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Adolescent Onset of the Gender Difference in Lifetime Rates of Major Depression: A Theoretical Model
Abstract
Prepubescent boys are, if anything, more likely than girls to be depressed. During adolescence, however, a dramatic shift occurs: between the ages of 11 and 13 years, this trend in depression rates is reversed. By 15 years of age, females are approximately twice as likely as males to have experienced an episode of depression, and this gender gap persists for the next 35 to 40 years. We offer a theoretical framework that addresses the timing of this phenomenon. First, we discuss the social and hormonal mechanisms that stimulate affiliative needs for females at puberty. Next, we describe how heightened affiliative need can interact with adolescent transition difficulties to create a depressogenic diathesis as at-risk females reach puberty. This gender-linked vulnerability explains why adolescent females are more likely than males to become depressed when faced with negative life events and, particularly, life events with interpersonal consequences.
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“There now is consensus that the gender difference in depression has a multifactorial etiology”
From Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms (2017) · cites this paper as Cyranowski et al., 2000
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“In the context of the established gender difference in depression that emerges between ages 11 and 14, with levels rising more in girls than boys (Cyranowski et al., 2000), we examine whether any increase in young adolescent mental health symptoms is moderated by child gender.”
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“With profoundness of the sudden gender difference in depression as a backdrop, several etiological models have been developed to account for this phenomenon (Cyranowski et al., 2000; Hankin & Abramson, 2001; Hankin et al., 2007; Hyde & Mezulis, 2020; Hyde et al., 2008; Nolen-Hoeksema & Girgus, 1994).”
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“This sex difference is particularly noteworthy because several theories suggest that the female bias in mood and anxiety disorders that emerges during adolescence may relate to sex differences in emotional responsiveness and social relationships that become particularly marked during the same period ( Cyranowski, Fran…”
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“For example, youth with elevated depressive symptoms are more likely to be female (Cyranowski et al. 2000), have less educated parents (Goodman, Slap, and Huang 2003), have single parents and less support (Carlson 2006), and lower self-esteem (Dumont and Provost 1999).”
InfluentialOuyang, M., Gui, D., Cai, X., Yin, Y., Mao, X., Huang, S., Zeng, P., & Wang, P. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.603511 · Cited by 71
“According to the cognitive vulnerability-stress model of depression (Cyranowski et al., 2000), female adolescents compared with their male counterparts tend to rate life events as more negative and less controllable (Matud, 2004), and use more passive strategies (e.”
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“Furthermore, in addition to alternative measurement strategies, it is important to consider multiple reward modalities (Forbes, 2009; Forbes & Goodman, 2014; Kohls, Peltzer, Herpertz-Dahlmann, & Konrad, 2009).”
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“…stress, elevated reactivity to these stressors when they occur, greater affiliative focus, and/or different responses to peer stress compared to boys (e.g., Bukowski & Adams, 2005; Crick & Zahn-Wax-ler, 2003; Cyranowski et al., 2000; Nolen-Hoek-sema, 2001; Rose & Rudolph, 2006; Rudolph, 2002).”
Depression in children and adolescents: Does gender make a difference?
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“For instance, while depression rates are roughly equal among prepubescent boys and girls, the rate increases dramatically once girls reach puberty, where, by age 15, females are twice as likely as males to have had an episode of depression [120].”
BackgroundResilience to depression: Implication for psychological vaccination
Dai, Q., & Smith, G. D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1071859 · Cited by 60
“Although quite a few studies have reported that depression is twice as common in women than in men (26, 27).”
BackgroundLi, J., Tian, L., & Ouyang, W. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.882361 · Cited by 50
“Therefore, for elderly males, higher land-use mix has a greater impact on physical activity by providing diverse places for physical activity to meet their exercise needs, and improve their subjective wellbeing (79, 80).”
BackgroundSaylor, R. A., Hersey, M., West, A. M., Buchanan, A. M., Berger, S. N., Nijhout, H. F., Reed, M. C., Best, J. A., & Hashemi, P. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00362 · Cited by 56
“Clinical depression is more than twice as prevalent in adult females than males (Weissman and Klerman, 1977; Kessler et al., 1993; Hankin et al., 1998; Cyranowski et al., 2000; Piccinelli and Wilkinson, 2000; Grigoriadis and Robinson, 2007) and antidepressants exert varying degrees of efficacy by sex (Frackiewicz et a…”
BackgroundEpigenetic Modulation of Mood Disorders
Archer, T. (2013) · Journal of Genetic Syndromes & Gene Therapy · doi:10.4172/2157-7412.1000120 · Cited by 52
“Female sufferers from the disorder remain almost twice as many as male sufferers with the relative gender proportions evident already during adolescence [9].”
