Gender differences in depression risk and coping factors in a clinical sample

Relationship between perceived occupational stress and psychological well-being among secondary school heads in Khyber Pakhtunkhwa, Pakistan

The purpose of the study was to examine the relationship between perceived occupational stress and psychological well-being among secondary school heads in Khyber Pakhtunkhwa. A sample of 402 secondary school heads (male n = 260, female n = 142) was selected through multistage sampling technique. A descriptive, quantitative and correlative research design was used. For gathering information from the participants, two standardized tools i.e., "Occupational Stress Index (OSI)" and "Ryff's Psychological Wellbeing Scale (RPWB)" were used for measuring perceived occupational stress and psychological well-being respectively. For statistical analysis, mean, standard deviation, Pearson's product-moment correlation and multiple regression were employed. The findings revealed that there is a strong negative correlation between perceived occupational stress and psychological well-being. Furthermore, moderate negative correlation was found between all the sub-scales of perceived occupational stress and psychological well-being. All the subscales of occupational stress except low status were found significant predictors and have negative effect on psychological well-being of secondary school heads. So, it was suggested that Elementary & Secondary Education Department Khyber Pakhtunkhwa should have a collaboration with policy makers to formulate a comprehensive strategy for stress reduction management for secondary school heads so that they may develop good psychological well-being and perform their duties effectively.

Gender differences in psychiatric diagnoses in older people with intellectual disability: a register study

BACKGROUND

Gender differences regarding psychiatric ill-health are well known in the general population. However, not much research is done on people with intellectual disability, and especially not among older people with intellectual disability.

METHODS

People with intellectual disability aged 55+ years in 2012 in Sweden were identified through a register containing information on those receiving support and service for this type of disability. The cohort comprised 3609 women and 4327 men with mean age 65 and 64 years, respectively. Information on psychiatric diagnoses was collected from the National Patient Register for the period 2002-2012. Potential gender differences were evaluated both for diagnostic categories (e.g. affective disorders) and single diagnoses (e.g. depressive episodes).

RESULTS

The most common diagnoses among women were in the diagnostic category affective disorders, and among men in psychotic disorders. The majority of both women (72%) and men (71%) had diagnoses in only one diagnostic category. Women were more likely than men to have at least one diagnosis of dementia (odds ratio 1.40, 95% confidence interval 1.06-1.83) or affective disorders (1.33, 1.21-1.58) during the study period. They were, however, less likely to have at least one diagnosis of alcohol/substance use related disorder (0.59, 0.43-0.80). No gender differences were found for diagnoses of psychotic (1.04, 0.86-1.27) or anxiety disorders (1.15, 0.94-1.40). Regarding single diagnoses, women were more likely than men to have had at least one diagnosis of unspecified nonorganic psychosis (1.75, 1.23-2.50), depressive episode (1.47, 1.19-1.82), recurrent depressive disorder (1.53, 1.06-2.22), other anxiety disorder (1.34, 1.06-1.69), or dementia in Alzheimer disease (2.50, 1.40-4.49), but less likely to be diagnosed with psychiatric and behavioral disorders due to use of alcohol (0.41, 0.27-0.61).

CONCLUSIONS

As in the general population, there seem to be gender differences with respect to several types of psychiatric diagnoses among older people with intellectual disability. More research is needed to establish if this is due to gender differences in the occurrence of disease, inclination to seek care, health care utilization patterns, or ability to correctly identify disorders.

Depression and intimate partner violence among college students in Iran

Intimate partner violence (IPV) is a significant public health threat and causes mental as well as physical health problems. Depression is a common mental health consequence of IPV. While Iran has a high prevalence of IPV and depression, the association between IPV and depression has not been well examined. The Iranian data from the International Dating Violence Study (IDVS) 2001-2006 (ICPSR 29583) were analyzed. Twenty-three male and 75 female college students were selected in the IDVS Iranian data. Nearly all of the participants, male and female, reported being victims and perpetrators of IPV. Female participants were more likely to report depression compared to male participants. Participants who had experienced sexual IPV reported significantly higher levels of depression compared to those who did not experience sexual IPV. However, when substance abuse and partner conflict were analyzed, the contribution of sexual IPV on depression was no longer significant. This study suggests that IPV prevention and intervention programs should take into consideration that college-aged men and women frequently experience and use violence in dating relationships. Depression interventions should be included for female students. Substance abuse and partner conflict are important risk factors for depression.

