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Why is depression more common among women than among men?
Abstract
Women are about twice as likely as are men to develop depression during their lifetime. This Series paper summarises evidence regarding the epidemiology on gender differences in prevalence, incidence, and course of depression, and factors possibly explaining the gender gap. Gender-related subtypes of depression are suggested to exist, of which the developmental subtype has the strongest potential to contribute to the gender gap. Limited evidence exists for risk factors to be specifically linked to depression. Future research could profit from a transdiagnostic perspective, permitting the differentiation of specific susceptibilities from those predicting general psychopathologies within and across the internalising and externalising spectra. An integration of the Research Domain Criteria framework will allow examination of gender differences in core psychological functions, within the context of developmental transitions and environmental settings. Monitoring of changing socioeconomic and cultural trends in factors contributing to the gender gap will be important, as well as the influence of these trends on changes in symptom expression across psychopathologies in men and women.
... Gender differences in the prevalence of mental health disorders represent an important topic in global health, as these conditions significantly impact disability and reduced quality of life. Although the overall prevalence of mental health disorders appears relatively similar between men and women, recent evidence indicates distinctive genderbased patterns in the distribution of psychiatric disorders (Kuehner, 2014;WHO, 2004). Understanding these differences has become increasingly important for developing more Indonesian Journal of Global Health Research Volume 7 Number 4, August 2025e-ISSN 2715-1972p-ISSN 2714-9749 http://jurnal.globalhealthsciencegroup.com/index.php/IJGHR ...
... Understanding these differences has become increasingly important for developing more Indonesian Journal of Global Health Research Volume 7 Number 4, August 2025e-ISSN 2715-1972p-ISSN 2714-9749 http://jurnal.globalhealthsciencegroup.com/index.php/IJGHR targeted prevention strategies, improving diagnostic accuracy, and optimizing treatment approaches for various mental health conditions.Recent comprehensive analyses show that approximately one in five adults experience a common mental disorder within a 12month period, with lifetime prevalence estimates approaching 30% globally (Kuehner, 2014). However, these aggregate figures obscure important variations in how different categories of mental disorders manifest based on gender. ...
... However, these aggregate figures obscure important variations in how different categories of mental disorders manifest based on gender. Women consistently show higher prevalence rates of internalizing disorders, including anxiety and mood disorders, with female-to-male ratios of approximately 2:1 for anxiety disorders and 1.8:1 for mood disorders (Kuehner, 2014;Seedat et al., 2009). Conversely, men exhibit significantly higher rates of externalizing disorders, particularly substance use disorders, where prevalence may be 2-4 times higher than in women, depending on the substance type (Kuehner, 2014;McHugh et al., 2013). ...
Mental disorders represent a significant global health concern, adversely affecting individuals' well-being and quality of life. Empirical evidence suggests gender-based differences in the prevalence of mental disorders, yet comprehensive analyses within adult populations remain limited. This study aimed to examine gender differences in the prevalence of four major categories of mental disorders-neurotic disorders, substance use disorders (SUD), psychotic disorders, and post-traumatic stress disorder (PTSD)-in the adult population. The study population consisted of adult patients aged 18 years and older who were present in the designated research area during the study period. From this population, a total sample of 2,875 respondents was targeted using a consecutive sampling technique, where every eligible individual was selected in sequence until the required sample size was achieved. Inclusion criteria included adults who were able to communicate and willing to complete the questionnaire, while those with severe cognitive impairment or in emergency conditions were excluded. Data were collected using the Self-Reporting Questionnaire (SRQ-29), a validated and reliable instrument comprising 29 closed-ended items that assess symptoms across four mental health domains: neurotic, substance use, psychotic, and PTSD. Each "YES" answer was scored as 1 and each "NO" as 0. The responses were analyzed using SPSS version 25.0. Descriptive statistics (frequencies and percentages) were used to summarize the data, while the Chi-Square Test of Independence was applied to examine gender-based differences. Additionally, Odds Ratios (OR) and 95% confidence intervals were calculated to assess the strength of association between gender and mental disorder indications. The findings revealed that neurotic disorders, psychotic disorders, and PTSD were more prevalent in females than in males. Neurotic disorders affected 47.7% of females and 28.3% of males; psychotic disorders were present in 32.6% of females and 27.2% of males; PTSD affected 63.6% of females compared to 46.8% of males. No cases of substance use disorders were reported in either gender group. There are significant gender differences in the prevalence of certain mental disorders, with females exhibiting higher rates of neurotic disorders, psychotic disorders, and PTSD. These findings highlight the need for gender-responsive approaches in mental health interventions, services, and public health policy planning.
... Anxiety is often comorbid with other psychiatric disorders shown to be associated with diabetes risk, such as depression [13]. Obesity is another relevant factor that may partly mediate the association of T2DM with depression [14][15][16][17][18]. Unhealthy behaviors such as alcohol consumption and smoking can also increase the risk of depression among patients with T2DM [19,20]. ...
... Similarly, a national study conducted in Spain between 2001 and 2020 showed that the prevalence of diagnosed depression was approximately 3.32-fold higher in women with T2DM than in men [35]. The association between T2DM and depression has also been found to vary by sex, suggesting a potentially greater relative impact of diabetes on depression risk among women [14,36]. The proposed explanations include hormonal factors, sex-specific psychosocial stressors, and differences in help-seeking behaviors or clinical diagnosis patterns [14]. ...
... The association between T2DM and depression has also been found to vary by sex, suggesting a potentially greater relative impact of diabetes on depression risk among women [14,36]. The proposed explanations include hormonal factors, sex-specific psychosocial stressors, and differences in help-seeking behaviors or clinical diagnosis patterns [14]. ...
Background/Objectives: There is a growing body of evidence supporting a bidirectional relationship between depression and type 2 diabetes mellitus (T2DM). The coexistence of depression and T2DM has substantial clinical implications. However, there is little research looking at how these two conditions cluster together in people hospitalized with T2DM, the associated factors, and their effect on hospital outcomes. In this study, we aimed to assess temporal trends in depression prevalence among hospitalized patients with T2DM in Spain from 2017 to 2023. Additionally, we analyzed the association of variables such as gender, age, anxiety, obesity, alcohol and tobacco use, dementia, COVID-19 infection, and personality disorders in the presence of depression among hospitalized T2DM patients and the impact of these variables on in-hospital mortality (IHM). Methods: We conducted a population-based cohort study using the Spanish Hospital Discharge Registry (RAE-CMBD). Adults aged ≥ 40 years with a T2DM diagnosis were included. Depression was identified by using ICD-10 codes. Time trends were analyzed by using joinpoint regression. Multivariable logistic regression models were employed to identify factors associated with depression and in-hospital mortality (IHM), stratified by sex. Results: Among 4,597,668 hospitalizations with T2DM, 202,094 (4.39%) included a depression diagnosis. Depression prevalence increased slightly over time (APC: 1.09% in women and 0.98% in men). Women consistently showed higher prevalence (OR 3.21; 95% CI: 3.18–3.24). Age, anxiety, obesity, alcohol and tobacco use, and personality disorders were significantly associated with the presence of a code for depression, with notable sex differences. Among patients with T2DM and depression, IHM was significantly associated with older age, more comorbidities, COVID-19 infection, hypoglycemia, dementia, and female gender, whereas obesity and anxiety had a protective effect. Conclusions: From 2017 to 2023, the prevalence of depression in hospitalized patients with T2DM in Spain increased slightly, particularly among older women, highlighting the need for integrated mental health screening and management during hospitalization.
... Regarding physical activity, a meta-analysis revealed no gender differences in adherence to PA guidelines among adolescents but significant differences among adults and Type 2 diabetes patients, with women consistently engaging in lower levels of moderate-to-vigorous physical activity throughout the lifespan [39], mirroring the physical activity differences observed in our study. In the context of depression, Kuehner noted that women were twice as likely to experience depression throughout their lifetime compared to men [40], a finding consistent with our sample. Another meta-analysis suggested that gender differences in the severity of depression were more pronounced in countries with higher gender equality, with no differences in depressive symptoms; nonetheless, male depression should not be disregarded [41]. ...
... Another meta-analysis suggested that gender differences in the severity of depression were more pronounced in countries with higher gender equality, with no differences in depressive symptoms; nonetheless, male depression should not be disregarded [41]. Meanwhile, women are generally more susceptible to depressive symptoms than men, a disparity that becomes more pronounced following stressful life events [40]. Regular physical activity may improve mood in women by enhancing circadian rhythm synchronization, whereas in men, the beneficial effects may be more directly dependent on exercise intensity [42]. ...
The joint effects of physical activity and sleep duration on depression remain unclear. The aim of this study is to explore the independent and joint associations between physical activity (PA) and sleep duration with depressive symptoms.
We included and analyzed 18,052 participants (age ≥ 20 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2014.
After adjustment, both males and females showed a significant correlation between PA, sleep duration, and depressive symptoms. In the joint association analysis, we found: 1. The interaction between PA and sleep duration was statistically significant in males but not significant in females (P = 0.380). 2. Compared to individuals with the lowest PA level and not meeting the National Sleep Foundation’s (NSF) guidelines, those with the highest PA level and recommended sleep duration had a 79% decrease in depression risk in males (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.14–0.32) and a 74% decrease in females (OR 0.26, 95% CI 0.20–0.35). 3. In male participants adhering to NSF guidelines, each increase in PA quartile is associated with a 19% reduction in the risk of depression (OR 0.81, 95% CI 0.71–0.92). Conversely, among male participants not adhering to NSF guidelines, there is a 23% decrease in depression risk (OR 0.77, 95% CI 0.69–0.86). For female participants, the respective reductions in depression risk are 20% (OR 0.80, 95% CI 0.73–0.89) and 14% (OR 0.86, 95% CI 0.80–0.93).
For males, adherence to recommended sleep duration weakens the relationship between physical activity and depression, while the opposite is observed for females.
... Based on consultations with experts in adolescent mental health (RS, URS), the study assessments were systematically screened and a broad set of predictors of future mental health was included and assigned to the domains of mental health and well-being (eg, questions on depressive and anxiety symptoms, history of self-harm [22]), physical health (chronic diseases, BMI [23]), psychological and cognitive testing (school grades, cognitive assessments, moral attitudes), socioeconomic and family factors (family climate, socioeconomic status, and mental health problems of the parents [24,25]), lifestyle and peer relationships (substance use, media consumption, activities [11,26,27]), and others (sex [28]). A complete list of selected predictors, domain assignments, and the percentage of missing values can be found in Tables S1 and S2 in Multimedia Appendix 1. ...
... In both cohorts, we moreover found that female sex predicted worse mental health in late adolescence also when statistically correcting for baseline mental health symptoms in young adolescence. This finding is in accordance with a well-established gender gap in depressive symptoms, which starts to manifest during puberty, increases until adulthood, and has multifaceted reasons [28]. ...
Background
Converging evidence indicates an adolescent mental health crisis in Western societies that has developed and exacerbated over the past decade. The proposed driving factors of this trend include more screen time, physical inactivity, and social isolation, but their causal influence on mental health is insufficiently understood.
Objective
The objective of this study is to test whether and based on which predictor variables the development of mental health in adolescents in the last decade can be predicted and to better understand the causal chain of factors at work.
Methods
We implemented an interpretable machine learning pipeline based on gradient boosting regression with repeated cross-validation to assess the development of mental health throughout adolescence in members of 2 longitudinal cohort studies, the British Millenium cohort (MC; n=8599) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) cohort (n=1212). In total, 144 (MC) and 102 (KiGGS) predictors assessed at the age of around 13.8 years (MC) and 11.6 years (KiGGS) were used to assess mental health at the ages of around 16.7 years (MC) and 16.4 years (KiGGS). Based on these predictive models, we used permutation-based feature importance analyses to identify relevant predictors and predictor domains. Moreover, we performed partial dependence analyses in a causal inference framework to determine the direct effects of physical inactivity, screen time, and peer problems on the development of mental health.
Results
The average cross-validated Pearson correlation coefficient ( r ) between predicted and true mental health in late adolescence was 0.614 (MC) and 0.466 (KiGGS). Feature importance analyses indicated a strong impact of preexisting mental health and weaker impacts of sex (female as a risk factor), physical health (chronic disease as a risk factor), lifestyle, and socioeconomic and family factors (eg, low parental education, income, and mental health as risk factors). Causal inference analyses suggested a strong direct effect of peer relationships, but only a small direct effect of physical inactivity and a very small direct effect of screen time.
Conclusions
Mental health development during adolescence can be assessed by a combination of variables from early adolescence. Peer problems represent an important direct cause of mental health development, and their deterioration may contribute to the current mental health crisis.
... One potential explanation is variation in help-seeking and symptom reporting, as males are generally less likely to seek professional help or disclose symptoms, leading to under-diagnosis [7]. Environmental exposures also vary by sex; for example, females are more frequently exposed to sexual abuse and other forms of interpersonal violence, and experience structural forms of discrimination such as the gender wage gap, which may contribute to the higher prevalence of MDD in females [8,9]. ...
... The origin of the MDD prevalence difference across sexes could also affect interpretation of our heritability findings. If the higher prevalence of MDD in females is predominantly driven by environmental factors, such as trauma and structural forms of discrimination [8,9], the sex difference in h 2 SNP may arise from the statistical relationship between prevalence and liability scale h 2 SNP rather than underlying sex differences in genetic architecture. However, if the prevalence difference is a consequence of genetic or biological factors, the difference in h 2 SNP could indeed signal genuine sex differences in genetic architecture. ...
There are striking sex differences in the prevalence and symptomology of Major Depressive Disorder (MDD). We conducted the largest sex-stratified genome wide association and genotype-by-sex interaction meta-analyses of MDD to date (Females: 130,471 cases, 159,521 controls. Males: 64,805 cases, 132,185 controls). We found 16 and eight independent genome-wide significant SNPs in females and males, respectively, including one novel variant on the X chromosome. MDD in females and males shows substantial genetic overlap with a large proportion of MDD variants displaying similar effect sizes across sexes. However, we also provide evidence for a higher burden of genetic risk in females which could be due to female-specific variants. Additionally, sex-specific pleiotropic effects may contribute to the higher prevalence of metabolic symptoms in females with MDD. These findings underscore the importance of considering sex-specific genetic architectures in the study of health conditions, including MDD, paving the way for more targeted treatment strategies.
... Pregnancy and postpartum depression have necessitated thought-provoking decisionmaking regarding medication prescribing, weighing maternal and fetal risks. Increased realization of gender variability in psychiatric symptomatology and response has resulted in more specific pharmacological intervention (Kuehner, 2020) [45] . ...
... Pregnancy and postpartum depression have necessitated thought-provoking decisionmaking regarding medication prescribing, weighing maternal and fetal risks. Increased realization of gender variability in psychiatric symptomatology and response has resulted in more specific pharmacological intervention (Kuehner, 2020) [45] . ...