BackgroundGender–age interaction in incidence rates of childhood emotional disorders
Wesselhoeft, R., Pedersen, C. B., Mortensen, P. B., Mors, O., & Bilenberg, N. (2015) · Psychological Medicine · doi:10.1017/s0033291714001901 · Cited by 52
“…al. 2011; Bufferd et al. 2012; Vicente et al. 2012), or that it is either equal or slightly higher for boys (McGee et al. 1992; Angold et al. 1998; Almqvist et al. 1999; Cyranowski et al. 2000; Rutter et al. 2003; Steiner, 2003; Zahn-Waxler et al. 2008; Carballo et al. 2011; Wichstrom et al. 2012).”
BackgroundKim, J., Kang, S., Choi, T.-Y., Chang, K., & Koo, J. W. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2022.01.006 · Cited by 57
Adolescent Depression in the Arab Region: A Systematic Literature Review
Dardas, L. A., Bailey, D. E., & Simmons, L. A. (2016) · Issues in Mental Health Nursing · doi:10.1080/01612840.2016.1177760 · Cited by 52
Becker, S. P., McBurnett, K., Hinshaw, S. P., & Pfiffner, L. J. (2013) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.828298 · Cited by 55
Incidence and Cost of Depression After Occupational Injury
Asfaw, A., & Souza, K. (2012) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e3182636e29 · Cited by 48
A Multilevel Analysis of Gender Differences in Psychological Distress Over Time
Botticello, A. (2009) · Journal of Research on Adolescence · doi:10.1111/j.1532-7795.2009.00591.x · Cited by 45
Aznar, M. P. M. (2008) · Dialnet (Universidad de la Rioja) · doi:10.14349/sumapsi2008.17 · Cited by 16
Steinsbekk, S., Nesi, J. L., & Wichstrøm, L. (2023) · Computers in Human Behavior · doi:10.1016/j.chb.2023.107859 · Cited by 66
“Adolescence is a period of social reorientation from the nuclear family towards friends and changing friendships in the process of identity formation (Marcia, 1980), which often involves an increase in potentially stressful interpersonal events (e.g., Cyranowski, Frank, Young, & Shear, 2000).”
BackgroundHjetland, G. J., Finserås, T. R., Sivertsen, B., Colman, I., Hella, R. T., & Skogen, J. C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191711133 · Cited by 69
Roberts, A. L., Chen, Y., Slopen, N. B., McLaughlin, K. A., Koenen, K. C., & Austin, S. B. (2015) · Depression and Anxiety · doi:10.1002/da.22395 · Cited by 51
“As strong sex differences in the prevalence of depression emerge in adolescence and persist into adulthood,[54] we investigated whether associations between maternal abuse and offspring depressive symptoms differed by offspring’s sex.”
BackgroundA longitudinal perspective on childhood adversities and onset risk of various psychiatric disorders
Oldehinkel, A. J., & Ormel, J. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0540-0 · Cited by 55
PARENTAL FAMILISM AND ANTISOCIAL BEHAVIORS: DEVELOPMENT, GENDER AND POTENTIAL MECHANISMS
Morcillo, C., Duarte, C., Shen, S., Blanco, C., Canino, G., & Bird, H. (2011) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1016/j.jaac.2011.01.014 · Cited by 47
Brief psychotherapy for maternal depression: impact on mothers and children
Swartz, H. A., Cyranowski, J. M., Cheng, Y., Zuckoff, A., Brent, D. A., Markowitz, J. C., Martin, S., Amole, M. C., Ritchey, F., & Frank, E. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2016.04.003 · Cited by 46
Self-citationSocial Fragmentation and Schizophrenia: A Systematic Review
Ku, B. S., Compton, M., Walker, E., & Druss, B. (2021) · Journal of Clinical Psychiatry · doi:10.4088/jcp.21r13941 · Cited by 46
“43 Although the causal direction of social fragmentation and psychosis is still unclear, several studies 6,18,21,22 have proposed that chronic social stress may partially explain the relationship between area-level characteristics measuring social fragmentation and psychosis.”
Metadata
- Authors
- Cyranowski, J. M., Frank, E., Young, E., & Shear, M. K.
- Affiliations
- University of Pittsburgh Medical Center (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2000-01-01
- Volume
- 57
- Issue
- 1
- Pages
- 21
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2025113055
- Cited by
- 1,276
- References
- 0
- Citations by year
- 2026: 32 · 2025: 44 · 2024: 57 · 2023: 51 · 2022: 69 · 2021: 72 · 2020: 77 · 2019: 49 · 2018: 43 · 2017: 83 · 2016: 44 · 2015: 72 · 2014: 51 · 2013: 53 · 2012: 53
- FWCI
- 30.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-18269, T32MH018269)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- adolescent depression, gender differences, major depressive disorder, puberty, endocrine effects, adolescent transition, diathesis
- MeSH terms
- Adolescent, Adult, Age Factors, Depressive Disorder, Humans, Interpersonal Relations, Life Change Events, Models, Psychological, Puberty, Risk Factors, Sex Factors, Socialization, Age of Onset, Sex Distribution
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