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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
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BackgroundGender differences in variables associated with sleep quality in chronic tension type headache
Cigarán-Méndez, M., Fernández-Muñoz, J. J., Navarro-Pardo, E., Jiménez-Antona, C., Parás-Bravo, P., Alburquerque-Sendín, F., & Fernández-de-las-Peñas, C. (2018) · Women & health · doi:10.1080/03630242.2017.1372845 · Cited by 7
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Sex and gender differences in OCD: A scoping review and a two subtypes hypothesisPreprint
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DSM‐5‐TR diagnosis as a guide to suicide risk assessment
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“This aligns with the literature suggesting that women may be more vulnerable to mental health challenges due to biological, social, and cultural factors, including caregiving roles and societal expectations (Altemus et al. 2014).”
ADHD and Suicidality in Adolescents: A Systematic Review of Moderators and Mediators
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Sex Differences in Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry
Tam, L. M., Naderi, S., Chi, G., Gornik, H. L., Wells, B. J., Kadian‐Dodov, D. L., Grodzinsky, A., Taylor, A. M., Hess, C. N., Lewey, J., et al. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.042773 · Cited by 5
The impact of living in a bio-secure bubble on mental health: An examination in elite cricket
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“It has been suggested that one of the reasons women are more likely to experience anxiety or depression is their increased sensitivity to things such as separation and isolation (Altemus et al., 2014).”
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“The difference of impact on mental health may be due to the divergence of psychological defense mechanisms between genders (52), emanating from biomedical, psychosocial as well as epidemiological perspective (53, 54).”
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Hospitalized Women Have Anxiety and Worse Mental Health Scores than Men
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“The prevalence of this diagnosis in women is caused by a higher percentage of sexual abuse than in men or hormonal disturbances that cause stress responsivity [20].”
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“Whilst depression and anxiety disorders are more common in females (Altemus et al., 2014), neurodevelopmental disorders are more commonly diagnosed in males (Scott et al., 2002).”
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“Although the gender disparity in the current sample aligns with prior research that has found women more likely to experience food cravings than obese males [80,81], and develop mood and anxiety disorders throughout the lifespan [82,83], a more gender-balanced sample should be sought for future research.”
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“2017) and adults (Altemus et al. 2014), it seems critical to examine sex-specific indicators for depression.”
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Qin, X., Yinzhen, D., Liu, X., Li, X., Gang, C., Li, Z., & Gao, D. (2021) · Parkinson s Disease · doi:10.1155/2021/3118948 · Cited by 5
“In general populations, females are as well at significantly greater risk to have depression than males [38].”
BackgroundVoisin, D. A., Wakeford, A. G. P., Nye, J. A., Mun, J.-Y., Jones, S. R., Locke, J. L., Huhman, K. L., Wilson, M. E., Albers, H. E., & Michopoulos, V. (2022) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2022.173362 · Cited by 5
Song, L., Keyserling, T. C., Chen, R. C., Ma, C., Xu, S., Shieh, K., Fuller, G. P., Nielsen, M. E., Northouse, L., Tan, X. M., et al. (2023) · Cancer Medicine · doi:10.1002/cam4.5646 · Cited by 5
Using signals associated with safety in avoidance learning: computational model of sex differences
Radell, M. L., Beck, K. D., Pang, K. C. H., & Myers, C. E. (2015) · PeerJ · doi:10.7717/peerj.1081 · Cited by 6
EL PAPEL DE LA PERSONALIDAD Y LA INTELIGENCIA EN LA AUTOEFICACIA INTERPERSONAL
de Miguel, A., Marrero, R. J., Fumero, A., & Abella, M. C. (2017) · Revista Iberoamericana de Diagnóstico y Evaluación - e Avaliação Psicológica · doi:10.21865/ridep44.2.02 · Cited by 6
A Susceptible Period of Photic Day-Night Rhythm Loss in Common Marmoset Social Behavior Development
Koshiba, M., Senoo, A., Karino, G., Ozawa, S., Kamei, Y., Honda, Y., Tanaka, I., Kodama, T., Usui, S., & Tokuno, H. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2020.539411 · Cited by 5
Hajj, A., Badro, D. A., Selwan, C. A., Sacre, H., Aoun, R., & Salameh, P. (2020) · Research Square · doi:10.21203/rs.3.rs-122511/v1 · Cited by 5
Stevanovic, K. D., Fry, S. A., DeFilipp, J. S., Wu, N., Bernstein, B. J., & Cushman, J. D. (2022) · Learning & Memory · doi:10.1101/lm.053599.122 · Cited by 6
“There are wide-spread sex differences in the incidence of behavioral disorders, such as anxiety, depression, and substance use disorders (Altemus et al. 2014; Agabioet al. 2016).”
