Gender Differences in Depression

Endocannabinoid levels in female-sexed individuals with diagnosed depression: a systematic review

BACKGROUND

Major depressive disorder (MDD) is a highly prevalent mental health disorder with females experiencing higher rates of depression (11.6%), anxiety (15.7%) and physiological distress (14.5%) than males. Recently, the Endocannabinoid system (ECS) has been proposed to be a key contributing factor in the pathogenesis and symptom severity of MDD due to its role in neurotransmitter production, inflammatory response and even regulation of the female reproductive cycle. This review critically evaluates evidence regarding ECS levels in female-sexed individuals with depressive disorders to further understand ECS role.

MATERIALS AND METHODS

A systematic literature review of available research published prior to April 2022 was identified using PubMed (U.S. National Library of Medicine), CINAHL (EBSCO), Web of Science, AMED and Scopus (Elsevier). Studies were included if they reported ECS analysis of female-sexed individuals with depression and were excluded if they did not differentiate results between sexes, assessed mental health conditions other than depression, tested efficacy of endocannabinoid/n-acylethanolamine/cannabis or marijuana administration and that were unable to be translated. Critical appraisal of each included study was undertaken using the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews.

RESULTS

The 894 located citations were screened for duplicates (n = 357) and eligibility by title and abstract (n = 501). The full text of 33 studies were reviewed, and 7 studies were determined eligible for inclusion. These studies indicated that depressed female-sexed individuals have altered levels of ECS however no significant pattern was identified due to variability of study outcomes and measures, limiting overall interpretation.

DISCUSSION

This review suggests potential involvement of ECS in underlying mechanisms of MDD in female sexed-individuals, however no pattern was able to be determined. A major contributor to the inability to attain reliable and valid understanding of the ECS levels in female-sexed individuals with depression was the inconsistency of depression screening tools, inclusion criteria's and analysis methods used to measure eCBs. Future studies need to implement more standardised methodology to gain a deeper understanding of ECS in female-sexed individuals with depressive disorders. TRIAL REGISTRATION : This review was submitted to PROSPERO for approval in April 2022 (Registration #CRD42022324212).

The influence of anxiety and depression on critical care nurses' performance: A multicenter correlational study

BACKGROUND

Anxiety and depression among critical care nurses (CCNs) negatively affect performance because of association with clinical medical errors, ineffective communication, absenteeism from work, and burnout.

OBJECTIVES

The aim of this study was to investigate the prevalence of anxiety and depression and their associated factors as well as their impact on the CCNs' performance in Hail city, Saudi Arabia.

METHODS

A cross-sectional correlational study was conducted among 262 CCNs from April to June 2023.

RESULTS

The mean scores of anxiety and depression were significantly higher among male and Saudi CCNs than among their counterparts (p < 0.05). CCNs caring for patients in a ratio of 1:5 or more had significantly higher anxiety scores than those with lower nurse-to-patient ratios (p = 0.004). CCNs who were working night shifts had significantly higher mean scores of anxiety (p = 0.005) and lower mean scores of performance (p = 0.041) than their counterparts. Borderline anxiety and depression were prevalent among 43.1% and 38.5% of CCNs, respectively. In contrast, abnormal anxiety and depression were prevalent among 8.8% and 5.7% of CCNs, respectively. CCNs' mental, general, and total performance showed a significant negative correlation with both anxiety ([r = -0.247, p <0.001], [r = -0.183, p = 0.003], and [r = -0.172, p = 0.005], respectively) and depression (r = -0.287, p <0.001), (r = -0.207, p <0.001), and (r = -0.180, p = 0.003), respectively.

CONCLUSIONS

Anxiety and depression levels are significantly higher among male, Saudi CCNs, higher nurse-to-patient ratios, those who work night shifts than among their counterparts. Less than half of CCNs experience borderline anxiety and/or depression that had significantly negative correlation with their performance. Anxiety and depression in shift nurses may be treated by reducing workload, causes of stress during night shifts, and giving practical coping mechanisms for typical nurse job pressures.

Personality traits and the degree of work addiction among Polish women: the mediating role of depressiveness

Objectives

Workaholism is an addiction, however the obsessive-compulsive components alone may prove insufficient in determining its nature. The aim of the following study was to determine the mediating role of depressiveness in the relationships between workaholism and personality traits according to the five-factor model among Polish women.