Chronic Stress and Suicidal Thinking Among Medical Students

Introduction: The subject of chronic stress and ways of dealing with it are very broad. The aim of this study was to analyze stress and anxiety and their influence on suicidal thinking among medical students. Materials and Methods: The study was conducted in the years 2014 to 2015 in Poland, at the Medical University—Nicolaus Copernicus University, Collegium Medicum. The objective of this study was to assess chronic stress and suicidal thinking among students and how students cope with this huge problem. Descriptive statistics and chi-square analyses were conducted to detect differences. Results: Analyses showed that students’ life is full of stressors. Students toward the end of their education cope better with stress than students starting their university studies. Chronic stress has a strong impact on mental health and suicidal thinking among students. Conclusions: The results of the study confirmed that chronic stress and anxiety have a negative influence on mental health and also confirm a relation to suicidal thinking in medical students. Students cope with stress by listening to music, talking to relatives or people close to them, resting or engaging in sports, with cycling, running and swimming being the most common methods used to affect suicidal thinking.

Early dysautonomia detected by heart rate variability predicts late depression in female patients following mild traumatic brain injury

Depression is one of the frequent complications following a mild traumatic brain injury (mTBI). Recent research indicated that abnormalities in the autonomic nervous system (ANS) can be evaluated by a noninvasive power spectral analysis of the heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV was correlated with late depression in mTBI patients. In total, 181 patients diagnosed with mTBI and 83 volunteers as healthy controls were recruited in 2010-2014. Beck Depression Inventory (BDI) scores were used to evaluate depression in the 1st week of assessment and at 1.5-, 3-, 6-, 12-, and 18-month follow-ups. Correlation and logistic regression analyses of the 1st week HRV parameters with BDI scores at 18 months were performed in individual female mTBI patients. Female mTBI patients were more vulnerable to depression accompanied by reduced HRV compared to healthy controls. Over time, depression was aggravated in female mTBI patients but was alleviated in male mTBI patients. A significantly lower parasympathetic proportion of the ANS was noted at 18 months with respect to the 1st week in female mTBI patients. In addition, depression in female mTBI patients at 18 months after injury was significantly correlated with a decrease in the parasympathetic proportion of the ANS in the 1st week (ρ = -0.411; p < .05). Dysautonomia resulted in higher risks of depression in female mTBI patients. We concluded that early dysautonomia following an mTBI contributes to late depression in female mTBI patients.

Are students prone to depression and suicidal thoughts?

INTRODUCTION

Depression may affect up to 9.8% of adolescents and young adults and is associated with significant life-long consequences. The aim of our study was to assess the association between symptoms of depression and demographic factors such as gender, having brothers or sisters, background (rural/small town or urban permanent place of residence), perceived financial status, current living arrangements, year and major area of study.

MATERIAL AND METHODS

One thousand one hundred eighty-three students of medical or similar faculties, 71% of whom were females, anonymously answered the Kutcher Adolescent Depression Scale (KADS) and completed a demographic questionnaire.

RESULTS

We found that 6.5% of all participants (n = 77) had depression according to Kutcher's criteria whereas 1.5% of them (n = 18) reported suicidal thoughts. We also observed the influence of such factors as gender (p < 0.009), year (p < 0.001), major area of study (p < 0.034), and financial status (p < 0.000-0.003), on depression scores. Moreover, depressive symptomatology was most frequent in subjects who were only children, in freshmen and in students of psychology (11.5%, 13.2% and 16.7% respectively). However, we did not observe an impact of such agents as students' permanent place of residence (p = 0.929) or current living arrangements on depressive symptoms (p = 0.940).

CONCLUSIONS

Susceptibility to depression fluctuates throughout the course of study and depends on factors associated with the study itself such as the student's major or year of study and other socio-demographic agents, i.e. gender or self-reported financial status.

Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse

INTRODUCTION

Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.

AIM

We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.

METHODS

Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.

MAIN OUTCOME MEASURES

The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.

RESULTS

CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.

CONCLUSIONS

Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.

THE RELATIONSHIPS AMONG VIGILANT COPING STYLE, RACE, AND DEPRESSION

Although Black-white differences in depression are well documented, vigilant coping style as an explanation for the observed inequalities in depression is less understood. Using data from 718 adults in the Exploring Health Disparities in Integrated Communities (EHDIC) Study, we estimated logistic regression models to examine the cross sectional relationship between race, vigilant coping style, and depression. After controlling for demographic variables, white adults were more likely to report depression than Black adults. Moreover, when accounting for coping style, the Black-white difference in depression widened. This association persisted even with the addition of the covariates. While high rates of depression among whites compared with Blacks are well documented, the degree of the differences appears to be greater than previously reported once vigilance is accounted for. This finding suggests that if it were not for the high prevalence of vigilant coping in blacks, the well-documented black advantage regarding depression compared to whites would likely be even greater.

