Sex differences in the expression of depression in adolescents

The purpose of the present study is to examine the patterns of depressive response of adolescents on The Beck Depression Inventory (BDI). Subjects, who were registered at the Western Québec Regional School Board (Grades 7–12), completed the BDI in the context of intact classes. Out of 1015 subjects, 249 (152 females, 97 males) met the cut-off score of 15 and above on the BDI, and were retained for the study. Sixty-three percent were francophone and 37 percent were anglophone. Ages ranged from 12 to 17 years. Results did not reveal any difference in the BDI scores as a function of either sex, age, or language. However, a significant discriminant function was obtained from subjects' responses that correctly differentiates depressed males from depressed females in 67.8% of the cases. These differential patterns of depressive responding are compared with those observed in depressed college students and adult psychiatric patients, and discussed in light of the literature on adolescent depression.This is an extended version of a poster paper presented at the 48th annual meeting of the Canadian Psychological Association, Vancouver, June 1987.     

Sex differences in depression

The role of housewife has been hypothesized as the source of excess mental illness among married women as compared with married men. The present study found both housewives and working wives significantly more depressed than working husbands. Although working wives report that they do more housework than husbands, this factor was not significantly related to depression for either wives or husbands. It is suggested that the risk factors for depression, including marriage for women, may be better understood in the context of clinical theories of depression, especially the learned helplessness model.     

Sex differences in the expression of depression: A developmental interaction effect

A 1982 study by Kleinke and colleagues indicated sex differences among college students in the expression of depression on the Depression Coping Questionnaire and Beck's Depression Inventory, with females showing a significantly greater tendency to label their feelings and symptomatology. Using the Structured Pediatric Psychosocial Interview (SPPI), we have examined 1015 public-school pupils ranging from 5 through 19 years of age. On the SPPI's depression-related scales of Unhappiness and Resentfulness, developmental age level appears to interact significantly with respondent's gender in determining the extensity of content expressed. Our results with older adolescents replicate the sex differences reported by Kleinke et al. (Sex Roles, 1982, 8, 877–889), but at earlier age levels such differences may not be salient. Therefore, the inclusion of a developmental parameter would appear especially important to the investigation of processes by which sex differences in the expression of affectivity become manifest by late adolescence.We wish to thank Mr. Gayle Seymour of the University of Akron Computer Center for his technical programming which culminated in graphics displayed in the present study.     

Sex differences in coping with depression

A Depression Coping Questionnaire (DCQ) was devised to compare strategies for coping with depression reported by male and female college students. Discriminant analysis showed that females were significantly more likely than males to report crying, eating, smoking cigarettes, becoming irritable, and confronting their feelings when depressed. Males were significantly more likely than females to report becoming aggressive and engaging in sexual behavior when depressed. Discriminant analysis data from students in Massachusetts showed significant cross-validation with discriminant analysis data from students in California. Comparison of depressed males and females indicated that depressed males reported behaviors of withdrawal such as spending time alone and using stimulating and tranquilizing drugs. Depressed females reported self-blame. Significant multiple correlations between DCQ questions and depression scores on the Beck Depression Inventory (BDI) showed that high BDI scores were associated with isolation and escape in males, and with self-blame and acting out in females. It is concluded that depressed females might benefit most from alleviation of self-blame and adaptive relabeling of depressive symptoms, and depressed males might benefit most from increased self-awareness and active coping.The authors are indebted to Colleen F. Surber, John R. Surber, and Frederick B. Meeker.     

Sex differences and adolescent depression

This study investigates the role of certain psychosocial variables--sex, age, body image/self-esteem, self-consciousness, stressful life events, and the degree to which an individual identifies with the cultural stereotype of masculinity--as correlates and antecedents to depression in adolescents and explores possible intraindividual mediators of the stress-depression relationship in adolescents. A battery of self-report measures was administered to public high school students in Grades 9-12 in their classrooms at two different times 1 month apart. Female adolescents reported more depressive symptoms, self-consciousness, stressful recent events, feminine attributes, and negative body image and self-esteem; no age effects were obtained. Results suggest a model of adolescent depression in which body/self-esteem and stressful recent events are significant contributors.     

Sex differences in problems related to depression

The study investigated possible sex differences in the types of problems that are correlated with Beck Depression Inventory (BDI) scores, using a sample of college students. Problems related to assertiveness and feeling ill at ease were positively correlated with BDI scores for males, but not for females. In contrast, conflicts with parents, feelings of being boxed in and of boredom, lack of money, and chronic physical complaints were positively related to BDI scores for females, but not for males.     

