An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample
Open accessAbstract
Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.
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Other internalizing disorders, such as bulimia nervosa or another anxiety disorder, may appear alongside anxiety.
“Therefore, other internalizing disorders, such as bulimia nervosa or another anxiety disorder, may appear alongside anxiety.37,43”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [37]
The Results (Comorbidity Structure; page not provided) group several anxiety disorders under a shared internalizing factor, supporting the possibility that another anxiety disorder may appear alongside anxiety. The Method (Assessment; page not provided) lists the diagnoses examined but does not include bulimia nervosa, so the bulimia example is not supported by this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAnxiety and depression are more common in females than males.
“In general, anxiety and depression are more common in females than males, which is likely due to a variety of biopsychosocial factors that contribute to more internalizing symptoms in females and more externalizing symptoms in males (Bandelow & Michaelis, 2015;Boyd et al., 2015;Eaton et al., 2012;Steel et al., 2014).”
From Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment (2024) · cites this paper as Eaton et al., 2012
Depression is common among women, and the ages when women are most likely to give birth coincide with the ages when depression rates across the lifespan appear highest.
“Of course, depression is common among women, and the ages at which women are most likely to have children are those at which women seem to have the highest rates of depression across the life-span [56,57].”
From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [57]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Evaluating Goodness-of-Fit Indexes for Testing Measurement Invariance
Cheung, G. W., & Rensvold, R. B. (2002) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1207/s15328007sem0902_5 · Cited by 16,280 · see citing works
Kessler, R. C. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950010008002 · Cited by 12,370 · see citing works
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008) · Perspectives on Psychological Science · doi:10.1111/j.1745-6924.2008.00088.x · Cited by 5,172 · see citing works
Gender differences in depression: Critical review
Piccinelli, M., & Wilkinson, G. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.6.486 · Cited by 2,376 · cited 1× · see citing works
“These explanations include response bias, differential service utilization rates, and various biological, social, and demographic influences (see Klose & Jacobi, 2004; Piccinelli & Wilkinson, 2000).”
Wittchen, H.-U. (1994) · Journal of Psychiatric Research · doi:10.1016/0022-3956(94)90036-1 · Cited by 2,348 · see citing works
Kessler, R. (1993) · Journal of Affective Disorders · doi:10.1016/0165-0327(93)90026-g · Cited by 2,207 · cited 1× · see citing works
“Specifically, women show significantly higher prevalence rates of internalizing disorders, while men show significantly higher rates of externalizing disorders (Grant & Weissman, 2007; Kessler et al., 1993, 1994).”
Sex differences in unipolar depression: Evidence and theory.
Nolen–Hoeksema, S. (1987) · Psychological Bulletin · doi:10.1037/0033-2909.101.2.259 · Cited by 2,001 · see citing works
The Structure of Common Mental Disorders
Krueger, R. F. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.10.921 · Cited by 1,881 · see citing works
Self-citationKendler, K. S., Prescott, C. A., Myers, J., & Neale, M. C. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.9.929 · Cited by 1,868 · see citing works
Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.10.1097 · Cited by 1,645 · see citing works
Self-citationGrant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. P., Dufour, M. C., & Pickering, R. P. (2004) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2004.02.004 · Cited by 1,509 · see citing works
Self-citationKrueger, R. F., Hicks, B. M., Patrick, C. J., Carlson, S. R., Iacono, W. G., & McGue, M. (2002) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.111.3.411 · Cited by 1,378 · see citing works
Self-citation(2010) · Cited by 874 · see citing works
Assessing Factorial Invariance in Ordered-Categorical Measures
