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Gender Differences In Depression Essay Outline

Department of Psychology, The University of Tennessee, Knoxville, 307 Austin Peay Building, Knoxville, TN 37996-0900, USA

Copyright © 2012 Marlena M. Ryba and Derek R. Hopko. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gender differences in the prevalence of depression are well documented. To further explore the relation between gender and depression, this study used daily diaries to examine gender differences within thirteen behavioral domains and whether differential frequency of overt behaviors and environmental reward mediated the relationship between gender and depression severity. The sample included 82 undergraduate students [66% females; 84% Caucasian; Mean age = 20.2 years]. Overall, females engaged in a significantly greater breadth of behavioral domains and reported a higher level of environmental reward. Females spent more time in the domains of health/hygiene, spiritual activities, and eating with others. Males spent more time in the domains of physical activity, sexual activity, and hobbies and recreational experiences. Females found social activities, passive/sedentary behaviors, eating with others, and engagement in “other” activities more rewarding. Gender had a significant direct effect on depression severity, with females reporting increased depression. This effect was attenuated by the mediator (total environmental reward) such that to the extent females exhibited increased environmental reward, the gender effect on depression was attenuated. These data support behavioral models of depression, indicate increased reinforcement sensitivity among females, and have clinical relevance in the context of assessment and behavioral activation interventions for depression.

1. Introduction

Gender differences are apparent in prevalence rates of certain mental health problems. For example, females are more likely to present with internalizing disorders such as depression and anxiety [1–4], whereas men have a higher prevalence of several externalizing disorders, including antisocial personality disorder and substance abuse [5–7]. Pertaining to gender differences in depression, beginning in late adolescence [8], and continuing through adulthood, it is widely established that depression is more common among females (21%) than males (13%; [9]). Many factors may account for this gender difference, including biological influences such as genetics, hormones, adrenal functioning, and neurotransmitter systems, as well as psychosocial variables such as more frequent victimization and trauma in childhood, gender role factors (e.g., competing social roles, role restrictions), interpersonal orientation such as increased vulnerability to the emotional pain of others, being more prone to rumination, differential attributional styles, and greater reactivity to stress in terms of biological responses, self-concept, and coping styles [4, 10–19]. Anxiety disorders are highly coexistent with depression, are more prevalent among females, and also may contribute to the onset, maintenance, and severity of depressive episodes [2, 20–22].

Behavioral theories explain the development and persistence of depression as the result of decreased response-contingent positive reinforcement (RCPR) [23–27]. A low rate of RCPR is proposed as the critical mediator between overt behaviors and depression severity [26, 28], RCPR defined as an increase in the frequency or duration of behavior as a result of positive or pleasurable outcomes. Minimal environmental (and social) reinforcement results in the extinction of “healthy” behaviors and consequently the dysphoria and passivity that often characterize depression. A low rate of RCPR is a product of decreased availability of potential reinforcers in the environment, inabilities to experience rewarding contingencies due to inadequate instrumental behaviors such as social, occupational, or academic skills, and increased exposure to distressing or unpleasant events [26, 29]. Supporting behavior theory, several studies highlight relationships between pleasant events and mood state, with individuals reporting fewer positive events, decreased environmental reward, and more limited abilities to obtain reinforcement endorsing greater depression [28, 30–34]. Depressed individuals also tend to engage in fewer interpersonal behaviors, suggesting that insufficient social interaction and decreased social reinforcement may predict negative affect [35–37].

Also supporting behavioral models of depression, behavioral activation interventions that focus on increasing RCPR are largely effective, with meta-analyses supporting their efficacy such that behavioral activation is now considered an empirically validated treatment for depression [38–41]. In one of the more compelling studies, behavioral activation was comparable to antidepressant medication and superior to cognitive therapy in treating severe depression [42], results that were maintained at 2-year follow-up [43]. Behavioral activation also has been effectively used with depressed patients in a variety of settings and among samples with divergent medical and psychiatric problems [44–52].