... Even before COVID-19, HCWs faced a mental health crisis marked by high rates of psychiatric symptoms and maladaptive coping strategies [23]. In addition to environmental factors, personal characteristics such as being younger, female, less experienced, or having a history of psychiatric disorders have been associated with increased vulnerability to PTSS, anxiety, and depression [24,25]. Gender disparities may also be heightened by the predominance of women in nursing roles, who provide direct patient care [18,26]. ...
Introduction
The COVID-19 pandemic generated a global health crisis that significantly impacted healthcare systems and professionals. Healthcare workers were exposed to high levels of psychological distress, including posttraumatic stress symptomatology (PTSS).
Aim
Analyse the evolution of PTSS among Spanish healthcare workers during the COVID-19 pandemic, and to identify associated factors.
Method
A multicenter prospective cohort study with a 12-month follow-up was conducted. PTSS was the primary outcome. Secondary variables included sociodemographic, occupational, psychological, and coping-related factors. Statistical analyses comprised bivariate comparisons and multivariate modelling, such as generalized linear models and linear mixed models.
Results
Of the 428 participants, 180 completed the 12-month follow-up. At baseline, changes in work posts, negative family-work relations, avoidant coping, burnout symptoms, and emotional intelligence were associated with PTSS levels. Linear mixed models showed a significant decrease in PTSS over the 12-month period, regardless of gender, age, household type, occupational role, contract type, job title, level of care or type of service (p < 0.001). The generalised linear model explained 25.5% of the variance in PTSS levels at baseline, highlighting the role of psychological and coping factors over sociodemographic or occupational characteristics.
Conclusions
This study highlights the need for early identification and intervention focused on psychological and coping mechanisms. Promoting emotional regulation, reducing burnout, and addressing maladaptive coping may help mitigate long-term psychological effects among healthcare workers during public health crises.
... In contrast, our study found no difference in depression scores between patients with and without LLE. This discrepancy may be explained by the often higher prevalence of depression among women, as suggested by other studies [40]. However, these results highlight the relationship between LLE and physical and emotional burden, emphasizing the need for patient support. ...
Purpose
Lower limb edema (LLE) is characterized by swelling due to fluid accumulation and is an under-recognized condition in men with prostate cancer. This study investigated the prevalence of LLE and explored its impact on daily living, depression, and health-related quality of life (HRQoL).
Methods
This cross-sectional study included men with prostate cancer who attended follow-up at the Department of Urology, Rigshospitalet, Denmark, during a 3-month period. LLE was defined as an L-Dex ≥ 10, measured by using bioimpedance spectroscopy, combined with self-reported symptoms (≥ 2 of heaviness, swelling, or tightness) using items from European Organisation for Research and Treatment of Cancer Quality of Life (EORTC) QLQ-VU34. HRQoL, depression, and the impact of LLE on daily living were assessed using self-reported questionnaires.
Results
Among 401 patients, LLE was identified in 45 (11%) patients. Self-reported swelling before diagnosis, comorbidities, BMI ≥ 30, and androgen deprivation therapy (ADT) showed the highest odds of LLE. Patients with LLE demonstrated lower HRQoL scores in global health, physical, role, and social functioning and reported higher bowel and hormonal treatment-related symptoms (p < 0.05). LLE impacted daily activities, including walking (42%) and clothing choices (41%). Most patients (76%) wanted more information on managing LLE symptoms.
Conclusions
LLE is prevalent among men with prostate cancer and is associated with poorer HRQoL and daily living. Despite its impact, many patients report a lack of information and express a desire for more knowledge about the condition. Improved patient education and attention to potential underlying causes are crucial for timely treatment of LLE.
... This heightened vulnerability may stem from gender-speci c neurobiological mechanisms, sociocultural roles, and unequal access to psychosocial resources. In traditional settings, women often bear primary responsibilities for caregiving and household management while receiving limited external support, rendering them more susceptible to psychological stressors [32][33] . During famine, resource scarcity may have further intensi ed emotional burdens and survival pressures for females [34] .Socioeconomic status has also been suggested as a potential mediator in the relationship between early-life famine exposure and adult mental health outcomes [35][36] . ...
Background Depression and anxiety are significant public health concerns worldwide and among the most common mental disorders. The impact of early-life famine exposure on mental health has increasingly drawn attention. However, research on the association between early-life famine exposure and the risk of depression and anxiety in adulthood, especially across different ethnic backgrounds, remains scarce in worldwide. Methods The study is based on the baseline data from the China Multi-Ethnic Cohort (CMEC), and includes 18,376 individuals who were born between 1939 and 1978 and experienced early life famine exposure. All participants underwent face-to-face interviews and physical examinations, and their anxiety and depression symptoms were assessed using the PHQ-2 and GAD-2 scales. Multivariable logistic regression analysis was conducted to examine the association between early-life famine exposure and the risk of depression and anxiety in adulthood. Results The study revealed that exposure to famine during childhood and adolescence significantly increases the risk of depressive symptoms in adulthood (childhood: OR = 1.65, 95% CI: 1.33–2.05; adolescence: OR = 1.64, 95% CI: 1.18–2.28). Among females, famine exposure during both childhood and adolescence was associated with a markedly elevated risk of adult depressive symptoms (childhood: OR = 1.87, 95% CI: 1.47–2.39; adolescence: OR = 1.96, 95% CI: 1.36–2.81). In the Han ethnic group, childhood famine exposure was significantly associated with an increased risk of depressive symptoms in later life (OR = 1.92, 95% CI: 1.44–2.56). In contrast, among the Yi ethnic group, fetal exposure to famine was significantly related to an increased risk of both depressive symptoms (OR = 2.33, 95% CI: 1.28–4.25) and anxiety symptoms in adulthood (OR = 1.99, 95% CI: 1.37–2.88), whereas no significant associations were observed in the Bai ethnic group. Regarding anxiety symptoms, males exposed to famine during childhood and adolescence were found to have a significantly reduced risk of developing anxiety symptoms in adulthood (childhood: OR = 0.53, 95% CI: 0.33–0.85; adolescence: OR = 0.32, 95% CI: 0.13–0.78). Among the Yi population, fetal famine exposure emerged as a significant risk factor for adult anxiety symptoms (OR = 1.99, 95% CI: 1.37–2.88). Conclusion Famine exposure during childhood and adolescence significantly impacts the risk of mental health disorders in adulthood, exhibiting different patterns across ethnic groups. Early-life nutritional deprivation may have long-term effects on mental health, with variations based on gender and ethnicity.
... The gender gap in depression warrants attention regarding socio-cultural and economic influences on psychopathology (Kuehner, 2017). Mental healthcare for Brazilian men is characterized by neglect and limited visibility of mental suffering, suggesting a silent crisis (Silva;Melo, 2021). ...
Individuals with hearing impairments are more vulnerable to depression. According to the 2010 Brazilian Demographic Census, around 10 million people have some degree of hearing impairment. Brazil also ranks highest in depression among middle-income countries. The prevalence of mental health conditions in the Brazilian hearing-impaired population remains an understudied topic. This study aims to quantify the impact of depression on the life expectancy of the Brazilian population with hearing impairment. We used data from the 2019 edition of the National Health Survey and from the 2010 Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) Census to apply the Sullivan method (1971). Our results show that young women with severe hearing impairment are the population group that requires special attention due to the strong effect of depression on life expectancy. It is also possible that men have an underestimated prevalence of depression, which may obscure their years lived without depression. Targeted public policies are recommended to reduce communication barriers between patients, physicians, and other health professionals by promoting fluency in Brazilian Sign Language and knowledge of Deaf culture and their specific needs.
... Consistent with a previous report, 3 no difference in global cognitive status was observed between genders. Although it has been reported that women generally suffer more often from depressed mood and depression than men, 10 we did not find the gender disparity in depression in PSP patients. ...
Gender differences in progressive supranuclear palsy (PSP) may become relevant for clinical trials, treatment decisions and patient counseling. To study gender associated differences we conducted a retrospective data analysis of 191 male and 157 female PSP patients from a large multicenter observational cohort in Germany. While no differences in motor skills, disease severity, daily living abilities, global cognitive status and depressive symptoms were observed between genders, male patients showed significantly higher apathy scores, a finding also noted in other neurological diseases. In this study, apart from male patients exhibiting higher levels of apathy, no significant disease-specific gender differences were observed in PSP patients.
... As a heterogeneous and multifactorial disease, the gender gap in depression may be inferred from many biological, psychological, and environmental factors [2]. Heredity may play a role in explaining gender differences in certain human traits, but no sufficient evidence can explain the gender difference in depression solely from genetic underpinnings [3]. ...
Background
Gender is a sensor in certain professional psychological risks. One of those professions is nursing; it has a humanistic nature that is double-loaded with triggers of negative psychological sequelae such as depression and compassion fatigue. To help male and female nurses cope successfully with variable trauma, resilience pathways are activated, yet using different mechanisms. The purpose of this study was to assess the differences in depression, compassion fatigue, and resilience based on gender and the variables of education, marital status, and income.
Methods
631 hospital-based nurses participated in this correlational descriptive study. Measurements included a demographic survey, depression risk score measured by the Center for Epidemiologic Studies of Depression Scale (CESD), compassion fatigue score by Charles Figley, and resilience score measured by Connor-Davidson resilience scale-10 items. Analysis used descriptive statistics for gender, health sector, education, marital status, income, and department. Student t-test and ANOVA were used to investigate the differences in depression, compassion fatigue, and resilience based on gender, education, marital status, and income.
Results
Male nurses significantly reported higher depression levels (t (629) = 4.8, p <.001, M = 29.1, SD = 10.3) than female nurses (M = 27.2, SD = 9.2). They reported significantly higher compassion fatigue (t (629) = 4.8, p <.001, M = 46,9, SD = 24.3) when compared to female nurses (M = 38.2, SD = 21.3). There was no gender-based difference in resilience scores between male (t = 0.037, P =.97 >.05), M = 23.7, SD = 7.8)) and female nurses (M = 23.7, SD = 8.2). There were no significant differences in depression, compassion fatigue, and resilience based on other demographic variables such as education, marital status, and income (p >.05). Depression had little negative relationship with resilience (r = −.116, p =.004) and a moderate positive relationship with compassion fatigue (r =.529, p <.001).
Conclusion
Nurses’ male gender showed dominance in depression and compassion fatigue over nurses’ female gender. Resilience capabilities were generally the same between the two genders. Nevertheless, for both genders, compassion fatigue and depression risks were high and resilience scores were low. The negative relationship between depression and resilience suggests that health authorities should promote nurses’ mental health to increase resilience capacities. Adopting gender-sensitive approaches in research and clinical practice in nurses’ mental health is increasingly recommended with special cultural and contextual considerations.
... Research indicates that women in perimenopausal and postmenopausal phases are at a higher risk for depression compared to premenopausal women (Cohen et al., 2013). Estragon fluctuations, particularly a decrease in serotonin levels, are thought to contribute to the onset of depressive and anxiety symptoms (Kuehner, 2017). Moreover, the reduction in progesterone, which has a calming effect on the brain, further exacerbates mood instability. ...
The present study employed a cross-sectional design with a quantitative methodology to examine the relationship among menopausal symptoms, depressive symptoms, and mood disorders in a sample of 120 women aged 40–60 years from both rural and urban areas of Sialkot, selected through purposive sampling. Data were collected using a self-developed demographic sheet (in Urdu), the Hamilton Depression Rating Scale (HDRS), the Mood Disorder Questionnaire (MDQ), and the Menopause Rating Scale (MRS). Results revealed that the majority of participants were housewives living in joint families, with a predominant representation of Muslim women and nearly equal distribution between rural and urban areas. Descriptive statistics showed acceptable reliability for the MRS (α = .723), moderate reliability for HDRS (α = .528), and relatively low reliability for MDQ (α = .342). A significant positive correlation was found between MRS and HDRS (r = .351, p < .05), indicating that more severe menopausal symptoms were associated with higher depressive symptoms, while MDQ showed no significant relationship with either MRS or HDRS. Multiple regression analysis revealed that depressive symptoms (HDRS) significantly predicted the severity of menopausal symptoms (β = .360, p < .001), whereas mood disorder symptoms (MDQ) did not. These findings underscore the significant impact of depression on menopausal symptom severity and highlight the need for targeted psychological interventions to enhance the well-being of menopausal women.
... These differences have been associated with a combination of biological, psychological, and environmental factors, such as exposure to childhood sexual abuse, intimate partner violence, and structural gender inequalities. 59 Intimate partner violence against women is widespread within the ASEAN, with a lifetime prevalence ranging from 15% to 44% in six member states (Cambodia, Indonesia, Myanmar, the Philippines, Thailand, and Viet Nam). 60 In Myanmar and Brunei, there is no specific law against domestic violence. ...
Background The Association of Southeast Asian Nations (ASEAN), a geopolitical and economic network of ten member states, recognises mental disorders as a health priority; however, sparse epidemiological data hinder the development of effective strategies to reduce their prevalence and burden. We aimed to examine the prevalence, morbidity, and disease burden associated with ten mental disorders from 1990 to 2021 in the ASEAN. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2021), we analysed estimates for depressive disorders, anxiety disorders, bipolar disorders, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder (ADHD), eating disorders, idiopathic developmental intellectual disability, and other mental disorders in ten ASEAN member states (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Viet Nam). Case definitions were based on Diagnostic and Statistical Manual of Mental Disorders or ICD criteria. Prevalence estimates by age, sex, year, and location were derived using DisMod-MR 2.1, a Bayesian meta-regression modelling tool. Disease burden was quantified by estimating years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). Findings In 2021, 80·4 million (95% UI 73·8–87·2) cases of mental disorders were reported across ASEAN countries, representing a 70·0% (63·5–77·2) increase since 1990. The age-standardised prevalence of mental disorders was 11·9% (10·9–12·9) in 2021, ranging from 10·1% (9·1–11·3) in Viet Nam to 13·2% (11·6–15·3) in Malaysia, with anxiety and depressive disorders being the most common. The age-standardised prevalence of mental disorders increased by 6·5% (3·7–9·8) between 1990 and 2021. Mental disorders accounted for 11·2 million (8·5–14·3) DALYs in 2021, representing an 87·4% (81·1–94·0) increase since 1990. The 10–14 years age group had the highest disease burden attributable to mental disorders, which accounted for 16·3% (12·7–20·5) of total DALYs in this age group. The largest relative increases in the number of cases of mental disorders between 1990 and 2021 were seen in older adults (182·8% [174·9–192·1] among those aged ≥70 years), despite small relative changes in prevalence in these age groups. Interpretation The increase in mental disorder prevalence and burden found in this study might partly reflect recent improvements in detection. However, mental disorders now rank among the top ten causes of disease burden in all ASEAN countries except Myanmar, underscoring the urgent need for a comprehensive intersectoral approach to address prevention and treatment gaps across entire populations.