Millsap, R. E., & Tein, J. Y. (2004) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr3903_4 · Cited by 864 · see citing works
Grant, B., Harford, T., Dawson, D., Chou, P., & Pickering, R. (1995) · Drug and Alcohol Dependence · doi:10.1016/0376-8716(95)01134-k · Cited by 689 · see citing works
Self-citationTrull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.4.412 · Cited by 651 · see citing works
A Population-Based Twin Study of the Relationship Between Neuroticism and Internalizing Disorders
Hettema, J. M., Neale, M. C., Myers, J., Prescott, C. A., & Kendler, K. S. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.5.857 · Cited by 633 · see citing works
Age differences in the Big Five across the life span: evidence from two national samples
Donnellan, M. B., & Lucas, R. E. (2008) · Psychology and Aging · doi:10.1037/a0012897 · Cited by 560 · see citing works
STRUCTURAL MODELS OF PERSONALITY AND THEIR RELATION TO ANTISOCIAL BEHAVIOR: A META‐ANALYTIC REVIEW*
Miller, J. D., & Lynam, D. R. (2001) · Criminology · doi:10.1111/j.1745-9125.2001.tb00940.x · Cited by 556 · see citing works
Keyes, K. M., Grant, B. F., & Hasin, D. S. (2008) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.08.017 · Cited by 526 · see citing works
Self-citationNeuroticism as a common dimension in the internalizing disorders
Griffith, J. W., Zinbarg, R. E., Craske, M. G., Mineka, S., Rose, R. D., Waters, A. M., & Sutton, J. M. (2010) · Psychological Medicine · doi:10.1017/s0033291709991449 · Cited by 440 · see citing works
The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population
SLADE, T., & WATSON, D. (2006) · Psychological Medicine · doi:10.1017/s0033291706008452 · Cited by 419 · see citing works
Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders
Markon, K. E. (2010) · Psychological Medicine · doi:10.1017/s0033291709990183 · Cited by 311 · see citing works
Self-citationHicks, B. M., Blonigen, D., Kramer, M., Krueger, R., Patrick, C. J., Iacono, W., & McGue, M. (2007) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.116.3.433 · Cited by 243 · see citing works
Self-citationAndrews, G., Goldberg, D. P., Krueger, R. F., Carpenter, W. T., Hyman, S. E., Sachdev, P., & Pine, D. S. (2009) · Psychological Medicine · doi:10.1017/s0033291709990250 · Cited by 242 · see citing works
Self-citationPersonality and the genetic risk for alcohol dependence.
Slutske, W. S., Heath, A. C., Madden, P. A. F., Bucholz, K. K., Statham, D. J., & Martin, N. G. (2002) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.111.1.124 · Cited by 224 · see citing works
Vesga-López, O., Schneier, F. R., Wang, S., Heimberg, R. G., Liu, S.-M., Hasin, D. S., & Blanco, C. (2008) · PubMed · Cited by 205 · see citing works
Self-citationIntroduction to the National Epidemiologic Survey on Alcohol and Related Conditions
Grant, B. F., & Dawson, D. A. (2006) · PubMed Central · Cited by 201 · see citing works
Self-citationKramer, M. D., Krueger, R. F., & Hicks, B. M. (2008) · Psychological Medicine · doi:10.1017/s0033291707001572 · Cited by 190 · see citing works
Self-citationThe Conceptual Evolution of DSM-5
Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2010) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378111 · Cited by 190 · see citing works
Klose, M., & Jacobi, F. (2004) · Archives of Women s Mental Health · doi:10.1007/s00737-004-0047-7 · Cited by 187 · see citing works
Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda For DSM-V
First, M. B., Sirovatka, P. J., & Regier, D. A. (2007) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890427668 · Cited by 151 · see citing works
LAM, D., SMITH, N., CHECKLEY, S., RIJSDIJK, F., & SHAM, P. (2003) · Psychological Medicine · doi:10.1017/s0033291702007304 · Cited by 125 · see citing works
Harkness, K. L., Alavi, N., Monroe, S. M., Slavich, G. M., Gotlib, I. H., & Bagby, R. M. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0020629 · Cited by 116 · see citing works
Dawson, D. A., Goldstein, R. B., Moss, H. B., Li, T., & Grant, B. F. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.04.019 · Cited by 75 · see citing works
Self-citationThe Meaning of Comorbidity Among Common Mental DisordersPreprint
Eaton, N. R., South, S. C., & Krueger, R. F. (2020) · doi:10.31234/osf.io/xra9y · Cited by 52 · see citing works
Self-citationBarrantes‐Vidal, N., Ros‐Morente, A., & Kwapil, T. R. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2009.09.021 · Cited by 50 · see citing works
Gender and the prevalence of psychiatric disorders.
