Most studies have found clear gender differences in the prevalence of depressive disorders. Typically, studies report that women have a prevalence rate for depression up to twice that of men (Bebbington, 1996; Nolen-Hoeksema, 1987). For example, Kessler et al. (1994) reported that women in the United States are about two-thirds more likely than men to be depressed, and a national psychiatric morbidity survey in Britain showed a similar greater risk of depression for women (Meltzer et al., 1995). Gender differences in depression appear to be at their greatest during reproductive years (Bebbington, 1996).
Recently, my colleagues and I set out to explore some of the possible explanations for gender differences in depression (Nazroo et al., 1997, 1998). A starting point to our research was Brown and Harris (1978), who showed that episodes of depression were almost always preceded by a major life event, a finding that has been confirmed in a number of other studies.
Our sample consisted of 97 couples recruited from an inner city area in Britain who had experienced a total of 115 shared crises, made up of one or more major life events. The members of each couple were interviewed separately by different interviewers. The interviews covered the nature of the crisis, responses to the crisis, role behaviors, responsibilities and role commitment, quality of marriage, childhood experiences, and psychiatric disorders. The latter were assessed using a shortened version of the Present State Examination, which covers a wide range of psychiatric symptoms and allowed the use of clinically validated diagnostic thresholds.
Are Gender Differences an Artifact?
It has been suggested that apparent gender differences in the rate of depression are the result of one or more possible artifacts. In particular, it has been suggested that perceived differences in rate are the result of the use of assessments of depression that do not draw a distinction between clinical depression and subclinical symptoms. Typically, such approaches count the number of symptoms that each respondent reports and then average the number of symptoms across a population. This average score might be higher among women because they are more likely to report subclinical symptoms (Newmann, 1984, as cited in Nazroo et al., 1998).
We examined this theory by exploring whether any detected gender difference in depression was sensitive to a raising of the threshold for diagnosing depression. Contrary to the hypothesis, we found that, if anything, the size of the gender difference in depression increased, rather than decreased, as the threshold was increased (Nazroo et al., 1997, 1998). This suggests that the gender difference was neither a consequence of using too low a threshold nor of using an average score that emphasized women's hypothesized greater reporting of milder symptom states.
Do Men Develop Alternative Disorders?
Another possibility is that gender differences in depression rates may be the result of men developing alternative disorders in response to stress, such as antisocial behavior and alcohol abuse. In particular, women may be more likely to have been socialized to express dysphoria in response to stress and men may be more likely to have been socialized to express anger or other forms of acting out. In support of this, studies have shown that expected gender differences in depressive disorders were balanced out by higher male rates of alcohol abuse and drug dependency (Kessler et al., 1994; Metzler et al., 1995).
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