... According to a number of studies, women are twice as likely as men to experience stress or depression in their lifetime. This could be because of a variety of factors, such as hormonal differences, cultural backgrounds, gender differences in social activities, and how people react to stressors [11][12][13]. ...
... The higher prevalence of antidepressant use in women could be attributed to several factors. Research has shown that women are more likely to seek help for mental health issues and are more likely to be diagnosed with depression than men (Kuehner, 2017) [16]. Additionally, biological and hormonal factors, such as fluctuations in estrogen and progesterone levels, may contribute to the higher rates of depression observed in women, which could, in turn, explain the higher use of antidepressants (Kundakovic and Rocks, 2022) [17]. ...
... Depresyon, hem bireysel hem de toplumsal düzeyde önemli bir sağlık sorunu oluşturmakta ve iş gücü kaybı yolunda yol açmaktadır (Bloom vd., 2011). Kadınlar, erkeklere göre virüse karşı daha dayanıklı olup, virüsün prevalansı kişilerin yaklaşık iki katıdır (Kuehner, 2017). Genetik faktörler, stresörler ve sosyoekonomik durum belirtilerinin önemli bir rolü vardır (González ve ark., 2015). ...
This review study addresses the definition, etiology, symptoms, history and theoretical explanations of depression; and examines the role of mindfulness-based approaches in the treatment of depression. It is emphasized that depression is a multidimensional mental disorder that deeply affects the individual's mood, thoughts and functionality. The effects of biological, social and psychological factors on the development of depression are evaluated in detail. In addition, literature reviews have shown that methods such as mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction program (MBSR) are effective in reducing depressive symptoms. Mindfulness practices have been found to provide positive changes in depression at both psychological and neurobiological levels. The study shows that mindfulness-based interventions are an effective complementary method in the treatment of depression and suggests that they reduce the risk of relapse by increasing the psychological flexibility of individuals. The aim of this study is to examine the effectiveness of mindfulness-based therapy approaches in individuals experiencing depression using the review method. In line with the research in the literature, the effects of mindfulness practices on depressive symptoms, their contribution to reducing relapse rates and their roles in supporting psychological well-being were analyzed. The study aimed to determine how mindfulness therapies are used as an alternative and complementary method in the treatment of depression, under what conditions they are effective and to develop recommendations for future studies in the light of the current findings. Key words: Depression, Mindfulness. Psychological Flexibility, Neurobiological Effects.
... 41 In Western and industrialised countries, firmly established societal norms surrounding appearance, thinness and caregiving contribute to higher rates of anxiety among women. 42 Similarly, in Mexico, traditional gender norms place significant pressure on women to prioritise the needs of others over their own, leading to elevated levels of stress and anxiety. 43 Age emerged as another significant determinant of mental health outcomes in this study, particularly with Open access regard to anxiety and stress levels. ...
Background
Rapid urbanisation and the dense population of Bangladesh foster the growth of slum settlements, where poverty and food insecurity are magnified by economic instability and inflationary pressures, adversely affecting psychological health.
Objectives
This study aimed to assess household food security and its influence on psychological well-being among adults living in urban slums of Bangladesh.
Methods
A cross-sectional study using convenient sampling was conducted among 300 adults in slums in Dhaka, Bangladesh, using a semistructured questionnaire to collect data on sociodemographics, food security and mental health status. Multivariable logistic regression analyses were conducted to observe the influence of food insecurity on mental health status, controlling for other covariates.
Results
The majority of the participants experienced food insecurity, with 38.0% expressing severe food insecurity. High levels of psychological distress were observed, including stress (54.7%), anxiety (63.3%) and depression (73.3%). Older adults (aOR 4.5, 95% CI 1.3 to 15.5) and females (aOR 4.1, 95% CI 2.0 to 8.4) had higher odds of experiencing anxiety. Single individuals were more prone to experience depression, while homemakers exhibited elevated levels of both depression and anxiety. Furthermore, moderate to severe food insecurity was significantly associated with higher odds of depression (aOR 2.8, 95% CI 1.2 to 6.7) and anxiety (aOR 8.2, 95% CI 3.3 to 20.3) compared with no or mild food insecurity.
Conclusions
This study highlights the pervasive influence of household food insecurity on urban slum dwellers’ psychological well-being. Addressing vulnerabilities tied to age, marital status and occupation is crucial for alleviating mental health burdens.
... However, compared to men, women may have particular stressors associated with managing a variety of obligations and cultural demands, which may affect their quality of life (Rice et al., 2016). Moreover, anxiety and sadness may be more common in women, which could lower their quality of life (Kuehner, 2017). Support systems, mental health services, and stress reduction programs should be specifically designed to address these issues to enhance the quality of life for female students. ...
Bacolod City College recognizes the importance of mental health for its diverse student body, addressing academic
pressures, financial concerns, and social challenges. By identifying priorities, the guidance center can implement
proactive measures for effective stress management. The study used a quantitative descriptive design to gather data
on the mental health priorities of Bacolod City College students, incorporating factors like age, sex, and living
conditions, aligning with the Department of Science and Technology's Mental Health Research Agenda. LGBTQ+
issues were viewed as low priority in this school while suicide/self-harm issues and family issues were seen as a high
priority. The Business Administration-Entrepreneurship department also views Abuse and Trauma and HIV and STDs
as high-priority mental health issues. The quality of life for older students with mental health issues is generally good,
regardless of demographic variables such as sex, living conditions, and parental employment. Mental health issues are
well understood by male students, high-income students, and employed parents, with age and sex showing significant
differences within-group. The Guidance Center of Bacolod City College should continue to support students with
unique mental health concerns, focusing on improving their quality of life and family environment.
... Mental health difficulties (such as anxiety, depression, or eating disorders) can be associated with a range of challenges for individuals including distress, impaired functioning, and risk of selfharm [55]. Biological factors (e.g., hormones or genes), psychological factors (e.g., coping styles or body image perceptions), micro-level environment factors (e.g., adverse or stressful life events), and macro-level environment factors (e.g., gender inequity in society) may all contribute to gender differences in rates of mental health difficulties [22]. We need to better understand the challenges faced by young women and girls to determine how we can best support them to prevent and manage mental health difficulties. ...
Background
Recent data in England show rising levels of mental health difficulties among young women, as compared to young men. Thus, the aim of this study was to explore the lived experiences of young women and girls (across different ethnic groups, who are neurodivergent, and/or who identify with the LGBTQIA + community) in the UK about their mental health and associated support.
Method
Narrative interviews were conducted with 29 young women and girls aged 14 to 24 years. Using ideal-type analysis, a method for identifying broad patterns or ‘types’ within qualitative datasets, two typologies were developed to explore similarities and differences between participants’ stories and delineate overarching narratives across stories.
Results
The first typology was titled: ‘What is my mental health story?’ Three overarching types or narratives within the dataset were identified in terms of participants’ mental health stories: ‘Traumatic and impactful experiences’; ‘Body-mind-society interaction’; and ‘Prolonged distress and disruption’. The second typology was titled: ‘How would I like to be supported in relation to my mental health?’ Three overarching types or narratives were also identified in relation to participants’ stories about how they would like to be supported with their mental health: ‘Empathy, understanding, and connection’; ‘Support from/for intersecting (overlapping) identities’; and ‘Heard, seen, and accepted’.
Conclusions
Hearing from young women and girls, in their own words, about their mental health stories is crucial to optimise prevention and treatment efforts. Our findings show that a positive therapeutic relationship, supportive social relationships, feeling heard and accepted, and consideration of the multiple overlapping facets of one’s identity are key mechanisms influencing the utility of support. Ultimately, mental health support should be individualised, consistent, and available.
... This finding aligns with existing literature, which consistently identifies being female as a significant risk for presenting depression [37]. The greater prevalence of depression among women is probably affected by a combination of factors, including genetic predispositions, hormonal influences, and physiological stress responses, rather than a single specific mechanism [38]. Unemployment also emerged as a notable predictor of depression in our study, mirroring prior research on the psychological toll of job loss [39]. ...
Background
Depression is the leading cause of disability worldwide and a growing public health concern. In Iran, the prevalence of depression has shown an increasing trend, with rural populations facing unique challenges in access to mental health care. This study aimed to determine sociodemographic and clinical predictors of depression and explore how these factors influence age at onset in a rural population, providing valuable insights for preventive strategies.
Methods
The present cross-sectional investigation utilized baseline data of the Fasa PERSIAN Cohort, comprising 10,133 adults aged 35 and older from a rural region in southern Iran. Depression diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Logistic regression analyses were conducted to identify predictors of depression, while linear regression models examined associations between baseline characteristics and age at depression onset.
Results
Among participants, 6.7% met the criteria for depression, with a higher prevalence among females (78.7%) and the unemployed (70.9%). Independent predictors included female sex, unemployed status, literacy, diabetes, fatty liver disease, and psychiatric comorbidities, which emerged as the strongest predictor (odds ratio = 6.605, p < 0.001). The average age at depression onset was 39.5 years, with men experiencing onset earlier than women. Earlier onset was also associated with higher education levels, opioid use, psychiatric comorbidities, and higher energy intake, whereas later onset was linked to medical conditions, including hypertension, cardiovascular disease, and stroke.
Conclusion
This study highlights important demographic and clinical factors linked to depression and its age of onset, underscoring the complex interplay between sociodemographic characteristics, lifestyle factors, and comorbidities. These findings can guide targeted mental health interventions and support tailored prevention strategies in similar rural populations.
... Throughout the lifespan, females consistently engage in less moderate-to-vigorous physical activity (MVPA) than males [47]. Kuehner pointed out that females are twice as likely to develop depression as males [48]. Women are generally more susceptible to depressive symptoms than men, a disparity that becomes more pronounced following stressful life events. ...
This study aimed to explore the association between physical activity and depression risk among middle‐aged and elderly Chinese using both cross‐sectional and longitudinal data. A total of 3564 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. The cross‐sectional analysis of 2020 data revealed a U‐shaped dose–response relationship between physical activity levels and depression risk. Longitudinally, group‐based trajectory modeling identified five distinct physical activity patterns from 2011 to 2020. Compared to the low‐stable group, the moderate‐stable group showed a 47% reduced risk of depression, while the highest‐stable group had a 37% increased risk. Gender‐stratified analyses showed that long‐term moderate physical activity had protective effects in both males and females, whereas excessive activity was only associated with higher depression risk in females. These findings suggest that physical activity can serve as both a protective and risk factor for depression, with gender‐specific considerations in older adults.
... It has an early onset, high recurrence rate, and often becomes chronic, significantly impacting individuals' quality of life (Richards, 2011). Globally, approximately 3.8% of the population is affected by depression, with women being nearly twice as likely to suffer from the condition as men (Kuehner, 2017;Koric et al., 2021). In addition to its psychological toll, depression has a profound impact on female reproductive health, leading to complications such as menstrual irregularities and impaired ovarian function (Koric et al., 2021;Luo et al., 2021). ...
The increasing prevalence of depression profoundly affects female ovarian health. Although Cuscutae Semen (CS) is acknowledged for treating reproductive disorders, its pharmacological mechanisms in depression-induced ovarian dysfunction remain insufficiently explored. This study investigated CS’s effects in a chronic unpredictable mild stress (CUMS) mouse model of depression. Mice were divided into control, CUMS model, CS treatment and estradiol treatment group. Behavioral and biochemical analyses assessed depressive-like behaviors and hormone levels. Untargeted metabolomics utilizing ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry was applied to identify differential metabolites of CS in the treatment of depression-induced ovarian dysfunction. These findings were confirmed through real-time quantitative polymerase chain reaction assays. Based on the outcomes from behavioral and biochemical assays, CS effectively ameliorated the chronic unpredictable mild stress-induced reproductive ailment in mice. Ten differential metabolites were identified, highlighting the impact of CUMS and CS’s ameliorative effects. Pathways linked to arachidonic acid metabolism, glycerophospholipid metabolism, linoleic acid metabolism, and steroid hormone biosynthesis were involved. Seven target genes further validated the metabolomic analysis. This study provides strong evidence of CS’s therapeutic potential in alleviating depression-induced ovarian dysfunction, shedding light on its pharmacological mechanisms and supporting its use as a functional medical food.
... The biopsychosocial model may explain gender differences as a result of the interplay between social, psychological, and biological factors (Bennett et al., 2018). Socially, women face greater exposure to gender-based violence, discrimination, and economic inequalities, which can contribute to higher stress (Graves et al., 2021;Kuehner, 2017;Riecher-Rössler, 2017;Seedat et al., 2009). Psychologically, differences in emotional regulation, personality traits, and prior experiences may influence stress perception and coping mechanisms (Salk et al., 2017;Stoica et al., 2021). ...
Cisgender women report higher stress than cisgender men, potentially due to psychosocial and biological factors, including sex hormone levels. Gender-affirming hormone therapy (GAHT) alters hormone levels, but its impact on perceived stress remains unclear. This study examined changes in perceived stress after 3 and 12 months of GAHT and potential differences between feminizing (FHT) and masculinizing hormone therapy (MHT).
Data were drawn from two prospective cohort studies (ENIGI and RESTED) in the Netherlands, Belgium, and Israel. A total of 442 individuals (median age 23 years, IQR 20.5 to 28.0) completed the 10-item Perceived Stress Scale (PSS) before starting GAHT and after 3 and 12 months. Linear mixed models assessed changes after starting GAHT and differences between FHT and MHT groups.
Baseline perceived stress levels did not significantly differ between groups (0.15, p = 0.84). No significant changes in perceived stress were observed after 3 or 12 months, nor were there significant differences in changes between FHT and MHT (-1.0, p = 0.21; 0.25, p = 0.76).
Improvements in well-being during GAHT may not reduce perceived stress, potentially due to ongoing gender minority stressors. Future research should explore stressors and coping mechanisms to identify strategies for reducing perceived stress during GAHT.
... The physiological changes in women such as fluctuation in estradiol and progesterone are the pertaining factors of trauma and anxiety-related disorders (Li & Graham, 2017). A potential number of studies predicted that the rate of depression is higher among women (Kuehner, 2017). Studies have predicted the leading cause of mental comorbidities among females is violence against them. ...
