The impact of socioeconomic position (SEP) on women's health over the lifetime

Paediatric melioidosis

Melioidosis is a tropical infectious disease caused by the saprophytic gram-negative bacterium Burkholderia pseudomallei. Despite the infection being endemic in southeast Asia and northern Australia, the broad clinical presentations and diagnostic difficulties limit its early detection, particularly in children. Melioidosis more commonly affects the immunocompromised and adults. Melioidosis is increasingly being diagnosed around the world and whole-genome sequencing indicates that these cases are not linked with travel to endemic areas. Research has concentrated on the adult population with limited experience reported in the care of this uncommon, but potentially fatal condition in children presenting with bacteraemia and pneumonia.

Educational status and the risk of adverse outcomes in Asian patients with atrial fibrillation: a report from the prospective APHRS-AF Registry

BACKGROUND

The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF).

METHODS

We used data from the prospective APHRS-AF Registry. ES was classified as follows: low (primary school), medium (secondary), and high (University). The primary outcome was a composite of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Secondary outcomes were each component of the primary outcome, cardiovascular death, and major bleeding. The one-year risk of primary and secondary outcomes was assessed through Cox-regressions. Adherence to the Atrial fibrillation Better Care (ABC) pathway was assessed.

RESULTS

Among 2697 AF patients (69±12 years, 34.8% females), 34.6% had low ES; 37.3% had medium ES; and 28.1% had high ES. Compared to patients with medium-high ES, patients with low ES were older, more often females, with a higher prevalence of cardiovascular risk factors, and a lower ABC pathway adherence (30.4% vs. 40.2%, P<0.001). On multivariable analysis, low ES was associated with a higher risk for the primary outcome (HR 1.52,95%CI 1.11-2.06) and all-cause death (HR 1.76,95%CI 1.10-2.83) than medium-high ES. A significant interaction was found for the risk of composite outcome among the different age strata, with the higher risk in the elderly (P for int=0.008), whereas the beneficial effect of the ABC pathway was irrespective of ES (P for int=0.691).

CONCLUSIONS

In Asian AF patients, low ES is associated with high mortality. Efforts to improve education and include ES evaluation in the integrated care approach for AF are necessary to reduce the cardiovascular burden in these patients.

Factors associated with pregnancy termination in six sub-Saharan African countries

Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15-29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value < 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15-29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20-24 as compared to women aged 15-19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20-24 & 25-29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.

Young adults from disadvantaged groups experience more stress and deterioration in mental health associated with polycrisis

The recent polycrisis (COVID-19, Ukraine war, climate change, economic crisis) has been associated with mental health through cumulative stress, with young people being particularly vulnerable. We surveyed 403 college students from Poland to examine their psychological responses to the experienced crises. The results showed that polycrisis was associated with worse mental health of college students from disadvantaged groups (based on gender, sexual orientation, and financial situation) compared to other college students, in four areas: sense of proximity to the crises, stress caused by the crises, sense of responsibility for mitigating the crises, and experiencing everyday moral dilemmas regarding the crises. These young adults also suffered more in terms of negative affectivity, depressive symptoms, and subjective physical and mental health. Our findings suggest that when discussing public mental health perspectives, it is important to consider consequences of cumulative stress and its greater impact on young people from disadvantaged groups.

Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis

BACKGROUND

The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives.

METHODS

Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia.

RESULTS

We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation.

CONCLUSION

The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.

Differential effects of western versus mediterranean diets and psychosocial stress on ovarian function in female monkeys (Macaca fascicularis)