Grant, B. F., & Weissman, M. M. (2007) · Cited by 40 · see citing works
Self-citationDSM's approach to gender: History and controversies.
Widiger, T. A. (2007) · Cited by 10 · see citing works
The Structure and Stability of Common Mental Disorders: The NEMESIS Study
Vollebergh, W. A. M., Iedema, J., Bijl, R. V., de Graaf, R., Smit, F., & Ormel, J. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.6.597 · Cited by 6 · see citing works
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Why is depression more common among women than among men?
Kuehner, C. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30263-2 · Cited by 1,752 · see citing works
Postpartum depression: current status and future directions
O'Hara, M. W., & McCabe, J. E. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185612 · Cited by 1,750 · see citing works
Evidence for a mental health crisis in graduate education
Evans, T. M., Bira, L., Gastelum, J. B., Weiss, L. T., & Vanderford, N. L. (2018) · Nature Biotechnology · doi:10.1038/nbt.4089 · Cited by 1,441 · see citing works
Perinatal mental illness: Definition, description and aetiology
O'Hara, M. W., & Wisner, K. L. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.09.002 · Cited by 986 · see citing works
One in two cancer patients is significantly distressed: Prevalence and indicators of distress
Mehnert, A., Hartung, T. J., Friedrich, M., Vehling, S., Brähler, E., Härter, M., Keller, M., Schulz, H., Wegscheider, K., Weis, J., et al. (2018) · Psycho-Oncology · doi:10.1002/pon.4464 · Cited by 615 · see citing works
A hierarchical causal taxonomy of psychopathology across the life span.
Lahey, B. B., Krueger, R. F., Rathouz, P. J., Waldman, I. D., & Zald, D. H. (2017) · Psychological Bulletin · doi:10.1037/bul0000069 · Cited by 443 · see citing works
Self-citationHasin, D. S., & Grant, B. F. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1088-0 · Cited by 452 · see citing works
Self-citationFarhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. (2022) · Science Progress · doi:10.1177/00368504221135469 · Cited by 409 · see citing works
“appear alongside anxiety.(37,43) In men, anxiety is often comorbid with disorders characterized by the presence of externalizing traits (i.”
BackgroundSocial identity, self‐esteem, and mental health in autism
Cooper, K., Smith, L. G. E., & Russell, A. (2017) · European Journal of Social Psychology · doi:10.1002/ejsp.2297 · Cited by 354 · see citing works
Transdiagnostic factors of mental disorders.
Krueger, R. F., & Eaton, N. R. (2015) · World Psychiatry · doi:10.1002/wps.20175 · Cited by 330 · see citing works
Self-citationThe structure and predictive validity of the internalizing disorders.
Eaton, N. R., Krueger, R. F., Markon, K. E., Keyes, K. M., Skodol, A. E., Wall, M., Hasin, D. S., & Grant, B. F. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0029598 · Cited by 225 · see citing works
Self-citationKessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullerton, C. S., Hwang, I., Naifeh, J. A., Nock, M. K., Petukhova, M., Sampson, N. A., et al. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.28 · Cited by 212 · see citing works
You’ve got male: Sex and the microbiota-gut-brain axis across the lifespan
Jaggar, M., Rea, K., Spichak, S., Dinan, T. G., & Cryan, J. F. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2019.100815 · Cited by 200 · see citing works
Are fit indices used to test psychopathology structure biased? A simulation study
Greene, A. L., Eaton, N. R., Li, K., Forbes, M. K., Krueger, R. F., Markon, K. E., Waldman, I. D., Cicero, D. C., Conway, C. C., Docherty, A. R., et al. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000434 · Cited by 148 · see citing works
Self-citationShalev, I., Moffitt, T. E., Braithwaite, A. W., Danese, A., Fleming, N. I., Goldman-Mellor, S., Harrington, H. L., Houts, R. M., Israel, S., Poulton, R., et al. (2014) · Molecular Psychiatry · doi:10.1038/mp.2013.183 · Cited by 155 · see citing works
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Forbush, K. T., & Watson, D. (2013) · Psychological Medicine · doi:10.1017/s0033291712001092 · Cited by 109 · see citing works
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Martin, J., Khramtsova, E. A., Goleva, S. B., Blokland, G. A. M., Traglia, M., Walters, R. K., Hübel, C., Coleman, J. R. I., Breen, G., Børglum, A. D., et al. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.12.024 · Cited by 79 · see citing works
Franco, S., Olfson, M., Wall, M. M., Wang, S., Hoertel, N., & Blanco, C. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.03.003 · Cited by 82 · see citing works
The cross-national structure of mental disorders: results from the World Mental Health Surveys
de Jonge, P., Wardenaar, K. J., Lim, C. C. W., Aguilar-Gaxiola, S., Alonso, J., Andrade, L. H., Bunting, B., Chatterji, S., Ciutan, M., Gureje, O., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291717003610 · Cited by 66 · see citing works
Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness
Christiansen, D. M., McCarthy, M. M., & Seeman, M. V. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.856436 · Cited by 65 · see citing works
“Externalizing disorders are characterized by behaviors rather than by emotions, and by impaired ability to communicate feelings (1, 4, 6, 7, 9).”
