Cited by 2,207Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Sex and depression in the National Comorbidity Survey, I: lifetime prevalence, chronicity and recurrence

Kessler, R·1993·Journal of Affective Disorders

DOI 10.1016/0165-0327(93)90026-g

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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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Stokes, M. L., McCoy, K. P., Abram, K. M., Byck, G. R., & Teplin, L. A. (2015) · Journal of Correctional Health Care · doi:10.1177/1078345815587001 · Cited by 110
A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students
Przedworski, J. M., Dovidio, J. F., Hardeman, R. R., Phelan, S. M., Burke, S. E., Ruben, M. A., Perry, S., Burgess, D. J., Nelson, D. B., Yeazel, M. W., et al. (2015) · Academic Medicine · doi:10.1097/acm.0000000000000658 · Cited by 113
Functional Connectivity Between Anterior Insula and Key Nodes of Frontoparietal Executive Control and Salience Networks Distinguish Bipolar Depression From Unipolar Depression and Healthy Control Subjects
Ellard, K. K., Zimmerman, J. P., Kaur, N., Dijk, K. R. A. V., Roffman, J. L., Nierenberg, A. A., Dougherty, D. D., Deckersbach, T., & Camprodon, J. A. (2018) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.01.013 · Cited by 114
“Second, although the distribution of gender was not significantly different across samples, this does not reflect the increased prevalence of depression found in women in epidemiological studies, potentially limiting the generalizability of these findings (68, 69).”
Result
Childhood adversity, gender and depression over the life-course
Wainwright, N. W. J., & Surtees, P. G. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00420-7 · Cited by 109
Outdoor light at night and the prevalence of depressive symptoms and suicidal behaviors: a cross-sectional study in a nationally representative sample of Korean adults.
Min, J.-Y., & Min, K.-B. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.10.039 · Cited by 115
Aging Out of Foster Care and Legal Involvement: Toward a Typology of Risk
Vaughn, M. G., Shook, J. J., & McMillen, J. C. (2008) · Social Service Review · doi:10.1086/592535 · Cited by 109
“7 times greater for women than men (Kessler et al. 1993; Weissman et al. 1993).”
BackgroundInfluential
Familiality of Symptom Dimensions in Depression
Korszun, A., Moskvina, V., Brewster, S., Craddock, N. J., Ferrero, F., Gill, M., Jones, I. R., Jones, L. A., Maier, W., Mors, O. N., et al. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.5.468 · Cited by 109
The influence of age on the female/male ratio of treated incidence rates in depression
Gutiérrez‐Lobos, K., Scherer, M., Anderer, P., & Katschnig, H. (2002) · BMC Psychiatry · doi:10.1186/1471-244x-2-3 · Cited by 112
“Also, in the US National Comorbidity Survey (NCS) [7] which provides age specific 12 months prevalence rates in five year categories up to the age of 55, an increasing gender gap was found towards mid-life with a decrease thereafter.”
A qualitative investigation of depression in men.
Chuick, C. D., Greenfeld, J. M., Greenberg, S. T., Shepard, S. J., Cochran, S. V., & Haley, J. T. (2009) · Psychology of Men & Masculinity · doi:10.1037/a0016672 · Cited by 108
The moderator role of emotion regulation ability in the link between stress and well-being
Extremera, N., & Rey, L. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01632 · Cited by 132
“Besides, many research study results consistently indicate that women score significantly higher in emotional disturbances than do men (Kessler et al., 1993; Alonso et al., 2004).”
Result
Vitamin D supplementation for the prevention of depression and poor physical function in older persons: the D-Vitaal study, a randomized clinical trial
de Koning, E. J., Lips, P. T. A. M., Penninx, B. W. J. H., Elders, P. J. M., Heijboer, A. C., den Heijer, M., Bet, P. M., van Marwijk, H., & van Schoor, N. M. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqz141 · Cited by 107
Neural correlates of the females' susceptibility to negative emotions: An insight into gender‐related prevalence of affective disturbances