Ovarian dysfunction increases risk for chronic diseases of aging including cardiovascular disease, depression, cognitive impairment, as well as bone and muscle loss which promote frailty. Psychosocial stress can disrupt ovarian function, and recent observations suggest that consumption of a Western Diet may also. Determination of causal relationships among diet, psychosocial stress, and ovarian physiology is difficult in humans. Long-tailed (a.k.a. cynomolgus) macaques (Macaca fascicularis) are an excellent translational model for the study of diet and psychosocial effects on ovarian physiology and aging-related processes. They have 28-day menstrual cycles with hormonal fluctuations like those of women, and similar physiologic responses to alterations and/or cessation of cyclicity. We examined ovarian function in 38 middle-aged socially housed females fed either a Western or Mediterranean diet for 31 months (≈ a 9-year period for humans). During the last year, we examined cycle length and peak progesterone per cycle using blood sampling (3/week) and vaginal swabbing for menses (6/week). Repeated measures analysis revealed a circannual pattern consistent with increased menstrual cycle disturbance during the late Summer and early Fall (F(11,348)= 4.05 p < 0.001). In addition, both Western diet (F(1,34)= 3.99; p = 0.05) and the stress of low social status (F(1,34)= 3.99; p = 0.04) reduced mean progesterone levels. Thus, on average, subordinates in the Western group had the lowest average progesterone levels (10.02 ng/pl). Compared to Western diets, Mediterranean diets exhibited protective effects via menstrual cycle regularity. For dominant monkeys, consuming Mediterranean diets resulted in significantly greater likelihood of having regular menstrual cycles. Mediterranean diets also protected individuals from shorter than normal menstrual cycles. The relationships between diet and menstrual regularity were partially mediated by both adrenal reactivity and social isolation. This study demonstrates the additive negative effects of poor diet and psychosocial stress on ovarian physiology in mid-life and lays the groundwork for future investigations to uncover their impact on metabolic signatures of accelerated aging. The results also suggest that - compared to Western-style diets - a Mediterranean diet may exert a protective influence against ovarian dysfunction and its pathologic sequelae.

Adolescents' self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study

BACKGROUND

We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland.

METHODS

Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours.

RESULTS

Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors.

CONCLUSIONS

Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.

Adherence to the Mediterranean Diet in Women and Reproductive Health across the Lifespan: A Narrative Review

The Mediterranean diet (MD) has been previously proven to have various health-related benefits; however, its effect on women's reproductive health over a lifespan is yet to be summarized. This study aimed to summarize the evidence-based knowledge regarding the association between the MD and selected reproductive health outcomes. By searching PubMed, ScienceDirect, and Google Scholar databases, as well as reference lists, 21 studies were included in this narrative review. The available evidence was very limited; however, there is some suggestion that higher adherence to the MD may be positively associated with a lower risk of early age menarche (1 study) and shorter menstrual cycles (1 study), but is unrelated to dysmenorrhea (1 study). Moreover, no study to date has examined the relationship between the MD and the onset age of natural menopause. Considering reproductive health diseases, there was limited evidence that a higher adherence to the MD was associated with a lower risk of premenstrual syndrome (1 study), an improvement in sexual health and a lower prevalence of sexual dysfunction (3 studies), and an improvement in the general condition of with endometriosis and the pain they can experience (1 study). The largest number of studies were found for polycystic ovarian syndrome (PCOS; 7 studies) and infertility (6 studies). Results showed that a higher adherence to the MD was associated with a lower risk of infertility, while results for PCOS were unclear, but mostly indicated a beneficial trend. Further investigations are necessary to establish the role of adherence to the MD in reproductive health maintenance and its possible role in the prevention and treatment of reproductive health diseases in women.

Females present higher dose-adjusted drug concentrations of metoprolol and allopurinol/oxypurinol than males

Females present a higher risk of adverse drug reactions. Sex-related differences in drug concentrations may contribute to these observations but they remain understudied given the underrepresentation of females in clinical trials. The aim of this study was to investigate whether anthropometric and socioeconomic factors and comorbidities could explain sex-related differences in concentrations and dosing for metoprolol and oxypurinol, the active metabolite of allopurinol. We conducted an analysis of two cross-sectional studies. Participants were self-described "White" adults taking metoprolol or allopurinol selected from the Montreal Heart Institute Hospital Cohort. A total of 1007 participants were included in the metoprolol subpopulation and 459 participants in the allopurinol subpopulation; 73% and 86% of the participants from the metoprolol and allopurinol subpopulations were males, respectively. Females presented higher age- and dose-adjusted concentrations of both metoprolol and oxypurinol (both p < 0.03). Accordingly, females presented higher unadjusted and age-adjusted concentration:dose ratio of both metoprolol and allopurinol/oxypurinol compared to males (all p < 3.0 × 10^-4 ). Sex remained an independent predictor of metoprolol concentrations (p < 0.01), but not of oxypurinol concentrations, after adjusting for other predictors. In addition to sex, age, daily dose, use of moderate to strong CYP2D6 inhibitors, weight, and CYP2D6 genotype-inferred phenotype were associated with concentrations of metoprolol (all p < 0.01). Daily dose, weight, estimated glomerular filtration rate (eGFR), and employment status were associated with oxypurinol concentrations (all p < 0.01). Females present higher dose-adjusted concentrations of metoprolol and oxypurinol than males. This suggests the need for sex-specific dosing requirements for these drugs, although this hypothesis should be validated in prospective studies.

