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Gender Differences in diagnosing depression

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Gender issues in diagnosing depression arise due to physician bias and patient reporting bias.

Physicans have biases about gendered behaviour based on their own experiences-- this can affect how they make diagnostic decisions. Some studies have found that physicians tend to inquire more about depressive symptoms in female patients, and given the same symptoms, diagnose women with depression more often than men. This can lead to overdiagnosing depression in women and underdiagnosing depression in men[1].

Men:

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  • tend not to recall depressive symptoms as often as women when asked about them by their doctor[2].

  • tend to have history of substance or alcohol abuse by the time they present with depression[3].

  • tend to notice effects of depression on their work life before their social life[4].

  • tend to present at a later stage of depression, when symptoms become severe, to specialist service[1].

Women:

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Creative Commons Attribution License. Image by Sam Fentress.
  • report the following symptoms more often than men[4] [2]: Increased/decreased appetite, increased/decreased weight, sleep disturbances, anxiety, somatization, psychomotor retardation, anger, feelings of failure, crying.

  • tend to report mental health concerns to family physician at an early stage of the disease[1].

  • tend to use outpatient services more than men[1].

  • are more likely than men to suffer from somatic symptoms, comorbid anxiety, and atypical depression[5].

  • tend to be aware of the way depression affects on marital or relationship adjustment[4].

  • are more likely to experience distress, or perceive themselves as having an emotional problem, even if they have the same symptoms as men.

  • report symptoms of depression to physicians more often than men (2/3 of women vs. 1/3 of men)[6].

  • report poor health status or physical symptoms to physicians more often than men do[4] [7].

 

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1. World Health Organization, Gender and Mental Health, Report June 2002.http://www.who.int/gender/other_health/en/

2. Angst J & Dobler-Mikolo A (1984). Do the diagnostic criteria determine the sex ratio in depression? Journal of Affective Disorders; 7:189-198.

3. Fava M, Abraham M, Alpert J, Nierenberg AA, Pava JA, Rosenbaum JF(1996). Gender differences in axis 1 co-morbidity among depressed outpatients. Journal of Affective Disorders; 38:129-133.

4. Kornstein SG, Schatzberg AF, Thase ME, Yonkers KA McMullough JP, Keitner GI, Gelenberg AJ, Davis SM, Harrison WM, Keller MB (2000) Gender differences in treatment responses to sertraline versus imiprimine in chronic depression. American Journal of Psychiatry; 157:1445-1452.

5. Kuehner C (2003) Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavia 108(6):406, 163-74.

6. Ernst C, Angst J (1992). The Zurich Study XII. Sex Difference in Depression. Evidence from longitudinal epidemiological data. European Archives of Psychiatry Clinical Neuroscience 241:222-30.

7. Kroenke K, and Spitzer RL (1998). Gender differences in the reporting of physical and somatoform symptoms. Psychosomatic Medicine 60(2):150-5.

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