Sex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs

Abstract

Objective The authors sought to clarify the nature of sex differences in the etiologic pathways to major depression. Method Retrospective and prospective assessments of 20 developmentally organized risk factors and the occurrence of past-year major depression were conducted at two waves of personal interviews at least 12 months apart in 1,057 opposite-sex dizygotic twin pairs from a population-based register. Analyses were conducted by structural modeling, examining within-pair differences. Results Sixty percent of all paths in the best-fit model exhibited sex differences. Eleven of the 20 risk factors differed across sexes in their impact on liability to major depression. Five had a greater impact in women: parental warmth, neuroticism, divorce, social support, and marital satisfaction. Six had a greater impact in men: childhood sexual abuse, conduct disorder, drug abuse, prior history of major depression, and distal and dependent proximal stressful life events. The life event categories responsible for the stronger effect in males were financial, occupational, and legal in nature. Conclusions In a co-twin control design, which matches sisters and brothers on genetic and familial-environmental background, personality and failures in interpersonal relationships played a stronger etiologic role in major depression for women than for men. Externalizing psychopathology, prior depression, and specific “instrumental” classes of acute stressors were more important in the etiologic pathway to major depression for men. The results are consistent with previously proposed typologies of major depression that suggest two subtypes that differ in prevalence in women (deficiencies in caring relationships and interpersonal loss) and men (failures to achieve expected goals, with lowered self-worth).

Stress and depression: old questions, new approaches

“…Thus, stress research warrants examination of early, chronic, continuing, cumulative, and proximal acute stress exposure. Moreover, there is growing evidence of the uniquely powerful role of interpersonal types of stress such as marital, family, and social relationships, losses, conflicts, and rejection in the prediction of depression especially in women [14,15].…”

Why is depression more prevalent in women?

“…15 Women also experience specific forms of depression-related illness, including premenstrual dysphoric disorder, postpartum depression and postmenopausal depression and anxiety, that are associated with changes in ovarian hormones and could contribute to the increased prevalence in women. However, the underlying mechanisms remain unclear; thus, treatments specific to women have not been developed.…”

Influences of the Big Five personality traits on the treatment response and longitudinal course of depression in patients with acute coronary syndrome: A randomised controlled trial

“…Whereas approximately 60% of the participants were female in the previous study, more than 60% of the participants in the EsDEPACS study were male, which reflects the prevalence of ACS Thibodeau et al, 2015, Tang et al, 2009). These differences are important because the relationships between FFM personality and depression differ by gender (Fanous et al, 2007;Kendler and Gardner 2014). The vulnerable type may be associated with poor outcome because the FFM model of personality shares generic risk factors with depression (Kendler and Myers, 2010), which has a greater genetic overlap in men than women (Fanous et al, 2007).…”