Lead research reportGender differences in depression: Findings from the STAR*D study☆
Introduction
Gender difference in rates of major depressive disorder (MDD) is one of the most consistent findings in epidemiologic research (Nolen-Hoeksema, 1990, Regier et al., 1993), with an unadjusted mean gender ratio of 2.1 (lifetime prevalence) and 1.7 (point prevalence; Kuehner, 2003). In community samples (National Comorbidity Survey), 12.9% experienced MDD within the past 12 months compared to 7.7% of men, with lifetime rates about twice the 12-month rates (Kessler et al., 1994).
While much research has focused upon gender differences in depression, less attention has been paid to comorbidity which often impacts the course of illness. In the National Comorbidity Study, the most frequent disorders comorbid with depression include anxiety, alcohol, substance abuse, and eating disorders. Women were much more likely to have depression comorbid with anxiety, and some data suggest that the increase in anxiety–depression comorbidity may explain the greater lifetime prevalence of depression in women (Breslau et al., 1995). Men were significantly more likely than women to meet criteria for lifetime alcohol and other substance use disorders.
Comorbidity often affects treatment response and symptom presentation. Greater severity and suicidality have been noted in comorbid cases, particularly those with comorbid anxiety (Bronisch and Wittchen, 1994). In a clinical sample, Frank et al. (1988) found no differences in symptom severity, length of illness, or functional impairment in men and women, although the women scored somewhat higher on the self-report Beck Depression Inventory (BDI; Beck et al., 1961). Young et al. (1990) also found that global severity and functional impairment did not distinguish men and women.
Gender-specific symptom patterns may also occur. Women seem to report more appetite and weight increase, hypochondriasis, and somatic concerns, while men report more weight loss (Kornstein et al., 2000, Young et al., 1990). Similar findings are reported in a population of chronically depressed outpatients with more anxiety, somatization, sleep change, and psychomotor symptoms found in women (Kornstein et al., 2000).
Section snippets
Methods
This report evaluates a broadly representative clinical sample of outpatients with nonpsychotic MDD enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D; www.stard.org) trial. The sample provides data on the first 1500 subjects. The analyses are exploratory and aim to identify gender differences in illness characteristics and rates of MDD which will be further analyzed once the full sample (expected n=4041) is acquired.
The rationale and design of STAR*D have been
Results
Table 1 summarizes the baseline characteristics of the entire study population, while Table 2 compares the genders with respect to clinical and demographic variables.
Discussion
The gender prevalence (62.8% women) found in the STAR*D study replicates many previous reports using clinical and epidemiologic samples. The gender ratio of 1.7 seen in women vs. men willing to enroll in STAR*D is identical to that reported in the National Comorbidity Survey (Kessler et al., 1994), and in the worldwide multicenter study conducted by the Cross National Collaborative Group (Weissman et al., 1996).
This finding argues against increased treatment seeking in women, or increased
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This project has been funded with Federal funds from the National Institute of Mental Health, National Institutes of Health, under Contract N01MH90003 to UT Southwestern Medical Center at Dallas (P.I.: A.J. Rush). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.