Methods

The research study was carried out among 556 women residing in the West Pomerania Voivodeship in Poland. The research was based on a survey performed using a questionnaire technique. The following research instruments adapted to Polish conditions were employed to assess the incidence of work addiction among female adults: The NEO Five-Factor Inventory (NEO-FFI), The Work Addiction Risk Test (WART) Questionnaire, and The Beck Depression Inventory-BDI I-II.

Results

A positive correlation between the intensity of neuroticism and the work addiction risk was revealed (β = 0.204, p < 0.001). A partial mediation (35%) with the severity of depression symptoms as a mediating factor was observed (β = 0.110, p < 0.001). Respondents characterized by high neuroticism showed a greater severity of the symptoms of depression (β = 0.482, p < 0.001), which is a factor increasing the work addiction risk (β = 0.228, p < 0.001). No effect of extraversion intensity on the work addiction risk was found (β = 0.068, p = 0.081). Respondents characterized by a high level of extraversion displayed lower severity of the symptoms of depression (β = -0.274, p < 0.001). A negative correlation between the intensity of agreeableness and the work addiction risk was revealed (β = -0.147, p < 0.001). A partial mediation (27.8%) was observed. A positive correlation between the intensity of conscientiousness and the work addiction risk was revealed (β = 0.082, p = 0.047). Respondents characterized by a high level of conscientiousness showed a lower severity of depression symptoms (β = -0.211, p < 0.001).

Conclusion

Depressiveness plays the role of a mediator between neuroticism, extraversion, agreeableness as well as conscientiousness, and work addiction. Depressiveness is a factor which increases the risk of work addiction.

The importance of social activity to risk of major depression in older adults

BACKGROUND

Several social determinants of health (SDoH) have been associated with the onset of major depressive disorder (MDD). However, prior studies largely focused on individual SDoH and thus less is known about the relative importance (RI) of SDoH variables, especially in older adults. Given that risk factors for MDD may differ across the lifespan, we aimed to identify the SDoH that was most strongly related to newly diagnosed MDD in a cohort of older adults.

METHODS

We used self-reported health-related survey data from 41 174 older adults (50-89 years, median age = 67 years) who participated in the Mayo Clinic Biobank, and linked ICD codes for MDD in the participants' electronic health records. Participants with a history of clinically documented or self-reported MDD prior to survey completion were excluded from analysis (N = 10 938, 27%). We used Cox proportional hazards models with a gradient boosting machine approach to quantify the RI of 30 pre-selected SDoH variables on the risk of future MDD diagnosis.

RESULTS

Following biobank enrollment, 2073 older participants were diagnosed with MDD during the follow-up period (median duration = 6.7 years). The most influential SDoH was perceived level of social activity (RI = 0.17). Lower level of social activity was associated with a higher risk of MDD [hazard ratio = 2.27 (95% CI 2.00-2.50) for highest v. lowest level].

CONCLUSION

Across a range of SDoH variables, perceived level of social activity is most strongly related to MDD in older adults. Monitoring changes in the level of social activity may help identify older adults at an increased risk of MDD.

The role of identity in the development of depressive, anxiety, and psychosis symptoms in adolescents exposed to childhood adversity

INTRODUCTION

Childhood adversity is a major risk factor for psychiatric disorders and has especially been associated with an admixture of depressive, anxiety, and psychosis symptoms. Identity formation, a main developmental task during adolescence, may be impacted by these adverse experiences and act as an important process in the association between childhood adversity and psychopathology.

METHODS

We investigated the association between childhood adversity, identity formation, and depressive, anxiety, and psychosis symptoms cross-sectionally in 1913 Flemish adolescents between 11 and 20 years old (mean = 13.76, SD = 1.86). Adolescents completed questionnaires during the first wave of the SIGMA study between January 2018 and May 2019.

RESULTS

Childhood interpersonal adversity was associated with increased identity confusion and decreased identity synthesis. Additionally, identity confusion was associated with increased self-reported levels of psychopathology and potentially mediated the association between childhood adversity and psychopathology.

