The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression

Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden

Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register. Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%. Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.

Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study

In the general population, females experience depression at significantly higher rates than males. Individuals with traumatic brain injury (TBI) are at substantially greater risk for depression compared to the overall population. Treatment of, and recovery from, TBI can be hindered by depression; comorbid TBI and depression can lead to adverse outcomes and negatively affect multiple aspects of individuals’ lives. Gender differences in depression following TBI are not well understood, and relevant empirical findings have been mixed. Utilizing the Patient Health Questionnaire-9 (PHQ-9) 1 year after TBI, we examined whether women would experience more severe depressive symptoms, and would endorse higher levels of depression within each category of depression severity, than would men. Interestingly, and contrary to our hypothesis, men and women reported mild depression at equal rates; PHQ-9 total scores were slightly lower in women than in men. Men and women did not differ significantly in any PHQ-9 depression severity category. Item analyses, yielded significant gender differences on the following items: greater concentration difficulties (cognitive problems) in men and more sleep disturbances (psychosomatic issues) in women per uncorrected two-sample Z-test for proportions analyses; however, these results were not significant after the family-wise Bonferroni correction. Our results indicate that, in contrast to the general population, mild depression in persons with moderate to severe TBI may not be gender-specific. These findings underscore the need for early identification, active screening, and depression treatment equally for men and women to improve emotional well-being, promote recovery, and enhance quality of life following TBI.

Configural and scalar invariance of the center for epidemiologic studies depression scale in Egypt and Canada: Differential symptom emphasis across cultures and genders

BACKGROUND

Depression is a significant contributor of global disease burden. Previous studies have revealed cross-cultural and gender differences in the presentation of depressive symptoms. Using the Center for Epidemiologic Studies-Depression Scale (CES-D), the present study examined differences in self-reported somatic, negative affective, and anhedonia symptoms of depression among Egyptian and Canadian university students.

METHODS

A total of 338 university students completed study questionnaires from two major universities in Egypt (n=152) and Canada (n=186). Symptom domains were calculated based on the 14-item model of the CES-D.

RESULTS

We found significant culture by gender interactions of total CES-D scores, wherein Egyptian females reported higher scores compared to their Canadian and Egyptian male counterparts.

LIMITATIONS

Limitations include using analogue student samples and using only one self-report measure to examine different depressive symptom domains.

CONCLUSIONS

Findings of this study provided support that males and females may differentially report depressive symptoms across cultures. Implications of these results are further discussed.

Personality Factors and Depressive Configurations. An Exploratory Study in an Italian Clinical Sample

Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results.

Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200).

Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression.

Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.

The gender difference in depressive prevalence is due to high prevalence of somatic depression among women who do not have depressed relatives

BACKGROUND

Given that several studies have found the gender difference in depression to be rooted in psychosocial forces and others have shown the difference to be due to a gender difference in somatic depression, we compared the gender difference in somatic depression among respondents who reported no relative depressed with that of all other depressed respondents.

METHODS

Respondents in a representative sample from the Zurich study who met criteria for somatic depression and reported no relatives (first-degree, or parents, or mothers, or fathers in separate analyses) with depression were compared to other depressed respondents as to gender.

RESULTS

The gender difference in the prevalence of depression among respondents with somatic depression who reported no relatives with depression (whether the relatives were all first-degree, or any parent, or mothers only or fathers only) was significantly greater than the gender difference in depression among other respondents LIMITATIONS: The measure of depression among relatives was based upon reports of the respondents.

CONCLUSION

All or almost all of the gender difference in depression in this representative sample.is due to a gender difference in somatic depression among respondents who reported no depressed relative. Somatic depression may be a disorder distinct from depression without significant additional somatic symptomatology. If so, it is likely that it should be treated differently.

Using the Center for Epidemiologic Studies Depression Scale to assess depression in women with HIV and women at risk for HIV: Are somatic items invariant?