Across the world, mental health problems are increasing day to day because of increasing day to day challenges and Pakistan is also included in this. Mental disorders especially in the rural areas of Pakistan are also growing day to day and is becoming very common in rural Pakistan due to the lack of facilities and services, socio/economic problems, cultural stigmas and many more. So, the aim of the current study is to determine the prevalence of mental health disorder among the patients in rural district of Pakistan on the basis of the demographic patterns. Across-sectional research method is used to investigate the prevalence of mental health conditions in rural Pakistan. The research was conducted at Idraak Centre of psychiatry, located in District Mandibahaudin, Punjab, Pakistan. The sample for this study included 1,747 individuals who sought treatment at Idraak Centre of psychiatry between March and October2024 and non probability, purposive sampling was used in this study. Data were gathered retrospectively from patients records maintained at Idraak Centre of psychiatry. To ensure data reliability and accuracy the collection process was conducted over a six – month period (March –October 2024). The data was analyzed through SPSS (statistical package of social sciences). Descriptive statistics were used to analyzed the data. Results revealed that Major depressive disorder is a most commonly reported condition in rural areas of Pakistan. Thus, it is very important to work on the infrastructure in which the mental health services should be provided timely and is easily accessible to the people there in rural areas. There should be a proper implementation of community outreach programs, to get people aware from the mental problems and about the proper diagnosis and timely interventions. Furthermore, telehealth mental service should also be provided to the people in rural areas. These all measure with the assurance on the regulations of these rules and policies can be very effective in treating the mental problems of people living in the rural areas.
... As associações entre os escores de saúde cardiovascular e a depressão foram testadas com modelos de regressão logística ajustados por sexo, idade, raça/cor, escolaridade e estado civil. Essas variáveis de ajuste foram consideradas por se associarem tanto à exposição (saúde cardiovascular) quanto ao desfecho (depressão), segundo estudos anteriores 35 Em relação às variáveis que compõem o escore de saúde cardiovascular e a análise da associação com o diagnóstico de depressão, sabe-se que alguns estudos já mostraram os efeitos do exercício físico na prevenção e no tratamento da depressão 46,47 , assim como os efeitos de uma boa nutrição 20 , da pressão arterial controlada 24,25 e da glicemia controlada 26 . Os componentes do escore de saúde cardiovascular apresentaram associações diretas e significativas dos comportamentos não saudáveis (tabagismo, inatividade física) com o diagnóstico de depressão 48 , corroborando com os achados desta pesquisa. ...
Resumo O objetivo é analisar a associação entre o escore de saúde cardiovascular ideal e o diagnóstico autorreferido de depressão em adultos brasileiros. Estudo transversal, com 57.898 adultos brasileiros da Pesquisa Nacional de Saúde de 2019. Presença de depressão autorreferida. Exposições: escores comportamental (IMC, tabagismo, dieta, atividade física, ideal se ≥3 fatores ideais), biológico (tabagismo, dislipidemia, hipertensão e diabetes, ideal se ≥3 fatores ideais) e saúde cardiovascular (todos os fatores, ideal se ≥4 fatores ideais), com base no escore proposto pela American Heart Association. Foram categorizados em ruim/intermediário ou ideal. As associações foram testadas por meio de modelos de regressão logística ajustados por características sociodemográficas. A prevalência de depressão foi de 11,1%. Todos os escores classificados como ideais foram inversamente associados à depressão após ajustes por variáveis sociodemográficas (Escore comportamental ideal: OR: 0,58 [IC95%: 0,48-0,70], biológico ideal: OR: 0,48 [IC95%: 0,43-0,53] e cardiovascular ideal: OR: 0,53 [IC95%: 0,48-0,59]). O escore de saúde cardiovascular ideal associou-se inversamente ao diagnóstico autorreferido de depressão entre adultos brasileiros.
... Associations between cardiovascular health scores and depression were tested using logistic regression models adjusted for gender, age, race/color, education and marital status. These adjustment variables were considered because they were associated with both the exposure (cardiovascular health) and the outcome (depression), according to previous studies [35][36][37][38][39][40][41][42][43][44][45] , and according to the analyses in this study. In the final model, scores with a p-value of <0.05 were considered associated. ...
The aim is to analyze the association between the ideal cardiovascular health score and the self-reported diagnosis of depression in Brazilian adults. Cross-sectional study, with 57,898 Brazilian adults from the 2019 National Health Survey. Presence of self-reported depression. Exposures: behavioral scores (BMI, smoking, diet, physical activity, ideal if ≥3 ideal factors), biological (smoking, dyslipidemia, hypertension and diabetes, ideal if ≥3 ideal factors) and cardiovascular health (all factors, ideal if ≥4 ideal factors), based on the score proposed by the American Heart Association. They were categorized as poor/intermediate or ideal. Associations were tested using logistic regression models adjusted for sociodemographic characteristics. The prevalence of depression was 11.1%. All scores classified as ideal were inversely associated with depression after adjustments for sociodemographic variables (Ideal behavioral score: OR: 0.58 [95%CI: 0.48-0.70], ideal biological score: OR: 0.48 [95%CI: 0.43-0.53] and ideal cardiovascular health: OR: 0.53 [95%CI: 0.48-0.59]). The ideal cardiovascular health score was inversely associated with the self-reported diagnosis of depression among Brazilian adults.
... Research consistently shows women are more prone to internalizing disorders, while men tend towards externalizing disorders [20]. These differences stem from biological, psychological, and social factors [21]. Among college students, females generally report higher rates of depression [22], anxiety, and stress [23]. ...
Mental health problems are prevalent among Chinese college students, with gender differences in symptom presentation. Network analysis provides a novel approach to investigate the complex interactions between symptoms and identify gender differences in the structure and dynamics of mental health problems. Psychological assessment data were collected from 18,629 freshmen at a university in Chengdu, China, between 2020 and 2023. Gaussian Graphical Models and centrality indices were used to estimate and visualize symptom networks. Network comparison tests, accuracy and stability tests, and community detection were performed using R packages to examine gender differences. Mental health symptom networks differed across psychological distress levels. In the severe distress group, male and female students’ networks exhibited significant differences in 10 edges and overall strength. Inferiority, depression, and anxiety emerged as central symptoms, and revealed by community detection. The single-university setting may limit the generalizability of the findings to other populations or cultural contexts. The cross-sectional design precludes causal inferences about symptom relationships. Network analysis offers valuable insights into the complex interactions of mental health symptoms among Chinese college students, highlighting gender differences in the severe distress group. The findings reveal central symptoms and distinct symptom clusters, underscoring the importance of developing targeted, personalized interventions that address these specific patterns of psychological distress. By illuminating the intricate structure of mental health networks, this research provides a foundation for more effective, tailored approaches to support student well-being in higher education settings.
... 16 The most common initial psychiatric diagnosis that bvFTD patients received is major depressive disorder, possibly due to the similarity between some of their typical symptoms, such as apathy in bvFTD and social withdrawal in major depressive disorder. 41,42 As it is commonly known that the lifetime prevalence of major depressive disorder in females is almost two times that in males, 43,44 females with bvFTD are likely to be more susceptible to mistaken psychiatric diagnosis, especially those without genetic mutations known for FTD. In this study, the depression symptoms of females with sporadic bvFTD were relatively mild compared to other behavioral symptoms. ...
INTRODUCTION
Higher male prevalence in sporadic behavioral variant frontotemporal dementia (bvFTD) has been reported. We hypothesized differences in phenotypes between genetic and sporadic bvFTD females resulting in underdiagnosis of sporadic bvFTD females.
METHODS
We included genetic and sporadic bvFTD patients from two multicenter cohorts. We compared behavioral and cognitive symptoms, and gray matter volumes, between genetic and sporadic cases in each sex.
RESULTS
Females with sporadic bvFTD showed worse compulsive behavior (p = 0.026) and language impairments (p = 0.024) compared to females with genetic bvFTD (n = 152). Genetic bvFTD females had smaller gray matter volumes than sporadic bvFTD females, particularly in the parietal lobe.
DISCUSSION
Females with sporadic bvFTD exhibit a distinct clinical phenotype compared to females with genetic bvFTD. This difference may explain the discrepancy in prevalence between genetic and sporadic cases, as some females without genetic mutations may be misdiagnosed due to atypical bvFTD symptom presentation.
Highlights
Sex ratio is equal in genetic behavioral variant of frontotemporal dementia (bvFTD), whereas more males are present in sporadic bvFTD.
Distinct neuropsychiatric phenotypes exist between sporadic and genetic bvFTD in females.
Phenotype might explain the sex ratio difference between sporadic and genetic cases.
... Gender differences in depression severity were also noted: men were more commonly represented in the mild to moderate depression categories, while women predominated in the severe depression group. This finding aligns with existing epidemiological data showing higher lifetime rates of depression in women [17]. Several factors may contribute to this difference, including the anti-inflammatory role of estrogen [18], heightened immune sensitivity in females [19], and sociocultural stressors such as caregiving roles or unequal access to mental health services [20]. ...
Background/Objectives: Depression is associated with an increased risk for the development and progression of cardiovascular disease. This research investigated the association between depressive symptoms and inflammation in the development of atherosclerotic coronary events. Methods: This retrospective observational study included 276 patients who were not previously diagnosed with atherosclerotic coronary artery disease at the beginning of the research. Participants were categorized using the Hamilton Depression Rating Scale (HDRS) and the Structured Clinical Interview for DSM-5 (SCID) into two groups: the depression group and the control group. Inflammatory biomarkers (C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and cortisol) were measured at the beginning of the study, as well as at six months, one year, and two years. Results: Among patients with mild depression (17.3% vs. 4.2%) or moderate depression (15.4% vs. 6.7%), there were significantly more men than women, while among patients with very severe depression, there were significantly more women than men (21.7% vs. 11.5%). Participants with depression showed significantly higher increases at 2 years compared to baseline for all investigated parameters (p < 0.001). Depressed patients were significantly associated with an acute coronary syndrome (p = 0.038). Conclusions: This research highlights that individuals with depression face a greater risk of developing an acute coronary syndrome than those without depression.
... The reasons for these differences are still subject to debate. On the one hand, research has focused on biological sex differences, such as differences based on genes or hormone levels (Kuehner, 2017;Schiller et al., 2016;Walther et al., 2017). On the other hand, there is increasing evidence that gender role socialization impacts how men and women perceive and respond to psychological stress differently. ...
Theoretical Background: Traditional masculinity ideologies (TMIs) comprise social beliefs about how men should be. Higher conformity to TMIs has been associated with increased psychopathology. However, the underlying mechanisms remain unclear. Network analysis, increasingly used in clinical psychology, visualizes psychopathology as a system of interconnected symptoms that co-occur through reciprocal reinforcement. Applying this method, we examined the associations between TMIs and psychopathology in men. Methods: An online survey of 517 cisgender men (Mage = 44.3 ± 15.3) from German- speaking Europe rated conformity to TMIs, depression, alcohol abuse, anxiety, anger and aggression, suicidality, and PTSD symptoms using validated self-report questionnaires. Participants were stratified into high TMI and low TMI groups by median split. Four networks were estimated: Models 1 and 2 compared high vs. low TMI groups while Models 3 and 4 examined the total sample, with TMIs as nodes in the psychopathology network. Results: Men with high conformity to TMIs exhibited elevated psychopathology. No significant differences in the psychopathology network structure were found between the TMI groups. Model 3 showed that TMIs were positively associated with anger and aggression, and externalizing depression symptoms. Model 4 showed that the TMI subdimensions risk-taking, violence, and winning were linked to increased anger and aggression. Self-reliance was associated with higher suicidality, whereas higher pursuit of status was correlated with lower suicidality. Greater risk-taking was associated with lower anxiety.Conclusion: Incorporating TMIs into psychopathology networks highlights their role in reinforcing maladaptive symptom patterns. Conformity to TMIs should be considered when assessing and treating psychopathology in men.
... The results indicated that women are more likely to experience D/B-related AEs, which is consistent with the epidemiological profile of depression by sex [28]. Biological, psychological, and environmental factors at both the microlevels and macrolevels contribute to this sex disparity [29]. Most AEs were reported in the 18-44-year-old age group, which is consistent with the onset characteristics of major depression, which typically occurs between mid-adolescence and mid-40 s [30]. ...
Background
Dextromethorphan/bupropion (D/B) is an innovative pharmacological treatment for major depressive disorder. Nevertheless, the current evidence regarding the safety profile of D/B is predominantly derived from clinical trials, thus hindering the timely updating of adverse event (AE) data for this medication. Therefore, this study conducted data mining and analysis of AE signals (especially for suicide/self-injury) associated with D/B using the Food and Drug Administration Adverse Event Reporting System (FAERS) database.
Methods
This study used the disproportionality method to systematically evaluate the associations between D/B and potential AEs and compared these AEs with AEs related to bupropion and esketamine by using data from the FAERS collected between the third quarter of 2022 and the second quarter of 2024.
Results
A total of 2451 AE reports identifying D/B as the “primary suspect” were collected. From these reports, 81 preferred terms and 24 system organ classifications were identified, with a predominant focus on psychiatric disorders (22.07%) and nervous system disorders (18.77%). These AEs were mostly found in individuals aged 18–44 years. The median time to onset for D/B-related AEs was determined to be 2 days. Nearly 20 novel AEs identified during the labelling process were detected, such as a sensation of inebriation and panic attacks. Importantly, the risk signals for suicide/self-injury associated with D/B were significantly lower than those associated with bupropion and esketamine. However, these signals cannot be ignored in view of their serious consequences.
Conclusion
Psychiatric and nervous system disorders, such as suicidal/self-injurious behaviours, require careful monitoring in clinical applications. It is imperative to conduct traditional pharmacoepidemiological research to evaluate whether D/B is linked to an increased risk of dissociative disorders in the future. Moreover, health care professionals should remain vigilant for AE signals not listed in package inserts.
... Gut dysbiosis, which is caused by stresses such as pathogen infection or immobilization stress, induces depression and anxiety with systemic inflammation and gut inflammation [4,5]. Interestingly, the prevalence of depression is approximately two times higher in women than in men [6][7][8][9]. Many patients with depression show increased levels of inflammatory cytokines, including TNF-α and interleukin (IL)-6 [10]. ...
Gardnerella vaginalis (GV), an opportunistic pathogen excessively proliferated in vaginal dysbiosis, causes systemic inflammation including vaginitis, neuroinflammation, and osteitis. To understand its systemic inflammation-triggering factor, we purified extracellular vesicles isolated from GV (gEVs) and examined their effect on the occurrence of vaginitis, osteitis, and neuroinflammation in mice with and without ovariectomy (Ov). The gEVs consisted of lipopolysaccharide, proteins, and nucleic acid and induced TNF-α and RANKL expression in macrophage cells. When the gEVs were vaginally exposed in mice without Ov, they significantly induced RANK, RANKL, and TNF-α expression and NF-κB⁺ cell numbers in the vagina, femur, hypothalamus, and hippocampus, as observed in GV infection. The gEVs decreased time spent in the open field (OT) in the elevated plus maze test by 47.3%, as well as the distance traveled in the central area (DC) by 28.6%. In the open field test, they also decreased the time spent in the central area (TC) by 39.3%. Additionally, gEVs decreased spontaneous alteration (SA) in the Y-maze test by 33.8% and the recognition index (RI) in the novel object recognition test by 26.5%, while increasing the immobility time (IT) in the tail suspension test by 36.7%. In mice with OV (Ov), the gEVs also induced RANK, RANKL, and TNF-α expression and increased NF-κB⁺ cell numbers in the vagina, femur, hypothalamus, and hippocampus compared to vehicle-treated mice. When gEVs were exposed to mice with Ov, gEVs also reduced the DC, TC, OT, SA, and RI to 62.1%, 62.7%, 28.2%, 90.7%, and 85.4% of mice with Ov, respectively, and increased IT to 122.9% of mice with Ov. Vaginally exposed fluorescein-isothiocyanate-tagged gEVs were detected in the blood, femur, and hippocampus. These findings indicate that GV-derived gEVs may induce systemic inflammation through the activation of RANK/RANKL-involved NF-κB signaling, leading to systemic disorders including vaginitis, osteoporosis, depression, and cognitive impairment. Therefore, gEVs may be an important risk factor for vaginitis, osteoporosis, depression, and cognitive impairment in women.