CONCLUSION

This study highlights the importance of promoting healthy identity formation in adolescents with and without exposure to adverse childhood experiences.

Gender differences in medication prescribing patterns for veterans with posttraumatic stress disorder: A 10-year follow-up study

Women veterans with posttraumatic stress disorder (PTSD) have historically received more psychiatric medications than men. The current analysis identified prescribing trends of medications recommended for (i.e., select antidepressants) and against (i.e., benzodiazepines, select antidepressants, antipsychotics, and select anticonvulsants) use in PTSD treatment among women and men in 2010-2019. All veterans receiving care for PTSD in 2019 were identified using national U.S. Department of Veterans Affairs (VA) administrative data. Multivariable logistic regression analyses, adjusted for demographic characteristics and psychiatric comorbidities, were used to contrast the likelihood of receiving a medication class across genders. Sensitivity analyses using identical selection methods were conducted for the calendar years 2010, 2013, and 2016. In 2019, 877,785 veterans received treatment for PTSD within the VA, 13.5% of whom were women. Across medication classes and years, women were more likely to receive all psychiatric medications of interest. Relative to men, women were slightly more likely to receive antidepressants recommended for PTSD in 2019, adjusted odds ratio (aOR) = 1.07, 95% CI [1.06, 1.09]. However, gender differences for medications recommended against use for PTSD were notably larger, including benzodiazepines, aOR = 1.62, 95% CI [1.59, 1.65]; anticonvulsants. aOR = 1.41, 95% CI [1.38, 1.44]; and antidepressants recommended against use for PTSD, aOR = 1.26, 95% CI [1.19, 1.33]. To inform tailored intervention strategies, future work is needed to fully understand why women receive more medications recommended against use for PTSD.

Depression and workaholism in undergraduates: Examining gender as a moderator

Introduction: This study aims to examine the association between depression and workaholism among university students. Methods: Participants were 182 undergraduates at a large university in the South of Poland, aged between 20-28 years old (M = 22.17, SD = 1.39), including 102 women (56%). The cross-sectional study used the Beck Depression Inventory (BDI) and the Work Addiction Risk Test (WART). Results: This study shows that depression and workaholism levels are significantly lower in Physical Education students than other faculties' students. Gender moderates the relationship between workaholism and depression. Women demonstrate a stronger association between depression and workaholism than men. Conclusions: Both physical activity and gender appear to play an essential role in mental health prevention. The result of this study should be considered in therapy and prevention programs at university campuses.

Loneliness and the Degree of Addiction to Shopping and Work among Polish Women: The Mediating Role of Depression

(1) The aim of the research was to try to define the mediating role of depression in the relationship between addiction to shopping and work and loneliness, understood in terms of general loneliness among Polish women. (2) The study was conducted among 556 women. The research was carried out with the use of the diagnostic survey method, using the questionnaire technique: the De Jong Gierveld Loneliness Scale, the Purchasing Behavior Scale, the Work Addiction Risk Test, Beck Depression Inventory, and our own questionnaire. (3) Depression is a mediator in the relationship between the feeling of loneliness and the degree of addiction to shopping (β = −0.0246, z = −2.03, p = 0.043) and in the relationship between the feeling of loneliness and the degree of addiction to work (β = −0.0722, z = −4.002, p < 0.001). The direct impact of the feeling of loneliness on the degree of addiction to shopping (p = 0.237) and work (p = 0.576) is statistically insignificant. (4) Depression plays the role of a mediator between the feeling of loneliness and the degree of addiction to shopping and work. An increase in the level of depression increases the degree of addiction to shopping and work. The mediator’s participation lowers the loneliness feeling level.

Gratitude Can Help Women At-Risk for Depression Accept Their Depressive Symptoms, Which Leads to Improved Mental Health

Introduction

Gratitude is commonly known as a positive emotion, but it can also be understood as a disposition-one's inherent quality that includes being grateful for the positive aspects of one's life and appreciating altruistic gifts. A growing body of research suggests that having a disposition of gratitude is positively related to wellbeing and psychological adjustment. The present study examined the extent to which acceptance of illness-a measure of adjustment to a distressing condition-mediated relationships between dispositional gratitude and wellbeing among women who had elevated levels of depressive symptoms.