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Creswell, K. G., Bachrach, R. L., Wright, A. G. C., Pinto, A., & Ansell, E. (2016) · Personality Disorders: Theory, Research, and Treatment · doi:10.1037/per0000131 · Cited by 56 · see citing works
Mackie, C., Dunn, N., MacLean, S., Testa, V., Heisel, M., & Hatcher, S. (2017) · Evidence Based Mental Health · doi:10.1136/eb-2017-102764 · Cited by 41 · see citing works
Core dimensions of anxiety and depression change independently during adolescence.
Conway, C. C., Zinbarg, R. E., Mineka, S., & Craske, M. G. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000222 · Cited by 51 · see citing works
Leventhal, A. M., Huh, J., & Dunton, G. F. (2014) · Perspectives in Public Health · doi:10.1177/1757913913495780 · Cited by 47 · see citing works
Elucidating the relationship between borderline personality disorder and intimate partner violence
Munro, O. E., & Sellbom, M. (2020) · Personality and Mental Health · doi:10.1002/pmh.1480 · Cited by 26 · see citing works
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Eaton, N. R., Rodriguez-Seijas, C., Krueger, R. F., Campbell, W. K., Grant, B. F., & Hasin, D. S. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2016_30_260 · Cited by 25 · see citing works
Self-citationAutonomy-connectedness mediates sex differences in symptoms of psychopathology
Bekker, M. H. J., & van Assen, M. A. L. M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181626 · Cited by 23 · see citing works
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- Authors
- Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., Grant, B. F., & Hasin, D. S.
- Affiliations
- University of Minnesota (US)
- Columbia University (US)
- Texas A&M University (US)
- University of Arizona (US)
- University of Iowa (US)
- National Institutes of Health (US)
- ORCID
- Venue
- Journal of Abnormal Psychology
- Published
- 2012-02
- Volume
- 121
- Issue
- 1
- Pages
- 282-288
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC3402021
- OpenAlex
- W1966262235
- Cited by
- 701
- References
- 42
- Citations by year
- 2026: 29 · 2025: 40 · 2024: 52 · 2023: 55 · 2022: 74 · 2021: 53 · 2020: 46 · 2019: 49 · 2018: 46 · 2017: 86 · 2016: 45 · 2015: 52 · 2014: 33 · 2013: 23 · 2012: 13
- FWCI
- 28.83
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Abnormal Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Sponsor Name Not Included (U01AA018111; R01DA018652; K05AA014223, F31DA026689)
- National Institute on Drug Abuse
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- gender differences, prevalence of mental disorders, internalizing disorders, externalizing disorders, mood disorders, anxiety disorders, antisocial personality disorder, substance use disorders, comorbidities, NESARC, psychopathology
- MeSH terms
- Adolescent, Adult, Aged, Analysis of Variance, Mental Disorders, Female, Humans, Internal-External Control, Male, Middle Aged, Sex Factors, United States, Comorbidity, Prevalence, Odds Ratio, Young Adult
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