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Sex differences in anxiety and depression clinical perspectives
Open accessAbstract
Sex differences are prominent in mood and anxiety disorders and may provide a window into mechanisms of onset and maintenance of affective disturbances in both men and women. With the plethora of sex differences in brain structure, function, and stress responsivity, as well as differences in exposure to reproductive hormones, social expectations and experiences, the challenge is to understand which sex differences are relevant to affective illness. This review will focus on clinical aspects of sex differences in affective disorders including the emergence of sex differences across developmental stages and the impact of reproductive events. Biological, cultural, and experiential factors that may underlie sex differences in the phenomenology of mood and anxiety disorders are discussed.
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“This result is consistent with previous studies showing that women experience anxiety more and are twice more likely to develop anxiety disorders over their lifetime than men [42].”
From Adaptive function and correlates of anxiety during a pandemic (2021) · cites this paper as [42]
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“with women at an increased risk (96, 97)”
From Higher Circulating Cortisol in the Follicular vs. Luteal Phase of the Menstrual Cycle: A Meta-Analysis (2020) · cites this paper as [96]
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“Other studies do not distinguish between gender and sex differences, 23 which may lead to ambiguity in the analysis.”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [23]
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“Notably, IDs are highly comorbid [17–19] with females [20–23] and young people (i.e. <65 years) [8, 10, 17–19, 22, 24–29] disproportionately affected.”
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“These findings are consistent with previous studies that females have shown higher rates of depressive symptoms (Kandel and Davies, 1982), generalized anxiety disorder (Altemus et al., 2014; Kessler et al., 1994), and suicidal ideation (Borges et al., 2006; Crosby et al., 1999).”
From Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment (2020) · cites this paper as Altemus et al., 2014
In the citing paper
“and surprising given that women are more susceptible to anxiety and depressive disorders than men (53).”
From Perineuronal nets, inhibitory interneurons and anxiety-related ventral hippocampal neuronal oscillations are altered by early life adversity (2019) · cites this paper as [53]
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Citations
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BackgroundInfluential
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“Examples of differing prevalence would be the 3:1 male to female ratio observed in ADHD or the 2:1 female to male ratio for anxiety/depression (Altemus et al., 2014; Ji et al., 2018).”
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“Although all clinically dissociated groups included more women than men, consistent with the literature on sex differences in depression (47), the proportion of women was signi fi cantly larger in the acute impairment group (85%, p , .029) than in most other dissociated groups (51% – 62%; Table S3).”
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“Research has documented a greater incidence of anxiety, stress, and depression among females compared to males (Altemus et al., 2014; Basta et al., 2022; Parker & Brotchie, 2010; Ramón-Arbués et al., 2020), although these differences are not attributed to innate biological factors but rather to…”
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“Though depression and anxiety occur about twice as commonly in females than in males [41,42], animal studies have tended to use males for a long time, which might result from the mistaken bias that females were more variable in behavior due to hormone levels and other reasons [43,44].”
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Sex/Gender Differences in Depression and Anxiety Disorders
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“There are sex differences in depressive and anxiety related symptoms with women being at greater risk of mental health symptoms than men [26, 27].”
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“Conversely, when anxiety is evaluated in dentists during work, this gender difference seems not to be relevant (Altemus et al., 2014; Davidovich et al., 2015; Asif et al., 2022).”
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“Within the brain, sex differences have been observed in different regions [10–14] as well as in memory [15–21] and prevalence of psychological disorders [22–24].”
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Hoogstoel, F., Fassinou, L. C., Samadoulougou, S., Mahieu, C., Coppieters, Y., & Kirakoya‐Samadoulougou, F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168602 · Cited by 10
“4%) of children aged 0 to 17 lived in a poor household in 2015 [34], this factor should be seriously considered in strategies to address suicide among adolescents.”
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“Influenced by gender chromosome genes and psychological characteristics, women are found to exhibit more self-blame in stressful events and show a tendency toward avoidance, depression, and other negative coping methods, which are closely related to the increase in anxiety symptoms in women (26).”
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The neurogenetics of sexually dimorphic behaviors from a postdevelopmental perspective
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Molecular programs underlying differences in the expression of mood disorders in males and females
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“In the general population, a higher prevalence of depression has been shown among women than men (12).”
