Depression in Men vs Women: Subtle Differences?

Depression affects everyone; regardless of gender, age, race, belief, or social status. 

Let’s all focus on the gender aspect. How does depression differ between men and women? 

According to the World Health Organization, gender is a vital determinant of mental health and mental illness. Across different countries and different settings; depression, anxiety, psychological distress, and domestic violence poses a more significant effect on women compared to men. 

So, what are the subtle differences that can be observed in men and women, regarding depression? 

1. Women are more likely to be diagnosed with depression compared to men

• 

Psych2goers, let’s take a look at your group of friends or acquaintances. Among them, how many do you know have been diagnosed with depression (if they ever disclose their diagnosis to you)? How many of them are men, and how many of them are women? 

One of the most robust discoveries in psychiatric epidemiology is the gender difference in depression. As stated in a comprehensive review of nearly all general population studies in the United States of America, Puerto Rico, Canada, France, Iceland, Taiwan, Korea, Germany, and Hong Kong conducted by Piccinelli & Homen (1997), there are higher lifetime prevalence rates of major depression among women than men. 

It is also predicted that by 2020, unipolar depression is going to be the second leading cause of global disability burden, and this occurs twice as often in women than men (World Health Organization, n.d.)

Why do these differences happen? 

It is postulated that this can be due to molecular and genetic changes. According to a 2018 study published in the journal Biological Psychiatry, postmortem brain tissue samples from 50 subjects were examined by a group of researchers, to investigate if there were any distinction between the brains of people who had received the diagnosis of major depressive disorder and those who had not. They evaluated the gene expression in three different brain regions which were linked to mood regulation. One of the key differences observed was that there was more expression of the genes which determine synaptic activity in female brains compared to male brains. Apart from that, in several cases, the male brain experienced an opposite change compared to the female brain. For instance, gene expression in a particular region of the male brain was decreased when the gene expression of the same region of the female brain was increased. However, the limitation of this research was that the brains were only examined after death, thus it is not transparent whether or not people living with depression experienced similar genetic changes (Seney et al., 2018). 

Another possible explanation for such difference is that women experienced specific hormonal changes which could influence the onset of depression (Kuehner, 2017). During pregnancy, childbirth, and lactation, women experienced hormonal changes, and coupled with the psychological stress of becoming a parent, women are more vulnerable to postpartum depression (Brummelte & Galea, 2010). 

2. Men is more likely to die by suicide compared to women 

• 

Psych2goers, do you know that there is also gender disparity noted when the suicide rate was analyzed in multiple countries? 

Okay, first, let’s take a look in the UK. According to the Mental Health Foundation in the UK, men are three times more likely to die by suicide compared to women. The rate of women who die by suicide in the UK was a third of men’s, which translates to 4.9 suicides per 100,000. 

Next, let’s travel to Australia. It is reported that three times as many men as women die by suicide (Australian Bureau of Statistics, 2018). In the US, in 2019, men are 3.63 times more likely to die by suicide, whereas in Russia and Argentina, men are four times more likely to die by suicide compared to women. 

However, this is different when we talk about suicide attempts. It is reported that suicide attempt is more common among women compared to men. For example, in the US, there was 1.5 times as many women who attempted suicide compared to men. One reason to this statistic is that, men are more likely to resort to a more violent suicide attempt (eg guns and firearms), thus they are more likely to complete their attempt before any intervention. 

3. Men are less likely to access psychological therapies than women 

“Let’s go and get you examined for your mental health, it seems that your behaviour has changed recently. You said to me that you are unable to focus at your workplace,” you said to your significant other. 

“No, no need. I can still manage.” 

According to Yousaf (2015), men exhibit more negative attitudes towards psychological therapies compared to women. They are less willing to seek help from mental health services.  The United Kingdom’s Improving Access to Psychological Therapies (IAPT) service that offers evidence-based psychological treatments for depression and anxiety receives 36% male referrals (NHS Digital, 2016).  

4. Men are more likely to use potentially harmful coping methods (alcohol abuse and other substances) 

Your brother has just lost his fiancee due to a terminal illness. You notice that he never cries in front of you, he never confesses about his sadness, instead he always tries to work overtime and during his off day from work, he plays video games continuously for many hours. 

The societal pressure often pushes men to resort to a more stoic approach when they deal with depression. They are less likely than women to express freely what they feel with their partner or friend. When they are hindered from expressing their feelings openly, these negative feelings can appear in other forms. For instance, repressed feelings of sadness cause them to potentially resort to negative coping behaviours such as explosive anger, substance abuse, risk-taking behaviour (eg reckless driving or having unprotected sex), and escapism (e.g. playing video games for hours, working late) (Schimelpfening & Snyder, 2020). 