Considering the well-documented gender differences in depression and strong empirical support for behavioral models of depression, there is a pressing need to explore potential gender differences across a breadth of behavioral domains and determine whether these differences contribute to increased depression in females. Indeed, depressed and nondepressed individuals have been shown to differ substantially in terms of overt behavior. For example, in addition to increased social avoidance alluded to earlier, depressed individuals generally report participating in fewer rewarding and pleasurable activities [30, 33, 34] and engage in fewer physical and educational behaviors [31, 53]. Depressed individuals also generally exhibit a slower and more monotonous rate of speech, take longer to respond to the verbal behavior of others, exhibit an increased frequency of self-focused negative remarks, and use fewer “achievement” and “power” words in their speech [37, 54]. Depressed and nondepressed individuals also differ in their non-verbal behavior. Depressed individuals smile less frequently, make less eye contact, more frequently hold their head in a downward position, and are rated as less competent in social situations [54–56]. Accordingly, understanding gender differences in overt behavioral patterns may allow further insight into the higher prevalence of depression in females and potentially have important assessment and treatment implications. If males and females differ in the frequency and possibly reward derived from certain overt behaviors, it is conceivable that these differences could contribute to the development and maintenance of psychological problems such as depression [26]. In such cases, it would be feasible to proactively recommend healthy behavioral repertoires and modify treatment interventions to more adequately address psychological distress while taking gender into account. As an important step in this process, it is necessary to more validly assess potential gender differences in overt behaviors in the context of major life domains [57].

The primary aim of this study was to evaluate differences between males and females in activities assessed via self-monitoring through daily diaries. Relative to self-report strategies that retrospectively assess overt behaviors, a more ecologically valid method of determining the frequency of behaviors may be through use of such daily diaries [30]. Studies incorporating daily diaries have found daily ratings of behaviors and depression symptoms to correlate strongly with self-report and clinician-rated measures of depression [30, 31, 58–60]. Similar daily diary designs have demonstrated adequate internal consistency and good convergent and discriminate validity in research on anxiety [61, 62] and other symptom presentations [63–67]. Using this methodology as a novel approach to exploring behavioral gender differences, it was hypothesized that females would engage in more passive and sedentary behaviors, while males would engage in more physical and active behaviors as evolutionary theory and social learning models would suggest [68]. Second, in addition to increased behavioral frequency and based on matching theory [69], it was hypothesized that males and females would find these specific activities more rewarding. Finally, based on behavioral models of depression [24, 26], it was hypothesized that decreased engagement in nondepressive healthy behaviors and diminished environmental reward would significantly mediate the relationship between gender and depression severity [70].

2. Method

2.1. Participants

Participants included 82 undergraduate students (females: ; males: ) from an introductory psychology class at a large southeastern university. The sample consisted of 69 Caucasians (84.1%), 8 African Americans (8.5%), and 6 (7.3%) participants who self-identified as Asian American. The mean age of participants was 20.2 years (SD = 3.9 years). All participants received course-related research credit for their participation and the research was approved by the University of Tennessee Institutional Review Board.

2.2. Assessment Measures

Participants completed the Beck Depression Inventory-II (BDI-II; [71]), a 21-item measure of depression symptom severity, each of which is rated on a 4-point Likert scale (0–3 point anchors), with items summed to form a total score. The instrument has excellent internal consistency () as well as strong convergent validity with other measures of depression [71, 72]. Internal consistency in this sample was excellent (). For the current sample (BDI-II: = 11.7, SD = 7.8), females reported increased depressive symptoms ( = 13.0, SD = 8.0) relative to male participants ( = 9.3, SD = 7.1) (, ).

2.3. Procedure

Participants met with an experimenter on two occasions. During the first meeting, participants first completed the BDI-II and a demographic form. Participants were then given a packet that included seven daily activity-monitoring forms and detailed instructions. Participants were instructed to record all of their behaviors and activities for the following week. These daily forms contained space for participants to record their behavioral data from 8 A.M to 2 A.M, within half-hour intervals. Participants were also encouraged to be as honest as possible and to record their behaviors every couple of hours to help them accurately recall their behaviors. They were then asked to code each behavioral activity according to one of the following categories: (1)social: time with friends, family, boyfriend or girlfriend, and so forth;(2)physical: hiking, biking, walking to class, any other exercise, and so forth;(3)health/hygiene: showering, bathing, brushing teeth, being at the doctor or dentist, and so forth;(4)spiritual: attending church, engaging in prayer/ meditation, reading religious text, and so forth;(5)educational: classes, homework, lectures, computer work, and so forth;(6)passivity/sedentary: napping, sitting, watching television, Internet surfing for fun, and so forth;(7)sexual: intimate physical acts, intercourse, masturbation, and so forth;(8)employment/volunteering: working at your job, babysitting, helping the elderly, and so forth;(9)hobbies and recreation: reading, drawing, writing, scrapbooking, playing music, and so forth;(10)eating alone: snacking, meals, and so forth;(11)eating with others: snacking, meals, and so forth;(12)travel: commuting to school, home, work, flying, traveling to foreign countries, and so forth;(13)other: any behavior not coded in domains 1–12.

