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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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“Furthermore, depression is almost twofold higher among women as compared with men [9].”
BackgroundRevisiting Gender Differences in Somatic Symptoms of Depression: Much Ado about Nothing?
Delisle, V. C., Beck, A. T., Dobson, K. S., Dozois, D. J. A., & Thombs, B. D. (2012) · PLoS ONE · doi:10.1371/journal.pone.0032490 · Cited by 74
“The higher prevalence of MDD among women compared to men begins in early adolescence and continues through adulthood [5,6].”
BackgroundThe influence of gender and the estrous cycle on learned helplessness in the rat
Jenkins, J. A., Williams, P., Kramer, G. L., Davis, L. L., & Petty, F. (2001) · Biological Psychology · doi:10.1016/s0301-0511(01)00111-9 · Cited by 67
“For example, the prevalence of major depression is similar in males and females until menarche, at which time the incidence in women doubles (Angold and Worthman, 1993; Kessler et al., 1993) and this difference narrows after menopause (Hale and Cochran, 1983).”
BackgroundThe epidemiology of depressive disorders
Angst, J. (1995) · European Neuropsychopharmacology · doi:10.1016/0924-977x(95)00025-k · Cited by 68
Udeh-Momoh, C., & Watermeyer, T. (2021) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101459 · Cited by 67
Kaufman, J., Sullivan, G. M., Yang, J., Ogden, R. T., Miller, J. M., Oquendo, M. A., Mann, J. J., Parsey, R. V., & DeLorenzo, C. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.15 · Cited by 67
Self-silencing mediates the link between marital conflict and depression
Whiffen, V. E., Foot, M., & Thompson, J. (2007) · Journal of Social and Personal Relationships · doi:10.1177/0265407507084813 · Cited by 67
“If men self-silence more than women do, why are women at greater risk for depression ( Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993 )?”
Alvarado, R., Enrique Jadresic, M., Viviana Guajardo, T., & Rojas, G. (2014) · Archives of Women s Mental Health · doi:10.1007/s00737-014-0466-z · Cited by 66
“Studies have consistently shown that, beginning in early adolescence, women have higher prevalence than men (Kessler et al. 1993), and that pregnancy does not protect against the emergence or persistence of the illness (Evans et al.”
BackgroundFabricatore, A. N., & Wadden, T. A. (2006) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.2.022305.095249 · Cited by 67
Cabrera-Vera, T. M., & Battaglia, G. (1998) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1016/s0022-3565(24)37746-8 · Cited by 67
“…Thomas et al., 1987; Wong et al., 1991) fluoxetine is routinely prescribed to millions of Americans each year, including women of reproductive age, for the treatment of a variety of psychiatric disorders (Dubovsky, 1994; Hudson et al., 1996; Kessler et al., 1993; Sheehan and Harnett-Sheehan, 1996).”
van Loo, H. M., Beijers, L., Wieling, M. B., A, T. R. D. J., Schoevers, R. A., & Kendler, K. S. (2021) · Psychological Medicine · doi:10.1017/s0033291721001148 · Cited by 71
“…that the gap between the sexes remains the same across the lifespan (Baxter et al., 2014; Cairney & Wade, 2002; Ferrari et al., 2013; Jorm, 2000; Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993), but other studies found a decreased (Bebbington et al., 1998; Jorm, 2000; Wittchen & Jacobi,…”
ResultFunctional MRI study of memory-related brain regions in patients with depressive disorder
Werner, N. S., Meindl, T., Materne, J., Engel, R. R., Huber, D., Riedel, M. J., Reiser, M. F., & Hennig‐Fast, K. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.03.003 · Cited by 69
Walf, A. A., Ciriza, I., García‐Segura, L. M., & Frye, C. A. (2007) · Neuropsychopharmacology · doi:10.1038/sj.npp.1301416 · Cited by 66
Physical Activity, Gender Difference, and Depressive Symptoms
Zhang, J., & Yen, S. T. (2015) · Health Services Research · doi:10.1111/1475-6773.12285 · Cited by 69
“Kessler et al. (1993) find depressive disorders more common in women, who have a lifetime rate for major depressive episodes of 21.3 percent, compared with 12.7 percent in men.”
ResultInfluentialDiabetes Distress, Depression and Glycemic Control in a Canadian-Based Specialty Care Setting
Wong, E. M., Afshar, R., Qian, H., Zhang, M., Elliott, T. G., & Tang, T. S. (2017) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2016.11.006 · Cited by 71
Patterns of axis I comorbidity in early-onset versus late-onset major depressive disorder
Alpert, J. E., D, M. F. M., Uebelacker, L. A., Nierenberg, A. A., Pava, J. A., Worthington, J. J., & Rosenbaum, J. F. (1999) · Biological Psychiatry · doi:10.1016/s0006-3223(99)00017-7 · Cited by 66
Role of Estrogen in the Treatment of Depression
Grigoriadis, S., & Kennedy, S. H. (2002) · American Journal of Therapeutics · doi:10.1097/00045391-200211000-00008 · Cited by 66
“It is estimated that as many as 33% of women suffer a major depressive episode in their lifetime.(2) Moreover, women are more vulnerable to depression at various points in the life cycle(3); this is exemplified by premenstrual dysphoric disorder, postpartum depression, and the increased rates of depression in perimeno…”
BackgroundPsychometric properties of a menopausal symptom list
Freeman, E. W., Sammel, M. D., Liu, L., & Martin, P. (2003) · Menopause The Journal of The North American Menopause Society · doi:10.1097/00042192-200310030-00014 · Cited by 66
“The inverse association with age seems to be consistent with epidemiologic data, which consistently show that 12-month and lifetime rates of depression decrease among women who are older than 44 years.(20) Education was associated with somatic and vasomotor symptoms but not the psychologic symptoms in the multivariate…”
ResultParker, G. B., & Brotchie, H. (2004) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000116464.60500.63 · Cited by 65
“, 1990), whereas in the NCS study (Kessler et al., 1993), a female preponderance emerged earlier in the 10 to 14 years age band.”
BackgroundInfluentialEffects of long-term ovariectomy on anxiety and behavioral despair in rats
de Chaves, G., Moretti, M., de Castro, A. A., Dagostin, W., da Silva, G. G., Boeck, C. R., Quevedo, J., & Gavioli, E. C. (2009) · Physiology & Behavior · doi:10.1016/j.physbeh.2009.03.016 · Cited by 67
Humphreys, K. L., Moore, S. R., Davis, E., MacIsaac, J. L., Lin, D. T. S., Kobor, M. S., & Gotlib, I. H. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0582-7 · Cited by 70
Are higher rates of depression in women accounted for by differential symptom reporting?
Bogner, H. R., & Gallo, J. J. (2004) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-004-0714-z · Cited by 65
“N IH -PA Author M anuscript N IH -PA Author M anuscript among men (Kessler et al. 1993; Robins and Regier 1991).”
Background
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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