Sex differences in symptoms of depression among American children and adolescents

The Arabic Children's Depression Inventory in its English version was administered to a sample of 535 U.S. school students (11 to 18 years old). By sex, differences on total score and on 19 of 27 items (70.4%) were not statistically significant. Nevertheless, differences were significant for 8 (29.6%) items on which girls had higher mean scores. Half of the items were positive indicators of depression (I am sad, I feel lonely, I feel miserable, and I hate myself), while the other half were negative (I feel happy, Life is rosy, A lot of people like me, and I am optimistic).     

Sex differences of salivary cortisol secretion in patients with major depression

Depression is associated with increased cortisol secretion and occurs more often in women than in men. Thus, it has been hypothesized that differences in cortisol secretion might, in part, be responsible for the greater risk of developing depression in women. However, only few studies have examined sex differences in baseline cortisol secretion in depressed patients and healthy controls. We examined sex effects on cortisol secretion in 52 medication-free patients with major depression (37 women, 15 men, mean ± SD age 35 ± 11 years, Hamilton Depression Scale mean score 27 ± 5) and 50 healthy age- and sex-matched control subjects. Salivary cortisol concentrations were measured at 8:00, 12:00, 16:00, and 22:00 h. Repeated measures analysis of covariance revealed a group × sex interaction (p = 0.05). Post hoc tests revealed higher cortisol concentrations in depressed compared to healthy men [F(1;29) = 7.5, p = 0.01]. No differences were found between depressed and non-depressed women. Our results do not support the hypothesis that differences in cortisol secretion between depressed and non-depressed subjects are more pronounced in women than in men. Study characteristics and methods as well as sex-specific confounding variables such as menstrual cycle, menopause and the use of oral contraceptives may account for inconclusive results across studies.     

A cross-validation of sex differences in the expression of depression

A considerable amount of evidence has accumulated indicating a greater rate of depression among females compared to males. In addition, recent investigations have revealed distinct patterns of depressive responding as a function of sex. The present study provided a cross-validational test of findings reported by Funabiki and colleagues. Male and female college students indicated the likelihood that they would engage in 79 behavioral analytically derived behaviors or cognitions if depressed. Stepwise discriminant function analyses were performed to determine maximum separation of male and female responses. This procedure yielded a 55.6% overall variable cross-validation rate. Many of the findings were consistent with Radloff and Rae's theoretical view of sex differences in learned susceptibility to depression. The data also suggest several avenues for future research and support the utility of investigating theories of depression within the context of a continuity between normal mood states and depressive phenomena.Useful comments on an earlier draft of this article were provided by Mark Hammarlund and Lorence S. Miller. The order of authorship was determined by the flip of a coin.     

Sex differences in the expression of emotion in a structured social encounter

The stereotypic portrayal of women as more emotional than men was evaluated in the present study. Equal numbers of female and male subjects were administered an interview consisting of questions designed to elicit two different levels of affect. Measures of subjects' facial expressions, speech, and visual behavior were analyzed for indications of emotionality, the affective state elicited in the interview, and emotional expression, a trait which is independent of question content. As hypothesized, it was found that women were more expressive of emotion in their higher level of facial activity. However, measures of speech and visual behavior, which reflected the expected difference in the affective states elicited by the different types of interview questions, did not differentiate between men and women. Finally, ratings of the quality of the subjects' facial expressions provided some evidence of sex differences in reactions to the questions. It was concluded that a reconsideration of the question of sex differences in emotionality is needed. Previous generalizations based on indirect experimental data and on potentially unreliable subjective reports must be challenged by more direct and dependable investigations.The author is grateful to Galen Baril for his assistance in the collection of the data and to Max Zachau for coding the data. This research was supported by a Faculty Research Grant from the University of Maine at Orono.     

Sex differences in clinical judgments of male and female therapists

This study asked whether clinicians would judge a case differently if the patient were male or female. One hundred and three clinical social workers were given a clinical vignette with age and sex randomly varied. Clinicians were asked to evaluate the patient's functioning and to make treatment recommendations. As predicted, the female was rated more favorably than the male, suggesting that participants used different mental health standards for men and women. Predictions that the female would be seen as more organic and more in need of medication were not supported. Therapist gender effects emerged: female (but not male) therapists saw psychodynamic issues as less important for the older patient, and especially the older woman. Implications of these findings are discussed.The authors wish to acknowledge the contributions of April E. Fallon, Ph.D., to this study.     

