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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Result
Challenges and Opportunities to Manage Depression During the Menopausal Transition and Beyond
Soares, C. N., & Frey, B. N. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.01.007 · Cited by 47
Sex Differences in Outcomes of Sinus Surgery
Mendolia‐Loffredo, S., Laud, P. W., Sparapani, R., Loehrl, T. A., & Smith, T. L. (2006) · The Laryngoscope · doi:10.1097/01.mlg.0000224575.12945.90 · Cited by 46
Sex similarities and differences in risk factors for recurrence of major depression
van Loo, H. M., Aggen, S. H., Gardner, C. O., & Kendler, K. S. (2018) · Psychological Medicine · doi:10.1017/s0033291717003178 · Cited by 45
Effects of Gender, Diagnostic Labels, and Causal Theories on Willingness to Report Symptoms of Depression
Berger, J. L., Addis, M. E., Reilly, E. D., Syzdek, M. R., & Green, J. D. (2012) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2012.31.5.439 · Cited by 45
“The study confirmed previous findings that men report less symptoms compared to women on measures of depression (Kessler et al., 1993).”
Result
Testing Models of Associations Between Depression and Parenting Self-efficacy in Mothers: A Meta-analytic Review
Goodman, S. H., Simon, H. F. M., McCarthy, L., Ziegler, J., & Ceballos, A. (2022) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-022-00398-0 · Cited by 45
“First, depression among women of childbearing age is common (Guo et al., 2018; Kessler et al., 1993), including characterizing 17% of women raising young children (Lyons-Ruth et al.”
Background
Sex-Related Neuroanatomical Basis of Emotion Regulation Ability
Kong, F., Zhen, Z., Li, J., Huang, L., Wang, X., Song, Y., & Liu, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0097071 · Cited by 48
“, depression) in females [73].”
Gender differences in the link between intimate partner physical violence and depression
Winstok, Z., & Straus, M. A. (2014) · Aggression and Violent Behavior · doi:10.1016/j.avb.2014.01.003 · Cited by 45
Dietary patterns and anthropometric indices among Iranian women with major depressive disorder
Rashidkhani, B., Gargari, B. P., Ranjbar, F., Zareiy, S., & Kargarnovin, Z. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.05.022 · Cited by 45
“hence, the number of women who become ill during their childbearing ages is increasing (Kessler et al., 1993; Zisook et al., 2004).”
Background
Gender and gonadal hormone effects in the olfactory bulbectomy animal model of depression
Stock, H. S., Ford, K., & Wilson, M. A. (2000) · Pharmacology Biochemistry and Behavior · doi:10.1016/s0091-3057(00)00318-x · Cited by 45
Anxiety and depression in adults in their eighties: do gender differences remain?
Pachana, N. A., McLaughlin, D., Leung, J., Byrne, G. J., & Dobson, A. J. (2011) · International Psychogeriatrics · doi:10.1017/s1041610211001372 · Cited by 45
“Throughout the lifespan, women are more likely than men to report psychological distress: the lifetime prevalence of major depressive disorder and any anxiety disorder in women is 1.5 times that of men (Kessler et al., 1993).”
BackgroundInfluential
Duloxetine and Pregnancy Outcomes: Safety Surveillance Findings
HOOG, S. L., Cheng, Y., ELPERS, J. C., & Dowsett, S. A. (2013) · International Journal of Medical Sciences · doi:10.7150/ijms.5213 · Cited by 45
“It is more common in women, and its prevalence peaks from the age of 25 to 44 years (2).”
Background
Depression, Obesity, and Metabolic Syndrome
Olvera, R. L., Williamson, D. E., Fisher‐Hoch, S. P., Vatcheva, K. P., & McCormick, J. B. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14m09118 · Cited by 49
Cash transfers, maternal depression and emotional well-being: Quasi-experimental evidence from India's Janani Suraksha Yojana programme.
Powell-Jackson, T., Pereira, S. K., Dutt, V., Tougher, S., Haldar, K., & Kumar, P. (2016) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2016.06.034 · Cited by 51
“Women disproportionately suffer from depression (Piccinelli and Wilkinson, 2000), with gender disparities emerging in adolescence then becoming most stark during the childbearing years (Kessler et al., 1993).”