Yuan, J., Luo, Y., Yan, J. H., Meng, X., Yu, F., & Li, H. (2009) · Human Brain Mapping · doi:10.1002/hbm.20796 · Cited by 112
“…as a general mechanism underlying the liability of females to various affective disturbances throughout the life development, rather than only during some specific periods [e.g. pregnancy, lactation, or menopausal periods; Kessler et al., 1993; Nolen-Hoeksema and Girgu, 1994, Angold et al., 1999].”
Background
Are gender differences in depression explained by gender differences in co-morbid anxiety?
Simonds, V. M. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00113-1 · Cited by 109
“reported lifetime prevalence rates for major depression of 21% for women and 13% for men (Kessler et al., 1993).”
Background
Sex differences in stress-related receptors: ″micro″ differences with ″macro″ implications for mood and anxiety disorders
Bangasser, D. A. (2013) · Biology of Sex Differences · doi:10.1186/2042-6410-4-2 · Cited by 110
“PTSD: Post-traumatic stress disorder; CRF: Corticotropin releasing factor; GRs: Glucocorticoid receptors; HPA: Hypothalamic pituitary adrenal; CRF1: CRF1 receptor type; CRF2: CRF2 receptor type; BNST: Bed nucleus of the stria terminalis; cAMP: cyclic adenosine monophosphate; PKA: Protein kinase A; LC: Locus coeruleus;…”
BackgroundInfluential
Life events and early onset depression: cause or consequence?
Patton, G. C., Coffey, C., Posterino, M., Carlin, J. B., & Bowes, G. (2003) · Psychological Medicine · doi:10.1017/s0033291703008626 · Cited by 106
Cingulum White Matter in Young Women at Risk of Depression: The Effect of Family History and Anhedonia
Keedwell, P. A., Chapman, R., Christiansen, K., Richardson, H., Evans, J., & Jones, D. K. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2012.01.022 · Cited by 108
Summary of the National Institute on Aging-sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition
Maki, P. M., Freeman, E. W., Greendale, G. A., Henderson, V. W., NEWHOUSE, P. A., Schmidt, P. J., Scott, N. F., Shively, C. A., & Soares, C. N. (2010) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3181d763d2 · Cited by 105
“The sex difference in depression rates is most pronounced during the reproductive years, and, at times, women may have twice the rates of depression as those of men.(16) Sadness, the hallmark symptom of depression, is a normal emotion and is common during times of change.”
Background
Assessment and treatment of hot flushes and menopausal mood disturbance
Joffe, H., Soares, C. N., & Cohen, L. S. (2003) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(03)00045-5 · Cited by 105
“However, women in their mid-40s through mid-50s are not at increased risk for depression when compared with younger premenopausal-aged women [70].”
Background
Inflaming sex differences in mood disorders
Rainville, J. R., & Hodes, G. E. (2018) · Neuropsychopharmacology · doi:10.1038/s41386-018-0124-7 · Cited by 112
Sex Differences in Diencephalon Serotonin Transporter Availability in Major Depression
Staley, J. K., Sanacora, G., Tamagnan, G. D., Maciejewski, P. K., Malison, R. T., Berman, R., Vythilingam, M., Kugaya, A., Baldwin, R. M., Seibyl, J. P., et al. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.06.012 · Cited by 106
Resilience in Young Adulthood: The Moderating Influences of Gender-related Personality Traits and Coping Flexibility
Lam, C. B., & McBride-Chang, C. A. (2007) · Sex Roles · doi:10.1007/s11199-006-9159-z · Cited by 104
“This finding appears to be counter-intuitive because a large number of previous studies showed that women report more internal distress than do men (e.g., Davis & Katzman, 1997; Kessler, McGonagle, Swartz, & Blazer, 1993; Nolen-Hoeksema, 1991).”
Result
Parental Maltreatment, Bullying, and Adolescent Depression: Evidence for the Mediating Role of Perceived Social Support
Seeds, P. M., Harkness, K. L., & Quilty, L. C. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2010.501289 · Cited by 105
Regional Patterns of Brain Activity in Adults With a History of Childhood-Onset Depression: Gender Differences and Clinical Variability