Methods

Participants were 131 women who, based on scores on the Center for Epidemiological Studies Depression scale, were at-risk for experiencing clinical depression. Thirty-five of these participants had been diagnosed as depressed at some point in their lives and 96 had not. Participants completed measures of dispositional gratitude, wellbeing, anxiety, and acceptance of illness.

Results

Dispositional gratitude was positively correlated with wellbeing and was negatively correlated with depression and anxiety. Dispositional gratitude was also positively correlated with acceptance of illness. Mediational analyses found that acceptance of illness mediated relationships between dispositional gratitude and wellbeing, between dispositional gratitude and anxiety, and between dispositional gratitude and depression. Moreover, such mediation varied as a function of whether women had ever been diagnosed as depressed. Acceptance of illness was related more strongly to wellbeing for women who had been diagnosed as depressed at some time in their lives than it was for women who had never been diagnosed as depressed.

Conclusion

Women with elevated depressive symptoms who were more grateful (compared to those who were less grateful) were more accepting of their condition, which was related to increased wellbeing and decreased feelings of depression and anxiety.

The Effect of Worktime Control on Overtime Employees' Mental Health and Work-Family Conflict: The Mediating Role of Voluntary Overtime

Overtime has become a widespread phenomenon in the current information age that creates a high speed working pace and fierce competition in the high technology global economy. Based on the time-regulation mechanism and effort-recovery model, we examined the effect of worktime control (WTC) on mental health and work-family conflict (WFC) among overtime employees, and whether voluntary overtime mediated the relationships. We also examined two separate dimensions of WTC (control over time-off and control over daily hours). The results showed that control over time-off was related to decreased depression, anxiety, stress and WFC, while control over daily hours was related to decreased stress and WFC. Generally, control over time-off was beneficial to females and employees with dependents. Furthermore, mediation results showed that voluntary overtime was a complete mediator of relationships between WTC and depression and anxiety as well as a partial mediator of the relationship between WTC and stress. However, this study did not find a mediating effect of voluntary overtime on the WTC-WFC relationship. Limitations and practical implications are discussed.

Major Depressive Disorder and Difference between Genders

Background

Depression is a common mental disorder and represents a global mental health concern. Presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration. Epidemiologic research have found clear genders differences in the prevalence of Major depressive disorders (MDD).

Objective

The aim of this study was to find the difference in the symptoms of Major depressive disorder (MDD) between genders.

Methods

It was analyzed 92 subjects from Health Center Zivinice in the period from September 2019 to May 2021, of which 57 (62 %) are women and 35 (38%) are men. The study identified and measured the severity of 25 different symptoms of depressive disorders in the analyzed subjects. The average age of women is 56 years ± 8.88, and the average age of men is 52 years ± 11.03. Statistical data were analyzed in SPSS statistical program.

Results

Comparing the results t tests revealed significant difference between genders in symptoms like depressed mood, lack of energy, psychomotor retardation, pessimistic attitude towards the future. Symptoms such as angry outbursts, irritability from frustration, even over small matters, frequent or recurrent thoughts of death, suicidal thoughts suicide attempts and impulsive reaction, risky behaviour statistical significance in men in relation to women.

Conclusion

In this study it was confirmed that MDD is more often diagnosed in women and showing different ways of experiencing, expressing and dealing with the symptoms of MDD. Women complained more about the typical symptoms of depressive disorder according, while men complained more about anger, irritability, waking up early in the morning and alcohol abuse.

Gender differences among medical students, house staff, and faculty physicians at high risk for suicide: A HEAR report

BACKGROUND

In comparison with the general population, physicians, and physicians-in-training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians-in-training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help-seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide.

METHODS

We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017.

RESULTS

High-risk female trainees and physicians had higher mean Patient Health Questionnaire-9 (PHQ-9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High-risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow-up (9.4% vs. 4.3%). There were no gender differences in help-seeking behaviors.

CONCLUSIONS

This is the first study to report gender differences among risk factors, presentation, and help-seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at-risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.