Sex differences in clinical predictors of depression: a prospective study

BACKGROUND

Estimating the likelihood of future major depressive episodes (MDEs) would assist clinicians in decision-making regarding the optimal length of treatment for MDE. Unfortunately, little data are available to guide clinical practice.

METHODS

We followed 200 females and 152 males who responded to treatment for a MDE for 2 years to determine risk factors for future MDE. Cox Proportional Hazard Regression modeled time to first relapse into MDE and mixed effect logistic regression modeled monthly depression status.

RESULTS

Females were more likely than males to experience a MDE in any month of the study, and marginally more likely to experience a relapse. By 12 months, 60% of females had relapsed compared to 51% of males (median time to relapse 8 vs. 13 months, respectively). Several factors predicted worse outcome for both men and women: reported childhood abuse, earlier age of onset of first MDE, bipolar disorder, unemployment, and more years of education. For females, but not males, suicidal ideation predicted MDE relapse and both suicidal ideation and prior suicide attempts were associated with more time in a MDE.

LIMITATIONS

The naturalistic treatment of participants, exclusion of individuals with current comorbid alcohol or substance use disorder, and a follow up period of two years are limitations.

CONCLUSIONS

Women are more vulnerable to relapse and spend more time depressed compared to men. Identification of general and sex-specific risk factors for future depression may provide clinicians with useful tools to estimate need for ongoing pharmacotherapy in MDE.

Response to antidepressants in major depressive disorder with melancholic features: the CRESCEND study

BACKGROUND

This study aimed to determine whether major depressive disorders with melancholic and without melancholic features differ with respect to their responses to treatment with antidepressants.

METHODS

From a nationwide sample of 18 hospitals in South Korea, 559 presenting patients with major depressive disorder were recruited. The DSM-IV based Structured Clinical Interview was administered for confirmatory diagnoses and depression subtypes with/without melancholic features. After baseline evaluation, they received naturalistic clinician-determined antidepressant interventions. Assessment scales for evaluating depression (HAMD), anxiety (HAMA), global severity (CGI-s), and functioning (SOFAS) were administered at baseline and re-evaluated at 1, 2, 4, 8, and 12 weeks later.

RESULTS

At baseline, the 243 (43.5%) participants with melancholic features were more likely to have a previous history of depression, and had higher HAMA and lower SOFAS scores. After adjustment for baseline status, participants with melancholic features were more likely to achieve and to experience shorter times to CGI-s remission and associated with an enhanced global symptomatic remission with any antidepressant treatment. They were more likely to achieve and to experience shorter times to CGI-s remission and this difference was strongest in those receiving selective serotonin reuptake inhibitor (SSRI) antidepressants treatment.

LIMITATIONS

The study was observational, and the treatment modality was naturalistic.

CONCLUSIONS

These findings suggest a faster and more evident global response to pharmacotherapy in melancholia compared to other depressive syndromes, particularly where SSRI agents are used.

Does age moderate the effect of personality disorder on coping style in psychiatric inpatients?

OBJECTIVE

To examine age-related differences in the relationship between personality and coping strategies in an Australian population of psychiatric inpatients.

METHOD

Consenting eligible adults (N=238) from 18-100 years of age consecutively admitted to inpatient psychiatry units were assessed using the SCID I and II, the Coping Orientations to Problems Experienced Scale (COPE), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment Scale (SOFAS), the 12 Item Short-Form Heath Survey (SF12), the Sarason Social Support Questionnaire, and the NEO Five Factor Inventory (NEO-FFI) (cognitively impaired, and non-English speaking patients were excluded).

RESULTS

Older adults reported less symptomatology than younger patients and younger patients described more personality dysfunction than older patients. As assessed by the COPE, older adults reported lower levels of dysfunctional coping strategies than younger adults. Personality traits, social supports, gender, and age predicted coping strategies, while Axis I diagnosis, education, personality disorder, and symptom severity were not significant predictors of coping strategies.

CONCLUSION

This study found that influences on coping were multifactorial and moderated by age. These factors have implications for interventions designed to enhance coping strategies.

