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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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Cites
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BackgroundInfluential
Cited by
Sorted by citations
Items 701–800 of 1,000
Heikura, E. E., Aunola, K., Tolvanen, A. J., Ryba, T. V., & Selänne, H. (2023) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2022.2158250 · Cited by 8
“Overall, it has been suggested that sex differences in brain structure and function, such as those that promote reproductive function, may make females more prone to negative moods and therefore to mood and anxiety disorders (Altemus et al., 2014).”
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“The odds of developing elevated anxiety symptoms differs by sex in the general population, with females more likely compared to males (17).”
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“An interesting feature about these disorders is the presence of a sex bias in their prevalence, with females showing higher rates of anxiety and depression, whereas an increased proportion of males have ADHD and autism [4–6].”
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Clayborne, Z. M., Gilman, S. E., Khandaker, G. M., & Colman, I. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107162 · Cited by 8
“…to pre-natal adversity (Sutherland and Brunwasser, 2018), and sex differences in the prevalence of anxiety and mood disorders begin to emerge during middle childhood to early adolescence, respectively, with the prevalence of both being higher in girls compared to boys (Altemus et al., 2014).”
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Autonomic control of blood pressure in women: The roles of hypertension and aging
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Climate Anxiety in Perspective: A Look at Dominant Stressors in Youth Mental Health and Sleep
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“The choice of covariates is justified by evidence of greater prevalence of depression, anxiety disorders, and insomnia among females and younger adults [74, 75].”
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“With respect to the covariates included in this study, girls experienced higher levels of anxiety than boys, which is in line with previous literature (Altemus et al., 2014).”
ResultYang, Y., Li, Y., Zhao, P., Wang, J., Mi, B., Pei, L., Zhao, Y., & Chen, F. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.934801 · Cited by 9
“Previous studies have shown that DS is more common in women than men (Altemus et al., 2014), and our study confirms this conclusion.”
ResultPrepubertal ovariectomy confers resilience to stress-induced anxiety in adult female mice
Woodward, E. M., Ringland, A., Ackerman, J., & Coutellier, L. D. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105997 · Cited by 8
Mental Health in Adults With ADHD: Examining the Relationship With Cardiorespiratory Fitness
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“Biological sex was used as a covariate in all regression and moderation analyses as sex differences have been noted in ADHD symptoms (Fedele et al., 2012), CRF (Al-Mallah et al., 2016; Dimech et al., 2019), and mental health (Altemus et al., 2014).”
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“Interestingly, this pattern was seen even when controlling for psychological distress, and therefore cannot be explained by greater psychological distress in this group (Altemus et al., 2014).”
BackgroundHeart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex
Díez‐Villanueva, P., Jiménez-Méndez, C., López-Lluva, M. T., Wasniewski, S., Solı́s, J., Fernández‐Friera, L., & Martínez‐Sellés, M. (2023) · Current Heart Failure Reports · doi:10.1007/s11897-023-00619-9 · Cited by 8
“These differences could be explained in part by different coping styles between men and women since women experience more rumination, an internalizing coping style by repetitive thinking which can cause great suffering when encountering chronic health conditions [101].”
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Attachment Insecurity in Rats Subjected to Maternal Separation and Early Weaning: Sex Differences
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Impact of COVID– 19 on the Psychological Health of Dental Professionals: A Systematic Review
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Sex-specific gene expression in the blood of four primates
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Depression, Anxiety, and Pubertal Timing: Current Research and Future Directions
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Risk factors for mental health in general population during SARS-COV2 pandemic: a systematic review
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“Furthermore, psychosocial stress is associated with a proinflammatory phenotype – here again a significant female predominance exists (Altemus et al. 2014).”
BackgroundSaraiva, M., Oliveira, S., Coimbra, M., & Ferreira, C. (2024) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2024.2308861 · Cited by 7
“The proximity of competition increases the athlete ’ s level of anxiety because of a threatening competitive environment, since important goals are at stake (Altemus et al., 2014).”
Post-weaning social isolation alters sociability in a sex-specific manner
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Sex Differences in Psychosocial Factors and Angina in Patients With Chronic Coronary Disease
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“Women have twice the lifetime prevalence of depression and most ADs compared to men [92, 93].”
