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Sex and depression in the National Comorbidity Survey, I: lifetime prevalence, chronicity and recurrence
Abstract
Basic epidemiologic prevalence data are presented on sex differences in DSM-III-R major depressive episodes (MDE). The data come from the National Comorbidity Survey (NCS), the first survey in the U.S. to administer a structured psychiatric interview to a nationally representative sample of the general population. Consistent with previous research, women are approximately 1.7 times as likely as men to report a lifetime history of MDE. Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s. Women also have a much higher rate of 12-month depression than men. However, women with a history of depression do not differ from men with a history of depression in either the probability of being chronically depressed in the past year or in the probability of having an acute recurrence in the past year. This means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset. The implications of these results for future research are discussed in a closing section of the paper.
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“It is primarily girls who account for the increase in adolescence,2,3 evidencing a 2:1 sex difference in depression that continues throughout the reproductive years.4”
From Subthreshold Symptoms of Depression in Preadolescent Girls Are Stable and Predictive of Depressive Disorders (2008) · cites this paper as [4]
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Dudek, K. A., Dion-Albert, L., Lebel, M., LeClair, K., Labrecque, S., Tuck, E., Ferrer Perez, C., Golden, S. A., Tamminga, C., Turecki, G., et al. (2020) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1914655117 · Cited by 361
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Elgar, F. J., Mills, R. S. L., McGrath, P. J., Waschbusch, D. A., & Brownridge, D. A. (2007) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-007-9145-0 · Cited by 359
“We expected but did not find a higher rate of depressive symptoms among mothers than among fathers (Kessler et al. 1993).”
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“Sexually dimorphic development of stresssensitive corticostriatal-limbic regions(30-33) has been suggested to contribute to sex differences in psychiatric disorders, such as in regions subserving emotions and in increased depression risk in females, and in regions subserving impulse control and in increased risk for s…”
The neural correlates of sex differences in emotional reactivity and emotion regulation
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“The past-year GAD prevalence of 7.0% averaged across ages 18 to 32 for the Dunedin cohort is comparable to the past-year prevalence of 5.5% across all ages in the NCS (Kessler et al. 2005) (published NCS data did not allow a comparison matched on age group).”
MethodResultInfluentialGender differences in the developmental course of depression
Essau, C. A., Lewinsohn, P. M., Seeley, J. R., & Sasagawa, S. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.05.016 · Cited by 346
“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.”
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Murphy, J. M., Laird, N. M., Monson, R. R., Sobol, A. M., & Leighton, A. H. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.3.209 · Cited by 318
“One is that the prevalence of MDE is about twice as high among women as men, and the other is that both lifetime and recent prevalence rates are higher among younger than older persons.(1-7,34-36,41,53-57) The results from the 1952 and 1970 samples in Stirling County were not congruent with these DIS and CIDI results.”
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“The female preponderance of depression and its emergence in adolescence are among the most robust findings in the field of psychology (e.g., Ge, Conger, & Elder, 2001; Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993; Wade, Cairney, & Pevalin, 2002).”
BackgroundSex, Steroids, and Sleep: A Review
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“For example, it is well-established that there is no gender difference in depression before early adolescence [3], the gender difference in depression emerges between ages of 11 and 15 [4], and that the size of the gender difference increases into adulthood when it apparently levels off [5].”
BackgroundSex Differences in the Pathways to Major Depression: A Study of Opposite-Sex Twin Pairs
Kendler, K. S., & Gardner, C. O. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13101375 · Cited by 307
“Most studies have reported either no sex difference in rates of recurrence (1) or a higher risk in females (59), whereas we found that past history was more predictive of risk for major depression in men.”
BackgroundRisk factors for chronic depression—a systematic review
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“W OMEN AND MEN are at risk for different types of stress-related disorders, with women at greater risk for depression and anxiety and men at greater risk for alcohol-use disorders (Kajantie and Phillips, 2005; Kessler et al., 1993).”
BackgroundDepression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005–2009
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“Although the high female to male sex ratio in the prevalence of depression, especially during the reproductive years, is one of the most replicated findings in epidemiology (1), the explanation remains uncertain.”
BackgroundGender differences in bipolar disorder
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BackgroundIntegrating Interleukin-6 into depression diagnosis and treatment
Hodes, G. E., Ménard, C., & Russo, S. J. (2016) · Neurobiology of Stress · doi:10.1016/j.ynstr.2016.03.003 · Cited by 271
“There are implications that sex differences in the immune system may contribute to the greater incidence of depression in women (Kessler et al., 1993).”