Wu, S., Liu, Y., Mo, H., Li, L., Li, Z., & Ying, Y. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1494629 · Cited by 4
Li, T., Zhang, D., Jiang, T., Che, W., Zhang, Y., Wan, Y., Tao, F., Tao, S., & Wu, X. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07036-3 · Cited by 4
“…symptoms and bridge symptoms in the depression-anxiety network; and (3) given the significant influence of gender on both depression and anxiety [24, 25], we also aimed to explore the impact of gender on the depression-anxiety comorbidity network. influence (1-step) = 0.51, expected influence…”
InfluentialSuominen, E. H., Zahir, R., Hampton, S., Cooper, K., Midouhas, E., Flouri, E., Saunders, R., & Mandy, W. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120678 · Cited by 5
Kożybska, M., Starkowska, A., Szpakow, A., & Fedortsiv, O. (2025) · Scientific Reports · doi:10.1038/s41598-025-27728-w · Cited by 4
“Numerous theories have been proposed to explain the causes of this gender gap, for example through biological factors (cyclical hormonal changes 42 or genetic predispositions), psychosocial factors (exposure and susceptibility to stress and more emotional coping styles) and cultural factors…”
İzmir, S. B. İ., Korkmazlar, Ü., & Ercan, E. S. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231184757 · Cited by 4
“In terms of sex differences, all anxiety disorders occur more frequently among females than males (McLean et al., 2011; Altemus et al., 2014).”
Wakeford, A. G. P., Nye, J. A., Grieb, Z. A., Voisin, D. A., Mun, J.-Y., Huhman, K. L., Albers, E. H., & Michopoulos, V. (2023) · Biology of Sex Differences · doi:10.1186/s13293-023-00562-3 · Cited by 4
Threat sensitivity in emotion dynamics: Negativity effects and sex differences
Robinson, M. D., Irvin, R. L., & Asad, M. R. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104542 · Cited by 5
Heart rate variability: A primer for alcohol researchers
Frasier, R. M., Sergio, T. D. O., Starski, P. A., & Hopf, F. W. (2024) · Alcohol · doi:10.1016/j.alcohol.2024.06.003 · Cited by 4
Maoz, H., Grossman‐Giron, A., Baruch, N., Sedoff, O., Mama, Y., Nitzan, U., & Bitan, D. T. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116269 · Cited by 4
Ciolac, L., Bernad, E. S., Tudor, A., Nițu, D.-R., Buleu, F. N., Popa, D. I., Toc, T., Haivas, C. C., & Craina, M. L. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14124286 · Cited by 4
“…recurrent depression [11,12], the prevalence of hormone-influenced episodes of depression, such as premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression, suggests that fluctuating hormone levels have been linked to an elevated distinct risk in women [13].”
de Lacy, N., Kutz, J. N., & Calhoun, V. D. (2020) · Cognitive Neuroscience · doi:10.1080/17588928.2020.1793752 · Cited by 4
“…other proposed neural bases of traits for anxiety and depression nor imply causality, it is also instructive to consider how our findings may relate to the different emphases in the presentation of clinical anxiety and depression found in males/men and females/ women (Altemus et al., 2014).”
