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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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“For example, regions (PFC, amygdala and hippocampus) subserving emotions might be related with increased depression or anxiety risk in females (Davis et al., 2012; Kessler et al., 1993; Lieberwirth et al., 2012), and regions (PFC and striatum) subserving impulse control might be associated with increased risk for subs…”
BackgroundPreadolescent Clues to Understanding Depression in Girls
Keenan, K., & Hipwell, A. E. (2005) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-005-4750-3 · Cited by 118
Manifestations of affective disturbance in sub-Saharan Africa: Key themes
Tomlinson, M., Swartz, L. M., Kruger, L., & Gureje, O. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.09.029 · Cited by 94
“Depression also has a more severe course and higher rates of relapse in women than is the case for men (Brown, 1991; Kessler et al., 1993; Kessler, 2003).”
BackgroundA Longitudinal Twin Study of Insomnia Symptoms in Adults
Lind, M. J., Aggen, S. H., Kirkpatrick, R. M., Kendler, K. S., & Amstadter, A. B. (2015) · SLEEP · doi:10.5665/sleep.4982 · Cited by 84
Huang, C., Wei, I., Chou, Y.-H., & Su, T. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.03.006 · Cited by 87
Carter, J. D., Joyce, P. R., Mulder, R., Luty, S. E., & McKenzie, J. M. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00151-8 · Cited by 87
Circuit-based frameworks of depressive behaviors: The role of reward circuitry and beyond
Knowland, D., & Lim, B. K. (2018) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2017.12.010 · Cited by 89
Prevalence of hormone-related mood disorder symptoms in women with ADHD
Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.12.005 · Cited by 86
Treatment of Mood Disorders During Pregnancy and Postpartum
Cohen, L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., & Freeman, M. P. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.02.001 · Cited by 118
Sampasa‐Kanyinga, H., Lalande, K. M., & Colman, I. (2018) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000653 · Cited by 88
“A large body of research has demonstrated that females are particularly vulnerable to experiencing distress and depressive symptoms from early adolescence through adulthood (Kessler et al., 1993; Nolen-Hoeksema, 1995).”
BackgroundSolomon, M. B., Loftspring, M., de Kloet, A. D., Ghosal, S., Jankord, R., Flak, J. N., Wulsin, A. C., Krause, E. G., Zhang, R., Rice, T., et al. (2015) · Endocrinology · doi:10.1210/en.2015-1276 · Cited by 85
Sexual Differentiation of the Brain: Mode, Mechanisms, and Meaning
McCarthy, M. M., Vries, G. J. D., & Forger, N. G. (2009) · Elsevier eBooks · doi:10.1016/b978-008088783-8.00054-1 · Cited by 85
Does sexual violence contribute to elevated rates of anxiety and depression in females?
Fergusson, D. M., Swain, N., & Horwood, L. J. (2002) · Psychological Medicine · doi:10.1017/s0033291702005986 · Cited by 84
“It has been well documented that rates of depression and anxiety are higher in females than in males (Kessler et al. 1993; Weissman et al. 1993; American Psychiatric Association, 1994; Pigott, 1999; Seeman, 1999).”
BackgroundPlante, D. T., Goldstein, M. R., Landsness, E. C., Peterson, M. J., Riedner, B. A., Ferrarelli, F., Wanger, T., Guokas, J. J., Tononi, G., & Benca, R. M. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.06.016 · Cited by 83
“First, the findings of this study must be considered in the context of the ratio of women to men, which was roughly 2:1, approximating the differential prevalence of MDD among women and men in the population (Kessler et al., 1993).”
BackgroundSex, stress, and epigenetics: regulation of behavior in animal models of mood disorders
Hodes, G. E. (2013) · Biology of Sex Differences · doi:10.1186/2042-6410-4-1 · Cited by 85
“Within the clinical populations presenting for stress-related disorders, there is a higher incidence in women compared to men [3].”
BackgroundUnderstanding the epigenetic basis of sex differences in depression
Hodes, G. E., Walker, D. M., Labonté, B., Nestler, E. J., & Russo, S. J. (2016) · Journal of Neuroscience Research · doi:10.1002/jnr.23876 · Cited by 87
Du, N., Yu, K., Ye, Y., & Chen, S. (2016) · Asia-Pacific Psychiatry · doi:10.1111/appy.12266 · Cited by 83
Carroll, L., Cassidy, J. D., & Côté, P. (2000) · Canadian Journal of Public Health · doi:10.1007/bf03404830 · Cited by 83
Depression in multiple sclerosis: a longitudinal analysis.
Beal, C. C., Stuifbergen, A., & Brown, A. (2007) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2007.02.008 · Cited by 87
Depression and obesity: do shared genes explain the relationship?
Afari, N., Noonan, C., Goldberg, J. H., Roy‐Byrne, P., Schur, E. A., Golnari, G., & Buchwald, D. (2010) · Depression and Anxiety · doi:10.1002/da.20704 · Cited by 88
“Although the selfreported rates of doctor diagnosed depression in our sample were consistent with earlier-reported population-based rates of lifetime depression in women,([77]) nonetheless, our findings should be replicated with symptom- or diagnosis-based measures of depression.”
ResultLipovac, M., Chedraui, P. A., Grünhut, C., Gocan, A., Stammler, M., & Imhof, M. (2009) · Maturitas · doi:10.1016/j.maturitas.2009.10.014 · Cited by 83
“Epidemiological data indicate that women are at higher risk for mood disorders in comparison to men [3,4], with an increased prevalence among those peri- and postmenopausal [13,14,16].”
BackgroundMurphy, R. A., Hagaman, A. K., Reinders, I., Steeves, J. A., Newman, A. B., Rubin, S. M., Satterfield, S., Kritchevsky, S. B., Yaffe, K. S., Ayonayon, H. N., et al. (2015) · The Journals of Gerontology Series A · doi:10.1093/gerona/glv139 · Cited by 82
“Women are more than twice as likely to be diagnosed with depression as men (41,42), which likely reflects differences in depressive symptoms and care seeking (43).”
BackgroundSpeed, B. C., Nelson, B. D., Auerbach, R. P., Klein, D. N., & Hajcak, G. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000173 · Cited by 86
Rosen, R. C., Shabsigh, R., Berber, M. J., Assalian, P., Menza, M., Rodriguez-Vela, L., Porto, R., Bangerter, K., Seger, M. A., Montorsi, F., et al. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.1.79 · Cited by 83
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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