Additionally, participants were instructed to engage in their normal routines and to not alter their behaviors for the purpose of this study. For each behavior listed on their daily activity-monitoring forms, participants indicated the degree to which they found the activity to be rewarding (on a 1 (minimally rewarding) to 4 (highly rewarding) Likert scale). Finally, participants were provided with an explanation as to what constituted overt behavior and were asked not to record specific thoughts, physiological responses, feelings, and emotional experiences. Participants returned approximately 1 week later (pending participant and experimenter availability), returned their daily diaries, and completed a postassessment BDI-II.

3. Results

The total duration of time (hours per week) spent in each activity domain was calculated for each participant and is presented in Table 1. For the entire sample (), the most commonly reported behaviors were as follows, presented in descending order based on the percentage of time activities engaged in during the monitoring week: educational (26%), passivity/sedentary (25%), social (13%), eating with others (6%), employment/volunteering (6%), travel (5%), health/hygiene (4%), hobbies and recreation (4%), physical (3%), other (3%), eating alone (3%), spiritual (1%), and sexual (1%). independent-sample -tests were used to examine whether the mean duration of time in each activity domain statistically differed as a function of gender. Estimated Cohen’s [73] is presented as a measure of effect size ( = 0.20 = small; = 0.50 = medium; = 0.80 = large). As indicated in Table 1, on a more global level, females engaged in a significantly greater number of behavioral domains and reported a higher level of overall environmental reward relative to males. On a more specific level of analysis, females reported spending a greater duration of time in the behavioral domains of health/hygiene, spiritual activities, and eating with other individuals. In contrast, males reported spending more time in the behavioral domains of physical activity, sexual activity, and hobbies and recreational experiences. Males and females did not differ in the duration of time spent in the following domains: social, educational, passive/sedentary, employment, travel, time spent eating alone, or engagement in “other” activities. Also presented in Table 1, the average reward value recorded on the daily diaries for each behavioral domain was compared as a function of gender. In relation to males, females found social activities, passive/sedentary behaviors, eating with others, and engagement in “other” activities more rewarding. There were no group differences in reward ratings in the behavioral domains of eating alone, physical activity, health/hygiene, spiritual, educational, sexual, employment, recreation/hobbies, or travel activities.

Table 1: Time duration and reward value of overt behaviors as a function of gender.

3.1. Mediation Analyses

Mediation analyses (e.g., tests of indirect effects) were conducted using a bootstrapping method [74], which has a lower Type II error rate and greater statistical power than the traditionally used causal steps approach advocated by Baron and Kenny [75] (see [74, 76–78]). Bootstrapping techniques were performed in line with recommendations by Preacher and Hayes [74], with re-samples and 95% bias-corrected and accelerated (BCa) confidence intervals (CIs) used to evaluate indirect effects. BCa confidence intervals include corrections for median bias and skew [79]. The use of 95% confidence intervals is equivalent to testing for significance at the 0.05 level. The confidence interval estimates are reflective of the 5000 resamples and the point estimates indicate best estimations of single sample population parameters. Mediation was considered to have occurred if the 95% BCa confidence intervals generated by the bootstrapping method did not contain zero. Mediation analyses were conducted only for those behavioral domains and reward values that were identified as differing as a function of gender. For all mediation analyses, gender was the independent variable and depression severity (BDI-II) was the dependent variable. Consistent with prior studies [30, 31, 70] depression severity was based on the average BDI-II score from both administrations. This strategy was used to obtain a more accurate index of psychological functioning during the one-week assessment period as opposed to using either the time 1 or time 2 administration. As presented in Table 2, daily diary-measured total overall reward significantly mediated the relationship between gender and depression severity. In terms of other diary-based variables identified as differing as a function of gender, time spent in hobbies and recreational activities and reward value of “other” activities also mediated the relationship between gender and depression severity.

Table 2: Indirect effects of gender on depression through duration and reward values of overt behaviors using bootstrapping technique (: 5000 bootstrap samples).

4. Discussion

In the last several decades, substantial research has explored gender differences on a wide range of abilities and behaviors and the potential implications of these differences on a number of outcome variables, including but not limited to academic performance, occupational status, and mental health functioning. The current investigation expanded on these initiatives by utilizing a daily diary monitoring methodology to examine gender differences on thirteen primary life domains that are considered fairly comprehensive insofar as capturing major categories of overt human behaviors [57]. In contrast to past research, behavioral gender differences were identified using a more direct and naturalistic assessment method [80] that extended beyond retrospective behavioral accounts, minimized experimental demand characteristics, and did not rely on experimental manipulations to infer relationships between variables. The study also was novel in the aim of addressing how gender differences in overt behavior might mediate the well-established relation between female gender and increased depression prevalence [1, 9]. Consistent with evolutionary and social learning theories of behavioral gender differences [68], results supported the notion that males and females differ in the duration of time engaged in particular behavioral domains as well as reward experienced in different domains. As predicted, males engaged in more active behaviors for significantly longer time durations, including physical-, sexual-, and recreational-based activities. In contrast, females spent more time engaged in social activities such as spiritual and religious behaviors as well as dining with others. As indicated by increased duration of time in health- and hygiene-based activities, females also generally appeared more concerned with physical appearance. Also consistent with hypotheses, females reported social behaviors (including eating with others) as well as passive and sedentary activities to be more rewarding.

