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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Wroolie, T. E., Williams, K. E., Keller, J., Zappert, L. N., Shelton, S. D., Kenna, H. A., Reynolds, M. F., & Rasgon, N. L. (2006) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000227699.26375.f8 · Cited by 56
Regional gene expression signatures are associated with sex-specific functional connectivity changes in depression
Talishinsky, A., Downar, J. H., Vértes, P. E., Seidlitz, J., Dunlop, K., Lynch, C. J., Whalley, H. C., McIntosh, A. M., Vila‐Rodriguez, F., Daskalakis, Z. J., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-32617-1 · Cited by 56
Is the Positive Illusory Bias Illusory? Examining Discrepant Self-Perceptions of Competence in Girls with ADHD
Swanson, E. N., Owens, E. B., & Hinshaw, S. P. (2012) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-012-9615-x · Cited by 56
“Given the high rates of depression symptoms in females (Kessler et al. 1993; Lewinsohn et al. 1994), replication of this finding in larger samples of girls is needed.”
Background
Depression treatment for impoverished mothers by point-of-care providers: A randomized controlled trial.
Segre, L. S., Brock, R. L., & O’Hara, M. W. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0038495 · Cited by 56
Alcohol use and trauma exposure among male and female veterans before, during, and after military service
Kelley, M. L., Runnals, J. J., Pearson, M. R., Miller, M. M., Fairbank, J. A., & Brancu, M. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.08.002 · Cited by 56
Relationship of Age, Age at Onset, and Sex to Depression in Older Adults
Lavretsky, H., Lesser, I. M., Wohl, M. A., & Miller, B. L. (1998) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-199800630-00007 · Cited by 56
Sex differences in effects of dopamine D1 receptors on social withdrawal
Campi, K. L., Greenberg, G. D., Kapoor, A., Ziegler, T. E., & Trainor, B. C. (2014) · Neuropharmacology · doi:10.1016/j.neuropharm.2013.09.026 · Cited by 55
“Stress-induced anxiety and depression disorders are more common in women versus men (Kessler et al., 1993).”
Depression and activity limitations: examining gender differences in the general population
Breslin, F. C., Gnam, W., Franche, R.-L., Mustard, C., & Lin, E. (2006) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-006-0079-6 · Cited by 55
“Both major depression and dysthymia are about twice as common in females than in males [3, 4].”
Background
Personality predicts recurrence of late-life depression
Steunenberg, B., Beekman, A. T. F., Deeg, D. J. H., & Kerkhof, A. J. F. M. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.08.002 · Cited by 55
“A study including respondents till the age of 79 found that men and women with a history of depression did not significantly differ in the chance of recurrence (Kessler et al., 1993).”
Background
Unique patterns of FOS, phospho-CREB and BrdU immunoreactivity in the female rat brain following chronic stress and citalopram treatment
Kuipers, S. D., Trentani, A., Westenbroek, C., Bramham, C. R., Korf, J., Kema, I. P., Horst, G. J. T., & den Boer, J. A. (2005) · Neuropharmacology · doi:10.1016/j.neuropharm.2005.10.006 · Cited by 56
Skin Colour, Perception of Racism and Depression among Adolescents in Urban Brazil
Santana, V. S., Filho, N. D. A., ROBERTS, R. E., & Cooper, S. P. (2007) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2007.00447.x · Cited by 54
Role of epigenetic factors in the development of mental illness throughout life
Guintivano, J., & Kaminsky, Z. A. (2014) · Neuroscience Research · doi:10.1016/j.neures.2014.08.003 · Cited by 62
Sex differences in the effects of social defeat on brain and behavior in the California mouse: Insights from a monogamous rodent
Steinman, M. Q., & Trainor, B. C. (2016) · Seminars in Cell and Developmental Biology · doi:10.1016/j.semcdb.2016.06.021 · Cited by 56
Gene regulatory mechanisms underlying sex differences in brain development and psychiatric disease
Manoli, D. S., & Tollkühn, J. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13564 · Cited by 58
The androgen model of suicide completion
Lenz, B., Röther, M., Bouna-Pyrrou, P., Mühle, C., Tektas, O. Y., & Kornhuber, J. (2018) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2018.06.003 · Cited by 60
“by a major depressive disorder than men (Kessler et al., 1993; Weissman et al., 1993), one might expect more suicides in women than in men.”
Screening for Depression in Mothers Bringing Their Offspring for Evaluation or Treatment of Depression
Ferro, T., Verdeli, H., Pierre, F., & Weissman, M. M. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.3.375 · Cited by 54
The gender gap in depression reconsidered: the influence of marital and employment status on the female/male ratio of treated incidence rates
Gutiérrez‐Lobos, K., Wölfl, G., Scherer, M., Anderer, P., & Schmidl-Mohl, B. (2000) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270050229 · Cited by 54
“…conducted clinical and epidemiological studies have repeatedly con®rmed that women su er more often from depression than men (Bebbington et al. 1981; Weissman et al. 1984; Der and Bebbington 1987; Jenkins 1987; Bebbington 1988; Kessler et al. 1993; Weissman et al. 1993; Meltzer et al. 1995).”