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A wavelet-based technique to predict treatment outcome for Major Depressive Disorder
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Depression in neurodegenerative diseases: Common mechanisms and current treatment options
Galts, C., Bettio, L. E. B., Jewett, D. C., Yang, C. C., Brocardo, P. S., Rodrigues, A. L. S., Thacker, J. S., & Gil‐Mohapel, J. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.04.002 · Cited by 278
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“These observations might partially explain the greater incidence of MDD in women than men (Kessler et al., 1993), but these experiments need to be repeated in much larger cohorts of depressed and control women and men.”
BackgroundEstrogen receptors in the human forebrain and the relation to neuropsychiatric disorders
Österlund, M. K., & Hurd, Y. L. (2001) · Progress in Neurobiology · doi:10.1016/s0301-0082(00)00059-9 · Cited by 267
Marcus, S. M., Kerber, K. B., Rush, A. J., Wisniewski, S. R., Nierenberg, A., Balasubramani, G. K., Ritz, L., Kornstein, S., Young, E. A., & Trivedi, M. H. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2007.06.012 · Cited by 266
“However, in the National Comorbidity Survey, rates of relapse and chronicity were not associated with sex [28].”
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Sex differences in the locus coeruleus-norepinephrine system and its regulation by stress
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“The data indicating that the rates of depression in women exceed that of men only following puberty and prior to menopause (Angold and Worthman, 1993; Kessler et al., 1993; Kessler, 2003), support the role of ovarian hormones in contributing to the pathophysiology of this disorder.”
BackgroundBreese, G. R., Sinha, R., & Heilig, M. A. (2010) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2010.09.007 · Cited by 274
“These distinct tendencies seen with gender may contribute to the well known sex differences observed in the prevalence of alcohol use disorders (Kessler et al., 1993; 1994).”
BackgroundAngold, A., & Costello, E. J. (2006) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2006.05.013 · Cited by 252
Radley, J., Morilak, D., Viau, V., & Campeau, S. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.06.018 · Cited by 339
“…in the prevalence of stress-related psychiatric disorders highlight the role of gonadal steroids in differentially altering stress responses and susceptibility under repeated conditions (Kessler, 2003; Kessler et al., 1993; Kessler et al., 1995; Ter Horst et al., 2009; Weissman et al., 1993).”
BackgroundHormonal Treatments for Major Depressive Disorder: State of the Art
Dwyer, J. B., Aftab, A., Radhakrishnan, R., Widge, A., Rodriguez, C. I., Carpenter, L. L., Nemeroff, C. B., McDonald, W. M., Kalin, N. H., & APA Council of Research Task Force on Novel Biomarkers and Treatments (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.19080848 · Cited by 252
Scott, K. M., Wells, J. E., Angermeyer, M., Brugha, T. S., Bromet, E. J., Demyttenaere, K., de Girolamo, G., Gureje, O., Haro, J. M., Jin, R., et al. (2009) · Psychological Medicine · doi:10.1017/s0033291709991942 · Cited by 257
“An additional advantage of the ability to differentiate between first onset and recurrent disorder is that it is in first onsets that gender differences in psychopathology have been found most reliably (Kessler et al. 1993).”
BackgroundSelf-citationSymptoms of anxiety and depression in Estonian medical students with sleep problems
Eller, T., Aluoja, A., Vasar, V., & Veldi, M. (2006) · Depression and Anxiety · doi:10.1002/da.20166 · Cited by 258
Interaction of cognitive avoidance coping and stress in predicting depression/anxiety
Blalock, J. A., & Joiner, T. E. (2000) · Cognitive Therapy and Research · doi:10.1023/a:1005450908245 · Cited by 256
“First, results of this study are important in light of the consistent finding that women are more likely than men to become depressed (Kessler et al., 1993; Weissman, Bland, Joyce, Newman, Wells & Witchen, 1993; Weissman & Klerman, 1977).”
ResultChildhood Maltreatment as a Risk Factor for Adult Cardiovascular Disease and Depression
Batten, S. V., Aslan, M., Maciejewski, P. K., & Mazure, C. M. (2004) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v65n0217 · Cited by 256
Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders
Rao, U., & Chen, L.-A. (2009) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2009.11.1/urao · Cited by 252
Gender differences in cardiovascular disease and comorbid depression.
Möller-Leimkühler, A. M. (2007) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2007.9.1/ammoeller · Cited by 251
“It is known that major depression is twice as common in women as in men.(93,94) The female predominance begins in adolescence and persists into middle age and early old age.”
BackgroundShi, P., Yang, A., Zhao, Q., Chen, Z., Ren, X., & Dai, Q. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.589687 · Cited by 292
“9% of men experiencing major depressive episodes during their lifetimes (12).”