The prevalence of depression among women living with HIV/AIDS is elevated, compared with women in the general population and men diagnosed with HIV/AIDS. Although symptoms of HIV may overlap with somatic symptoms of depression, little research has explored how well screening tools accurately assess depression rather than symptoms of HIV/AIDS among women. The present study examined the utility of a widely used tool for assessing depression symptoms among women living with HIV/AIDS. Data are from the Women's Interagency HIV Study (WIHS), a multisite, longitudinal cohort study of women living with HIV/AIDS (n = 1,329) and seronegative women (n = 541) matched on key risk factors for HIV/AIDS. Confirmatory factor analysis-based measurement invariance tests of the Center for Epidemiologic Studies Depression Scale (CES-D) were conducted to determine whether women with HIV and those without HIV responded to the scale similarly. Results supported measurement invariance of CES-D scores. Findings suggest that the CES-D can be used to assess for burden of depression symptoms among women diagnosed with HIV/AIDS. (PsycINFO Database Record

Why is depression more common among women than among men?

Women are about twice as likely as are men to develop depression during their lifetime. This Series paper summarises evidence regarding the epidemiology on gender differences in prevalence, incidence, and course of depression, and factors possibly explaining the gender gap. Gender-related subtypes of depression are suggested to exist, of which the developmental subtype has the strongest potential to contribute to the gender gap. Limited evidence exists for risk factors to be specifically linked to depression. Future research could profit from a transdiagnostic perspective, permitting the differentiation of specific susceptibilities from those predicting general psychopathologies within and across the internalising and externalising spectra. An integration of the Research Domain Criteria framework will allow examination of gender differences in core psychological functions, within the context of developmental transitions and environmental settings. Monitoring of changing socioeconomic and cultural trends in factors contributing to the gender gap will be important, as well as the influence of these trends on changes in symptom expression across psychopathologies in men and women.

Two-week neurasthenic major depression

The relationship between the two syndromes neurasthenia and depression is of interest in the context of burnout, which, although not a diagnosis, is often treated in psychiatry. This study defines major depressive episodes according to DSM-5 and neurasthenia by ICD-10 symptom criteria, and both syndromes on the basis of a 2-week minimum duration. The study includes all subjects of the Zurich epidemiological study who had taken part in the last five interviews (1986-2008) and compares three groups, pure depression, pure neurasthenia and their combination (neurasthenic depression), applying nonparametric statistics. The three groups did not differ in common validators: age of onset, course, a family history for depression and anxiety/panic. Psychiatric comorbidity was also very similar, with the exception of suicide attempts and substance abuse, which were less frequent in the pure neurasthenic group. Somatic comorbidity was also highly comparable, except for stomach problems, which were more common in subjects with neurasthenic syndromes. Surprisingly, the well-known preponderance of depression in women was explained by the association with neurasthenic syndromes. The proposed new diagnosis of neurasthenic depression could help diagnose subjects treated for burnout but needs replication by other representative studies.

Heart rate variability and depressive symptoms: a cross-lagged analysis over a 10-year period in the Whitehall II study

BACKGROUND

People with depression tend to have lower heart rate variability (HRV), but the temporal sequence is poorly understood. In a sample of the general population, we prospectively examined whether HRV measures predict subsequent depressive symptoms or whether depressive symptoms predict subsequent levels of HRV.

METHOD

Data from the fifth (1997-1999) and ninth (2007-2009) phases of the UK Whitehall II longitudinal population-based cohort study were analysed with an average follow-up of 10.5 years. The sample size for the prospective analysis depended on the analysis and ranged from 2334 (644 women) to 2276 (602 women). HRV measures during 5 min of supine rest were obtained. Depressive symptoms were evaluated by four cognitive symptoms of depression from the General Health Questionnaire.

RESULTS

At follow-up assessment, depressive symptoms were inversely associated with HRV measures independently of antidepressant medication use in men but not in women. Prospectively, lower baseline heart rate and higher HRV measures were associated with a lower likelihood of incident depressive symptoms at follow-up in men without depressive symptoms at baseline. Similar but statistically insignificant associations were found in women. Adjustments for known confounders including sociodemographic and lifestyle factors, cardiometabolic conditions or medication did not change the predictive effect of HRV on incident depressive symptoms at follow-up. Depressive symptoms at baseline were not associated with heart rate or HRV at follow-up in either sex.

CONCLUSIONS

These findings are consistent with an aetiological role of the autonomic nervous system in depression onset.

Gender differences in depression and pain: A two year follow-up study of the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries.