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“Moreover, prevalence rates of internalizing pathology vary by sex, such that female adolescents are 2 – 3 times more likely to develop pathological anxiety and/or depression compared to male adolescents (Altemus et al., 2014).”
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Gender differences in symptom profiles of individuals being treated for mood disorders
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BackgroundA single-center assessment of mental health and well-being in a biomedical sciences graduate program
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“It is important to note that these differences could be in fl uenced by biological, psychological, and sociocultural factors (37).”
BackgroundAssociation Between Self-Construals, Social Pain Sensitivity, and Gender in Young Adults
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“It is documented that women typically exhibit higher risks of anxiety disorders and levels of anxiety compared to men (Altemus et al., 2014; Spielberger et al., 1983), suggesting that gender differences in anxiety may potentially explain gender differences in social pain sensitivity.”
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“Previous research has stated that there is an onset of anxiety and depression disorders in stages of adolescence and early adulthood with females being at greater risk compared to males (Altemus et al., 2014).”
BackgroundPsychological resilience is positively correlated with Habenula volume
Dai, Q., Kyuragi, Y., Zakia, H., Oishi, N., Yao, L., Zhang, Z., Wang, L., Yang, J., Murai, T., & Fujiwara, H. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.012 · Cited by 11
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“Broadly speaking, females are at significantly higher risk for developing most mood and anxiety disorders than males, however, these differences may not begin to emerge until middle childhood or post-puberty [42].”
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“Moreover, female sex is associated with higher rates of anxiety and depression (Altemus et al. 2014), this may have contributed to the high rates of mental disorder seen, particularly in our Canadian sample of HCPs. Additional bias may also be present as we are unable to determine a true…”
BackgroundLongitudinal Impact of Social Restrictions on Sexual Health in the Italian Population
Vedovo, F., Capogrosso, P., Blas, L. D., Cai, T., Arcaniolo, D., Privitera, S., Palumbo, F., Palmieri, A., & Trombetta, C. S. (2022) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2022.03.607 · Cited by 7
“Reconfirming that, as it is known for other clinical sets, the female gender is more susceptible to stressful conditions.(30)”
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“disorders beginning at childhood or adolescence (Donner and Lowry, 2013; Altemus et al., 2014; Bekhbat and Neigh, 2018).”
Single-Cell Analysis of Sex and Gender Differences in the Human Brain During Development and Disease
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“…diseases, differences in the number, distribution, and activity of particular cells, such as neurons and immune cells, have been observed between males and females (Altemus et al. 2014; Arain et al. 2013; Bao and Swaab 2011; Clayton 2016; Hanamsagar and Bilbo 2016; Hines 2020; Turner et al. 2019).”
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“Because females are at a significantly greater risk of developing affect-related disorders in humans [65], we used female mice for this study (additionally, females of both strains are known to be able to be mixed-housed with no detrimental impact on welfare [66]).”
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Protracted opioid withdrawal behaviors are reduced by nitric oxide inhibition in mice
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BackgroundA real-world pharmacovigilance study of esketamine nasal spray
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Estrous cycle stage gates the effect of stress on reward learning
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PERUBAHAN FISIK DAN PSIKOSOSIAL MEMPENGARUHI KUALITAS HIDUP PASIEN HEMODIALISIS
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“somatoform disorder, and suicide attempts, whereas male patients are more likely to have comorbid substance abuse (10).”
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Influence of negative mood states on moral decision-making
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Poststress social isolation exerts anxiolytic effects by activating the ventral dentate gyrus
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The genetics of a “femaleness/maleness” score in cardiometabolic traits in the UK biobank
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Effects of cannabidiol on reward contextual memories induced by cocaine in male and female mice
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“…include clinical symptoms (Fried and Nesse, 2015), response to treatment (Rush et al., 2006), and biological sex, gender identity, and gender expression in clinical as well as brain features (Whiteford et al., 2013; Altemus et al., 2014; Labaka et al., 2018; Bangasser and Cuarenta, 2021).”
Background
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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