Sex Differences in Symptoms of Depression in Unrelated Individuals and Opposite-Sex Twin and Sibling Pairs

Diagnosis of a major depressive episode by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association requires 5 out of 9 symptoms to be present. Therefore, individuals may differ in the specific symptoms they experience and reach a diagnosis of depression via different pathways. It has been suggested that depressed women more often report symptoms of sleep disturbance, appetite or weight disturbance, fatigue, feelings of guilt/worthlessness and psychomotor retardation than depressed men. In the current study, we investigate whether depressed men and women differ in the symptoms they report. Two samples were selected from a sample of Dutch and Australian twins and siblings. First, Dutch and Australian unrelated depressed individuals were selected. Second, a matched epidemiological sample was created consisting of opposite-sex twin and sibling pairs in which both members were depressed. No sex differences in prevalence rates for symptoms were found, with the exception of decreased weight in women in the sample of unrelated individuals. In general, the similarities in symptoms seem to far outweigh the differences in symptoms between men and women. This signifies that men and women are alike in their symptom profiles for major depression and genes for depression are probably expressed in the same way in the two sexes.

The impact of gender on antidepressants

There is a large body of literature debating whether and how gender affects the metabolism, side-effect profile, and efficacy of antidepressants. Gender differences in antidepressant pharmacokinetics and efficacy profiles have been attributed to not only anatomic and physiological differences between the sexes, but also behavioral factors, comorbid disorders, and gender-specific conditions, such as pregnancy and menopause. Despite the large body of research on this topic, few definitive conclusions regarding effects of gender on antidepressant treatment exist, and much of this research is incomplete, contradictory, or not fully used to optimize the administration of antidepressants and the response to treatment. This chapter will review the latest research on gender-specific effects of antidepressant treatment, focusing on the overall, gender-related differences in efficacy, metabolism, and side-effect profile of antidepressants, and how these differences can be used to better optimize treatment of depression in a clinical setting.

The relationship between beliefs about depression and coping strategies: Gender differences

OBJECTIVE

Leventhal's common-sense model of illness representation provides a conceptual framework for exploring the relationship between beliefs about depressive illness and use of coping strategies. We explored this relationship among depressed patients both across genders and in terms of gender differences.

DESIGN

Depressed primary care patients prescribed antidepressants provided self-report measures of beliefs about depression, emotional reaction to depression, beliefs about medications and coping strategies used. Baseline data from a longitudinal study is presented.

METHOD

Primary data analyses were conducted using canonical correlation analysis, a multivariate statistical method akin to principal component and regression analyses. It allows for parsimonious description of the association between two multivariate sets of variables (in this case, beliefs about depression and coping strategies) by identifying pairs of linear combinations that account for the majority of the between association from the two sets of variables.

RESULTS

The sample consisted of 189 depressed primary care patients (70.4% female). Results indicated that emotional reaction to depression is a major factor in determining coping strategies. Greater emotional reaction to depression was associated with maladaptive coping for men and women, while women showed additional relationships between greater perceived control over depression and more adaptive coping techniques as well as between perception of consequences of depression and problem solving.

CONCLUSIONS

The present research provides preliminary evidence that beliefs about depression are related to coping styles. Further, men and women may differ in the way in which their perceptions about depression influence coping styles adopted.

Depression, marital satisfaction and communication in couples: investigating gender differences

The correlation between depression and dysfunctional marital interaction is well documented, but only a few studies have examined gender-related differences in marital interaction patterns of couples with a depressed partner. In this paper we examined differences in observed marital communication in a sample of 62 Swiss couples presenting for treatment of depression. There were 16 maritally distressed couples with a depressed wife, 21 maritally nondistressed couples with a depressed wife, 18 maritally distressed couples with a depressed husband, and 7 maritally nondistressed couples with a depressed husband. Marital interaction behavior was found to depend on gender, depression, marital distress, as well as gender of the depressed partner. Our results suggest the need for a gender-sensitive model of the link between marital interaction and depression.

A longitudinal study of cognitive function in melancholic and non-melancholic subtypes of major depressive disorder

BACKGROUND

Research concerning cognition in depression has often yielded inconsistent findings. The presence of mixed melancholic and non-melancholic subtypes of major depressive disorder (MDD) in most previous research may explain some of the contradictory results (Hickie, 1996).

METHODS

This longitudinal study compared the cognitive performance of people with melancholic (n=17) and non-melancholic (n=17) MDD admitted to one of two university hospitals. Participants received an extensive clinical and cognitive assessment at admission and again 3 months after recovery and discharge.