5. Women may respond differently to stressful life events 

• 

Family crises, financial difficulties, job pressures. These are stressful events that we can experience in our lives. It is reported that there were significant differences on how women and men respond to stressful life events. Women produce hormones like adrenaline and cortisol in response to stress. Apart from that, they also produce higher levels of oxytocin, a hormone that can encourage bonding and affection for others. Therefore, women tend to respond to stress by reaching out for social connection and support and by seeking to protect others in their lives, known as the “tend and befriend” response. On the other hand, men are more likely to react to stress by producing cortisol and adrenaline, which lead to “fight and flight” responses such as sweaty palms, racing heart beats, and having the impulse to either fight or escape a difficult situation (Collier & Lloyd III, 2021).  

6. Men’s symptoms of depression may be harder for others to recognize

You notice your son is becoming more irritable recently. He also becomes less interested in spending time outdoors and gets involved in his hobbies (hiking, fishing). 

A report from National Institute of Mental Health (NIMH) stated that approximately six million American men suffer from depression every year. Although the idea of a “male-based depression” is only recently postulated, researchers and clinicians are coming to believe that men are less likely to experience “cliché” signs of depression such as sadness, worthlessness, or excessive guilt, instead, they are more likely to experience fatigue, irritability, abusive anger, loss of interest in work or hobbies, and sleep disturbances when they are depressed. 

Final thoughts 

According to a clinical psychologist, Dr. R. Kathryn McHugh, there is emerging evidence for the benefits of sex- or gender-informed treatment. However, we should avoid focusing solely on the aspect of biology alone as depression can also involve a complex interplay of social role expectations, gender discrimination, and violence. It is wrong to assume that these differences are strictly biological or strictly cultural. 

REFERENCES 

American Foundation for Suicide Prevention. (2021, September 9). Suicide statistics. American Foundation for Suicide Prevention. Retrieved September 15, 2021, from https://afsp.org/suicide-statistics/.

Brummelte S, Galea LA. Depression during pregnancy and postpartum: contribution of stress and ovarian hormones. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(5):766-776. doi:10.1016/j.pnpbp.2009.09.006

‘Causes of Death’, 26 Sep 2018, Australian Bureau of Statistics, http://www.abs.gov.au/Causes-of-Death

Collier, L., & Lloyd III, W. C. (2021, April 9). How men and women deal with stress. Healthgrades. Retrieved September 15, 2021, from https://www.healthgrades.com/right-care/mental-health-and-behavior/how-men-and-women-deal-with-stress.

Kuehner C. Why is depression more common among women than among men? The Lancet Psychiatry. 2017;4(2):146-158. doi:10.1016/S2215-0366(16)30263-2

National Institute of Mental Health. Real Men. Real Depression. Web site retrieved June 15, 2005: http://menanddepression.nimh.nih.gov. Washington, DC: National Institute of Mental Health.

NHS Digital, N. A. (2016). Psychological therapies: Annual report on the use of IAPT services – England, 2015–16. Retrieved from http://webarchive.nationalarchives.gov.uk/20180328133700/http://digital.nhs.uk/catalogue/PUB22110

Piccinelli, M. and Homen, F.G. (1997). Gender differences in the epidemiology of affective disorders and schizophrenia. Geneva: World Health Organization. 

Schimelpfening, N., & Snyder, C. (2020, November 30). What are the differences of depression symptoms between the sexes? Verywell Mind. Retrieved September 15, 2021, from https://www.verywellmind.com/difference-between-male-and-female-depression-symptoms-3892841#citation-24.

Seney ML, Huo Z, Cahill K, et al. Opposite Molecular Signatures of Depression in Men and Women. Biol Psychiatry. 2018;84(1):18-27. doi:10.1016/j.biopsych.2018.01.017

The impact of age and gender on Mental Health. The Impact of Age and Gender on Mental Health | McLean Hospital. (2020, July 22). Retrieved September 15, 2021, from https://www.mcleanhospital.org/essential/impact-age-and-gender-mental-health.

World Health Organization. (n.d.). Gender and women’s mental health. World Health Organization. Retrieved September 15, 2021, from https://www.who.int/teams/mental-health-and-substance-use/gender-and-women-s-mental-health.

Yousaf O., Popat A., Hunter M. S. (2015). An investigation of masculinity attitudes, gender and attitudes toward psychological help-seeking. Psychology of Men & Masculinity, 16(2), 234–237.