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“…level, side of arthritis (unilateral versus bilateral), psychological comorbidities (PHQ-2 anxiety score, PHQ-2 depression score), pain (KOOS pain score), and disease severity (Kellgren-Lawrence grade) were key confounding factors identi fi ed from the evidence [1, 3, 8, 19, 21, 32, 33, 40, 52].”
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Maternal behavior promotes resilience to adolescent stress in mice through a microglia-neuron axis
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“Women have a lower incidence of stroke (which also depends on age), but the effectiveness of treatment after stroke in women is lower than in men [128].”
Microglia reactivity is brain region and sex specific in the context of chronic stress
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“This period is characterized by disruptions in serotonin and dopamine pathways [12,17], diminished trophic support in the hippocampus, and altered HPA-axis feedback regulation, contributing to a second major peak in female depressive vulnerability described across epidemiological studies [1,2].”
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“Sex differences have been implicated in the higher prevalence of AD in females [5], and females are more susceptible to NPS than males [6].”
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“Indeed, in line with the evidence showing the influence of sex on the development of psychiatric disorders (Altemus et al., 2014; May et al., 2019; Tesic et al., 2019), which becomes manifest in adulthood (Solmi et al.”
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“Furthermore, given the consistent sex differences observed in psychological distress, and PA (Altemus et al., 2014; Bann et al., 2019; Farooq et al., 2018; Gao et al., 2020; McLean et al., 2011; Salk et al., 2017), it is important to consider sex when examining the relationships between these…”
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“Furthermore, in the study of humans, it is often challenging to truly disambiguate biological versus socio-cultural contributions to psychopathologies, including anxiety disorders (2, 5, 6).”
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“That said, females often report sleep disturbances and nightmare at a higher rate than males, as well as high levels of anxiety, depression, and stress (Altemus et al., 2014; Schredl & Pallmer, 1998; Sivertsen et al., 2009; Zhang & Wing, 2006).”
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Gender and Psychotropic Poisoning in the USA
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Predictors of prodromal Parkinson’s disease in young adult Pink1−/− rats
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“Multiple lines of work that suggest individuals diagnosed with PD have increased rates of anxiety and depression, and prevalence is higher in women (Shiba et al., 2000; Quelhas and Costa, 2009; Leentjens et al., 2011; Yamanishi et al., 2013; Altemus et al., 2014; Broen et al., 2016; Cui et al., 2017).”
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Genetic and Epigenetic Mechanisms Linking Pain and Psychiatric Disorders
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Depression is associated with CRP SNPs in patients with family history
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Development of the Parenting In a Pandemic Scale (PIPS)Preprint
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“…significantly more depressed (men: median = 3 (interquartile range (IQR) = 5) vs. women: median = 4 (IQR = 5.5); Z = -4.29, p -bon < 0.001) and more anxious (men: median 2 (IQR = 4) vs. women: median = 3 (IQR = 6); Z = -5.52, p -bon < 0.001), a well-known gender difference (Altemus et al., 2014).”
Influential
Metadata
- Authors
- Altemus, M., Sarvaiya, N., & Neill Epperson, C.
- Affiliations
- Cornell University (US)
- Northwell Health (US)
- Corresponding author
- Altemus, Margaret
- ORCID
- Altemus, Margaret
- Venue
- Frontiers in Neuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 35
- Issue
- 3
- Pages
- 320-330
- ISSN
- 0091-3022 (ISSN-L)
- PMC
- PMC4890708
- OpenAlex
- W2049163404
- Cited by
- 1,413
- References
- 176
- Citations by year
- 2026: 113 · 2025: 181 · 2024: 177 · 2023: 174 · 2022: 178 · 2021: 194 · 2020: 141 · 2019: 87 · 2018: 68 · 2017: 38 · 2016: 28 · 2015: 30 · 2014: 3
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Frontiers in Neuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health and NIH Office of Research on Women’s Health (P50 MH099910)
- National Institute on Drug Abuse (K24 DA03031)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sex differences, anxiety disorders, depression, mood disorders, reproductive hormones, reproductive events, stress responsivity, social expectations
- MeSH terms
- Animals, Anxiety, Anxiety Disorders, Depression, Humans, Sex Characteristics, Stress, Psychological
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