Sex differences in depression

Abstract

The proposition that there is a female preponderance in depressive experience is examined in a cohort of young adults. A number of psychosocial variables ( e.g. age, career opportunities, marital status) were initially controlled, with the expectation that there would initially be no sex differences and that a female preponderance would emerge over the subsequent decade as social heterogeneity occurred, allowing the identification of psychosocial risk factors to depression.The classification of depression and the definition of caseness in non-clinical groups are reviewed, noting the application of structured case-finding instruments with particular reference to the Diagnostic Interview Schedule or DIS, which is used here.Literature concerning the epidemiology of sex differences in depression is considered in terms of real and artifactual explanations.The study cohort commenced with 113 females and 56 males in 1978, with data on three assessments over ten years from 108 females and 53 males. The author conducted DIS interviews at a five-year follow-up then a lay interviewer conducted at a ten-year follow-up. There was moderate reliability over the ten-year period but evidence of some sex differences in recall of depressive episodes.Three different definitions of caseness were used. Sex differences in rates of depression were not found at the five-year follow-up. Sex differences at ten years were found only for the caseness definition with the lowest symptom threshold. There were no sex differences for self-report measures of trait, state depression or perceptions of parental or current intimate relationships. Females rated higher on measures of neuroticism, dependency and femininity. Sex differences in social support and coping styles when depressed are described.Using discriminant function analysis, the following risk factors relating to caseness were isolated: high trait depression, low self-esteem, high perceived maternal protection. Risk factors related to non-caseness included high paternal care and protection scores, and the presence of an intimate partner. A model linking perceived parental environment, the acquisition of self-esteem and consequent ability to sustain a good relationship with a partner and other social supports is considered. Gender did not constitute a significant risk factor, indicating the importance of social, rather than biological factors in determining onset of depressive disorders in young adults. CHAPTER ONE DEFINITION OF DEPRESSION AND ISSUES OF CASENESS CONTENTS The concept of depression Current theoretical classifications of depression Primary and secondary depression Unipolar and bipolar depression Endogenous and neurotic depression Depression categories in current diagnostic systems Diagnostic systems using operational criteria Historical development of concepts of caseness Use of self-report questionnaires Use of semi-structured instruments Discussion Summary of themes and relevance to the current research objectives CHAPTER 1WO DEVEWPMENT OF STRUCTIJRED CASE-FINDING INSTRUMEN...