BackgroundThe Epidemiology of Common Late-Life Mental Disorders in the Community: Themes for the New Century
Gallo, J. J., & Lebowitz, B. D. (1999) · Psychiatric Services · doi:10.1176/ps.50.9.1158 · Cited by 248
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Suri, R., Altshuler, L. L., Hellemann, G., Burt, V. K., Aquino, A., & Mintz, J. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.06071172 · Cited by 246
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Women with bipolar illness: clinical and research issues
Leibenluft, E. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.2.163 · Cited by 242
Seidman, S. N., Roose, S. P., Menza, M. A., Shabsigh, R., & Rosen, R. C. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.10.1623 · Cited by 242
Hudson, D., Bullard, K. M., Neighbors, H. W., Geronimus, A. T., Yang, J., & Jackson, J. S. (2012) · Journal of Men s Health · doi:10.1016/j.jomh.2012.03.006 · Cited by 240
“Because previous studies have typically shown a greater prevalence of depression among women compared to men [39–43], analyses were stratified by sex to examine differences between African American men and women.”
ResultThe origins of sex differences in depressive disorder: bridging the gap
Bebbington, P. (1996) · International Review of Psychiatry · doi:10.3109/09540269609051547 · Cited by 240
Toward a revised evolutionary adaptationist analysis of depression: the social navigation hypothesis
Watson, P. J., & Andrews, P. W. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00459-1 · Cited by 242
Time trends in adolescent mental health
Collishaw, S., Maughan, B., Goodman, R., & Pickles, A. R. (2004) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2004.00842.x · Cited by 247
Associations between sex hormones, sleep problems and depression: A systematic review
Morssinkhof, M. W. L., van Wylick, D. W., Priester-Vink, S., van der Werf, Y. D., den Heijer, M., van den Heuvel, O. A., & Broekman, B. F. P. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.08.006 · Cited by 257
“, 2002; Zhang and Wing, 2006) and two times more likely to suffer from depression (Kessler et al., 1993; Kuehner, 2003), even after adjustment for race, income and employment (Rai et al.”
BackgroundSex, trauma, stress hormones and depression
Young, E., & Korszun, A. (2010) · Molecular Psychiatry · doi:10.1038/mp.2009.94 · Cited by 235
Lifetime suicide risk in major depression: sex and age determinants
Blair-West, G. W., Cantor, C. H., Mellsop, G. W., & Eyeson‐Annan, M. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00004-x · Cited by 233
Jovanovic, H., Lundberg, J., Karlsson, P., Cerin, Å., Saijo, T., Varrone, A., Halldin, C., & Nordström, A. (2007) · NeuroImage · doi:10.1016/j.neuroimage.2007.10.016 · Cited by 232
“…(i) women have two times higher prevalence of depression compared to men, (ii) women have higher rates of recurrent depression compared to men, (iii) women are more likely than men to develop depression in response to stress (Ernst and Angst, 1992; Kendler et al., 2000; Kessler et al., 1993).”
Sex differences in antidepressant efficacy
LeGates, T. A., Kvarta, M. D., & Thompson, S. M. (2018) · Neuropsychopharmacology · doi:10.1038/s41386-018-0156-z · Cited by 242
Sex and Gender Differences in Alzheimer's Disease: Recommendations for Future Research
Carter, C. L., Resnick, E. M., Mallampalli, M., & Kalbarczyk, A. (2012) · Journal of Women's Health · doi:10.1089/jwh.2012.3789 · Cited by 231
“Women have higher rates of depression and anxiety, and these are emerging as risk factors for AD.(22) The role of hormone replacement therapy (HRT) is still a confused issue, and roundtable experts discussed research that supports improved cognitive function with HRT when given at early but not late stages of the meno…”
Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation
Kawa, I., Carter, J. D., Joyce, P. R., Doughty, C. J., Frampton, C. M., Wells, J. E., Walsh, A. E. S., & Olds, R. J. (2005) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00180.x · Cited by 231
Role of Estrogen in the Aetiology and Treatment of Mood Disorders
Halbreich, U. M., & Kahn, L. S. (2001) · CNS Drugs · doi:10.2165/00023210-200115100-00005 · Cited by 238
Depressive Symptoms, Menopausal Status, and Climacteric Symptoms in Women at Midlife
Bosworth, H. B., Bastian, L. A., Kuchibhatla, M. N., Steffens, D. C., McBride, C. M., Skinner, C. S., Rimer, B. K., & Siegler, I. C. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200107000-00013 · Cited by 224
“This study addressed two questions concerning depressive symptoms in this age cohort of women: (1) are menopausal status and climacteric symptoms associated with depression, and (2) is the association among menopausal status, climacteric symptoms, and depression moderated by the use of HRT?”