... In earlier research, gender and a history of international migration were repeatedly shown to be associated with depressive symptoms. With respect to gender and depressive symptoms, higher risks have consistently been detected in women than in men [4,[7][8][9][10][11][12][13]. On the basis of an international meta-analysis of data from more than 1.7 million women and men, Salk and colleagues reported significantly increased odds of depression in women compared with men [14]. ...
Background
The educational gradient in depressive symptoms is well documented. Gender and history of migration have also been found to be associated with depressive symptoms. Intersectional approaches enable the analysis of the interplay of different social factors at a time to gain a deeper understanding of inequalities in depressive symptoms. In this study, intersectional inequalities in depressive symptoms according to education, gender and history of migration are analysed.
Methods
The German National Cohort (NAKO, N = 204,783) collected information on depressive symptoms (PHQ-9), which was used as an outcome variable. Educational attainment (ISCED-97), gender, and history of migration constituted the different social strata in the analyses. The predicted probabilities of depressive symptoms for 30 social strata were calculated. Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was applied, using logistic regression and social strata were introduced as higher-level unit interaction terms.
Results
The analyses revealed an educational gradient in depressive symptoms, with differences within each educational group when gender and history of migration were introduced to the models. The predicted probabilities of depressive symptoms varied between the most advantaged and the most disadvantaged social strata by more than 20% points. Among the three studied variables, education contributed the most to the variance explained by the MAIHDA models. The between-strata differences were largely explained by additive effects.
Conclusions
We observed a robust educational gradient in depressive symptoms, but gender and history of migration had substantial contribution on the magnitude of educational inequalities. An intersectional perspective on inequalities in depressive symptoms enhances current knowledge by showing that different social dimensions may intersect and contribute to inequalities in depressive symptoms. Future studies on inequalities in depression may greatly benefit from an intersectional approach, as it reflects lived inequalities in their diversity.
Introduction: Faced with the health crisis due to the COVID-19 pandemic, faculty had to adapt their teaching activities in an untimely and imposing manner. This situation may have promoted mental health problems, especially among those who had an unstable professional tie. Objective: To identify and characterize mental health problems in faculty from private institutions in Mato Grosso (Brazil) during the COVID-19 pandemic. Methodology: Descriptive, exploratory, and cross-sectional study in faculty from private institutions in the State of Mato Grosso, Brazil. Data collection was carried out from November 2021 to January 2022 using an online form. The form included a sociodemographic, health, and work questionnaire; the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure–Adult; the Brunel Mood Scale; and the Escala de Estresse no Trabalho [Work Stress Scale]. Descriptive statistical analyses were used. Results: Fifty-four faculty members participated in the study. Most of them perceived a worsening of their mental health status during the COVID-19 pandemic (59.26%). The most frequent mental health problems were anxiety (77.78%), mania (68.52%), substance use (64.81%), somatic symptoms (61.11%), and depressive symptoms (59.26%). A high level of fatigue and an intermediate level of work stress were identified. Discussion and conclusions: The high prevalence of mental health problems in faculty from private institutions shows a significant concern related to mental health. It is essential to advance public policies and provide financial support for faculty mental care and protection in the workplace during the post-pandemic period.
Introducción: Ante la crisis sanitaria por la pandemia de COVID-19, los docentes universitarios tuvieron que adaptar de manera extemporánea e impositiva sus actividades pedagógicas, situación que pudo haber promovido problemas de salud mental, en especial entre aquellos con un vínculo profesional inestable. Objetivo: Identificar y caracterizar los problemas de salud mental de los docentes universitarios de instituciones privadas de Mato Grosso (Brasil) durante la pandemia de COVID-19. Metodología: Estudio descriptivo, exploratorio y transversal con docentes universitarios de instituciones privadas del estado de Mato Grosso, Brasil. La recolección de los datos tuvo lugar de noviembre de 2021 a enero de 2022 a través de un formulario en línea. El formulario se compuso de un cuestionario sociodemográfico, de salud y de trabajo; la DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure–Adult ‘Medida de Síntomas Transversal de Nivel 1 Autoaplicable del DSM-5 para Adultos’; la Brunel Mood Scale ‘Escala de Brunel del Estado de Ánimo’, y la Escala de Estresse no Trabalho ‘Escala de Estrés Laboral’. Se efectuaron análisis estadísticos descriptivos. Resultados: Participaron del estudio 54 docentes. La mayoría de ellos percibió un empeoramiento de su estado de salud mental durante la pandemia de COVID-19 (59.26 %). Los problemas de salud mental más frecuentes fueron la ansiedad (77.78 %), la manía (68.52 %), el consumo de sustancias (64.81 %), los síntomas somáticos (61.11 %) y los síntomas depresivos (59.26 %). Identificamos un nivel alto de fatiga y un nivel intermedio de estrés laboral. Discusión y conclusiones: La alta prevalencia de los problemas de salud mental entre los docentes de instituciones privadas expone una importante preocupación relacionada con su salud mental. Es fundamental promover políticas públicas y brindar subsidios para el cuidado y la protección mentales de los docentes en su lugar de trabajo durante el periodo pospandémico.
Objectives
The study aimed to identify and analyze gender-specific patterns in the perception of pain and anxiety sensitivity and how they interact to affect health-related quality of life (HRQoL) in myocardial infarction (MI) patients.
Materials and Methods
68 acute MI patients presented within 3 months of the cardiac event during the time span from May to September 2024 were included. They were assessed using Anxiety Sensitivity Index-3, Fear of Pain Questionnaire-III, McGill Pain Questionnaire-Short Form, and Short Form-36 Health Survey. Independent samples t -test was used to analyze the gender differences and Cohen’s d as a measure of effect size. Pearson correlation coefficient and linear regression analysis were done to assess the relationship between variables and to ascertain the predicted variance toward HRQoL.
Results
Anxiety sensitivity and fear of pain were higher in females. Women reported increased perception of sensory and affective pain. HRQoL was found to be higher in males. Anxiety sensitivity played a statistically significant role in the prediction of the HRQoL.
Conclusion
This study highlights the presence of significant differences in the anxiety sensitivity, pain perception, and fear of pain among male and female acute MI patients. Our findings suggest a significant role of anxiety sensitivity in mediating the quality of life in MI patients post the cardiac event. This may be a result of a unique combination of several biological, psychological, or sociocultural factors which tend to differ by gender and therefore require an individualized approach to assessment and comprehensive management.
Women's well‐being has gained increasing importance in global health agendas. This study employed longitudinal data from 36,144 women in China from 2010 to 2018 to investigate the impact of motherhood on women's mental health. Using a model that incorporated interactions between time trends and individual and household characteristics, the study revealed that women with newborns generally reported higher levels of mental well‐being. However, those with toddlers aged 3–6 were more likely to experience symptoms of depression. The impact of motherhood on mental health was shaped by the interplay between the emotional benefits linked to hormonal changes and the emotional costs associated with childcare obligations. Access to supportive childcare services can help women alleviate the stresses of maternal responsibility, thereby enhancing their mental well‐being. When adequate resources are available, motherhood may not pose significant challenges to women's mental health.
Objectives:
Some psychotropic medications could impair drivers' cognitive skills, concentration and reaction by affecting the central nervous system (CNS), thereby increasing the risk of traffic accidents. However, there is limited evidence regarding the prescription pattern of these medications in Iran. The present study aims to investigate the prescription pattern of psychotropic medications impairing driving in Tabriz, Iran.
Methods:
In this descriptive-analytical cross-sectional study, psychotropic medications prescribed by physicians in Tabriz from March, 2021, to March, 2022, were reviewed. The data were obtained from Iranian Social Security Organization (SSO), which included 1,167,460 eligible prescriptions. Psychotropic medications were classified into six main categories based on reliable scientific sources, and their level of effect on driving was determined using driving-impairing medication classification system. The data were analyzed using Stata 17.0 and Chi-square test. The significance level was considered to be less than 0.05.
Results:
The results showed out of 1,167,460 prescribed psychotropic medications, 65.32% were for women, and the rest were for men. The most frequently prescribed medications were antidepressants (38.07%), followed by anxiolytics (18.60%) and antipsychotics (15.48%), respectively. More than half of the medications (57.10%) was categorized to have moderate effect, 23.73% was categorized to have mild effect and 18.87% was categorized to have severe effect on driving. Gabapentin, sertraline, nortriptyline, fluoxetine and trifluoperazine were the most frequently prescribed medications, respectively. A significant correlation was observed between the impairment category of prescribed medications and patients' gender and age (P <0.001). Additionally, general practitioners prescribed the highest number of medications with severe adverse effects, while neurosurgeons, general surgeons, neurologists and psychiatrists prescribed the highest number of medications with moderate adverse effects on driving.
Conclusions:
More than half of the prescribed psychotropic medications in Tabriz was categorized to have moderate effects on driving, and about one-fifth was categorized to have severe effects. Antidepressants, anxiolytics and antipsychotics are considered to have the most relevant impairing effects on driving according to the categorization system, with gabapentin, sertraline, nortriptyline, fluoxetine and trifluoperazine being the most frequently prescribed medications. The findings highlighted the importance of raising awareness among physicians and patients about the effects of psychotropic medications on driving.
Introduction
This study examines the reciprocal relationship between social support and depressive symptoms among military cadets in Taiwan, a population facing unique academic and military pressures. While emerging adults are prone to mental health challenges, they encounter additional stressors such as strict hierarchies and separation from family. Social support is known to be a protective factor, yet its long-term effects and bidirectional relationship with depression remain underexplored, particularly in collectivist military cultures where mental health may be stigmatised. Using a cross-lagged panel model with three waves of data, this study also explores whether this relationship varies by gender.
Methods
A secondary analysis of longitudinal data was conducted from the “Career Development of Military Academy Students” project, which surveyed all Taiwanese military academy students from the 111th class across three waves (W1–W3). The final sample consisted of 898 students (73.2% male, average age=20.9) from six military academies. To analyse the bidirectional relationship between social support and depression, autoregressive cross-lagged panel analysis using structural equation modelling (SEM) was employed. Multigroup SEM was used to assess gender difference.
Results
The cross-lagged panel model revealed reciprocal effects between social support and depression in the overall sample, evident only between W1 and W2. From W2 to W3, depression influenced perceived social support, with a stronger effect observed in males than females. These results underscore the unique dynamics of social support and depression in military contexts, particularly for females, where the relationship appears more complex.
Conclusions
The findings highlight the need for both systemic support structures and individualised interventions in military settings, considering gender differences and the evolving nature of mental health challenges. By addressing these factors, military leaders and mental health professionals can better support cadets in managing stress and depression, fostering a more resilient and mentally healthy military community.
Secondary analyses of Revised NEO Personality Inventory data from 26 cultures (N = 23,031) suggest that gender differences are small relative to individual variation within genders; differences are replicated across cultures for both college-age and adult samples, and differences are broadly consistent with gender stereotypes: Women reported themselves to be higher in Neuroticism, Agreeableness, Warmth, and Openness to Feelings, whereas men were higher in Assertiveness and Openness to Ideas. Contrary to predictions from evolutionary theory, the magnitude of gender differences varied across cultures. Contrary to predictions from the social role model, gender differences were most pronounced in European and American cultures in which traditional sex roles are minimized. Possible explanations for this surprising finding are discussed, including the attribution of masculine and feminine behaviors to roles rather than traits in traditional cultures.
In the prospective long-term Zurich study, we re-examined the hypothesized association between mental health problems in women and the transition through menopausal stages. One hundred sixty-eight women from a population-based Swiss community cohort were prospectively followed up from age 21 to 50. At age 50, the occurrence of hot flushes/night sweats and sleep disturbances was significantly more frequent in peri- and post-menopausal women. Irritability/nervousness was increased only in peri-menopausal women, but that association was accounted for by neuroticism trait scores at age 30. Transitions to peri- or post-menopause were not related to changes in either the prevalence rates of DSM major depressive episode or anxiety disorders, or the course of psychopathological syndromes as assessed by the Symptom Checklist 90 - Revised. The null associations held when adjusting for duration of reproductive period or age at menopause. Preceding mental health problems between ages 21 and 41, increased neuroticism trait scores at age 30, and concurrent psychosocial distress were significantly related to mental health problems occurring between ages 41 and 50. Depending upon the cut-off point that was chosen, the arbitrary dichotomization of a continuous depression outcome produced spurious associations with the menopausal transition. We conclude that mental health problems between ages 41 and 50 are probably not directly related to the menopausal transition, and that previously reported associations could be false positives due to inadequate dichotomizations, reporting bias, undisclosed multiple adjustments or overfitting.
Background
Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses).
Methods and Findings
We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis.
Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality.
Conclusions
High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period.
Key findings:
Data from the National Vital Statistics System, Mortality •From 1999 through 2014, the age-adjusted suicide rate in the United States increased 24%, from 10.5 to 13.0 per 100,000 population, with the pace of increase greater after 2006. •Suicide rates increased from 1999 through 2014 for both males and females and for all ages 10-74. •The percent increase in suicide rates for females was greatest for those aged 10-14, and for males, those aged 45-64. •The most frequent suicide method in 2014 for males involved the use of firearms (55.4%), while poisoning was the most frequent method for females (34.1%). •Percentages of suicides attributable to suffocation increased for both sexes between 1999 and 2014.