BackgroundLvovs, A., Matrov, D., Kurrikoff, T., Veidebaum, T., & Harro, J. (2021) · Acta Neuropsychiatrica · doi:10.1017/neu.2021.41 · Cited by 5
Magson, N. R., Oar, E. L., Fardouly, J., Rapee, R. M., Freeman, J. Y. A., Richardson, C. E., & Johnco, C. J. (2022) · Journal of Youth and Adolescence · doi:10.1007/s10964-022-01700-7 · Cited by 5
Teh, R., & Krishnan-Vasanthi, R. (2022) · Journal of Sport and Health Research · doi:10.58727/jshr.96641 · Cited by 4
Kouga, T., Kouda, Y., Miwa, T., & Sunami, K. (2023) · Equilibrium Research · doi:10.3757/jser.82.254 · Cited by 4
The influence of gender differences on the illness perception and women’s point of view on COPD
Janković, J., Djurdjevic, N., Jandrić, A., Karić, U., Milivojević, I., Ratkovic, A., & Buha, I. (2023) · Bratislavské lekárske listy/Bratislava medical journal · doi:10.4149/bll_2023_122 · Cited by 4
Ross, A. J., Russotti, J. M., Toth, S. L., Cicchetti, D., & Handley, E. D. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001347 · Cited by 5
“An individual’s sex has been identified as a predictor of symptomatology, with males more likely to exhibit externalizing behaviors (Mayes et al., 2020) and females more likely to exhibit anxiety symptoms in childhood (e.g., Altemus et al., 2014).”
Exploring Mandala – Art as a Form of Therapy
Raimaini, N. H. A., & Zahit, R. A. (2023) · Trends in Undergraduate Research · doi:10.33736/tur.5986.2023 · Cited by 4
“Though an immense number of past findings contradict the hypothesis of this research (Altemus, et al. 2014; Parker & Brotchie, 2014; Viertiö et al ., 2021), a study in Malaysia by Shamsudin et al .”
BackgroundResultWallace, A. L., Courtney, K. E., Wade, N. E., Doran, N., Delfel, E. L., Baca, R. E., Hatz, L. E., Thompson, C., Andrade, G., & Jacobus, J. (2024) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108064 · Cited by 4
Huang, J., Xie, T., & Xu, W. (2024) · Mindfulness · doi:10.1007/s12671-024-02455-x · Cited by 4
“Meanwhile, due to differences in brain structure and hormone secretion, men and women can exhibit different characteristics in their development of psychopathology (Altemus et al., 2014).”
McChord, J., & Ong, P. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11120381 · Cited by 4
Hernández, P. A. F., Farías‐Valenzuela, C., Rezende, L. F. M., Nascimento, M. D. M., Marques, A., de Victo, E. R., & Ferrari, G. (2024) · Scientific Reports · doi:10.1038/s41598-024-82396-6 · Cited by 6
Carlson, K. W., Smolker, H. R., Smith, L. L., Snyder, H. R., Hankin, B. L., & Banich, M. T. (2025) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-024-01262-0 · Cited by 6
“Because of differential changes in brain development and psychopathology in males and females during adolescence (Altemus et al., 2014), we also ran models on each gender separately.”
Harbi, R. A., & Mouihate, A. (2025) · Neuroscience · doi:10.1016/j.neuroscience.2025.01.055 · Cited by 4
Moraga‐Amaro, R., Moreno, Ó., Llop, J., Bankstahl, M., & Bankstahl, J. P. (2025) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2025.1488261 · Cited by 5
“…recent research suggests that there is a differential response of each biological sex to stress with regard to neural development and early life events (Fernández-Guasti et al., 2012; Altemus et al., 2014; Rubinow and Schmidt, 2019), which might also contribute to neurological disease development.”
Zhu, R.-L., Wang, L., Wu, X., & Wang, K. (2025) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2025.100299 · Cited by 4
“Interestingly, the literature in the general population suggests that females have a greater overall risk of developing depression [36].”
Ren, S., Qin, P., Wang, Y., Li, Z., Sun, Z., Wang, G., & Yang, J. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07156-w · Cited by 5
Evaluation and Management of Behavioral Health Disorders in Women
Fitelson, E. M., & McGibbon, C. (2016) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2016.02.001 · Cited by 4
Sex Differences and Personalized Psychiatric Care
Eckstrand, K., Travis, M. J., Forbes, E. E., & Phillips, M. L. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.09.009 · Cited by 4
“At the same time that sex and gender differences are being investigated to a greater extent among adults, it has been well established that there are sex differences in brain development among typically developing adolescents (8) and in the onset and severity of certain psychiatric illnesses, including depressive and…”
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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