BackgroundMethodInfluentialEffect of Estrogen-Serotonin Interactions on Mood and Cognition
Amin, Z., Canli, T., & Epperson, C. N. (2005) · Behavioral and Cognitive Neuroscience Reviews · doi:10.1177/1534582305277152 · Cited by 238
“Such research is essential given the evidence of a significant sex difference in the incidence of major depression (Angst et al., 2002; Kessler et al., 1993; Weissman et al., 1996) as well as the increased likelihood of depression during periods of hormonal fluctuation (Burt & Stein, 2002; Rapkin et al.”
BackgroundNeumeister, A., Konstantinidis, A., Stastny, J., Schwarz, M. J., Vitouch, O., Willeit, M., Praschak-Rieder, N., Zach, J., de Zwaan, M., Bondy, B., et al. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.7.613 · Cited by 223
Prevalence, Correlates, and Persistence of Maternal Depression
Horwitz, S. M., Briggs‐Gowan, M. J., Storfer‐Isser, A., & Carter, A. S. (2007) · Journal of Women s Health · doi:10.1089/jwh.2006.0185 · Cited by 218
Calmes, C. A., & Roberts, J. E. (2008) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9200-3 · Cited by 247
Evidence of dysregulated peripheral oxytocin release among depressed women
Cyranowski, J. M., Hofkens, T. L., Frank, E., Seltman, H., Cai, H.-M., & Amico, J. A. (2008) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318188ade4 · Cited by 220
“Women are twice as likely as men to experience a lifetime episode of major depression (15,16).”
BackgroundGirgus, J. S., & Yang, K. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2015.01.019 · Cited by 217
“Although the absolute prevalence of both diagnosable depression and depressive symptoms varies across the age span, the gender difference continues with remarkable consistency at least until the age of about 55 [2,15,16].”
BackgroundClinical features of treatment-resistant depression.
Kornstein, S. G., & Schneider, R. K. (2001) · PubMed · Cited by 216
Bebbington, P., Dunn, G., Jenkins, R., Lewis, G., Brugha, T. S., Farrell, M., & Meltzer, H. (2003) · International Review of Psychiatry · doi:10.1080/0954026021000045976 · Cited by 227
“The US National Comorbidity Survey (Kessler et al. 1993) unfortunately only sampled subjects less than 55 years old: the excess prevalence of depression in women was maintained until that age.”
BackgroundThe role of cumulative trauma, betrayal, and appraisals in understanding trauma symptomatology.
Martin, C. G., Cromer, L. D., DePrince, A. P., & Freyd, J. J. (2011) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0025686 · Cited by 257
Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T. M. (2004) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.113.4.636 · Cited by 212
Lepine, J., Gasquet, I., Kovess, V., Arbabzadeh-Bouchez, S., Negre-pages, L., Nachbaur, G., & Gaudin, A. (2005) · L Encéphale · doi:10.1016/s0013-7006(05)82385-1 · Cited by 189
Sassarini, J. (2016) · Maturitas · doi:10.1016/j.maturitas.2016.09.004 · Cited by 214
“It is one of the leading causes of disease-related disability in women (2), and they are nearly twice as likely, compared with men, to suffer from an episod e of depression (3-5).”
BackgroundGender differences in a cohort study of 604 bipolar patients: The role of predominant polarity
Nivoli, A., Pacchiarotti, I., Rosa, A. R., Popović, D., Murru, A., Valentí, M., Bonnín, C. D. M., Grande, I., Sánchez‐Moreno, J., Vieta, E., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.04.055 · Cited by 221
“These data confirm epidemiological findings on general population (Regier et al., 1990; Kessler et al., 1993; Angst et al., 2010).”
ResultHudson, D., Puterman, E. M., Bibbins-Domingo, K. B., Matthews, K. A., & Adler, N. E. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.07.031 · Cited by 212
Metadata
- Authors
- Kessler, R.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Kessler, R
- ORCID
- Kessler, R
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 1993-11
- Volume
- 29
- Issue
- 2-3
- Pages
- 85-96
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W1992284534
- Cited by
- 2,207
- References
- 67
- Citations by year
- 2026: 31 · 2025: 50 · 2024: 47 · 2023: 58 · 2022: 84 · 2021: 71 · 2020: 73 · 2019: 78 · 2018: 78 · 2017: 124 · 2016: 81 · 2015: 98 · 2014: 119 · 2013: 105 · 2012: 101
- FWCI
- 21.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- State University of New York
- Johns Hopkins University
- York University
- University of Toronto
- National Institute of Mental Health (5RO1 MH46376, R01MH046376, MH 46376, 90135190)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sex differences, major depressive episode, depression prevalence, chronic depression, depression recurrence, age of onset, National Comorbidity Survey, men and women
- MeSH terms
- Adolescent, Adult, Age Factors, Chronic Disease, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Male, Middle Aged, Personality Assessment, Psychiatric Status Rating Scales, Recurrence, Sex Factors, United States, Cohort Studies, Comorbidity, Incidence
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