Association Between Social Determinants of Health and Glycemic Control Among African American People with Type 2 diabetes: The Jackson Heart Study

BACKGROUND

Social determinants of health have a significant impact on health outcomes. However, the complexity and interaction of multiple factors influencing glycemic control remain understudied.

PURPOSE

This study examined associations of socioeconomic position (income, education, and occupation), environmental (physical activity facilities, neighborhood social cohesion, neighborhood problem, and violence), behavioral (physical activity, nutrition, and smoking), and psychological factors (depressive symptoms, stress, and discrimination) with glycemic control (hemoglobin A1c [A1c]) using the World Health Organization Social Determinants of Health framework in African American adults with type 2 diabetes.

METHODS

A secondary data analysis was conducted using a longitudinal cohort of 1,240 African American adults with type 2 diabetes who participated in the community-based Jackson Heart Study. Socioeconomic position, environmental, behavioral, and psychological factors were measured using validated instruments in the Jackson Heart Study. Longitudinal structural equation modeling was used with glycemic control (A1c) collected over time (Exams 1-3) as the study outcome.

RESULTS

Our study presents the complex interplay of socioeconomic determinants of health and glycemic control over time. Higher socioeconomic position (higher income, higher level of education, and professional occupation) was directly associated with improvement in glycemic control over time. An association of socioeconomic position on glycemic control mediated through health behavior factors was also observed.

CONCLUSIONS

In this analysis, socioeconomic position components were determinants of glycemic control in African American adults with type 2 diabetes. Future studies aimed at reducing health disparities and achieving equality of outcomes in this population will benefit from embedding socioeconomic position components into their design.

Meta-analysis of donor-recipient gender profile in paediatric living donor liver transplantation

OBJECTIVE

Paediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse. We evaluated LDLT donor-recipient gender profiles, comparing country income categories and gender disparity level.

DESIGN

We performed a systematic review, searching PubMed, Embase and Cochrane databases for publications dated January 2006-September 2021. We included full-text English articles reporting gender in ≥40 universally sampled donor-recipient pairs. Search terms were permutations of 'liver transplant', 'living donor' and 'paediatric'. Countries were grouped as high/middle/low-income economies based on World Bank criteria and into groups based on deviation from gender parity in Gender Development Index (GDI) values (group 1 indicating closest to gender parity, group 5 indicating furthest). Proportions analysis with corresponding 95% CI were used for analysis of dichotomous variables, with significance when 95% CI did not cross 0.5. Data are reported as female proportion (%) and 95% CI.

RESULTS

Of 12 525 studies identified, 14 retrospective studies (12 countries; 6152 recipients and 6138 donors) fulfilled study inclusion criteria. Male recipient preponderance was seen in lower middle-income countries (all were also GDI group 5) (39.3 (95% CI 34.7 to 44.0)) and female recipient preponderance in GDI groups 1 and 3. Female donor preponderance was seen overall (57.4% (95% CI 55.1 to 59.6)), in middle income countries and in three of four GDI groups represented.

CONCLUSION

There are significant imbalances in recipient-donor gender profiles in paediatric LDLT that are not well explained. The reasons for overall female donor preponderance across income tiers must be scrutinised.