RESULTS

Overall, participants with melancholia had selective memory deficits with broader impairment of executive control skills. Specifically, after correcting for depression severity, they performed more poorly on tests requiring memory acquisition, mental flexibility, set-shifting, selective attention, concept-formation and multi-tasking compared to those with non-melancholic depression. These deficits were present at both assessments suggesting that the increased initial severity of cognitive deficits for those with melancholia mean that they require a longer time to recovery.

LIMITATIONS

The clinical homogeneity of the study sample may underestimate the extent of cognitive impairment for those presenting with comorbid illness and/or significant drug/alcohol histories.

CONCLUSIONS

These findings indicate that the depressed group with melancholia have a distinctly different and more impaired cognitive profile to those without melancholic features and suggest that these clinical subtypes should be considered separately in future research concerning MDD. Furthermore, the melancholic group appears to require longer periods for cognitive recovery and this has implications for return to work and daily functioning following clinical discharge.

Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome

BACKGROUND

The study examined the profile of stress in mothers and fathers of preschool children with autism, Down syndrome and typically developing children. A further aim was to assess the association between parenting stress and coping style.

METHODS

A total of 162 parents were examined using Holroyd's 66-item short form of Questionnaire of Resources and Stress for Families with Chronically Ill or Handicapped Members and the Coping Inventory for Stressful Situations by Endler and Parker.

RESULTS AND CONCLUSIONS

The results indicated a higher level of stress in parents of children with autism. Additionally, an interaction effect was revealed between child diagnostic group and parent's gender for two scales of parenting stress: dependency and management and limits of family opportunities. Mothers of children with autism scored higher than fathers in parental stress; no such differences were found in the group of parents of children with Down syndrome and typically developing children. It was also found that parents of children with autism differed from parents of typically developing children in social diversion coping. Emotion-oriented coping was the predictor for parental stress in the samples of parents of children with autism and Down syndrome, and task-oriented coping was the predictor of parental stress in the sample of parents of typically developing children. The results strongly supported earlier findings on parenting stress in parents of children with autism. They also shed interesting light on the relationship between coping styles and parental stress.

Parental bonding and self-esteem as predictors of severe depressive symptoms: a 10-year follow-up study of Norwegian physicians

Elevated rates of suicide and depression among physicians have been reported. The associations between perceived parental bonding and depressive symptoms have yet to be studied longitudinally in this occupational group. In a nationwide cohort, we sought to study parental bonding as a predictor for severe depressive symptoms and to determine whether self-esteem mediates this relationship. After graduation (T1), medical students (N = 631) were followed-up after 1 (T2), 4 (T3), and 10 (T4) years. There were no gender differences in mean depressive scores. Female physicians reported higher levels of care from their mothers (p < 0.05) and less overprotection from their fathers (p < 0.05). Low-care from the mother predicted severe depressive symptoms (p = 0.01), an effect shown to be stronger for male than for female physicians. The relationship between perceived parental bonding and depressive symptoms was partially mediated by low self-esteem for both sexes.

Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders

Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding the disorder during this developmental stage is critical for determining its etiology and course, as well as for deveiopinq effective intervention straieqies. This paper summarizes current knoviedqe reqardinq the etiology, phenomenoiogy, correlates, natural course, and consequences of unipolar depression in children and adolescents. Using adult depression as a framevork, the unique aspects of childhood and adolescence are considered in order to better understand depression within a developmental context. The data suggest that the clinical presentation, correlates, and natural course of depression are remarkably similar across the lifespan. There are, however, important developmental differences. Specifically, the familial and psychological context in which depression develops in youngsters is associated with variability in the frequency and nature of depressive symptoms and comorbid conditions among children and adolescents. Maturational differences have also been identified in the neurobiological correlates of depression. These developmental differences may be associated with the observed variability in clinical response to treatment and longitudinal course. Characterization of the developmental differences will be helpful in developing more specific and effective interventions for youngsters, thereby allowing them to reach their full potential as adults.

Sex and gender in psychoneuroimmunology research: past, present and future

To date, research suggests that sex and gender impact pathways central to the foci of psychoneuroimmunology (PNI). This review provides a historical perspective on the evolution of sex and gender in psychoneuroimmunology research. Gender and sexually dimorphic pathways may have synergistic effects on health differences in men and women. We provide an overview of the literature of sex and gender differences in brain structure and function, sex steroids, gender role identification, hypothalamic-pituitary-adrenal axis function, genetics, immunology and cytokine response. Specific examples shed light on the importance of attending to sex and gender methodology in PNI research and recommendations are provided.

A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population: the HUNT study

BACKGROUND

Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample.