METHODS

The study population was taken from waves 4-5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence.

RESULTS

Prevalences of depression, pain, and depression-pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9-2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2-1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2-2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3-2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1-1.7; treated OR=2.0; 95% CI=1.5-2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1-1.7; men OR=1.8; 95% CI=1.3-2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1-1.6).

LIMITATIONS

We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred.

CONCLUSIONS

Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.

Sex Differences in Depression: Does Inflammation Play a Role?

Women become depressed more frequently than men, a consistent pattern across cultures. Inflammation plays a key role in initiating depression among a subset of individuals, and depression also has inflammatory consequences. Notably, women experience higher levels of inflammation and greater autoimmune disease risk compared to men. In the current review, we explore the bidirectional relationship between inflammation and depression and describe how this link may be particularly relevant for women. Compared to men, women may be more vulnerable to inflammation-induced mood and behavior changes. For example, transient elevations in inflammation prompt greater feelings of loneliness and social disconnection for women than for men, which can contribute to the onset of depression. Women also appear to be disproportionately affected by several factors that elevate inflammation, including prior depression, somatic symptomatology, interpersonal stressors, childhood adversity, obesity, and physical inactivity. Relationship distress and obesity, both of which elevate depression risk, are also more strongly tied to inflammation for women than for men. Taken together, these findings suggest that women's susceptibility to inflammation and its mood effects may contribute to sex differences in depression. Depression continues to be a leading cause of disability worldwide, with women experiencing greater risk than men. Due to the depression-inflammation connection, these patterns may promote additional health risks for women. Considering the impact of inflammation on women's mental health may foster a better understanding of sex differences in depression, as well as the selection of effective depression treatments.

Development of the National Healthy Sleep Awareness Project Sleep Health Surveillance Questions

OBJECTIVES

For the first time ever, as emphasized by inclusion in the Healthy People 2020 goals, sleep health is an emphasis of national health aims. The National Healthy Sleep Awareness Project (NHSAP) was tasked to propose questions for inclusion in the next Behavioral Risk Factor Surveillance System (BRFSS), a survey that includes a number of questions that target behaviors thought to impact health, as a means to measure community sleep health. The total number of questions could not exceed five, and had to include an assessment of the risk for obstructive sleep apnea (OSA).

METHODS

An appointed workgroup met via teleconference and face-to-face venues to develop an inventory of published survey questions being used to identify sleep health, to develop a framework on which to analyze the strengths and weaknesses of current survey questions concerning sleep, and to develop recommendations for sleep health and disease surveillance questions going forward.

RESULTS

The recommendation was to focus on certain existing BRFSS questions pertaining to sleep duration, quality, satisfaction, daytime alertness, and to add to these other BRFSS existing questions to make a modified STOP-BANG questionnaire (minus the N for neck circumference) to assess for risk of OSA.

CONCLUSIONS

Sleep health is an important dimension of health that has previously received less attention in national health surveys. We believe that 5 questions recommended for the upcoming BRFSS question banks will assist as important measures of sleep health, and may help to evaluate the effectiveness of interventions to improve sleep health in our nation.

Evidence for Broadening Criteria for Atypical Depression Which May Define a Reactive Depressive Disorder

Objective. Arguing that additional symptoms should be added to the criteria for atypical depression. Method. Published research articles on atypical depression are reviewed. Results. (1) The original studies upon which the criteria for atypical depression were based cited fatigue, insomnia, pain, and loss of weight as characteristic symptoms. (2) Several studies of DSM depressive criteria found patients with atypical depression to exhibit high levels of insomnia, fatigue, and loss of appetite/weight. (3) Several studies have found atypical depression to be comorbid with headaches, bulimia, and body image issues. (4) Most probands who report atypical depression meet criteria for "somatic depression," defined as depression associated with several of disordered eating, poor body image, headaches, fatigue, and insomnia. The gender difference in prevalence of atypical depression results from its overlap with somatic depression. Somatic depression is associated with psychosocial measures related to gender, linking it with the descriptions of atypical depression as "reactive" appearing in the studies upon which the original criteria for atypical depression were based. Conclusion. Insomnia, disordered eating, poor body image, and aches/pains should be added as criteria for atypical depression matching criteria for somatic depression defining a reactive depressive disorder possibly distinct from endogenous melancholic depression.