Contrary to the matching theory hypothesis [69], all high-frequency behaviors were not necessarily endorsed as more rewarding. Furthermore, males did not report greater derived reward in any behavioral domain relative to females. One explanation for these findings involves possible gender differences in terms of reactivity to self monitoring [81, 82]. Second, it is conceivable that the perceived level of reward derived from engaging in particular behaviors is less operational for males than females, with the former gender potentially requiring less salient or potent reinforcement schedules to maintain overt behaviors. Third, the findings of this paper support previous research indicating that females are more communal in nature [83]. For example, it was found that women spent more time eating with others and engaging in health/hygiene and spiritual behaviors. While eating with others is clearly a communal activity, it is feasible that health/hygiene and spiritual behaviors serve the function of increasing the likelihood of rewarding communal activities. The finding that females also reported significantly greater reward associated with social activities also supports this assumption.

Interestingly, collapsed across all behavioral domains, females reported increased overall reward associated with overt behaviors as well as participation in a significantly greater breadth of behavioral domains. Intriguingly, and contrary to behavioral theory and research supporting the link between increased environmental reward and reduced depressive affect [24, 26, 30, 70, 84], females also reported increased depression severity on the BDI-II. To address this apparent anomaly, reference to mediational analyses is necessary. Specifically, although gender had a direct effect on depression severity, this effect was attenuated by the mediator (total environmental reward) such that to the extent that females exhibited increased self-reported environmental reward, the gender effect on depression was reduced. In other words, when you control for the significant relation between the mediator (environmental reward) and depression, gender and depression are less related—females are more likely to report elevated depression only when environmental reward also is lower. Thus, increased environmental reward serves to buffer the association between gender and depression such that when environmental reward is a statistical covariate, gender no longer is significantly associated with depression in this sample. This finding is entirely consistent with behavioral models of depression and supports conceptual foundations of behavioral activation treatment interventions designed to increase exposure to environmental reward and response-contingent positive reinforcement [38, 39, 41]. Moreover, these data suggest that at least one plausible mechanism to address gender differences in depression may be through concerted efforts to increase environmental reward and reinforcement in depressed females. Indeed, in a recently conducted randomized controlled trial examining the efficacy of behavioral activation for depressed women with breast cancer, the intervention reduced depression significantly and was associated with strong effect sizes, and treatment gains were maintained through 12-month follow-up [47]. Also noteworthy, the significant mediational effect of hobbies and recreational activities suggests that increasing the frequency of these behaviors may potentially attenuate depressive symptoms. Whether specifically targeting this behavioral domain among females with increased depression severity would be an effective behavioral intervention is an empirical question worthy of investigation. Indeed, it has recently been demonstrated that a behavioral activation protocol focused exclusively on religious behaviors effectively reduced depression [85].

Although study findings are highly provocative, several limitations are noteworthy. First, behavioral contingencies are experienced on a continuous basis. Accordingly, although perhaps an advancement, even the present methodology of monitoring activities in half-hour intervals does not allow measurement of the entire spectrum of overt behaviors and operant relations. Second, functional qualities of behaviors and the frequency of punished behaviors as a function of gender were not explored in the current study [26, 86]. This limitation is significant given the importance of functional relationships and environmental suppressors in conceptualizing the development and persistence of depression [87]. Third, although participants reported compliance with monitoring procedures when queried postexperimentally, we cannot be certain as to whether diaries were completed at reliable and regular intervals. Indeed, this limitation is inherent in a majority of studies that incorporate diary methods. Future studies can increase participant compliance with the use of Internet-based assessment or palm pilots [88]. Fourth, it is possible that unmeasured variables may account for unique variance in behaviors that in the present study were attributable to gender differences. For example, controlling for a masculine versus feminine gender identity (perhaps using the MMPI-2) would help determine the incremental validity of gender as a predictor of frequency and reward value of social behavior. Fifth, reward ratings and their association with negative affect were not assessed as a function of temporal factors. Accordingly, although a behavior may initially be perceived as rewarding, delayed negative consequences might occur that could subsequently affect self-reported reward and negatively impact mood. Longitudinal work is necessary to address this issue. Sixth, attention to private behaviors was not undertaken in this study, and therefore the presence of potential gender differences in covert behaviors cannot be addressed. Finally, some measurement error might have been associated with behavioral coding strategies. As the study required participants to code their activities, and although they received instruction on this process, they did not receive extensive guidance or training, which may have resulted in problems with inter-rater reliability and decreased study power. Related to this limitation, results based on daily self-ratings of environmental reward could have been strengthened (i.e., convergent validity) by including a psychometrically sound self-report measure of this construct such as that used in prior studies [23].

