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Cross-National Associations Between Gender and Mental Disorders in the World Health Organization World Mental Health Surveys
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CONTEXT: Gender differences in mental disorders, including more anxiety and mood disorders among women and more externalizing disorders among men, are found consistently in epidemiological surveys. The gender roles hypothesis suggests that these differences narrow as the roles of women and men become more equal. OBJECTIVES: To study time-space (cohort-country) variation in gender differences in lifetime DSM-IV mental disorders across cohorts in 15 countries in the World Health Organization World Mental Health Survey Initiative and to determine if this variation is significantly related to time-space variation in female gender role traditionality as measured by aggregate patterns of female education, employment, marital timing, and use of birth control. DESIGN: Face-to-face household surveys. SETTING: Africa, the Americas, Asia, Europe, the Middle East, and the Pacific. PARTICIPANTS: Community-dwelling adults (N = 72,933). MAIN OUTCOME MEASURES: The World Health Organization Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of 18 DSM-IV anxiety, mood, externalizing, and substance disorders. Survival analyses estimated time-space variation in female to male odds ratios of these disorders across cohorts defined by the following age ranges: 18 to 34, 35 to 49, 50 to 64, and 65 years and older. Structural equation analysis examined predictive effects of variation in gender role traditionality on these odds ratios. RESULTS: In all cohorts and countries, women had more anxiety and mood disorders than men, and men had more externalizing and substance disorders than women. Although gender differences were generally consistent across cohorts, significant narrowing was found in recent cohorts for major depressive disorder and substance disorders. This narrowing was significantly related to temporal (major depressive disorder) and spatial (substance disorders) variation in gender role traditionality. CONCLUSIONS: While gender differences in most lifetime mental disorders were fairly stable over the time-space units studied, substantial intercohort narrowing of differences in major depression was found to be related to changes in the traditionality of female gender roles. Additional research is needed to understand why this temporal narrowing was confined to major depression.
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“These studies found a relationship between gender roles and anxiety. 54”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [54]
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In the citing paper
“MDD occurs about twice as often in women than in men”
From Major depressive disorder (2016) · cites this paper as [2]
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“The results seem to indicate that gender socialization is, at least in part, responsible for the development of the psychosocial characteristics that act as risk factors for women and protective factors for men in the onset and course of anxiety.44,54,56,59,64,70”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [54]
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In the citing paper
“Note, however, that one study showed a single association in which the sex difference in depression diagnosis, instead, is smaller in countries with higher living conditions (Seedat et al., 2009).”
From A Systematic Review and New Analyses of the Gender-Equality Paradox (2025) · cites this paper as Seedat et al., 2009
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“Seedat and colleagues (2009) found a significant narrowing in the gender difference in depression in recent cohorts.”
From Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms (2017) · cites this paper as Seedat et al., 2009
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“Although SUDs remain more prevalent in men than in women, the gender gap has been narrowing 150,328- 330 , possibly in part due to changes in gender roles 331 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [331]
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“An epidemiological phenomenon consists in the repeatedly described sex differences in prevalence rates of MDD 2”
From Major depressive disorder (2016) · cites this paper as [2]
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In the citing paper
“Despite a similar prevalence of general mental health problems for men and women in both low- and high-income countries [7], men are less likely than women to seek formal treatment for mood and anxiety disorders [8].”
From Masculinity and mental health treatment initiation for former political prisoners in Yangon, Myanmar – a qualitative investigation (2021) · cites this paper as [7]
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“The authors concluded that prevention of depression seems feasible and psychological intervention may be an effective way to delay or prevent the onset of depressive disorders.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [449]
In the citing paper
“A meta-analysis of 32 RCTs (6,214 participants) of psychological interventions of various types among adults found that the chance of developing a depressive disorder was 21% lower than in the control groups. 449”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [449]
In the citing paper
“Many psychiatric disorders show a different prevalence or onset in males and females (Seedat et al., 2009).”
From Defining the genetic, genomic, cellular, and diagnostic architectures of psychiatric disorders (2019) · cites this paper as Seedat et al., 2009
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Metadata
- Authors
- Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet, E. J., Brugha, T. S., Demyttenaere, K., de Girolamo, G., Haro, J. M., Jin, R., Karam, E. G., Kovess-Masfety, V., Levinson, D., Medina Mora, M. E., Ono, Y., Ormel, J., Pennell, B.-E., Posada-Villa, J., Sampson, N. A., Williams, D., & Kessler, R. C.
- Affiliations
- Medical Research Council (GB)
- University of Otago (NZ)
- University of Michigan (US)
- State University of New York (US)
- University of Leicester (GB)
- Universitair Ziekenhuis Leuven (BE)
- Instituto de Salud Carlos III (ES)
- Harvard University (US)
- Saint George Hospital (LB)
- Israel Ministry of Health (IL)
- Keio University (JP)
- University Medical Center Groningen (NL)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2009-07-01
- Volume
- 66
- Issue
- 7
- Pages
- 785
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC2810067
- OpenAlex
- W1990663212
- Cited by
- 1,518
- References
- 59
- Citations by year
- 2026: 104 · 2025: 140 · 2024: 135 · 2023: 137 · 2022: 111 · 2021: 127 · 2020: 167 · 2019: 88 · 2018: 61 · 2017: 94 · 2016: 56 · 2015: 58 · 2014: 57 · 2013: 55 · 2012: 47
- FWCI
- 55.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust (R01-MH069864, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- World Health Organization
- Kaiser Permanente
- University of Michigan
- European Commission (1999-01042, QLG5–1999-01042, SANCO2004123, 2004123)
- Generalitat de Catalunya (01042, RETICS RD06/0011 REM-TAP, CB06/02/0046)
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Shire
- Regione Piemonte (00/0028)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization (FIRCA R03-TW006481)
- Instituto de Salud Carlos III (CB06/02/0046, RETICS RD06/0011 REM-TAP, RETICS RD06/0011, RD06/0011, FIS 00/0028, CIBER CB06/02/0046)
- Departament de Salut, Generalitat de Catalunya (CB06/02/0046, RETICS RD06/0011 REM-TAP)
- National Institute of Mental Health (R13-MH-066849, RO1-MH61905, R0 1-MH61905, R01‐MH070884, MH61905, U01-MH-60220, R01MH061905, R01MH059575, MH60220, HHSN271200700030C, MH069864, U13MH066849, MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (FIRCA R03TW006481, R03 TW0006481, R03TW006481)
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Gender Studies › Gender Roles and Identity Studies
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Keywords
- gender differences in mental illness, anxiety disorders, mood disorders, major depressive disorder, substance use disorders, externalizing disorders, lifetime prevalence, age of onset, cohort variation, cross-national variation, women's education and employment, contraceptive use
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Mental Disorders, Cross-Cultural Comparison, Depressive Disorder, Major, Major Depressive Disorder, Developing Countries, Female, Gender Identity, Health Surveys, Humans, Internal-External Control, Male, Middle Aged, Risk, World Health Organization, Cohort Studies, Developed Countries, Substance-Related Disorders, Young Adult
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