Gender differences and disabilities of perceived depression in the workplace

BACKGROUND

Few studies have investigated gender difference and associated disability among workers. Comprehensive investigations concerning the occurrence and consequences of depression in workplace are scarce. The study aims to evaluate how workers perceive depression in workplace, as well as to examine depression-related disabilities by gender.

METHODS

This is a cross-sectional web-based survey of 1000 Brazilian workers recruited from Internet sources. Participants answered an online questionnaire about depressive symptoms and related consequences in the workplace.

RESULTS

Common symptoms attributable to depression were crying, loss of interest, and sadness. Almost one in five (18.9%) participants reported had ever been "labeled" by a health professional as suffering from depression. However, the majority of ever-depressed workers (73.5%) remained working. Performance-related impairments were reported by around 60% of depressed workers who continued working. Over half of them also complained about cognitive symptoms (concentration difficulties, indecisiveness, forgetfulness), with men reporting more cognitive dysfunctions than women. One in three workers had taken off work due to depression (mean 65.7 out-of-role days), with these periods being lengthier for men than women.

LIMITATIONS

Some depressive events might have occurred before working age, since the participants have self-reported the diagnosis of health professionals in past timeframe. The representativeness of recruited workers was reliant upon the availability of Internet service.

CONCLUSIONS

The findings suggest that identification and management of symptoms of depression should be set as a priority in worker׳s health care. General and gender-related strategies to handle depression in the workplace are recommended.

Association of depression with coronary artery disease and QTc interval prolongation in women with chest pain: data from the KoRean wOmen'S chest pain rEgistry (KoROSE) study

The presence of depression is reportedly related with cardiovascular diseases, including coronary artery disease (CAD), but little is known concerning the association between depressive symptoms reflecting the cultural constructions of female patients with chest pain as well as coronary artery stenosis, coronary vasospasm, and the corrected QT (QTc) interval. In a multicenter prospective cross-sectional survey of 163 Korean women with chest pain, the presence of depression was evaluated using the Beck Depression Inventory (BDI) and Lee and Rhee Depression (LRD) scales. The differences in the QTc interval and the presence of CAD (defined as ≥ 50% coronary artery stenosis on coronary angiography) and coronary vasospasm were compared between depressed and non-depressed women. Significant CAD was present in 83 of 163 female patients (mean age, 61 years), and coronary vasospasm was present in 11 of 80 patients. The mean BDI and LRD scores were significantly higher in patients with significant CAD (BDI: 13.4 ± 9.6 vs. 6.9 ± 5.6, p < 0.001; LRD: 46.9 ± 21.4 vs. 39.8 ± 15.2, p = 0.027) and coronary vasospasm (BDI: 12.3 ± 6.4 vs. 4.6 ± 2.8; and LRD: 49.8 ± 12.3 vs. 30.5 ± 13.9; both p < 0.05). On multivariate analysis, BDI scores were important risk factors for the presence of CAD (odds ratio [OR] = 1.138; 95% confidence interval [CI] = 1.071-1.210; p=0.021) and coronary vasospasm (OR = 2.534; 95% CI = 1.161-2.028; p = 0.003), with similar findings obtained for LRD scores (CAD: OR = 1.034; 95% CI = 1.013-1.056; p = 0.001; coronary vasospasm: OR = 1.125; 95% CI = 1.050-1.206; p = 0.001). The mean QTc interval was also significantly higher in the depressed group than in the non-depressed group (440.1 ± 32.0 ms vs. 408.2 ± 26.4ms; p < 0.001). The QTc interval displayed significant positive with the BDI (r = 0.595; p < 0.001) and LRD scores (r = 0.467; p< 0.001). This study demonstrated that depression is associated with a prolonged QTc interval, CAD, and coronary vasospasm in female patients with chest pain, suggesting a possible mechanism by which depressive mood may be linked with coronary endothelial dysfunction and atherosclerosis.