Ethnic differences in clinical presentation of depression in adult women

This study examined ethnic differences in self-report and interviewer-rated depressive symptoms and estimated the contributions of sociodemographic and psychosocial factors in predicting severity of depression. One hundred twenty-five clinically depressed African American (n = 46), Caucasian (n = 36), and Latina (n = 43) women were recruited. After controlling for differences in socioeconomic status, African American women reported more symptoms of distress and Latinas were rated as significantly more depressed than the other groups. However, these ethnic differences were not moderated by either education or employment. Finally, hierarchical regression analysis indicated that severity of depression was predicted by low education, being single, being Latina, high perceived stress, and feelings of hopelessness. Additional research is needed to validate these results and to investigate their clinical significance.     

Sex differences in depressive symptom expression and help-seeking among college students

Considerable controversy has emerged around the issue of sex differences in depression. A recent study of a large sample of young, unmarried college student found no sex differences in degree of depression as measured by the Beck Depression Inventory, and yet significant sex differences emerged in the patterns of symptoms expressed by the most depressed subsample. It was speculated that sex differences in symptom expression may lead to sex differences in self-presentation, help-seeking, and evaluation by professionals — eventuating in predominance of women treated for depression. Two studies were conducted to clarify these issues. The first study attempted to replicate the findings on a similar large sample of college students using discriminant function analysis of male and female responses to the D30 subscale of the Depression scale of the MMPI. The results confirmed the previous finding that depressed men in a college population are more likely to express social withdrawal, cognitive and motivational deficits, and somatic concerns. Depressed women are characterized on the D30 by a lack of confidence, a lack of concern for what happens to them, and being hurt by criticism. The second study examined possible sex differences in the self-labeling of depression, attitudes toward seeking help for depression, and actual help-seeking behaviors. Men and women did not differ in willingness to report depression. However, there were clear sex differences in both help-seeking attitudes and reported behaviors, with men more reluctant to seek help.     

Sex differences in self-silencing

The construct of self-silencing was proposed to account for women's greater vulnerability to developing depression. This study of 1,117 students (795 women and 322 men) explored possible explanations for the empirical finding that men self-silence to the same or greater extent than women. Analysis showed that men reported more self-silencing than women. A factor analysis confirmed the subscale structure of the Silencing the Self Scale for women and men, with relatively few departures from the originally proposed subscales. Depression and self-silencing scores were correlated positively for both men and women. The results of two multiple regressions, performed separately for men and women, showed that depressive symptomatology accounted for a significant percentage of the variance in self-silencing but that social desirability did not account for a significant increment in the variance accounted for in silencing the self. The scores on the Care as Self-sacrifice and the Divided Self subscales were intercorrelated for women, but not for men, indicating that there may be a sex difference in perception of self-silencing behavior.     

Sex differences in pain

Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is "learned" and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production.     

Sex differences in cognition

Sex differences in cognitive skills, grouped into three areas — motor, spatial, and linguistic — are assessed in the context of current notions of cerebral lateralization (Buffery and Gray, 1972). There are few convincing sex differences, either overall, or in interactions with (putative) functional localization. There are several qualifying criteria (nature of further interactions with age, birth order, culture, sex of experimenter, sex role pressure) which would have to be met, but these are as yet inadequately documented. Serious caution is urged on the proliferating number of researchers in this area.     

Sex differences in the adolescent brain

Adolescence is a time of increased divergence between males and females in physical characteristics, behavior, and risk for psychopathology. Here we will review data regarding sex differences in brain structure and function during this period of the lifespan. The most consistent sex difference in brain morphometry is the 9–12% larger brain size that has been reported in males. Individual brain regions that have most consistently been reported as different in males and females include the basal ganglia, hippocampus, and amygdala. Diffusion tensor imaging and magnetization transfer imaging studies have also shown sex differences in white matter development during adolescence. Functional imaging studies have shown different patterns of activation without differences in performance, suggesting male and female brains may use slightly different strategies for achieving similar cognitive abilities. Longitudinal studies have shown sex differences in the trajectory of brain development, with females reaching peak values of brain volumes earlier than males. Although compelling, these sex differences are present as group averages and should not be taken as indicative of relative capacities of males or females.