In closing, study findings indicate gender differences in depression severity as well as the frequency and reward value of certain overt behaviors. Most substantially, consistent with behavioral theories of depression, mediation analyses indicated that one potential reason for gender differences may be that level of environmental reward may be more consequential toward eliciting depressive affect in females relative to males. Perhaps the most parsimonious explanation for this finding, albeit in need of replication, is the notion that females may have increased reinforcement sensitivity or reward responsiveness [89–91]—that is, behavioral activation systems more functional in attempting to seek rewards, such as a predilection towards novel experiences, spontaneous behavior, and exciting activities [92, 93]. This finding is highly unique and contributes to the multidimensional perspective of gender differences in depression. As this study was conducted with a nonclinical sample, it is conceivable to predict a magnification of already large effect sizes with a well-diagnosed clinical sample of depressed adults. Replication of study findings would provide additional support and utility for behavioral assessment and activation interventions among depressed individuals, in particular females. Further systematic research in this area will be critical toward continued refinement of behavioral interventions and conceptualizing the role of gender differences as they pertain to emotional health problems such as depression.

This article reviews evidence and findings related to the severe susceptibility of depression in women over men. Many different theories or potential explanations will be offered to better understand this phenomenon. These theories include: biological differences, age prevalence of depression differences, sex/gender- role identity differences, depression rate and recurrence differences, and comorbidity differences. (A brief glossary of terms used in this article appears in Table 1.) Although there are many theories that support why women are more susceptible to depression than men, consider that these are just theories, not facts.

The sex-/gender-role identity difference theory, can best answer why women are more susceptible to depression. In this theory gender, society, and parenting roles will illustrate that there are many gender differences influenced by environment which can lead to depression. Therefore it can be concluded that the susceptibility of depression, is largely affected by environmental roles and must be taken into account for when comparing women and men.

Biological Differences

The degree to which biological factors impinge on the severe susceptibility of depression in women over men is rather trivial; however it still provides a possible explanation for the occurrence. Hormones and heredity factors are taken into account and provide some evidence of truth when comparing depression susceptibility between women and men.

Hormonal regulation largely affects the rate of depression in women. Estrogen depletion, also known as menopausal symptoms, illustrates increased depressive rates and vasomotor instability (hot flashes). When including vasomotor instability rates as a cause of depression, rates of depression increased from 39% to 55% (Formanek & Gurian, 1987). The increase in depression rates can also be attributed to, women feeling less womanly. These thoughts can occur at menopausal stages because women become infertile and feel they have aged and are elderly. In addition it is true that men tend to value attractiveness and youth in their mates much more than do women. "Men prefer youthfulness because it is likely to be associated with higher fertility, reproductive potential, and health" (Ben Hamida, Mineka & Bailey, 1998). Following the rules of evolution after a woman becomes infertile she is less desired by men because the purpose in having intercourse is to produce offspring.

Both the many facts about hormones as well as the mind-set concerning menopause cause uncertainty as to what exactly produces the depression. The indistinctness remains unsolved because it is virtually impossible to perform an experiment of having women separate their feelings of depression from menopausal states. However, "depression may be a precursor rather than a consequence of emotional responses associated with menopause" (Denmark & Paludi, 1993).

To compare hormonal differences between men and women would be unfair. It is certain that women experience many more hormonal changes than do men (due to childbirth, premenstrual syndrome, menstruation, contraceptive drugs, postpartum period, and menopause). However, parallel to women, men do have symptoms similar to menopause, but are rather referred to as a "mid-life" crisis or depression. It is almost impossible to explain why women are more susceptible than men to depression when referring to biological differences. "Such a specific difference cannot be explained easily as a result of biology, particularly among women because rates of depression did not vary by parity" (Nazroo & Edwards, 1998).

Hereditarily speaking genetic transmission may cause women to be more susceptible to depression. In support of genetic transmission as an explanation for the sex differences there is reasonable evidence from twin and family studies that genetic factors are operating in the genesis of depression and affective disorders (Nazroo & Edwards, 1998). Two likely rationales will be given to support the hereditary theory and provide evidence that causes women to be more susceptible to depression.