Neuroticism is a personality trait of fundamental importance for psychological well-being and public health. It is strongly associated with major depressive disorder (MDD) and several other psychiatric conditions. Although neuroticism is heritable, attempts to identify the alleles involved in previous studies have been limited by relatively small sample sizes. Here we report a combined meta-analysis of genome-wide association study (GWAS) of neuroticism that includes 91 370 participants from the UK Biobank cohort, 6659 participants from the Generation Scotland: Scottish Family Health Study (GS:SFHS) and 8687 participants from a QIMR (Queensland Institute of Medical Research) Berghofer Medical Research Institute (QIMR) cohort. All participants were assessed using the same neuroticism instrument, the Eysenck Personality Questionnaire-Revised (EPQ-R-S) Short Form's Neuroticism scale. We found a single-nucleotide polymorphism-based heritability estimate for neuroticism of ∼15% (s.e.=0.7%). Meta-analysis identified nine novel loci associated with neuroticism. The strongest evidence for association was at a locus on chromosome 8 (P=1.5 × 10(-15)) spanning 4 Mb and containing at least 36 genes. Other associated loci included interesting candidate genes on chromosome 1 (GRIK3 (glutamate receptor ionotropic kainate 3)), chromosome 4 (KLHL2 (Kelch-like protein 2)), chromosome 17 (CRHR1 (corticotropin-releasing hormone receptor 1) and MAPT (microtubule-associated protein Tau)) and on chromosome 18 (CELF4 (CUGBP elav-like family member 4)). We found no evidence for genetic differences in the common allelic architecture of neuroticism by sex. By comparing our findings with those of the Psychiatric Genetics Consortia, we identified a strong genetic correlation between neuroticism and MDD and a less strong but significant genetic correlation with schizophrenia, although not with bipolar disorder. Polygenic risk scores derived from the primary UK Biobank sample captured ∼1% of the variance in neuroticism in the GS:SFHS and QIMR samples, although most of the genome-wide significant alleles identified within a UK Biobank-only GWAS of neuroticism were not independently replicated within these cohorts. The identification of nine novel neuroticism-associated loci will drive forward future work on the neurobiology of neuroticism and related phenotypes.Molecular Psychiatry advance online publication, 12 April 2016; doi:10.1038/mp.2016.49.
Background:
Most empirical studies into the covariance structure of psychopathology have been confined to adults. This work is not developmentally informed as the meaning, age-of-onset, persistence and expression of disorders differ across the lifespan. This study investigates the underlying structure of adolescent psychopathology and associations between the psychopathological dimensions and sex and personality risk profiles for substance misuse and mental health problems.
Method:
This study analyzed data from 2175 adolescents aged 13.3 years. Five dimensional models were tested using confirmatory factor analysis and the external validity was examined using a multiple-indicators multiple-causes model.
Results:
A modified bifactor model, with three correlated specific factors (internalizing, externalizing, thought disorder) and one general psychopathology factor, provided the best fit to the data. Females reported higher mean levels of internalizing, and males reported higher mean levels of externalizing. No significant sex differences emerged in liability to thought disorder or general psychopathology. Liability to internalizing, externalizing, thought disorder and general psychopathology was characterized by a number of differences in personality profiles.
Conclusions:
This study is the first to identify a bifactor model including a specific thought disorder factor. The findings highlight the utility of transdiagnostic treatment approaches and the importance of restructuring psychopathology in an empirically based manner.
Depression is a debilitating mental illness with clear developmental patterns from childhood through late adolescence. Here, we present data from the Gene Environment Mood GEM) study, which used an accelerated longitudinal cohort design with youth N = 665) starting in 3rd, 6th, and 9th grades, and a caretaker, who were recruited from the general community, and were then assessed repeatedly through semistructured diagnostic interviews every 6 months over 3 years 7 waves of data) to establish and then predict trajectories of depression from age 8 to 18. First, we demonstrated that overall prevalence rates of depression over time, by age, gender, and pubertal status, in the GEM study closely match those trajectories previously obtained in past developmental epidemiological research. Second, we tested whether a genetic vulnerability-stress model involving 5-HTTLPR and chronic peer stress was moderated by developmental factors. Results showed that older aged adolescents with SS/SL genotype, who experienced higher peer chronic stress over 3 years, were the most likely to be diagnosed with a depressive episode over time. Girls experiencing greater peer chronic stress were the most likely to develop depression. This study used repeated assessments of diagnostic interviewing in a moderately large sample of youth over 3 years to show that depression rates increase in middle to late adolescence, or postpubertally, and that the gender difference in depression emerges earlier in adolescence age 12.5), or postpubertally. Additionally, genetically susceptible older adolescents who experience chronic peer stress were the most likely to become depressed over time.
Stressor exposure during early life has the potential to increase an individual's susceptibility to a number of neuropsychiatric conditions such as mood and anxiety disorders and schizophrenia in adulthood. This occurs in part due to the dysfunctional stress axis that persists following early adversity impairing stress responsivity across life. The mechanisms underlying the prolonged nature of this vulnerability remain to be established. Alterations in the epigenetic signature of genes involved in stress responsivity may represent one of the neurobiological mechanisms. The overall aim of this review is to provide current evidence demonstrating changes in the epigenetic signature of candidate gene(s) in response to early environmental adversity. More specifically, this review analyses the epigenetic signatures of postnatal adversity such as childhood abuse or maltreatment and later-life psychopathology in human and animal models of early life stress. The results of this review shows that focus to date has been on genes involved in the regulation of hypothalamic-pituitary-adrenal (HPA) axis and its correlation to subsequent neurobiology, for example, the role of glucocorticoid receptor gene. However, epigenetic changes in other candidate genes such as brain-derived neurotrophic factor (BDNF) and serotonin transporter are also implicated in early life stress (ELS) and susceptibility to adult psychiatric disorders. DNA methylation is the predominantly studied epigenetic mark followed by histone modifications specifically acetylation and methylation. Further, these epigenetic changes are cell/tissue-specific in regulating expression of genes, providing potential biomarkers for understanding the trajectory of early stress-induced susceptibility to adult psychiatric disorders.
Durkheim conceived of suicide as a product of social integration and regulation. Although the sociology of suicide has focused
on the role of disintegration, to our knowledge, the interaction between integration and regulation has yet to be empirically
evaluated. In this article we test whether more egalitarian gender norms, an important form of macro-regulation, protects
men and women against suicidality during economic shocks. Using cross-national data covering 20 European Union countries from
the years 1991 to 2011, including the recent economic crises in Europe, we first assessed the relation between unemployment
and suicide. Then we evaluated potential effect modification using three measures of gender equality, the gender ratio in
labour force participation, the gender pay gap, and women’s representation in parliament using multiple measures. We found
no evidence of a significant, direct link between greater gender equality and suicide rates in either men or women. However,
a greater degree of gender equality helped protect against suicidality associated with economic shocks. At relatively high
levels of gender equality in Europe, such as those seen in Sweden and Austria, the relationship between rising unemployment
rates and suicide in men disappeared altogether. Our findings suggest that more egalitarian forms of gender regulation may
help buffer the suicidal consequences of economic shocks, especially in men.
Reward processing is crucial to our health and wellbeing and dysfunctional brain reward signaling is a component of a number of psychiatric disorders, including major depression and drug addiction. Rewarding behaviors like eating, parenting, nursing, social play, and sexual activity are powerfully preserved in evolution and are essential for survival. All of them gratifying, they represent enjoyable experiences with high reward values and activate the same brain circuits that mediate the positive reinforcing effects of drugs of abuse. In line with preclinical findings and clinical observations, recent imaging studies confirmed that natural (sex, food) and non-natural (drugs of abuse) rewards differently activate male and female brains (Haase et al., 2011; Wetherill et al., 2014) and also that men and women differ in the ability to resist reward-related impulses (Diekhof et al., 2012). The study of sexual morphological differences in human brain has provided evidence of critical effects of gender on brain architecture and morphometry (Giedd et al., 2012; Feis et al., 2013). Male-female differences in human brain anatomy have stimulated research on the difference in onset, prevalence, and symptomatology of many neuropsychiatric illnesses between women and men, including drug addiction (Rando et al., 2013; Tanabe et al., 2013; Ide et al., 2014). Following the official recognition by International Institutions and Funding Research Agencies on the importance of taking into account potential differences between men and women in all of the relevant aspects of health-related research, gender is receiving increasing attention by medical and scientific communities. As a consequence, evaluation of sex and gender (i.e., biological characteristics and socio-political-cultural influences associated with the terms “male” and “female,” respectively) differences in reward processing in general, and in drug addiction in particular, is increasingly being studied.
Numerous human behaviors are driven by evolved instincts and urges. We have evolved the capacity to experience considerable pleasure and happiness from several behaviors, among which are eating, drinking, mating, creating protective shelter, and reproducing, all activating an anatomical and neurochemically defined brain circuit commonly referred to as the “pleasure circuit” or “brain reward system.” In both animals and humans, males and females display diverse attitudes and expectancies, process information differently, perceive experience and emotions in different ways and are behaviorally determined by different needs and drives. Reward processing may also differ between male and female population with sexual hormones playing an important, although not exclusive, role. When looking at the most common behavioral features known to favor the development of drug dependence, such as poor impulse control, risk-taking behavior, a heightened reactivity to stress and psychiatric comorbidity, all reveal important differences between men and women. Here I will illustrate the most recent evidence showing sex/gender differences in these and other behavioral traits linked to reward processing and enhancing the vulnerability to drug addiction.
Recently designated as a disorder in the DSM-5, premenstrual dysphoric disorder (PMDD) presents an array of avenues for further research. PMDD's profile, characterized by cognitive-affective symptoms during the premenstruum, is unique from that of other affective disorders in its symptoms and cyclicity. Neurosteroids may be a key contributor to PMDD's clinical presentation and etiology, and represent a potential avenue for drug development. This review will present recent literature on potential contributors to PMDD's pathophysiology, including neurosteroids and stress, and explore potential treatment targets.
Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years.
Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data.
In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker.
Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
Personality is suggested to be a major risk factor for depression but large-scale individual participant meta-analyses on this topic are lacking.
Data from 10 prospective community cohort studies with 117,899 participants (mean age 49.0 years; 54.7% women) were pooled for individual participant meta-analysis to determine the association between personality traits of the five-factor model and risk of depressive symptoms.
In cross-sectional analysis, low extraversion (pooled standardized regression coefficient (B) = -.08; 95% confidence interval = -0.11, -0.04), high neuroticism (B = .39; 0.32, 0.45), and low conscientiousness (B = -.09; -0.10, -0.06) were associated with depressive symptoms. Similar associations were observed in longitudinal analyses adjusted for baseline depressive symptoms (n = 56,735; mean follow-up of 5.0 years): low extraversion (B = -.03; -0.05, -0.01), high neuroticism (B = .12; 0.10, 0.13), and low conscientiousness (B = -.04; -0.06, -0.02) were associated with an increased risk of depressive symptoms at follow-up. In turn, depressive symptoms were associated with personality change in extraversion (B = -.07; 95% CI = -0.12, -0.02), neuroticism (B = .23; 0.09, 0.36), agreeableness (B = -.09; -0.15, -0.04), conscientiousness (B = -.14; -0.21, -0.07), and openness to experience (B = -.04; -0.08, 0.00).
Personality traits are prospectively associated with the development of depressive symptoms. Depressive symptoms, in turn, are associated with changes in personality that may be temporary or persistent.
© 2015 Wiley Periodicals, Inc.
Background:
On average, intimate partner violence affects nearly one in three women worldwide within their lifetime. But the distribution of partner violence is highly uneven, with a prevalence of less than 4% in the past 12 months in many high-income countries compared with at least 40% in some low-income settings. Little is known about the factors that drive the geographical distribution of partner violence or how macro-level factors might combine with individual-level factors to affect individual women's risk of intimate partner violence. We aimed to assess the role that women's status and other gender-related factors might have in defining levels of partner violence among settings.
Methods:
We compiled data for the 12 month prevalence of partner violence from 66 surveys (88 survey years) from 44 countries, representing 481 205 women between Jan 1, 2000, and Apr 17, 2013. Only surveys with comparable questions and state-of-the-art methods to ensure safety and encourage violence disclosure were used. With linear and quantile regression, we examined associations between macro-level measures of socioeconomic development, women's status, gender inequality, and gender-related norms and the prevalence of current partner violence at a population level. Multilevel modelling and tests for interaction were used to explore whether and how macro-level factors affect individual-level risk. The outcome for this analysis was the population prevalence of current partner violence, defined as the percentage of ever-partnered women (excluding widows without a current partner), aged from 15 years to 49 years who were victims of at least one act of physical or sexual violence within the past 12 months.
Findings:
Gender-related factors at the national and subnational level help to predict the population prevalence of physical and sexual partner violence within the past 12 months. Especially predictive of the geographical distribution of partner violence are norms related to male authority over female behaviour (0·102, p<0·0001), norms justifying wife beating (0·263, p<0·0001), and the extent to which law and practice disadvantage women compared with men in access to land, property, and other productive resources (0·271, p<0·0001). The strong negative association between current partner violence and gross domestic product (GDP) per person (-0·055, p=0·0009) becomes non-significant in the presence of norm-related measures (-0·015, p=0·472), suggesting that GDP per person is a marker for social transformations that accompany economic growth and is unlikely to be causally related to levels of partner violence. We document several cross-level effects, including that a girl's education is more strongly associated with reduced risk of partner violence in countries where wife abuse is normative than where it is not. Likewise, partner violence is less prevalent in countries with a high proportion of women in the formal work force, but working for cash increases a woman's risk in countries where few women work.
Interpretation:
Our findings suggest that policy makers could reduce violence by eliminating gender bias in ownership rights and addressing norms that justify wife beating and male control of female behaviour. Prevention planners should place greater emphasis on policy reforms at the macro-level and take cross-level effects into account when designing interventions.
Funding:
What Works to Prevent Violence Against Women and Girls-a research and innovation project funded by UK Aid.
Objective:
In this conceptual review, the authors propose a novel mechanistic candidate in the etiology of depression with onset in the menopause transition ("perimenopausal depression") involving alterations in stress-responsive pathways, induced by ovarian hormone fluctuation.
Method:
The relevant literature in perimenopausal depression, including prevalence, predictors, and treatment with estrogen therapy, was reviewed. Subsequently, the growing evidence from animal models and clinical research in other reproductive mood disorders was synthesized to describe a heuristic model of perimenopausal depression development.
Results:
The rate of major depressive disorder and clinically meaningful elevations in depressive symptoms increases two- to threefold during the menopause transition. While the mechanisms by which ovarian hormone fluctuation might impact mood are poorly understood, growing evidence from basic and clinical research suggests that fluctuations in ovarian hormones and derived neurosteroids result in alterations in regulation of the HPA axis by γ-aminobutyric acid (GABA). The authors' heuristic model suggests that for some women, failure of the GABAA receptor to regulate overall GABA-ergic tone in the face of shifting levels of these neurosteroids may induce HPA axis dysfunction, thereby increasing sensitivity to stress and generating greater vulnerability to depression.
Conclusions:
The proposed model provides a basis for understanding the mechanisms by which the changing hormonal environment of the menopause transition may interact with the psychosocial environment of midlife to contribute to perimenopausal depression risk. Future research investigating this model may inform the development of novel pharmacological treatments for perimenopausal depression and related disorders, such as postpartum depression and premenstrual dysphoric disorder.