METHODS

Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995-1997), three groups were identified: Level 3 (n = 654, score >or= 25 points), Level 2 (n = 654, score 19-24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years.

RESULTS

Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28-4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76-4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46-0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19-0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34-1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24-2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years.

CONCLUSIONS

Though symptom fluctuation was considerable, conventional HADS-T caseness (>or=19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.

Women and depression: a 30 year learning curve

This paper reviews 30 years of longitudinal research, initially undertaken to examine gender differences in rates of major depression and psychosocial risk factors for depression. The research focus has broadened to include the impact of anxiety on depression onset, coping styles for stress and depression, genetic and environmental influences on depression onset, and more recently, a shift towards examining positive mental health. The original cohort consisted of a socially homogenous group of postgraduate teacher trainees and does not attempt to represent the normal variability in an adult population. However, the issues raised by this research provide many insights about real and artefactual factors that contribute to the rate and experience of depression. The study findings are supplemented by data from other studies undertaken by this research team that are pertinent to the topic and add weight to some of the observations from the Teachers' Study.

Gender differences in the symptoms of major depressive disorder

Data from the Canadian Community Health Survey 1.2 were used for a gender analysis of individual symptoms and overall rates of depression in the preceding 12 months. Major depressive disorder was assessed using the Composite International Diagnostic Interview in this national, cross-sectional survey. The female to male ratio of major depressive disorder prevalence was 1.64:1, with n = 1766 having experienced depression (men 668, women 1098). Women reported statistically more depressive symptoms than men (p < 0.001). Depressed women were more likely to report "increased appetite" (15.5% vs. 10.7%), being "often in tears" (82.6% vs. 44.0%), "loss of interest" (86.9% vs. 81.1%), and "thoughts of death" (70.3% vs. 63.4%). No significant gender differences were found for the remaining symptoms. The data are interpreted against women's greater tendency to cry and to restrict food intake when not depressed. The question is raised whether these items preferentially bias assessment of gender differences in depression, particularly in nonclinic samples.

Understanding the Sex Difference in Vulnerability to Adolescent Depression: An Examination of Child and Parent Characteristics

This study examined sex differences in risk factors associated with adolescent depression in a large sample of boys and girls. Moderation and mediation explanatory models of the sex difference in likelihood of depression were examined. Findings indicate that the factors associated with depression in adolescent boys and girls are quite similar. All of the variables considered were associated with depression, but sex did not moderate the impact of vulnerability factors on likelihood of depression diagnosis. However, negative self-perceptions in the domains of achievement, global self-worth, and physical appearance partially mediated the relationship between sex and depression. Further, girls had higher levels of positive self-perceptions in interpersonal domains that acted as suppressors and reduced the likelihood of depression in girls. These findings suggest that girls' higher incidence of depression is due in part to their higher levels of negative self-perceptions, whereas positive interpersonal factors serve to protect them from depressive episodes.

Predictors of suicidal ideation among high school students by gender in South Korea

The purpose of this study was to examine the evidence to determine if there are gender differences in suicidal ideation of adolescents. This study examined the main effect of risk factors from 5 domains and protective factors from 1 domain in relation to suicidal ideation by gender and identified the most important predictors of suicidal ideation for males (N = 654) and females (N = 658). This study was a cross-sectional survey, and data were collected through self-report questionnaires. In the univariate analysis, especially, risk factors from behavioral variables and psychosocial-environmental variables appeared to be gender skewed. For males, all behavioral variables were predictive of suicidal ideation. For the females, unlike the males, Wang-tta or victim of bullying behavior and sexual orientation as behavioral variables were predictive of suicidal ideation. For males, parental divorce and parental alcohol abuse as psychosocial-environmental variables were predictive of suicidal ideation. For the females, again unlike for the males, all the psychosocial-environmental variables were not predictive of suicidal ideation. The most important predictors of suicidal ideation for males as a result of the multivariate analysis were history of suicidal attempt, depression, hostility, smoking, parental alcohol abuse, communication with friends, and self-esteem. The most important predictors of suicidal ideation for females as a result of the multivariate analysis were depression, hostility, sexual orientation, and self-esteem. These results would indicate that an effective suicide screening and prevention program for adolescents should consider gender differences.

Actions taken to cope with depression in patients seeking specialist care

OBJECTIVE

To assess the rates and perceived effectiveness of actions used to cope with depression and the factors influencing these in an outpatient sample seeking help for depression.