Detection of Breast Cancer Lump and BRCA1/2 Genetic Mutation under Deep Learning

To diagnose and cure breast cancer early, thus reducing the mortality of patients with breast cancer, a method was provided to judge threshold of image segmentation by wavelet transform (WT). It was used to obtain information about the general area of breast lumps by making a rough segmentation of the suspected area of the lump on mammogram. The boundary signal of the lump was obtained by region growth calculation or contour model of local activity. Meanwhile, multiplex polymerase chain reaction (mPCR) and mPCR-next-generation sequencing (mPCR-NGS) were used to detect BRCA1/2 genome. Sanger test was used for newly high virulent mutations to verify the correctness of mutagenic sites. The results were compared with the information marked by experts in the database. According to Daubechies wavelet coefficients, the average measurement accuracy was 92.9% and the average false positive rate of each image was 86%. According to mPCR-NGS, there was no pathogenic mutation in the 7 patients with high-risk BRCA1/2 genetic mutations. Single nucleotide polymorphism (SNP) in nonsynonymous coding region was detected, which was consistent with the Sanger test results. This method effectively isolated the lump area of human mammogram, and mPCR-NGS had high specificity and sensitivity in detecting BRCA1/2 genetic mutation sites. Compared with traditional Sanger test and target sequence capture test, it also had such advantages as easy operation, short duration, and low cost of consumables, which was worthy of further promotion and adoption.

Influencia del gradiente social sobre la salud bucal de mujeres trabajadoras formales

Introducción. Las patologías bucales se asocian con las condiciones sociales, materiales y el nivel socioeconómico desfavorables. La salud bucal de las mujeres se ve afectada por aspectos sociales, que marcan inequidades en salud, si se compara con los hombres Objetivo. Evaluar la influencia del gradiente social sobre la salud bucal de mujeres trabajadoras de una universidad de Santander, Colombia. Materiales y métodos. Estudio observacional analítico de corte transversal que involucró a 84 mujeres trabajadoras. Se utilizaron variables sociodemográficas, de condición de salud bucal (presencia de caries dental, enfermedad periodontal y edentulismo) y posición social. Se estableció una relación entre estas. Para ello, se aplicaron las pruebas Chi cuadrado o Exacto de Fisher, t de Student o test de rangos de Wilcoxon, con una significancia α≤0,05. Resultados. Se evidenció una prevalencia de caries dental de un 85,7%, enfermedad periodontal de un 79,8%, y prevalencia de edentulismo de un 40,5%; los factores sociales que se presentaron con mayor frecuencia mostrando alguna relación con las condiciones bucales fueron edad, etnia, estado civil, nivel educativo, la labor que realiza diariamente, estrato socioeconómico, la responsabilidad económica dentro del hogar. Conclusión. El gradiente social no registró diferencias estadísticamente significativas al analizarlo con las patologías orales; sin embargo, se estableció que las mujeres que se ubicaron en la posición social alta tenían menos carga de enfermedades bucales; mientras que las mujeres que se encontraban en la posición social baja tenían mayor prevalencia de caries dental, enfermedad periodontal y edentulismo. Como citar este artículo: Almario-Barrera AJ, Concha-Sánchez SC. Influencia del gradiente social sobre la salud bucal de mujeres trabajadoras formales. Revista Cuidarte. 2022;13(3):e2334. http://dx.doi.org/10.15649/cuidarte.2334   

Comorbid depression and obesity among adults in Germany: Effects of age, sex, and socioeconomic status

BACKGROUND

Depression and obesity are common health problems with major public health implications. These conditions frequently co-occur, adversely affecting the course of the other. The sociodemographic and socioeconomic risk factors for comorbid depression and obesity in the German adult population have not yet been reported.

METHODS

We analyzed the prevalence and sociodemographic and socioeconomic correlates of comorbid depression and obesity using cross-sectional data from the national German health interview and examination survey for adults (DEGS1; n = 7987) and its mental health module (DEGS1-MH; n = 4493). The Composite International Diagnostic Interview was used to diagnose major depressive disorder (CIDI-MDD). Sensitivity was analyzed using the self-reported depression measure and current depressive symptoms measured by Patient Health Questionnaire-9 (PHQ-9). Obesity was defined by body mass index calculated from measured data.

RESULTS

Prevalence of comorbid depression and obesity was 1.3% (95% CI 0.8-2.0) in men and 2.0% (95% CI 1.3-3.0) in women. We found significant sex differences in results from the self-reported depression measure and the PHQ-9, but not from the CIDI-MDD. Low socioeconomic status and poor social support were linked to a higher prevalence of comorbid depression and obesity among women.