Background
The Turkish Version of the Ruminative Response Scale: An Examination of Its Reliability and Validity
Erdur‐Baker, Ö., & Bugay, A. (2012) · OpenMETU (Middle East Technical University) · Cited by 45
“Waking Up Every Day With the Worry”: A Mixed-Methods Study of Anxiety in Undocumented Latinx College Students
Suárez‐Orozco, C., & Hernández, G. L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.568167 · Cited by 45
What causes pregnancy loss? Preexisting mental illness as an independent risk factor
Gold, K. J., Dalton, V. K., Schwenk, T. L., & Hayward, R. A. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.02.002 · Cited by 44
Temporal coherence in ultradian sleep EEG rhythms in a never-depressed, high-risk cohort of female adolescents
Morehouse, R. L., Kusumakar, V., Kutcher, S., LeBlanc, J. C., & Armitage, R. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(01)01297-5 · Cited by 45
“This is especially true for women, since there is a twofold greater prevalence of MDD in women than in men (Heller 1993; Kessler et al 1993).”
Background
The progesterone metabolite allopregnanolone potentiates GABAA receptor-mediated inhibition of 5-HT neuronal activity
Kaura, V., Ingram, C. D., Gartside, S. E., Young, A. H., & Judge, S. J. (2007) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2006.02.006 · Cited by 44
“Keywords: electrophysiology, neurosteroid, rat, serotonin, slice.”
Background
Suicide risk and mental health indicators: Do they differ by abuse and HIV status?
Gielen, A. C., McDonnell, K. A., O’Campo, P. J., & Burke, J. G. (2005) · Women's Health Issues · doi:10.1016/j.whi.2004.12.004 · Cited by 59
Depression and Its Effect on the Menstrual Cycle
Padda, J., Khalid, K., Hitawala, G., Batra, N., Pokhriyal, S. C., Mohan, A., Zubair, U., Cooper, A. C., & Jean-Charles, G. (2021) · Cureus · doi:10.7759/cureus.16532 · Cited by 45
“Women diagnosed with MDD are more likely to experience severe disease with somatic symptoms and a higher degree of functional impairment [7-9].”
Background
Protective effect of sex on chronic stress- and depressive behavior-induced vascular dysfunction in BALB/cJ mice
Stanley, S., Brooks, S., Butcher, J. T., d’Audiffret, A. C., Frisbee, S. J., & Frisbee, J. C. (2014) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00537.2014 · Cited by 45
“These results suggest that compared with males, female rats are more susceptible to chronic stress in terms of the severity of depressive behaviors, but that the subsequent development of vasculopathy is blunted owing to an improved ability to tolerate elevated ROS and systemic inflammatory stress. vasodilation; endot…”
BackgroundInfluential
The influence of gender and personality traits on individual difference in auditory mismatch: A magnetoencephalographic (MMNm) study
Matsubayashi, J., Kawakubo, Y., Suga, M., Takei, Y., Kumano, S., Fukuda, M., Itoh, K., Yumoto, M., & Kasai, K. (2008) · Brain Research · doi:10.1016/j.brainres.2008.07.120 · Cited by 44
“In particular, observed gender differences in the prevalence and course of various psychiatric disorders makes it highly likely that gender is a factor in inter-individual differences (for example, Kessler et al., 1993; Smeeth et al., 2004).”
Social Problem-Solving Processes and Mood in College Students: An Examination of Self-report and Performance-based Approaches
Anderson, R. J., Goddard, L., & Powell, J. H. (2007) · Cognitive Therapy and Research · doi:10.1007/s10608-007-9169-3 · Cited by 47
“Kessler et al. 1993; Lewinsohn et al. 1998; Weissman and Olfson 1995).”
Background
Obstetrical and neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors: The relevance of dose
Roca, A., Garcia-Esteve, L., Imaz, M. L., Torres, A., Hernández, S., Botet, F., Gelabert, E., Subirà, S., Plaza, A., Valdés, M., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.07.022 · Cited by 45
“f (Grigoriadis and Robinson, 2007; Kessler et al., 1993).”
Background
Cortisol mediates the effects of stress on the contextual dependency of memories
van Ast, V. A., Cornelisse, S., Meeter, M., & Kindt, M. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.12.007 · Cited by 44
“mood and anxiety disorders in women (Kessler et al., 1993; Cahill, 2006).”