METHOD

One hundred and seventy-six patients (74 male, 102 female) aged 16-82 years (M = 42, SD = 14.4 years) with a major depressive episode (DSM-IV criteria) were assessed using a number of measures that covered sociodemographics, history of psychiatric illness, actions taken to alleviate depression and their perceived effectiveness. Logistic regression analyses assessed age, gender and illness characteristics associated with the use and perceived effectiveness of strategies adopted to manage depression.

RESULTS

Medical interventions were used and perceived to be effective in alleviating depressive symptoms by most of the sample, as were self-help and complementary therapies. Sociodemographic and illness-related characteristics had a significant influence, with younger age and having experienced an episode of anxiety disorder found to be the strongest predictors for the use of coping strategies. Being female was the strongest predictor for their effectiveness.

CONCLUSION

A range of actions for depression, including medical and complementary interventions, were used and found to be helpful in a sample that had sought professional help for depression. Gender, age, depression and anxiety factors were all found to predict the use and perceived effectiveness of these strategies.

Gender differences in adolescent depression: do symptoms differ for boys and girls?

BACKGROUND

Limited prior research suggests that depressed women are more likely to experience certain symptoms of depression than are depressed men. The purpose of this study was to examine whether such gender differences in depressive symptoms are present during adolescence.

METHODS

The Childhood Version of the Schedule for Affective Disorders and Schizophrenia and the Beck Depression Inventory were administered to adolescents presenting for evaluation at an outpatient clinic (n=383; ages 11.9 to 20.0).

RESULTS

Depressed girls and boys had similar symptom prevalence and severity ratings for most depressive symptoms. However, depressed girls had more guilt, body image dissatisfaction, self-blame, self-disappointment, feelings of failure, concentration problems, difficulty working, sadness/depressed mood, sleep problems, fatigue, and health worries than depressed boys on some comparisons. In contrast, depressed boys had higher clinician ratings of anhedonia, depressed morning mood, and morning fatigue.

LIMITATIONS

Longitudinal research is needed to test whether such relatively gender-specific symptoms play different roles in the onset, maintenance, or remittance of depression for boys and girls.

CONCLUSIONS

These findings indicate that, in general, the experience of depression is highly similar for adolescent girls and boys. However, some gender differences previously found among depressed adults appear to be present by adolescence, possibly suggesting somewhat distinct etiologies for depression among males and females.

Cognitive Processes Underlying Coping Flexibility: Differentiation and Integration

This study investigates how individuals formulate flexible coping strategies across situations by proposing differentiation and integration as two stress-appraisal processes. Results showed that participants who coped more flexibly adopted the dimensions of controllability and impact in differentiating among different stressful situations. They also deployed an integrated strategy: the deployment of more monitoring in situations perceived as controllable but less of this strategy in situations perceived as uncontrollable. Participants who coped less flexibly did not adopt any given dimensions and tended to use more monitoring regardless of situational characteristics. These results suggest that individuals with different extents of coping flexibility differ in the cognitive processes. Individuals who cope more flexibly display a greater extent of differentiation and integration than do those who cope less flexibly. These findings are translated into strategies for stress management workshops.

Gender differences in patients presenting with a single depressive episode according to ICD-10

BACKGROUND

It is unsure whether men and women present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of a single depressive episode according to ICD-10 for men and women in a nationwide sample of all patients treated in psychiatric in- or outpatient settings.

METHODS

All patients who got a diagnosis of a single depressive episode in a period from 1994 to 2002 at the end of the first outpatient treatment ever or at the first discharge from psychiatric hospitalisation ever in Denmark were identified in a nationwide register.

RESULTS

A total of 18,192 patients got a diagnosis of a single depressive episode at the first outpatient contact ever and 8,396 patients got a diagnosis of a single depressive episode at the first psychiatric hospitalisation ever. Significantly more women were treated as outpatients than as inpatients (68% vs. 60.4%). In outpatient settings, women slightly more often presented with milder types of depression than with severe depression, but no gender difference was found in the severity of depressive episodes among hospitalised patients. No differences were found between genders in the prevalence of depression with vs. without melancholic or psychotic symptoms in either of the settings. Women were treated for longer periods in both settings.

CONCLUSIONS

The distributions of the subtypes of a single depressive episode are remarkably similar for male and female patients with first contact to the psychiatric health care system.