Our article reviews and celebrates Susan Nolen-Hoeksema's remarkable contributions to psychological and clinical science, focusing on her vast body of theoretical and empirical work and her influence on colleagues and students. Susan spent her career trying to understand how and why a style of regulating emotions called rumination increases vulnerability to depression and exacerbates and perpetuates negative moods. More broadly, we describe research by Susan and her colleagues on the predictors of depression in childhood and adolescence; gender differences in depression and rumination in adolescence and adulthood; roots, correlates, and adverse consequences of ruminative response styles; and rumination as a transdiagnostic risk factor for not only depression but also a host of psychological disorders, including anxiety, substance abuse, and eating disorders. Susan's intellectual legacy is evident in her impressive publication and citation record, the clinical applications of her work, and the flourishing careers of the students she mentored. Expected final online publication date for the Annual Review of Clinical Psychology Volume 11 is March 28, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Violence against women and girls is prevalent worldwide but historically has been overlooked and condoned. Growing international recognition of these violations creates opportunities for elimination, although solutions will not be quick or easy. Governments need to address the political, social, and economic structures that subordinate women, and implement national plans and make budget commitments to invest in actions by multiple sectors to prevent and respond to abuse. Emphasis on prevention is crucial. Community and group interventions involving women and men can shift discriminatory social norms to reduce the risk of violence. Education and empowerment of women are fundamental. Health workers should be trained to identify and support survivors and strategies to address violence should be integrated into services for child health, maternal, sexual, and reproductive health, mental health, HIV, and alcohol or substance abuse. Research to learn how to respond to violence must be strengthened. The elimination of violence against women and girls is central to equitable and sustainable social and economic development and must be prioritised in the agenda for development after 2015.
Copyright © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.
Learning to respond to others' distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements. However, this important interpersonal skill set may also confer risk for depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts. The purpose of this review is to describe an empirically grounded theoretical rationale for the hypothesis that empathic tendencies can be "risky strengths." We propose a model in which typical development of affective and cognitive empathy can be influenced by complex interplay among intraindividual and interindividual moderators that increase risk for empathic personal distress and excessive interpersonal guilt. These intermediate states in turn precipitate internalizing problems that map onto empirically derived fear/arousal and anhedonia/misery subfactors of internalizing disorders. The intraindividual moderators include a genetically influenced propensity toward physiological hyperarousal, which is proposed to interact with genetic propensity to empathic sensitivity to contribute to neurobiological processes that underlie personal distress responses to others' pain or unhappiness. This empathic personal distress then increases risk for internalizing problems, particularly fear/arousal symptoms. In a similar fashion, interactions between genetic propensities toward negative thinking processes and empathic sensitivity are hypothesized to contribute to excess interpersonal guilt in response to others' distress. This interpersonal guilt then increases the risk for internalizing problems, especially anhedonia/misery symptoms. Interindividual moderators, such as maladaptive parenting or chronic exposure to parents' negative affect, further interact with these genetic liabilities to amplify risk for personal distress and interpersonal guilt as well as for consequent internalizing problems. Age-related increases in the heritability of depression, anxiety, and empathy-related constructs are consistent with developmental shifts toward greater influence of intraindividual moderators throughout childhood and adolescence, with interindividual moderators exerting their greatest influence during early childhood. Efforts to modulate neurobiological and behavioral expressions of genetic dysregulation liabilities and to promote adaptive empathic skills must thus begin early in development.
To present the 12-month prevalence of DSM-IV major depressive disorder (MDD) and severe MDD, examine sociodemographic correlates and comorbidity, and describe impairment and service utilization.Method
Data are from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using the Composite International Diagnostic Interview (CIDI) Version 3.0. One parent or surrogate of each participating adolescent was also asked to complete a self-administered questionnaire.ResultsLifetime and 12-month prevalence of MDD were 11.0% and 7.5%, respectively. The corresponding rates of severe MDD were 3.0% and 2.3%. The prevalence of MDD increased significantly across adolescence, with markedly greater increases among females than males. Most cases of MDD were associated with psychiatric comorbidity and severe role impairment, and a substantial minority reported suicidality. The prevalence of severe MDD was about a quarter of that of all MDD cases; estimates of impairment and clinical correlates were of 2- to 5-fold greater magnitude for severe versus mild/moderate depression, with markedly higher rates for suicidal thoughts and behaviors. Treatment in any form was received by the majority of adolescents with 12-month DSM-IV MDD (60.4%), but only a minority received treatment that was disorder-specific or from the mental health sector.Conclusion
Findings underscore the important public health significance of depression among US adolescents and the urgent need to improve screening and treatment access in this population.
Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum. Using the Dunedin Multidisciplinary Health and Development Study, we examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife. Psychiatric disorders were initially explained by three higher-order factors (Internalizing, Externalizing, and Thought Disorder) but explained even better with one General Psychopathology dimension. We have called this dimension the p factor because it conceptually parallels a familiar dimension in psychological science: the g factor of general intelligence. Higher p scores are associated with more life impairment, greater familiality, worse developmental histories, and more compromised early-life brain function. The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders. Transdiagnostic approaches may improve research.
In this review, we combine and compare the results of a series of meta‐analyses on the prevalence of child sexual, physical and emotional abuse and physical and emotional neglect, including 244 publications and 551 prevalence rates for the various types of maltreatment. Child maltreatment research seems to be dominated by research on sexual abuse, studies in developed parts of the world and research using self‐report measures. The overall estimated prevalence rates for self‐report studies (mainly assessing maltreatment ever during childhood) were 127/1000 for sexual abuse (76/1000 among boys and 180/1000 among girls), 226/1000 for physical abuse, 363/1000 for emotional abuse, 163/1000 for physical neglect and 184/1000 for emotional neglect. The overall estimated prevalence rates for studies using informants (mainly assessing the 1‐year prevalence of maltreatment) were four per 1000 for sexual abuse and three per 1000, respectively, for physical abuse and emotional abuse. We conclude that child maltreatment is a widespread, global phenomenon affecting the lives of millions of children all over the world, which is in sharp contrast with the United Nation's Convention on the Rights of the Child. Copyright © 2014 John Wiley & Sons, Ltd.
Key Practitioner Messages
Child maltreatment research is dominated by research on sexual abuse.
The prevalence rates for informant studies were lower than for self‐report studies.
The prevalence of child maltreatment is largely similar across the globe.
‘Research seems to be dominated by research on sexual abuse, studies in developed parts of the world and research using self‐report measures’
Despite decades of research aimed at identifying the causes of postpartum depression (PPD), PPD remains common, and the causes are poorly understood. Many have attributed the onset of PPD to the rapid perinatal change in reproductive hormones. Although a number of human and nonhuman animal studies support the role of reproductive hormones in PPD, several studies have failed to detect an association between hormone concentrations and PPD. The purpose of this review is to examine the hypothesis that fluctuations in reproductive hormone levels during pregnancy and the postpartum period trigger PPD in susceptible women. We discuss and integrate the literature on animal models of PPD and human studies of reproductive hormones and PPD. We also discuss alternative biological models of PPD to demonstrate the potential for multiple PPD phenotypes and to describe the complex interplay of changing reproductive hormones and alterations in thyroid function, immune function, hypothalamic-pituitary-adrenal (HPA) axis function, lactogenic hormones, and genetic expression that may contribute to affective dysfunction. There are 3 primary lines of inquiry that have addressed the role of reproductive hormones in PPD: nonhuman animal studies, correlational studies of postpartum hormone levels and mood symptoms, and hormone manipulation studies. Reproductive hormones influence virtually every biological system implicated in PPD, and a subgroup of women seem to be particularly sensitive to the effects of perinatal changes in hormone levels. We propose that these women constitute a "hormone-sensitive" PPD phenotype, which should be studied independent of other PPD phenotypes to identify underlying pathophysiology and develop novel treatment targets.
Women's health has traditionally been thought of in the realm of reproductive health, and that includes women's mental health (i.e., perinatal psychiatry). However, we now know there are significant sex differences in many chronic diseases, including brain disorders. Thus, understanding the causes of sex differences in disorders of the brain, within and outside of reproduction, is critical to understanding women's mental health and healthcare needs. In order to accomplish this, it is necessary for neuroscience to adopt a “sex-dependent” and/or “sex-specific” lens on investigations of the brain. In this review, we make the case for depression, which has among the largest sex differences in disorders of the brain.
Major depressive disorder (MDD) recently became the number one cause of disability worldwide (Murray and Lopez, 1997; Ustun et al., 2004; World Health Organization, 2012). Importantly, the incidence of MDD in women is twice that of men (Kessler, 2003; Kendler et al., 2006), and thus understanding its pathophysiology has widespread implications for attenuation and prevention of disease burden, particularly in women. Over 40 years of research implicate hormonal dysregulation underlying mood disorders (Board et al., 1956; Gibbons and McHugh, 1962; Coplan et al., 2000; Brouwer et al., 2005; Kurt et al., 2007; Barim et al., 2009), particularly involvement of hypothalamic-pituitary-adrenal (HPA) and HP-gonadal (HPG) axes (Board et al., 1956; Gibbons and McHugh, 1962; Plotsky et al., 1998; Young and Korszun, 2002; Swaab et al., 2005). Central dysregulation of hormonal axes can precede MDD onset suggesting a role for hormonal abnormalities in female MDD vulnerability. Ours and others' work demonstrated that the vulnerability for sex-dependent risk for MDD begins in fetal development (McClellan et al., 2010; Goldstein et al., 2011; Zuloaga et al., 2012a,b; Carbone and Handa, 2013; Seney et al., 2013). Despite these findings, a number of confounds (state vs. trait, treatment, age, and recurrence) present challenges to elucidating the contribution of hormonal or genetic sex (Seney et al., 2013) to the co-occurrence of hormonal dysregulation and mood disorders.
There has been a substantial rise in 'economic suicides' in the Great Recessions afflicting Europe and North America. We estimate that the Great Recession is associated with at least 10 000 additional economic suicides between 2008 and 2010. A critical question for policy and psychiatric practice is whether these suicide rises are inevitable. Marked cross-national variations in suicides in the recession offer one clue that they are potentially avoidable. Job loss, debt and foreclosure increase risks of suicidal thinking. A range of interventions, from upstream return-to-work programmes through to antidepressant prescriptions may help mitigate suicide risk during economic downturn.
It is not well-established whether excess mortality associated with depression is higher in men than in women.
We conducted a meta-analysis of prospective studies in which depression was measured at baseline, where mortality rates were reported at follow-up, and in which separate mortality rates for men and women were reported. We conducted systematic searches in bibliographical databases and calculated relative risks of excess mortality in men and women.
Thirteen studies were included. Among the people with depression, excess mortality in men was higher than in women (RR=1.97; 1.63-2.37). Compared with non-depressed participants, excess mortality was increased in depressed women (RR=1.55; 95% CI: 1.32-1.82), but not as much as in men (RR=2.04; 95% CI: 1.76-2.37), and the difference between excess mortality in men was significantly higher than in women (p<0.05).
Excess mortality related to depression is higher in men than in women. Although the exact mechanisms for this difference are not clear, it may point at differential or more intensified pathways leading from depression to increased mortality in depressed men compared to women.
This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample (N = 5318) of the adult (18–79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18–34: 37% versus 20% in age group 65–79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected. Copyright © 2014 John Wiley & Sons, Ltd.
In the past two decades, much evidence has accumulated unequivocally demonstrating that child abuse and neglect is associated with a marked increase in risk for major psychiatric disorders (major depression, bipolar disorder, post-traumatic stress disorder [PTSD], substance and alcohol abuse, and others) and medical disorders (cardiovascular disease, diabetes, irritable bowel syndrome, asthma, and others). Moreover, the course of psychiatric disorders in individuals exposed to childhood maltreatment is more severe. Recently, the biological substrates underlying this diathesis to medical and psychiatric morbidity have been studied. This Review summarizes many of the persistent biological alterations associated with childhood maltreatment including changes in neuroendocrine and neurotransmitter systems and pro-inflammatory cytokines in addition to specific alterations in brain areas associated with mood regulation. Finally, I discuss several candidate gene polymorphisms that interact with childhood maltreatment to modulate vulnerability to major depression and PTSD and epigenetic mechanisms thought to transduce environmental stressors into disease vulnerability.
Background:
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods:
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress-induced damage.
Results:
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions:
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Background:
Depression is a common psychiatric disorder, with a lifetime prevalence of 10-15% in the Danish population. Although depression is associated with excess mortality, it is not yet understood how this affects life expectancy. Our aim was to examine mortality rates and life expectancy in patients with unipolar depression compared to the general population, and to assess the impact of comorbid somatic illness and substance abuse.
Methods:
We followed a Danish population-based cohort from 1995-2013 (N=5,103,699). The cohort included all residents in Denmark during the study period. Mortality rate ratios (MRRs) and life expectancy in persons with unipolar depression were calculated using survival analysis techniques.
Results:
The overall MRR was 2.07 (95% Confidence Interval (CI): 2.05-2.09) in people with a previous unipolar depression diagnosis compared to the general Danish population. This excess mortality translated into a reduced life expectancy of 14.0 years in men and 10.1 years in women (assuming onset at age 15). The MRR was highest for death due to suicide and accidents (MRR: 4.66; 95% CI: 4.53-4.79), but the absolute number of deaths was highest for natural causes.
Conclusion:
People with unipolar depression have a significant shorter life expectancy, especially men.
Child sexual abuse (CSA) continues to be a significant problem with significant short and long term consequences. However, extant literature is limited by the reliance on retrospective recall of adult samples, single-time assessments, and lack of longitudinal data during the childhood and adolescent years. The purpose of this study was to compare internalizing and externalizing behavior problems of those with a history of sexual abuse to those with a history of maltreatment, but not sexual abuse. We examined whether gender moderated problems over time. Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 6, 8, 10, 12, 14, and 16 (N=977). The Child Behavior Checklist was used to assess internalizing and externalizing problems. Maltreatment history and types were obtained from official Child Protective Services (CPS) records. Generalized Estimating Equations (GEE) were used to assess behavior problems over time by maltreatment group. Findings indicated significantly more problems in the CSA group than the maltreated group without CSA over time. Internalizing problems were higher for sexually abused boys compared to girls. For sexually abused girls internalizing problems, but not externalizing problems increased with age relative to boys. This pattern was similar among maltreated but not sexually abused youth. Further efforts are needed to examine the psychological effects of maltreatment, particularly CSA longitudinally as well as better understand possible gender differences in order to best guide treatment efforts.
Background:
Serotonin transporter-linked polymorphic region (5-HTTLPR) variants have been extensively studied in psychiatric disorders. Although gender effects have been reported, they have not been comprehensively reviewed. The aim of our study was to summarize literature findings on 5-HTTLPR and gender differences in affective disorders.
Methods:
A systematic search of PubMed, ISI Web of Knowledge, and PsycINFO databases was performed for dates until January 2015. The included articles (n=78) analyzed the association between 5-HTTLPR and affective spectrum disorders, taking into account gender. The quality of each study was assessed through STROBE and CONSORT.