Tailoring Treatment of Depression for Women Across the Reproductive Lifecycle:The Importance of Pregnancy, Vasomotor Symptoms, and Other Estrogen-Related Events in Psychopharmacology
Wise, D. D., Felker, A., & Stahl, S. M. (2008) · CNS Spectrums · doi:10.1017/s1092852900013742 · Cited by 45
“The difference in prevalence between genders begins in early adolescence and persists until women are in their mid-50s.(9) Another study of 9,792 British adults(10) found that, from 16-54 years of age, depression was twice as likely in women than in men, but depression in postmenopause-aged females (55-64 years) retur…”
Background
Romantic attachment, childhood stability, depression, and PTSD in couples with an incarcerated partner
Tadros, E., & Ansell, A. (2022) · Journal of Forensic Sciences · doi:10.1111/1556-4029.14976 · Cited by 44
“Our research also indicated that women had higher rates of depression diagnosis and this gender difference is supported widely in the literature [73, 74].”
Result
Chronic restraint stress produces sex-specific behavioral and molecular outcomes in the dorsal and ventral rat hippocampus
Olave, F. A., Aguayo, F. I., Román-Albasini, L., Corrales, W. A., Silva, J. P., González, P. I., Lagos, S., García-Pérez, M. A., Alarcón-Mardones, M., Rojas, P. S., et al. (2022) · Neurobiology of Stress · doi:10.1016/j.ynstr.2022.100440 · Cited by 45
The role of sex steroids in catamenial epilepsy and premenstrual dysphoric disorder: implications for diagnosis and treatment.
Guille, C., Spencer, S., Cavus, I., & Epperson, C. N. (2008) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2008.02.004 · Cited by 40
“Although, in general, women are at greater risk for unipolar major depressive disorder (MDD) [4], it is not yet known whether this sex bias for MDD holds true in epileptic populations.”
Background
Hippocampal GR expression is increased in elderly depressed females
Wang, Q., Joëls, M., Swaab, D. F., & Lucassen, P. J. (2011) · Neuropharmacology · doi:10.1016/j.neuropharm.2011.09.014 · Cited by 48
“, 1997), the relatively high expression in female depressives may bear relevance to their higher susceptibility to depression (Bland, 1997; Kessler et al., 1993; Naninck et al., 2011; Ustun, 2000).”
Background
The associations among the dopamine D2 receptor Taq1, emotional intelligence, creative potential measured by divergent thinking, and motivational state and these associations' sex differences
Takeuchi, H., Tomita, H., Taki, Y., Kikuchi, Y., Ono, C., Yu, Z., Sekiguchi, A., Nouchi, R., Kotozaki, Y., Nakagawa, S., et al. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00912 · Cited by 44
“Additionally, there are sex differences in mood disorders (Kessler et al., 1993).”
Background
Interaction between specific forms of childhood maltreatment and the serotonin transporter gene (5-HTT) in recurrent depressive disorder
Fisher, H. L., Cohen‐Woods, S., Hosang, G. M., Korszun, A., Owen, M., Craddock, N. J., Craig, I., FARMER, A. E., McGuffin, P., & Uher, R. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.05.032 · Cited by 44
“Although patients in the current study were not systematically recruited, they are broadly comparable to more systematically collected series (Kessler et al., 1993) and it seems unlikely that cases with an unusually high severity of childhood maltreatment would have been recruited.”
Result
Cognitive disruptions in stress-related psychiatric disorders: A role for corticotropin releasing factor (CRF)
Bangasser, D. A., & Kawasumi, Y. (2015) · Hormones and Behavior · doi:10.1016/j.yhbeh.2015.04.003 · Cited by 46
Raphe-Hippocampal Serotonin Neurotransmission In The Sex Related Differences of Adaptation to Stress: Focus on Serotonin-1A Receptor
Haleem, D. J. (2011) · Current Neuropharmacology · doi:10.2174/157015911796558019 · Cited by 43
“The mean age of onset, the overall course of depression and the risk for chronic or recurrent depression does not differ between sexes [35], although some studies suggest that women have a higher rate of recurrent depression and slower recovery from a depressive episode [36].”
Background
Characteristics of adolescent girls with depressive symptoms in a so-called "normal" sample
McClure, E. B., Rogeness, G. A., & Thompson, N. M. (1997) · Journal of Affective Disorders · doi:10.1016/s0165-0327(96)01412-7 · Cited by 43

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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