Research report
Gender differences in the developmental course of depression

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Abstract

Background

There is ample evidence for female preponderance of major depressive disorder (MDD) in adolescence and adulthood. This study examined gender differences in the developmental course (i.e., incidence, duration, number of depressive episodes, and recovery rates) of MDD in non-referred adolescents and young adults.

Methods

Data from the Oregon Adolescent Depression Project were used to examine gender differences in the developmental course of MDD. Gender differences in the onset, duration, number of depressive episode and rate of recovery from MDD were examined in a population-based sample of the same individuals (participants: N = 773) during adolescence (age 14 to 17) and at age 30.

Results

Compared to males, females have higher incidence rates of MDD and had a more chronic course. Difference in duration of depressive episodes is marginally significant between male and female, with females having longer episodes. Lower onset age correlates significantly with more number of episodes in both genders; however, lower onset age predicts a worse course of depression only in females.

Limitations

The sample was from a single region of the country and consisted mostly of White adolescents.

Conclusions

Childhood depression may be a more serious risk factor for girls than for boys.

Introduction

One of the most consistent findings across studies is the female preponderance of major depressive disorder (MDD) and its emergence in adolescence. Studies of adolescents have reported gender differences consistent with adult populations, about twice as many girls as boys meet the criteria for MDD at some time in their lives (Anderson et al., 1987, Cohen et al., 1993, Essau et al., 2000, Fleming et al., 1989, Kashani et al., 1987, Lewinsohn et al., 1993, Reinherz et al., 1993). The change in the sex ratio usually emerges around puberty (Cohen et al., 1993, Essau et al., 2000, Hankin et al., 1998, Harrington et al., 1990, Petersen et al., 1991), with the greatest increase in gender difference occurring between ages 15 and 18 (Essau et al., 2000, Hankin et al., 1998). Mechanisms underlying this shift in prevalence are still unclear, however, it may reflect the interplay of gender socialization, social and hormonal mechanisms, and stressful events associated with adolescence (Cyranowski et al., 2000).

Although informative, the empirical literature on gender differences in MDD is problematic because of their reliance on cross-sectional studies. Cross-sectional studies do not provide a clear picture of the emergence of gender differences in depression as would a longitudinal study. However, longitudinal studies that followed the same group of individuals in the community and which assess MDD at multiple developmental age stages are rare. Therefore, it is not clear whether the gender difference in depression is due to girls experiencing more first onsets or more recurrence of depression.

Studies among adults (Eaton et al., 1997, Keller and Shapiro, 1981, Kessler et al., 1993) and adolescents (Hankin et al., 1998, Kovacs, 2001) have reported greater number of first onsets of depression in females than in males. Results on gender differences in the duration or recurrence of depression are somewhat inconsistent. For example, an early study by Amenson and Lewinsohn (1981) has shown that women compared to men with a history of depression were more likely to develop a subsequent depressive episode; no gender differences were found for new incidence of depression among those without a history of depression. In a study with older adults, Lewinsohn et al. (1989) found that the probability of depression recurrence was greater for females. In one of the publications of the Oregon Adolescent Depression Project data (OADP), Lewinsohn et al., 2003a, Lewinsohn et al., 2003b reported that girls with MDD were more likely than boys to experience recurrence in childhood or adolescence. Overall, these results suggest that females have more recurrences of depression than males. However, a study by Hankin et al. (1998) failed to find a gender difference in recurrence of depression. Kovacs (2001) similarly found no gender differences in risk of recurrent depressive episodes among the 11–17 year-olds with MDD. These findings seem to fit those found in the National Comorbidity Study (Kessler et al., 1993), in that adult gender difference was due to a greater number of first onsets of depression in women than men, and not to gender differences in the duration or recurrence of depression.

Knowledge on a developmental course for gender difference in depression holds important implications because theories on the development and maintenance of depression should be able to explain when these gender differences begin to emerge and how these differences progress over time. Therefore, the main aim of this study was to try to solve the contradictory findings in the literature on the role of gender on the developmental course of depression. Specifically, we examined gender differences in the number and duration of major depressive episodes, as well as the onset and recovery rates of MDD. We also examined the rates of chronic, new and recovered cases of depression over the 16-year span. To our knowledge, this study is the first to examine gender differences in the course, onset, recovery, and incidence rate of MDD prospectively from adolescence to young adulthood. We used the OADP data on MDD, which has collected this information in a population-based sample of the same individuals at multiple ages from age 14 to age 30.

Section snippets

Participants and procedures

Participants were randomly selected in three cohorts from nine senior high schools representative of urban and rural districts in western Oregon. Data collection has been completed at 4 points. A detailed description of the OADP has been reported in numerous papers (Lewinsohn et al., 2003a, Lewinsohn et al., 2003b, Pettit et al., 2006, Rohde et al., 2007) and therefore we will only make a brief summary of the OADP (Table 1). First, a total of 1709 adolescents (aged 14–19 years; mean = 16.6; SD = 

Number of episodes

The number of lifetime major depressive episodes was evaluated for 2 time periods: up to adolescence (T1 data; N = 1709, Male = 818, Female = 891, participants' age ranged from 14 to 18), and through adulthood (T4 data; N = 773, Male = 313, Female = 460, participants were followed up to age 30). The results are shown in Table 2. Significant gender differences were obtained for both T1 (chi-square (3) = 54.00, p < 0.001) and T4 data (chi-square (5) = 77.96, p < 0.001). Residual analysis for T1 data showed that more

Discussion

A major strength of the present study is its prospective, longitudinal design in which the participants were followed-up for a period of 16 years. This study adds to the literature by demonstrating gender differences in the developmental course of MDD from adolescence to young adulthood using a large sample derived from the general population. Four major findings were obtained.

First, in line with findings of several previous studies (e.g., Hankin et al., 1998, Galambos et al., 2004), females

Role of funding source

This research was supported in part by the National Institute of Mental Health awards MH40501 and MH50522 (Dr Lewinsohn). The NIMH had no further role in study design; in collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

The authors have no conflict of interest to report in relation to the research presented in this manuscript.

Acknowledgement

This research was supported in part by the National Institute of Mental Health awards MH40501 and MH50522 (Dr Lewinsohn).

The authors are grateful to all those who participated in the study.

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