the link between female gender and depression gets more robust with increasing economic development. This may be because women in higher-income countries are more likely to acknowledge their depressive symptoms and seek help.
The same study also discovered that divorced and widowed individuals have higher odds of depression than average. More notably, women tend to experience a more increased risk of poverty and stress associated with single parenting than men, which may also increase their risk of depression.
4. Differences in Coping Styles
The strategies used by depressed men and women can be different, which may also contribute to the female preponderance in depression.
One study found that between the two main coping strategies, including problem-focused and emotion-focused styles, men with depression tend to choose the former, while women often take the latter.
Problem-focused coping strategies include planning and active coping, aiming to eliminate or reduce a stressor. Emotion-focused coping strategies include venting, reflection, self-reproach, and positive reappraisal, and they aim to change the individual’s emotional responses to a stressor. However, certain emotion-focused coping styles such as venting and self-blame may have adverse effects.
This same study found that emotion-focused coping strategies are less effective than problem-focused ones. This may contribute to the higher female prevalence of depression. Furthermore, females with lower levels of positive reappraisal are also more depressed.
The Results of Different Treatment Approaches
Samantha is a 35-year-old woman experiencing symptoms of depression, including low mood, lack of interest in activities she used to enjoy, feelings of hopelessness, and difficulty sleeping. She has a history of premenstrual dysphoric disorder (PMDD), and her symptoms tend to worsen in the days leading up to her period.
Samantha’s depression is more related to hormonal changes during her menstrual cycle. Therefore, her treatment plan involves medications that regulate her hormonal balance, such as hormonal contraceptives or selective serotonin reuptake inhibitors (SSRIs) that are effective for treating PMDD. Samantha benefited from psychotherapy, such as cognitive behavioral therapy (CBT), which can help her develop coping skills to manage her symptoms.
David is a 45-year-old man struggling with depression, anxiety, and substance abuse for several years. He has a highly stressful job and feels pressured to conform to traditional masculine roles, which can be a source of stress for him.
David’s depression and anxiety are related to social and cultural factors that affect men’s mental health. Therefore, his treatment plan involves psychotherapy focusing on masculinity and men’s cultural expectations, such as cognitive behavioral therapy for men (CBTM). This therapy can help David develop a more flexible and authentic sense of masculinity, which may reduce his stress and help him cope with his symptoms. In addition, David benefited from medications that target his specific symptoms, such as antidepressants, anti-anxiety medications, and counseling on substance abuse.
Sarah is a 52-year-old woman who suffers from symptoms of depression. She reports feeling sad, irritable, and anxious most of the time and experiencing insomnia and fatigue. She also mentions hot flashes, night sweats, and vaginal dryness, which have been interfering with her quality of life.
After weighing each treatment option’s potential risks and benefits, Sarah decides to try hormonal therapy. She is prescribed estrogen therapy, which she has started taking daily.
Over several weeks, Sarah’s symptoms gradually improve. She reports feeling less depressed, having fewer hot flashes and night sweats, and experiencing less vaginal dryness. She continues to take her estrogen therapy, and after several months, she no longer meets the criteria for depression.
Through addressing individual needs and gender differences, in this innovative approach, all three patients have regained their health and are achieving their highest levels of physical, mental, emotional, and spiritual well-being.
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