Results:
5-HTTLPR modulation of affective disorders varied by gender. The S allele (or SS genotype) seemed to be differently associated with an increased risk of depression, depressive symptoms, anxiety traits and symptoms, and symptoms of internalizing behavior among women and an increased risk of aggressiveness, conduct disorder and symptom counts of externalizing behavior among men. Moreover, the presence of stressful life events reinforced the association. Interestingly, these differences seemed to begin with adolescence and were not consistent among the elderly, suggesting a plausible role of hormonal fluctuations.
Limitations:
The review is limited by the small number of included papers, due to the paucity of information in the literature regarding 5-HTTLPR and gender.
Conclusions:
5-HTTLPR variants may exert a differential modulation on a number of features depending on gender. Further studies are needed to more deeply investigate the effect of 5-HTTLPR×gender on the modulation of affective disorders.
Women become depressed more frequently than men, a consistent pattern across cultures. Inflammation plays a key role in initiating depression among a subset of individuals, and depression also has inflammatory consequences. Notably, women experience higher levels of inflammation and greater autoimmune disease risk compared to men. In the current review, we explore the bidirectional relationship between inflammation and depression and describe how this link may be particularly relevant for women. Compared to men, women may be more vulnerable to inflammation-induced mood and behavior changes. For example, transient elevations in inflammation prompt greater feelings of loneliness and social disconnection for women than for men, which can contribute to the onset of depression. Women also appear to be disproportionately affected by several factors that elevate inflammation, including prior depression, somatic symptomatology, interpersonal stressors, childhood adversity, obesity, and physical inactivity. Relationship distress and obesity, both of which elevate depression risk, are also more strongly tied to inflammation for women than for men. Taken together, these findings suggest that women's susceptibility to inflammation and its mood effects may contribute to sex differences in depression. Depression continues to be a leading cause of disability worldwide, with women experiencing greater risk than men. Due to the depression-inflammation connection, these patterns may promote additional health risks for women. Considering the impact of inflammation on women's mental health may foster a better understanding of sex differences in depression, as well as the selection of effective depression treatments.
Official nosological systems, such as the DSM-5 and ICD-10, define psychopathology and substance use disorders as distinct, independent, and categorical constructs. In other words, the classification systems imply that a patient either meets the diagnostic threshold for a particular mental disorder or does not (categorical), the disorder does not overlap with other disorders (distinct), and therefore presence of the disorder should not necessarily be associated with a higher probability of having another disorder (independent).
Both clinical experience and empirical research indicate that these assumptions are not justified, however. First, sub-threshold disorder manifestations can be associated with significant distress and dysfunction; moreover, there are important severity differences among individuals receiving the same diagnosis. This suggests an underlying dimensionality to mental disorders not captured by categorical diagnoses and highlights the information lost when reducing a complex constellation of signs and symptoms to a present-absent dichotomy. Second, comorbidity is the rule, rather than the exception. Individuals who have one disorder are likely to meet criteria for additional disorders at rates far exceeding what would be predicted from disorder prevalence rates.
Research on disorder dimensionality and comorbidity suggests that many mental disorders are manifestations of relatively few core underlying dimensions. Beginning several decades ago, investigations of common symptoms and behaviors in children, and diagnoses in adults, have repeatedly replicated such an underlying cross-cutting transdiagnostic structure: the internalizing-externalizing model. Internalizing accounts for comorbidity among major depression, generalized anxiety disorder, dysthymia, panic disorder, social and specific phobias, post-traumatic stress disorder, and so on, while externalizing accounts for comorbidity among substance use disorders and antisociality-, behavioral-, and impulsivity-related disorders.
Unlike the organizations of many official nosologies (e.g., “mood disorders” as separate from “anxiety disorders”), this internalizing-externalizing model provides excellent fit to the data and has been replicated in various populations, from around the world (1,2). This report highlights recent advances and contemporary directions in transdiagnostic comorbidity research.
Mood disorders and health risk behaviors increase in adolescence. Puberty is considered to contribute to these events. However, the precise impact of pubertal hormone changes to the emergence of mood disorders and risk behaviors is relatively unclear. It is important that inappropriate attribution is not made. Our aim was to determine what is known about the effect of endogenous estradiol on human adolescent girls’ mood and behavior. The databases searched were MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Pre-MEDLINE, Web of Science, and Scopus for all dates to October 2014. For inclusion, contemporaneous hormone and mood or behavioral assessment was required. Data were extracted following a template created by the authors. Fourteen studies met our inclusion criteria. There was some consistency in findings for mood and estradiol levels, with associations between estradiol and depression and emotional tone and risk taking. Results were less consistent for studies assessing other mood and behavioral outcomes. Most studies were cross-sectional in design; assay methodologies used in older studies may lack the precision to detect early pubertal hormone levels.
Conclusion: Three longitudinal and several cross-sectional studies indicate potential associations between estradiol and certain mood or affective states, especially depression and mood variability though there are insufficient data to confirm that the rise in estradiol during puberty is causative. We believe that it is important for health professionals to take care when attributing adolescent psychopathology to puberty hormones, as the current data supporting these assertions are limited.
Abstract This study assessed the effects of premenstrual syndrome (PMS) and menstrual phases on the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS) axis, and psychological responses to the Trier Social Stress Test (TSST). Thirty-six PMS women (mean age 21.69±2.16 years) and 36 control women (mean age 22.03±2.48 years) participated in the TSST task, either in the follicular phase or in the late luteal phase (each group N=18). Saliva samples, heart rate, and subjective stress levels were collected for seven time points throughout the test (10, 20, 30, 40, 55, 70, and 100 min). The results indicated that in comparison with control women, PMS women displayed blunted cortisol stress responses to the TSST irrespective of the menstrual phases, as indexed by the cortisol levels across time, AUCg, and peak change scores of cortisol. The results also demonstrated that the measurements indexed by cortisol levels across time, AUCg, and peak change scores of heart rate were smaller in women tested during the late luteal phase than during the follicular phase. Correlation results indicated that AUCg was negatively correlated with PMS scores. These results suggest that measures of cortisol, rather than heart rate or subjective responses to stress, may be most closely associated with PMS. Furthermore, hypo-reactivity of the HPA axis may be pathologically relevant to PMS because it predicts heightened PMS severity.
Mental disorders are among the most common morbidities of pregnancy and the postnatal period, and can have adverse effects on the mother, her child, and family. This Series paper summarises the evidence about epidemiology, risk factors, identification, and interventions for non-psychotic mental disorders. Although the phenomenology and risk factors for perinatal mental disorders are largely similar to those for the disorders at other times, treatment considerations differ during pregnancy and breastfeeding. Most randomised controlled trials have examined psychosocial and psychological interventions for postnatal depression, with evidence for effectiveness in treating and preventing the disorder. Few high-quality studies exist on the effectiveness or safety of pharmacological treatments in the perinatal period, despite quite high prescription rates. General principles of prescribing of drugs in the perinatal period are provided, but individual risk-benefit analyses are needed for decisions about treatment.
Copyright © 2014 Elsevier Ltd. All rights reserved.
The purpose of this study was to examine whether FKBP5 rs1360780 moderates relations between different forms of life stress/adversity (early institutional rearing and peer victimization) and depressive symptoms in adolescents. As reported previously, PI youth were at risk for being victimized by peers. Here, victimization was associated with elevated depressive symptoms. While FKBP5 did not moderate the association between early life adversity and depressive symptoms for either sex, it moderated the association between current adversity and depressive symptoms for victimized girls carrying the minor allele. Consistent with a differential susceptibility model, girls with the minor allele exhibited more depressive symptoms at higher levels of victimization, but fewer depressive symptoms at lower levels of victimization. Interestingly, boys with the CC genotype had higher rates of depressive symptoms compared to girls with the CC genotype in the context of heightened victimization.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Women's vulnerability for a first lifetime-onset of major depressive disorder (MDD) during midlife is substantial. It is unclear whether risk factors differ for first lifetime-onset and recurrent MDD. Identifying these risk factors can provide more focused depression screening and earlier intervention. This study aims to evaluate whether lifetime psychiatric and health histories, personality traits, menopausal status and factors that vary over time, e.g. symptoms, are independent risk factors for first-onset or recurrent MDD across 13 annual follow-ups.
Four hundred and forty-three women, aged 42-52 years, enrolled in the Study of Women's Health Across the Nation in Pittsburgh and participated in the Mental Health Study. Psychiatric interviews obtained information on lifetime psychiatric disorders at baseline and on occurrences of MDD episodes annually. Psychosocial and health-related data were collected annually. Cox multivariable analyses were conducted separately for women with and without a MDD history at baseline.
Women without lifetime MDD at baseline had a lower risk of developing MDD during midlife than those with a prior MDD history (28% v. 59%) and their risk profiles differed. Health conditions prior to baseline and during follow-ups perception of functioning (ps < 0.05) and vasomotor symptoms (VMS) (p = 0.08) were risk factors for first lifetime-onset MDD. Being peri- and post-menopausal, psychological symptoms and a prior anxiety disorder were predominant risk factors for MDD recurrence.
The menopausal transition warrants attention as a period of vulnerability to MDD recurrence, while health factors and VMS should be considered important risk factors for first lifetime-onset of MDD during midlife.
Background:
Objectification Theory positions self-objectification as a cause of depression. In particular, the authors offer Objectification Theory as a partial explanation for the higher prevalence of depression among women than men. To investigate the validity of this theory, we undertook a systematic review of quantitative studies that have investigated self-objectification as a predictor of depression.
Methods:
Studies were identified by searching the PsycINFO, Medline, EMBASE and Cochrane Library databases. Search terms were 'objectif⁎' OR 'body conscious⁎' AND 'depressi⁎' OR 'dysthymi⁎' OR 'mood disorder'. To be eligible, studies were required to be in the English-language, to include a measure of depression and a measure of self-objectification. Studies were excluded if they did not explicitly examine the association between these variables.
Results:
Among women most studies found a mediated effect for self-objectification on depression. All studies including adolescents found a direct effect. Each of the two prospective longitudinal studies found that an increase in self-objectification over time was associated with a concomitant increase in depression, suggesting a causal relationship. Among men the results were mixed.
Limitations:
The review did not include a quantitative synthesis due to the heterogeneity of the included observational studies. The majority of the studies were cross-sectional precluding conclusions concerning causality. Generalisations to culturally and linguistically diverse populations must be made with caution given the limited cultural diversity within the studies
Conclusions:
Self-objectification may be a useful predictor of depression, particularly among women and adolescents, and may have clinical relevance among these populations.
Gender medicine studies sex- and gender-based differences in the development and prevention of diseases, the awareness and presentation of symptoms, and the effectiveness of therapy. Gender medicine is part of personalized medicine, considering differences in biological and psychosocial factors individually. There are differences in genes, chromosomes, hormones, and metabolism as well as differences in culture, environment, and society. Lifelong interactions between physical and psychosocial factors will influence the health and ill-health of men and women in different ways. Epigenetic modifications provide evidence of the impact of environment and lifestyle during vulnerable phases on biological processes, effecting future generations. Maternal lifestyle and environmental factors during pregnancy can impact the health of offspring in later life already in utero in a sex-specific way. Pain, stress, and coping styles differ between men and women. Women experience more dramatic physical changes during their lifetime, which are associated with specific burdens and psychosocial alterations. Women with multiple roles and responsibilities suffering from stress develop depression more frequently. However, men are often not diagnosed and treated appropriately in cases of depression or osteoporosis, diseases that are typically considered "female." There are prominent differences between men and women in medicine regarding the immune system, inflammation, and noncommunicable diseases such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Women experience more often autoimmune diseases and suffer more frequently from (chronic) pain, neurodegenerative changes, and functional disabilities. Men have shorter life expectancy but relatively more healthy years of life, which is in greater part ascribed to psychosocial determinants. State-of-the-art clinical medicine comprises individual risk factors based on sex- and gender-sensitive health programs in order to improve the health-related quality of life for men and women.
Aim:
Depression is common and may have significant implications for the individual, their families and work and for the health care system. The menopause transition (MT) may be an 'at risk' time for the development of depression. This review aims to explore the relationship between depression and MT and the complex interaction between the biological, psychological and social factors that inform it.
Methods:
The literature on depressive disorders and MT is reviewed.
Results and conclusions:
Longitudinal studies have demonstrated an association between the menopause transition (MT) and an increase in depressive symptoms. A trend towards higher rates of depressive disorders during the MT, has also been shown, although not always reaching statistical significance. Risk factors for the development of depressive symptoms and depression in the MT include the presence of vasomotor symptoms (VMS), a personal history of depression (particularly depression that is related to pregnancy or hormonal changes through the menstrual cycle), surgical menopause, adverse life events, and negative attitudes to menopause and ageing. A treatment approach to depression during the MT exploits the biological as well as the psychosocial factors that are likely to be contributing in an individual.
Sex differences are prominent in mood and anxiety disorders and may provide a window into mechanisms of onset and maintenance of affective disturbances in both men and women. With the plethora of sex differences in brain structure, function, and stress responsivity, as well as differences in exposure to reproductive hormones, social expectations and experiences, the challenge is to understand which sex differences are relevant to affective illness. This review will focus on clinical aspects of sex differences in affective disorders including the emergence of sex differences across developmental stages and the impact of reproductive events. Biological, cultural, and experiential factors that may underlie sex differences in the phenomenology of mood and anxiety disorders are discussed.
Objective
The concept of fearful spells (FS) denotes distressing spells of anxiety that might or might not qualify for criteria of panic attacks (PA). Few studies examined prospective-longitudinal associations of FS not meeting criteria for PA with the subsequent onset of mental disorders to clarify the role of FS as risk markers of psychopathology.
Method
A representative community sample of adolescents and young adults (N=3,021, age 14-24 at baseline) was prospectively followed up in up to 3 assessment waves over (up to) 10 years. FS, PA, anxiety, depressive, and substance use disorders were assessed using the DSM-IV/M-CIDI. Odds Ratios (OR) from logistic regressions were used to examine the predictive value of FS-only (no PA) and PA at baseline for incident disorders at follow-up.
Results
In logistic regressions adjusted for sex and age, FS-only predicted the onset of any subsequent disorder, any anxiety disorder, panic disorder, agoraphobia, GAD, social phobia, any depressive disorder, major depression, and dysthymia (ORs 1.54-4.36); PA predicted the onset of any anxiety disorder, panic disorder, GAD, social phobia, any depressive disorder, major depression, dysthymia, any substance use disorder, alcohol abuse/dependence, and nicotine dependence (ORs 2.08-8.75; reference group: No FS-only and no PA). Associations with psychopathology were slightly smaller for FS-only than for PA, however, differences in associations (PA compared to FS-only) only reached significance for any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26).
Conclusions
Findings suggest that compared to PA, FS-only have similar predictive properties regarding subsequent psychopathology and might be useful for an early identification of high-risk individuals.