Duloxetine in the treatment of Major Depressive Disorder: a comparison of efficacy in patients with and without melancholic features

BACKGROUND

The most prominent feature of melancholic depression is a near-total loss of the capacity to derive pleasure from activities or other positive stimuli. Additional symptoms can include psychomotor disturbances, anorexia, excessive guilt, and early awakening from sleep. Melancholic patients may exhibit treatment responses and outcomes that differ from those of non-melancholic patients. Pooled data from double-blind, placebo-controlled studies were utilized to compare the efficacy of duloxetine in depressed patients with and without melancholic features.

METHODS

Efficacy data were pooled from 8 double-blind, placebo-controlled clinical trials of duloxetine. The presence of melancholic features (DSM-IV criteria) was determined using results from the Mini International Neuropsychiatric Interview (MINI). Patients (aged >or= 18 years) meeting DSM-IV criteria for major depressive disorder (MDD) received duloxetine (40-120 mg/d; melancholic, N = 759; non-melancholic, N = 379) or placebo (melancholic, N = 519; non-melancholic, N = 256) for up to 9 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score, HAMD17 subscales (Maier, anxiety, retardation, sleep), the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain.

RESULTS

In data from all 8 studies, duloxetine's advantage over placebo did not differ significantly between melancholic and non-melancholic patients (treatment-by-melancholic status interactions were not statistically significant). Duloxetine demonstrated significantly greater improvement in depressive symptom severity, compared with placebo, within both melancholic and non-melancholic cohorts (p <or= .001 for HAMD17 total score, CGI-S and PGI-I). When analyzed by gender, the magnitude of improvement in efficacy outcomes did not differ significantly between duloxetine-treated male and female melancholic patients. In the two studies that assessed duloxetine 60 mg once-daily dosing, duloxetine-treated melancholic patients had significantly greater improvement compared with placebo on HAMD17 total score, CGI-S, PGI-I, 3 of 4 subscales of the HAMD17, and VAS overall pain severity (p < .01). Estimated probabilities of response and remission were significantly greater for melancholic patients receiving duloxetine 60 mg QD compared with placebo (response 74.7% vs. 42.2%, respectively, p < .001; remission 44.4% vs. 24.7%, respectively, p = .002.

CONCLUSIONS

In this analysis of pooled data, the efficacy of duloxetine in patients with melancholic features did not differ significantly from that observed in non-melancholic patients.

Gender differences in severity, symptomatology and distribution of melancholia in major depression

BACKGROUND

Studies of gender differences in the clinical presentation of depression have provided divergent results. This study aimed at analyzing gender differences in severity, symptomatology and distribution of melancholia in major depression.

SAMPLING AND METHODS

The study comprised 930 in- and out-patients (652 women, 278 men) from 6 randomized controlled trials. All patients fulfilled DSM-III or DSM-III-R criteria for major depression. The 17-item Hamilton Depression Scale (HDS) was applied to all patients. A multi-axial evaluation was completed using the Newcastle 1 Depression Rating Scale from 1965 for melancholia (N1) in a subsample of patients (n = 439). A factor analysis on the HDS was performed. Non-parametric statistical tests were used and only gender differences greater than 20% were considered clinically relevant.

RESULTS

The median on the HDS total score was 22 and the median number of symptoms was 13 for both men and women. Presentation of specific symptoms was similar for men and women. The factor analysis revealed no gender differences, and neither did analyses on symptoms of Axes II and IV. According to the N1, 80% of the men and 66% of the women suffered from melancholic depression (p = 0.004).

CONCLUSIONS

In a large and broad sample of in- and out-patients with major depression, the severity and symptomatology of depression were similar for men and women. Melancholic depression was significantly more frequent among male than female patients. Inclusion and exclusion criteria in the randomized controlled trials provided a selected group of patients, which limited the generalisability of the results to an exclusive subgroup of patients treated for depression in routine clinical practice.

Gender and depression: a study of severity and symptomatology of depressive disorders (ICD-10) in general practice

OBJECTIVE

Gender differences in severity and symptomatology of depression in a large and representative sample of depressive patients from general practice were examined.

METHOD

During a 2-year study period, 31 Danish general practitioners consecutively assessed patients, aged >18, for depression. A total of 1033 patients (692 female, 341 male) fulfilled ICD-10 criteria for depressive disorders. Gender differences were examined with regard to severity and symptomatology of depression.

RESULTS

The severity of depression was similar for men and women with the following distribution: 22% mild, 56% moderate and 23% severe depressive episodes. The mean number of symptoms presented was 6.6 of 10 for both genders. There were no gender differences in prevalence of single depressive symptoms.

CONCLUSION

No gender differences in the severity or symptomatology of depression were found in a highly representative sample of patients with depressive disorders.