Miller, A., Fox, N. A., Cohn, J. F., Forbes, E. E., Sherrill, J. T., & Kovács, M. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.6.934 · Cited by 105
“Previous research has established that population base rates of depression are higher in women than in men (37) and that women and men differ in longitudinal patterns of comorbidity (38).”
Background
First-Episode Major Depression: Few Sex Differences in Course
Simpson, H. B. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830190059006 · Cited by 104
Gender Differences in the Link Between Depression and Cardiovascular Disease
Naqvi, T. Z., Naqvi, S. S. A., & Merz, C. N. B. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000164013.55453.05 · Cited by 105
“The prevalence of major depression is two times higher in women than in men, beginning in early adolescence (2).”
Background
Gender differences of depressive symptoms in depressed and nondepressed elderly persons
Kockler, M., & Heun, R. (2002) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.521 · Cited by 104
Assessment and treatment of depression during pregnancy: an update
Nonacs, R. M., & Cohen, L. S. (2003) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(03)00046-7 · Cited by 104
“Mood disorders are twice as common in women as compared with men and frequently cluster during the childbearing years [1].”
Background
Developmental changes in the phenomenology of depression in girls compared to boys from childhood onward
Kovacs, M. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00429-9 · Cited by 103
Gender Differences in the Cognitive Vulnerability-Stress Model of Depression in the Transition to Adolescence
Mezulis, A. H., Funasaki, K., Charbonneau, A. M., & Hyde, J. S. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-009-9281-7 · Cited by 110
“Research also indicates that much of this increase is accounted for by a rise in depression among girls in particular; although rates of depression between boys and girls are comparable in childhood, by age 18 females are twice as likely as males to become depressed (Kessler et al. 1993; Lucht et al. 2003).”
Background
Depression during menopausal transition: a review of treatment strategies and pathophysiological correlates
Frey, B. N., Lord, C., & Soares, C. N. (2008) · Menopause international · doi:10.1258/mi.2008.008019 · Cited by 102
Persistence of Maternal Depressive Symptoms throughout the Early Years of Childhood
Horwitz, S. M., Briggs‐Gowan, M. J., Storfer‐Isser, A., & Carter, A. S. (2009) · Journal of Women s Health · doi:10.1089/jwh.2008.1229 · Cited by 103
Masculine norms, avoidant coping, Asian values, and depression among Asian American men.
Iwamoto, D. K., Liao, L., & Liu, W. M. (2010) · Psychology of Men & Masculinity · doi:10.1037/a0017874 · Cited by 103
Inflammation: a mechanism of depression?
Han, Q.-Q., & Yu, J. M. (2014) · Neuroscience Bulletin · doi:10.1007/s12264-013-1439-3 · Cited by 107
“The prevalence of major depression has increased dramatically over the past few decades([1]), and women are nearly twice as likely as men to develop depressive disorder([2]).”
Background
The medical treatment of depression, 1991–1996: productive inefficiency, expected outcome variations, and price indexes
Berndt, E. R., Bir, A., Busch, S. H., Frank, R. G., & Normand, S. T. (2002) · Journal of Health Economics · doi:10.1016/s0167-6296(01)00132-1 · Cited by 103
Bisphenol A interferes with synaptic remodeling
Hajszan, T., & Leranth, C. (2010) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2010.06.004 · Cited by 101
“Indeed, women are twice as likely to suffer from depression as men [70], supporting the above view that gonadal steroid hormones contribute to the neurobiology of depression.”
Background
How does sex matter? Behavior, stress and animal models of neurobehavioral disorders
Palanza, P., & Parmigiani, S. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.01.037 · Cited by 107

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)
DOI: 10.1016/0165-0327(93)90026-g
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Sex and depression in the National Comorbidity Survey, I: lifetime prevalence, chronicity and recurrence

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