One possible genetic explanation is x-linkage; that is, the position of the relevant locus on the x chromosome. If the gene for depression is located in the x chromosome and the trait is dominant, females, who have two x chromosomes, will be more often affected than males, who have only one x chromosome (Nazroo & Edwards, 1998). However, we must remember that this is just a hypothesis�a tentative explanation, not a concrete fact.

A second possible genetic explanation involves the phenotype (the observable physical or biochemical characteristics of an organism, as determined by both genetic makeup and environmental influences) of women. This explanation hypothesizes that genetics and environmental influences together may result in the depression of women. An example of this hypothesis would be: If a woman�s parent was depressed, she is more than likely to become depressed herself due to environment and genetic predisposition. Having a family member present who is depressed, becomes a chronic environmental strain, which refers to ongoing "background" stressors that tax one�s coping abilities and resources. The sources of chronic strain are myriad; examples include unstable or unsafe housing (Kimberling & Ouimette, 2002). Phenotypes affects men as well; however its affects are stronger in women. This occurs because women have a higher tendency of awareness of their surroundings and are typically closely interconnected with their family members.

It is evident that phenotypic traits influence the rate of depression. However, as stated previously, the phenotype theory is just a possible explanation for the susceptibility of depression in women. There can not be definite conclusions, based on theoretical hypotheses.

Gender Differences in Adolescent Depressive Symptoms

"Gender differences in depressive symptoms appear to emerge in early adolescence and then remains throughout the adult life span" (Nolen-Hoeksema, Larson, & Grayson, 1999). Consistent findings indicate that adolescent girls develop depressive symptoms at an earlier age than do adolescent boys. Emerging gender differences can be caused by individual vulnerability, life stress, and pubertal transitional challenge. Although girls and boys go through puberty at the relatively same age, it has been suggested that girls are more vulnerable to depression than boys even before adolescence (Ge & Conger, 2003). This hypothesis will be further examined through the careful analysis of research and experimentation.

The experiment had many hypotheses that were evaluated. The following hypotheses guided the analysis (Ge & Conger, 2003, pp. 4-5):

  • Girls will demonstrate higher average levels of depressive symptoms than adolescent boys will during adolescence.
  • The higher average level of depressive symptoms among girls, compared with boys, will become evident during early adolescence.
  • Boys and girls with advanced pubertal status during early adolescence will manifest higher levels of depressive symptoms.
  • Boys and girls with higher levels of depressive symptoms in early adolescence will show higher levels of depressive symptoms in mid- and late adolescence.
  • Early depressive symptoms, the pubertal transition, and stressful life events will have interactive as well as additive main effects on risk for depressive symptoms.
  • The interactive and additive effects of early depressive symptoms, the pubertal transition, and stressful life events will explain a significant portion of the association between gender and depressive symptoms.
The choice of method was a 6-year longitudinal study of 451 families that lived in central Iowa. Interviewers visited each family at their homes for approximately 2 hours on each of two occasions. During the first visit, each of the family members was asked to independently complete a set of questionnaires focusing upon individual characteristics, emotions and life events experienced by family members. These independently reported emotions and events were used to come up with the conclusion (Ge & Conger, 2003).

The results found that early depressive symptoms carry forward to mid- and late adolescence and that the interaction between gender-linked vulnerabilities (diathesis) and the new biological and social challenges of early adolescence (stress) creates greater risk for depression for adolescent girls than boys (Ge & Conger, 2003). Studies have also found higher levels of depressive symptoms in girls than in boys as young as 12 years of age and have consistently found gender differences from then on out (Nolen-Hoeksema & Girgus, 1994). However, although this conclusion was found from the experiment, this has never been reported in earlier studies of adolescent depression.

Yet again, it is difficult to determine why women are more susceptible to depression. The experiment provides conclusions and theories that have never been proven prior. It is clear that girls are more susceptible to depression even in adolescence, but there is no concrete evidence to prove why. However, depressives (girls and boys) were found to come from families in which there was marked striving for prestige with the patient as the instrument of this need; the family showed marked concern for social achievement and the childhood background was characterized by envy and competitiveness (Weissman & Paykel, 1974).

Gender Stereotypes and Identity Roles

"The subtle influence of sex upon a person�s perceptions may vary with each observer and play both an unconscious and conscious role in influencing actions taken."
--Gesell, 1990
Recent evidence suggests that the higher prevalence of clinical and subclinical depression among females results because one subtype of depression, which is rooted in limitations placed upon women (Silberstein & Lynch, 1998). These limitations have been taken a long way, causing the likelihood of depression in women. Gender roles will be closely examined, and will provide examples of the limitations placed upon women. (Some explanations of why women become more depressed then men are illustrated in Table 2 and focus on status and gender identity.)

Many stereotypes that have been placed upon women help in the gender-related limitations. The stereotypes concerning women are endless. A catalog of different stereotypes between women and men is revealed in Table 3.