Gender differences in dynamic functional connectivity based on resting-state fMRI

Many neuroscience studies have found brain differences lead to the gender differences in behavior and cognitive ability. Functional connectivity is a common and effective measure to characterize brain. Most current studies based on fMRI functional connectivity basically assumed temporal stationarity across the duration of scanning, and thought that brain functional connectivity was constant in a certain period of time. However, some studies revealed that the functional connectivity was dynamic and fluctuant over time. Dynamic functional connectivity could more accurately describe changes in neural activity. A high value of flexibility indicates frequent interactions between regions. In this article, gender differences in global brain flexibility were further investigated, and twelve brain regions with significantly flexibility differences were found. The female's flexibility is lower than male's in the amygdala, hippocampus, and parahippocampal gyrus. And in the temporal lobe, precuneus, middle cingulate gyrus, superior occipital gyrus, and inferior occipital gyrus the flexibility of male group is lower than female group. The findings may improve the understanding and provide new insights into gender differences on behaviors and cognition from the perspective of resting-state brain function.

Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS)

The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.

Depressive symptoms in mothers after perinatal and early infant loss in rural Bangladesh: a population-based study

PURPOSE

We examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first 6 months postpartum.

METHODS

We performed secondary analyses using data from 41,348 married women aged 13-44 years, originally collected for the JiVitA-1 study (2001-2007) in northwest Bangladesh. Adjusted relative risk ratios were estimated to determine the associations between stillbirth and early infant death and women's risk of reported depressive symptoms (trichotomized 0, 1-2, 3-5) up to 6 months after the death. Adjusted risk ratios, comparing 0-2 versus 3-5 depressive symptoms, were used in stratified analyses.

RESULTS

Women having fetal/infant deaths had elevated risk of experiencing 1-2 postpartum depressive symptoms (adj RRRs between 1.2 and 1.7) and of experiencing 3-5 postpartum depressive symptoms (adj RRRs between 1.9 and 3.3), relative to women without a fetal/infant death. Notably, those whose infants died in the early postneonatal period had over a three-fold risk of 3-5 depressive symptoms (adj relative risk ratio [RRR] = 3.3; 95% confidence interval [CI], 2.6-4.3) compared to a two-fold risk for women experiencing a stillbirth (adj RRR = 1.9; 95% CI, 1.7-2.1). After early postneonatal deaths, women with higher levels of education were more likely to suffer 3-5 depressive symptoms (adj relative risk [RR] = 10.6; 95% CI, 5.2-21.7, ≥10 years of education) compared to women with lower levels of education (adj RR = 2.0; 95% CI, 1.6-2.4, no education; adj RR = 2.2; 95% CI, 1.6-2.9, 1-9 years of education).

CONCLUSIONS

Women's mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.

Serotonin and Female Psychopathology

There are sex differences in the prevalence and presentation of many psychiatric disorders. Various trends in symptomatology have emerged that are thought to be linked to periods of hormonal fluctuations such as with menses, pregnancy or menopause. With data from animal and human studies, it has become clear that there is an important interplay between the serotonergic system and gonadal hormones. The majority of the research to date has focused on the influence that estrogen has within the CNS and, in particular, how it leads to an overall increase in serotonin synthesis and availability. In reviewing this female-specific topic we hope to raise awareness to sex/gender differences in psychopathology, help identify at-risk populations and consider development of new treatment options. Future research will also need to consider the influence that progesterone and oxytocin may have on sex-specific psychopathology as well as incorporate neuroimaging and consider the influence of hormones on the serotonergic system at a genetic level.

Committed dating relationships and mental health among college students

OBJECTIVE

To examine whether involvement in committed dating relationships is associated with university students' mental health (depressive symptoms and problem alcohol use, including binge drinking), and whether these associations differ by gender.

PARTICIPANTS

A sample of 889 undergraduate students aged 18 to 25.

METHODS

Self-report measures of dating relationship status, depression, and problematic alcohol use were collected via an online survey from August to December 2010.

RESULTS

Involvement in a committed relationship, compared with being single, was associated with fewer depressive symptoms for college women but not for men. Committed relationship involvement was also associated with less problematic alcohol use for both genders.

CONCLUSIONS

Findings suggest that involvement in committed relationships may be protective to college student mental health, and highlight the potential of healthy relationship programming to benefit student well-being.