Sex and gender differences in risk scores for dementia and Alzheimer's disease among cisgender, transgender, and non-binary adults
Brady, B., Zheng, L., Kootar, S., & Anstey, K. J. (2024) · Alzheimer's & Dementia · doi:10.1002/alz.13317 · Cited by 54
Treatment Patterns for Schizoaffective Disorder and Schizophrenia Among Medicaid Patients
Olfson, M., Marcus, S. C., & Wan, G. J. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.2.210 · Cited by 58
Autobiographical Memory as a Predictor of Depression Vulnerability in Girls
Hipwell, A. E., Sapotichne, B., Klostermann, S., Battista, D. R., & Keenan, K. E. (2011) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2011.546037 · Cited by 54
Molecular epidemiology of major depressive disorder
Kiyohara, C., & Yoshimasu, K. (2009) · Environmental Health and Preventive Medicine · doi:10.1007/s12199-008-0073-6 · Cited by 53
The Sexual Self-Consciousness Scale: Psychometric Properties
van Lankveld, J. J. D. M., Geijen, W. E. H., & Sykora, H. (2007) · Archives of Sexual Behavior · doi:10.1007/s10508-007-9253-5 · Cited by 53
“There is robust epidemiological evidence that women are more vulnerable to depression and social anxiety ( Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993; Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996).”
Background
Attend or defend? Sex differences in behavioral, autonomic, and respiratory response patterns to emotion–eliciting films
Wilhelm, F. H., Rattel, J. A., Wegerer, M., Liedlgruber, M., Schweighofer, S., Kreibig, S. D., Kolodyazhniy, V., & Blechert, J. (2017) · Biological Psychology · doi:10.1016/j.biopsycho.2017.10.006 · Cited by 55
Future Antidepressants
Bosker, F. J., Westerink, B. H. C., Cremers, T. I. F. H., Gerrits, M., van der Hart, M. G. C., Kuipers, S. D., van der Pompe, G., Horst, G. J. T., den Boer, J. A., & Korf, J. (2004) · CNS Drugs · doi:10.2165/00023210-200418110-00002 · Cited by 55
Sex differences in the distribution of EEG frequencies during sleep: unipolar depressed outpatients
Armitage, R. (1995) · Journal of Affective Disorders · doi:10.1016/0165-0327(95)00009-c · Cited by 53
Response to Tricyclic Antidepressants: Independent of Gender?
Wohlfarth, T. D., Storosum, J. G., Elferink, A. J. A., van Zwieten, B. J., Fouwels, A., & van den Brink, W. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.2.370 · Cited by 53
Major depression and suicide attempts in patients with liver disease in the United States
Le Strat, Y., Le Foll, B., & Dubertret, C. (2015) · Liver International · doi:10.1111/liv.12612 · Cited by 50
“Depressive symptoms further predict longterm mortality after liver transplantation (19).”
Background
Validity of Gotland Male Depression Scale for male depression in a community study: The Sudurnesjamenn study
Sigurðsson, B., Palsson, S. P., Aevarsson, Ó., Ólafsdóttir, M., & Jóhannsson, M. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.065 · Cited by 58
“These studies show female preponderance in mood and anxiety disorders and male preponderance in substance abuse and antisocial personality disorders (Eaton et al., 2012; Kessler et al., 1993; Kuehner, 2003).”
Background
Early exposure to haloperidol or olanzapine induces long‐term alterations of dendritic form
Frost, D. O., Page, S. C., Carroll, C., & Kolb, B. E. (2009) · Synapse · doi:10.1002/syn.20715 · Cited by 50
“Schizophrenia and depression/bipolar disease have high incidences (1% and 15–20% respectively) and women are at an elevated risk of these diseases in their child bearing years (Kessler et al., 1993; Weissman, 1987).”
Background
Reproductive Aging, Sex Steroids, and Mood Disorders
Harsh, V., Meltzer-Brody, S. E., Rubinow, D. R., & Schmidt, P. J. (2009) · Harvard Review of Psychiatry · doi:10.1080/10673220902891877 · Cited by 50
Depressive symptoms in climacteric women are related to menopausal symptom intensity and partner factors
Chedraui, P. A., Pérez-López, F. R., Morales, B., & Hidalgo, L. A. (2009) · Climacteric · doi:10.1080/13697130902718150 · Cited by 52
“The MRS is a menopause-specific, health-related, quality-of-life instrument composed of 11 items assessing menopausal symptoms, divided into three subscales: (1) somatic: hot flushes, heart discomfort, sleeping problems and muscle and joint problems (items 1–3 and 11, respectively); (2) psychological: depressive mood,…”
Background
Role of Corticotropin Releasing Factor in the Neuroimmune Mechanisms of Depression: Examination of Current Pharmaceutical and Herbal Therapies
Jiang, Y., Peng, T., Gaur, U., Silva, M., Little, P. J., Chen, Z., Qiu, W., Zhang, Y., & Zheng, W. (2019) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2019.00290 · Cited by 55
“CRF2, however, is widely expressed in peripheral tissues including heart, lung, adrenal gland, ovaries and testes (Naughton et al., 2014; Ketchesin et al., 2017).”
Background
Does atypical interoception following physical change contribute to sex differences in mental illness?
Murphy, J., Viding, E., & Bird, G. (2019) · Psychological Review · doi:10.1037/rev0000158 · Cited by 52
“, anxiety and depression) are more prevalent in women than men (Kessler et al., 1993; Whiteford et al., 2015), with sex differences in symptom profiles also apparent; for example, women with depression are more likely to report somatic symptoms than men (Marcus et al.”
Background
Treatment Outcome and Physician-Patient Communication in Primary Care Patients With Chronic, Recurrent Depression
Schwenk, T. L., Evans, D. L., Laden, S. K., & Lewis, L. (2004) · American Journal of Psychiatry · doi:10.1176/ajp.161.10.1892 · Cited by 52
Gender-dependent impact of major depression on autonomic cardiovascular modulation
Voss, A., Boettger, M. K., Schulz, S., Gross, K., & Bär, K. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2011.03.015 · Cited by 52

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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