"Although women are usually socialized to be emotionally expressive, nurturing, and to direct their achievement through affiliation with others, men are usually socialized to be emotionally inhibited, assertive, and independent" (Kimberling & Ouimette, 2002). Through the analysis of these stereotypes, the belief that women are viewed as inferior to men is not far fetched. Women are conflicted to live up to these stereotypical roles and expectations of perfection everyday, no matter how many roles they take on in their everyday life.

A woman�s role as a wife, worker, mother, and caretaker contribute to the levels of everyday stress. The qualities of each of these roles are looked at differently through the eyes of women and men. In reference to marriage, it typically has value and merit if two partners love each other. However, the quality of marriage is more strongly related to home life satisfaction for women compared to men (Denmark & Paludi, 1993). This difference may be attributed to gender differences in the psychological purpose of marriage. Males may have more instrumental gains from marriage (e.g., in the form of services, such as housekeeping). Females, who have fewer alternatives, may invest more emotionally in their marital roles (Denmark & Paludi, 1993). From this it can clearly be stated that these differences may result in tension between two partners. And thus may result in depressive feelings for women that may leave them feeling as if they were servants to their husbands, not companions. Women reported higher rates of their partners as less caring and as more likely to be a depressogenic stressor (Wilhelm & Roy, 2002).

An additional role that women partake in that is parallel to marital roles is parental roles. These roles are very closely related, because marriage may be the main basis to raise children. Because women have been labeled in the past as child caretakers, this stereotype has been hard to break. There are very few families in our society that have males as the primary caretaker of their children. Women even if employed, spend about 70 hours a week with their children. On the opposite spectrum, fathers� involvement with children average about 30 hours a week and do not significantly vary with wives� employment (Denmark & Paludi, 1993). The average level of role strain for mothers who have careers was not greatly affected. However, women who are employed feel dissatisfaction with the amount of time they are allotted for their children and spouse. However, because of stereotypes and misconceptions women tend not to complain about their gender roles. Ratings by fathers revealed that the more time the mother spent, relative to him, in child care tasks, the greater his satisfaction with her work schedule and her overall time allocation (Denmark & Paludi, 1993). Similarly to that statement, men�s perceptions over sharing tasks appeared to depend only on how satisfied they were with the division of tasks. Thus, many men appear to be happy when they are not sharing in domestic tasks, and the fact that they know their wives are not happy about it does not lower their marital satisfaction (Denmark & Paludi, 1993).

Through the analysis of these two gender roles, it is evident that women are dissatisfied with their gender responsibilities. Women are faced with the problem of how to make their lives meaningful. With decreasing family size, increasing longevity, and increased self-expectation, the time over which the married woman undertakes other roles in addition to being a mother is becoming longer (Weissman & Paykel, 1974).

Correspondingly with gender roles; come gender identities. The gender stereotypes can be said to affect gender identities the most severely. Stereotypes that women should be beautiful and refined are ones that influence the American culture to such a great extent. Some researchers have suggested that information about physical appearance, and in particular physical attractiveness, might be more crucial to impression of women than of men (Denmark & Paludi, 1993). Girls show less satisfaction with their physical appearance than do boys, starting in third grade (Hankin & Abramson, 2001). In modern times the idea that "thin is beautiful" has become the socially accepted norm. The media publicizes what is beautiful; and more often than not women don�t seem to equate to these looks. Thus, these contributing factors if taken to the extreme can result in dangerous feelings and habits, such as depression and eating disorders. When in reference to women, these two disorders are extremely comorbid with each other. Eating disorders will be evaluated further in the section of comorbidity.


As stated in Table 1, comorbidity is the presence of coexisting or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. "Depressive disorders show substantial comorbidity with other psychiatric disorder, especially anxiety, externalizing, and eating disorders" (Hankin & Abramson, 2001). The disorders that largely affect women include: eating disorders and anxiety.

Eating disorders result in mental and physical health problems. Two of the most widespread eating disorders are anorexia and bulimia. Symptoms of these eating disorders are: obsession with weight, frequent and long trips to the bathroom (often with running water), food rituals (shifting food around, cutting food into tiny pieces, or keeping utensils from touching lips, hiding food), hair loss, and pale or "gray" skin. "These symptoms can be linked with women, since more women have been diagnosed with lifetime histories of eating disorder than men" (Hankin & Abramson, 2001).