LIMITATIONS

Severe depression may have been underreported.

CONCLUSIONS

Depression is statistically more prevalent in women than in men, which accounts for many of the sex differences in the prevalence of comorbid depression and obesity in our models. Targeted public health strategies need to be developed to prevent and treat comorbid depression and obesity in women with a low socioeconomic position.

Socioeconomic position is associated with N-terminal pro-brain natriuretic peptide (NT-proBNP)-Results of the population-based Heinz Nixdorf Recall study

OBJECTIVES

N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) is a diagnostic marker for heart failure and a prognostic factor for cardiovascular disease (CVD). The aim of this study was to examine the association of socioeconomic position (SEP) with NT-proBNP while assessing sex-differences and the impact of CVD risk factors and prevalent CVD on the association.

METHODS

Baseline data of 4598 participants aged 45-75 years of the Heinz Nixdorf Recall Study were used. Income and education were used as SEP indicators. Age- and sex-adjusted linear regression models were fitted to calculate effect size estimates and 95% confidence intervals (95%-CIs) for the total effect of SEP indicators on NT-proBNP, while potential mediation was assessed by additionally accounting for traditional CVD risk factors (i.e., systolic blood pressure, HDL cholesterol, LDL cholesterol, diabetes, anti-hypertensive medication, lipid-lowering medication, BMI, current smoking). Education and income were included separately in the models.

RESULTS

With an age- and sex-adjusted average change in NT-proBNP of -6.47% (95%-CI: -9.91; -2.91) per 1000€, the association between income and NT-proBNP was more pronounced compared to using education as a SEP indicator (-0.80% [95%-CI: -1.92; 0.32] per year of education). Sex-stratified results indicated stronger associations in men (-8.43% [95%-CI: -13.21; -3.38] per 1000€; -1.63% [95%-CI: -3.23; -0.001] per year of education) compared to women (-5.10% [95%-CI: -9.82; -0.01] per 1000€; -1.04% [95%-CI: -2.59; 0.50] per year of education). After adjusting for CVD risk factors some of the observed effect size estimates were attenuated, while the overall association between SEP indicators and NT-proBNP was still indicated. The exclusion of participants with prevalent coronary heart disease or stroke did not lead to a substantial change in the observed associations.

CONCLUSIONS

In the present study associations of education and income with NT-proBNP were observed in a population-based study sample. Only parts of the association were explained by traditional CVD risk factors, while there were substantial sex-differences in the strength of the observed association. Overt coronary heart disease or stroke did not seem to trigger the associations.

Similarities and Differences of Mental Health in Women and Men: A Systematic Review of Findings in Three Large German Cohorts

In Germany, large, population-based cohort studies have been implemented in order to identify risk and protective factors for maintaining health across the life span. The purpose of this systematic review is to analyse findings from three large ongoing cohorts and to identify sex-specific prevalence rates, risk and protective factors for mental health. Published studies from the Cooperative Health Research in the Region Augsburg (KORA), the Study of Health in Pomerania (SHIP) and the Gutenberg Health Study (GHS)), representing the southern, north-eastern and middle parts of Germany, were identified through searches of the databases PubMed and Web of Science. A total of 52 articles was identified from the start of each cohort until June 2019. Articles reporting prevalence rates of mental health [N = 22], explanatory factors for mental health [N = 25], or both [N = 5] were identified. Consistent across cohorts, higher prevalence rates of internalizing disorders were found for women and more externalizing disorders for men. Risk and protective factors for mental health included social factors, lifestyle, physical health, body mass index (BMI), diabetes, genetic and biological factors. In all areas, differences and similarities were found between women and men. The most evident were the sex-specific risk profiles for depression with mostly external risk factors for men and internal risk factors for women. Gender was not assessed directly, therefore we examined whether socioeconomic and family-related factors reflecting gender roles or institutionalized gender could be used as a proxy for gender. Overall, this systematic review shows differences and similarities in prevalence rates and determinants of mental health indicators between women and men. They underline the importance of focussing on sex specific approaches in mental health research and in the development of prevention measures. Current research on mental health still lacks focus on gender aspects. Therefore, an increased focus on sex and gender in mental health research is of great importance.