Chapter 13 – MENTAL HEALTH
- In 2005, 118 million prescriptions for antidepressants were written, making them the
most commonly prescribed drugs in the U.S.
- In 10 years, the use of antidepressants doubled, and 10% of Americans were on them.
- Women are twice as likely than men to use antidepressants.
- Women are more likely than men to suffer from depression or an eating disorder, and
men are more likely than women to commit suicide.
- Theories of this emphasize ideas that:
o 1) Women are led to perceive less control over their environment than men
o 2) Women and men cope differently with stress
o 3) Women and men face different stressors
o 4) Women are more vulnerable to different classes of stressors
Sex Differences in Depression
- Instruments that measure depressive symptoms include feeling sad or blue, feeling
depressed, having crying spells, difficulty concentrating, and loss of interest in activity
- Criteria for major depressive disorder (DSM-IV-TR) in table 13.2: Five or more of these
symptoms present for two weeks:
o Depressed mood most of the day, nearly every day
o Markedly diminished interested in activities
o Significant weight loss
o Psychomotor agitation or retardation
o Fatigue or loss of energy
o Feelings of worthlessness
o Diminished ability to think or concentrate or indecisiveness
o Recurrent thoughts of death
- If these symptoms occur in a period less of 2 weeks, it is commonly noted as clinical
- Depressive symptoms are typically evaluated with community surveys
o If men are less willing then women to report depression, community surveys
may underestimate men’s levels of depression
- Information on clinical depression is typically obtained from treatment facilities
o Depression can be evaluated with more sophisticated measures employed by
o The weakness is that respondents are not representative of the population
- Through the usage of these two methodologies, there has been a wealth of evidence
that women experience more depressive symptoms than men in the general population,
and women are more likely than men to be diagnosed with clinical depression
- In a study that combined the two methods described here by conducting face-to-face
clinical interviews with members of the community in 15 countries, females were
between 1.3 and 2.6 times more likely than males to be depressed across 15 countries. - It is not clear if the smaller sex difference is due to a lowered rate of depression in
females, or an elevated rate of depression in males.
o Interestingly, there is no overall sex difference in bipolar disorder
- Sex differences in depression are less likely found in homogeneous populations (college
students for example), and the widowed population.
o This is largely because rates of depression increase among men more than
women following widowhood
- A meta-analysis showed that girls are slightly less likely than boys to be depressed prior
to age 13, but girls’ depression increases after age 13, creating the sex difference.
o After this, sex difference remains stable over time
- Once women and men sustain an episode of major depression, they are equally likely to
o A study done showed that among those without a history of depression, women
are more likely than men to become depressed at any given point in time, but no
evidence indicates that depression is more likely to recur among women than
men among those with a history of depression.
- Higher prevalence of some mental health problems among gay and lesbian people
compared to heterosexual people.
o Sexual minorities feel more anxiety, depression, substance abuse, etc.
- One study of mood disorders (anxiety & depression) indicated that the difference
between gay and heterosexual men is larger than the difference between lesbians and
heterosexual women, whereas two other studies found just the opposite
o …. Not sure why they’d even print this then..
- Multiple reasons as to why sexual minorities experience elevated mental health issues:
o The impact of discrimination
o Lack of social support
o Minorities may internalize society’s negative attitudes towards them
- Three sets of methodological artifacts explaining why women “appear” more depressed
o 1) May be a bias on the part of clinicians (such that depression is over diagnosed
among women and under diagnosed among men)
o 2) May be a response bias on the part of depressed persons; men may be less
likely than women to admit depression or seek help for it
o 3) Women and men may manifest depression in different ways, and instruments
are biased in the direction of tapping female depression
- Perhaps clinicians are more likely to interpret a set of symptoms as depression when the
patient is female than male
- Clinicians may interpret feeling tired or lacking energy as depression in women, but
cardiac disease in men.
- They are aware of the sex differences – different sex schemas
- More of men’s than women’s depression went undetected by physicians - Psychiatrists did not fall into this bias – diagnosed individuals accordingly.
- A common concern is that men are less likely than women to report depression,
because depression is inconsistent with the male gender role
- The term ‘depression’ has negative connotations
o It implies a lack of self-confidence, a lack of control, and passivity – all of which
contradict the male gender role.