A 4-year longitudinal study of community adolescent girls found the peak risk for the onset of binge eating to occur at 16 and the peak onset for purging to occur at age 18 (Hankin & Abramson, 2001). These eating disorders seem to be age appropriate, because at these times girls are very aware of their appearances. The awareness or sensitivity may be caused between the ages of 16 and 18, because it is a prime time to prepare for physical relationships with the opposite sex. Girls fear rejection so much that they are willing to put the needs, interests, and desire of others above their own (Smolak & Fairman, 2002). Women most obviously want to be desired by the opposite sex and in result go to great lengths to appear attractive. The extent to which women are concerned with their appearances may become quiet frightening and create severe depressive cognitions.

The depressive thoughts of being unattractive may eventually lead to obsessive thoughts of being beautiful, resulting in compulsions such as working out and dieting. One theory is that depression, eating disorders and obsessive compulsive disorders (anxiety disorder) are all interconnected. There is certain proof that OCD (obsessive compulsive disorder) is comorbid with depression, but well known documented studies have not been completed to show the affects of this comorbidity on women.

Anxiety disorders, such as generalized anxiety disorder (GAD), social phobia, panic disorder, obsessive-compulsive disorder (OCD), and specific phobia, have been largely and functionally linked to depressive thoughts that affect women and adolescent girls. Though research in this area is limited the comorbidity between anxiety disorders and depression will help provide a solution as to why it is that women are more susceptible to depression over men. In this section of comorbidity, the focus will be directed to social phobia consequently due to the large affects on women.

"Statistics prove that girls develop anxiety disorders earlier and at a faster rate than boys, such that by age 6, twice as many girls have experienced an anxiety disorder" (Hankin & Abramson, 2001). A potential reason for the susceptibility of depression in girls and women is that they are at a much higher risk for the potential to be raped or sexually assaulted in our society. It is common for victims of interpersonal traumas, such as rape and domestic violence to experience shame about their environment in the traumatic experience and to be rejected or blamed by others. Rejection and blame from others will occur because people believe that women subject themselves to situations that can lead to no good. Shame and interpersonal rejection have also been theoretically linked to the development of social phobia, raising the possibility of shared etiology for the two disorders (Kimberling & Ouimette, 2002).

Social phobia comorbid with depression is likely to be one of the most difficult disorders to treat. Depressed men and women comorbid with social phobia may pose distinct treatment challenges because they may be less likely to accept referral into a therapy group given their fear of being exposed to the scrutiny of others and speaking in front of a group (Kimberling & Ouimette, 2002).

The cumulative burden of multiple diagnoses (comorbidity) may be that it has been strongly associated with decreased well-being, compromised health and quality of life, and poor psychosocial adjustment (Kimberling & Ouimette, 2002). These obstacles are just additives to all the gender stereotypes and identity roles that women already deal with.

Although women are diagnose with comorbidity of anxiety disorders and depression twice as often as men, the rates and pattern of comorbid disorders seem quite similar across the genders (Kimberling & Ouimette, 2002). Nevertheless, it is a reminder that the comorbidity theory is just a possible reason behind why women are more susceptible to depression.

Recurrence Rates

Recurrence is a new occurrence of a disorder after a period of remission of symptoms lasting for over a period of 2 months. Recurrence may be easily detected in some cases. Evident characteristics include: attempted suicide (para-suicide), family troubles, and social inabilities.

The recurrence hypothesis states that equal proportions of males and females will experience at least one episode of depression (the first episode), but that more females than males will go on to have greater than one lifetime episode (Hankin & Abramson, 1998). This hypothesis is later proven to be incorrect by substantial data gathered. 74% of males had only one lifetime depressive episode compared to 74% of females, whereas 26% of males had greater than one depressive episode compared to 26% of females (Hankin & Abramson, 1998). However this study is only a small sample of a population, so therefore this information should not be interpreted as a population recurrence rate.

Though the hypothesis that women have higher recurrence rates then men has been found to be incorrect--it is still fact that recurrence increases depressive cognitions. Thus resulting in a probable cause of susceptibility.

Summary of Women's Susceptibility

The noting of widespread gender differences in rates of depression now dates back two decades, with women consistently reported as having a twofold lifetime prevalence of depression, and a greater likelihood of seeking help for depression than men (Wilhelm & Roy, 2002). Though this is true, it is still not clearly evident as to why women are more susceptible to depression than men. In the course of this review article, there are many possibilities given to solve this indefinite difference. The possibilities of biological differences, age prevalence, gender stereotypes and identity roles, comorbidity, and recurrence rates, were all given. However none provided concrete evidence to solve such a phenomenon. From the evidence given, I can only conclude that the susceptibility of depression in women is so high, because of environmental factors. The environmental factors include the gender stereotypes and identity roles. The experiences women go through in life are much different than the experiences that men do. Therefore, the life events for women and men vary across the board; there is no way to possibly detect what exactly causes the large difference in susceptibility of depression.


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