- Men might be less willing than women to report depression because they are concerned
that others will view them negatively.
- A more subtle response bias on the part of men is that they may be less likely than
women to realize they are depressed or to interpret their symptoms as depression
- Men may fall victim to the same kind of clinician bias
o Men were more likely to report symptoms of depression on a questionnaire that
was labeled “hassles” rather than “depression”
- Men may under report their depression because they do not recognize the depressive
Different Manifestations of Depression
- Prevalence of disorders between sexes is typically large, however the DSM-IV is not
making things easier.
- Histronic personality disorder for example
o In the DSM-IV, a feature of this disorder was “over concern with physical
o Some concern that this feature was biased to favor women
o Now the wording has been changed to “physical appearance draws attention to
the self.” Which has reduced this bias towards women
- However, this brings forth the question whether this is right
- Changing the wording also alters the features of the disorder.
- If a feature of a disorder is linked to gender roles, should it be altered so it is equally
endorsed by both sexes?
o We certainly would not change the features of medical illnesses such as prostate
cancer or breast cancer so they are equally represented among both men and
- Females report more fatigue, excessive sleepiness, and slowed speech and body
- Males report more insomnia, and agitation
- A study of depressed adolescents showed that females reported more guilt, body
dissatisfaction, self-blame, feelings of failure, and difficulties concentrating than males
o Could be associated with female rumination
- The idea that some items are more likely to be associated with a trait, such as
depression, among men versus women is referred to as differential item functioning.
o For example, crying is a depression item that may be susceptible to differential
item functioning. That is, crying is a symptom of depression that characterizes
women more than men, even when women and men are equally depressed. o This item could cause depression to be over diagnosed in women
- Depression is more likely to be related to alcohol problems in men than women.
Theories of Depression
- Susceptibility factors are innate, usually biological, factors that place women at greater
risk for depression than men
- If we learn women are socialized in different ways than men that make them more at
risk for depression, their learning history would be a susceptibility factor
- Precipitating factors are environmental events that trigger depression
o If certain environmental factors induce depression – and women face them more
than men – such as poverty or high relationship strain, depression might be
triggered more in women than in men
- Sex differences in depression do not appear until adolescence. This suggests that any
theory of sex differences in depression must take one of three forms:
o 1) Same cause but cause activated in female during adolescence
o 2) Different causes but female cause activated in adolescence, or
o 3) Interactive theory, in which females have more of the cause than males and
the cause, is activated in adolescence.
- SAME CAUSE THEORY suggests that the same factor causes depression in both
females and males, but that factor must increase during adolescence for females only.
- DIFFERENT CAUSE THEORY suggests that there are different causes of girls’ and boys’
depression, and only the case of girls’ depression increases during adolescence
- INTERACTIVE THEORY suggests being female always poses a risk for depression, but
the events of adolescence activate that risk factor
o In sum, these theories suggest either that the cause of depression is the same for
men and women, that there are different causes for male and female
depression, or that environmental factors interact with predisposing factors to
- Genes play a large role in genetic influence of depression
- Because genes are present at birth, a genetic theory of depression has difficulty
explaining the emergence of depression in females during adolescence
- Genetic theories would have to suggest that women are at risk for depression and the
events of adolescence interact with that risk.
- Genetic factors may interact with psychological variables to increase depression.
- One study evaluated 8- to – 20 years old monozygotic and dizygotic twins showed that
some genetic effects are activated around the age of puberty, partly supporting this
- Hormones would seem to be an ideal explanation for sex differences in depression,
since puberty is the typical age that differences appear - However no consistent evidence supports the theory that the changes in hormones
during puberty are associated with the onset of depression in adolescent females
- Hormones associated with the interactive theory
- Fluctuations in women’s hormones, in particular estrogen, prior to menstruation and
after the birth of a child are related to depression, but these effects are not nearly large
enough to account for the sex difference in depression
- One study observed that depression increased as women transitioned through
menopause and then decreased after menopause
- In one study, testosterone showed a curvilinear relation to depression, such that people
with extremely low or high levels of testosterone were depressed.
o High testosterone men