Differences in the developmental patterns of depression with and without additional somatic symptoms

Depression accompanied by somatic symptoms ("somatic" depression) has been found to differ from depression without the additional symptoms ("pure" depression) in their gender ratio, their association with measures of perceived gender inequality taken from both respondents and their parents, and in their response to pharmacological treatment. Further evidence of the distinction between the two syndromes might come from differential patterns of development. Data on the annual incidence of new cases of depression exhibited by a representative sample of respondents aged 12-19 came from the National household survey on drug use and health. Between early adolescence (ages 12-14) and late adolescence (ages 15-19), female respondents exhibited a much larger increase in somatic depression than in pure depression. Males did not exhibit the same pattern. These results further support the hypothesis that somatic and pure depressions are two distinct disorders.

Status de fragilidade entre idosos com indicativo de depressão segundo o sexo

Objetivos : Descrever as variáveis socioeconômicas de idosos com indicativo de depressão segundo o sexo, verificar a associação entre o status de fragilidade e o sexo, e descrever o componente do fenótipo de fragilidade mais impactado entre os idosos com indicativo de depressão pré-frágeis e frágeis. Métodos Estudo observacional, transversal e analítico, conduzido com 418 idosos com indicativo de depressão residentes no município de Uberaba, MG. Utilizaram-se a Escala de Depressão Geriátrica Abreviada e o Fenótipo de Fragilidade de Fried. Foram utilizados análise descritiva e o teste Qui-quadrado (p < 0,05). Resultados Verificou-se que, entre os idosos com indicativo de depressão, 27,8% eram frágeis e 51,7%, pré-frágeis. O status de fragilidade não esteve associado ao sexo (p = 0,910). Dentre os pré-frágeis, os componentes do fenótipo mais impactados foram o autorrelato de exaustão/fadiga para as mulheres e diminuição da força muscular para os homens. Nos frágeis, prevaleceu a diminuição da força muscular para ambos os sexos. Conclusão Mediante os achados deste estudo, conclui-se que, embora não tenha ocorrido associação entre a síndrome de fragilidade e o sexo, a identificação dos componentes do fenótipo de fragilidade mais impactados pode favorecer o atendimento multiprofissional, considerando as especificidades dos grupos. O diagnóstico precoce contribui para o estabelecimento de condutas e prevenção de agravos.

The role of sex on stability and change of depression symptom subtypes over 20 years: a latent transition analysis

Prospective studies investigating the long-term stability of depression symptom subtypes are rare. Moreover, sex has received little attention as a predictor. This study aimed to investigate the role of sex on stability and transition patterns of depressive symptom subtypes over 20 years. The data were drawn from three follow-ups (1988, 1999, and 2008) of the longitudinal Zurich Study. Latent transition analyses were fitted to the data of 322 subjects, using depressive symptoms from the face-to-face interviews. The stable classes were characterized by psychosocial correlates. Three subtypes were identified: 'severe atypical,' 'severe typical,' and 'moderate.' While stability of the severe atypical and moderate subtype was relatively high and increased over time (70-71; 45-90%), stability of the severe typical subtype was lower (45-48%). Females had a higher risk of being in the severe atypical subtype and exhibited more transitions, particularly with respect to the severe typical subtype. In contrast, males displayed more stable subtypes. The stable severe atypical subtype was associated with comorbid eating disorders as well as psychosis syndromes, whereas the stable severe typical subtype was associated only with psychosis syndromes. Our results provide first evidence for the notion that long-term stability and transition patterns differ by sex and depression subtypes. This finding has received too little attention in previous research and should be considered in treatments.

Examining the effects of sleep delay on depressed males and females and healthy controls

Individuals with major depressive disorder typically exhibit sleep electroencephalograpy abnormalities which have been shown to vary by sex. Recent research has shown that depressed males display deficits in slow wave sleep and delta electroencephalograph (EEG) activity that are not apparent in depressed females. This may suggest that males and females with depression vary with respect to their homeostatic regulation of sleep. Utilizing archival data, the present study examined the effects of a 3-h sleep delay, which represents a mild sleep challenge, on slow wave activity in healthy controls and individuals with depression. All participants slept in the laboratory for three sequential nights. On the third night in the laboratory, the participants' bedtime was delayed by 3 h. Slow wave activity was calculated utilizing power spectral analysis and compared across groups. Following the sleep delay, males with depression exhibited the lowest slow wave activity compared to all other groups. These results may suggest that males with depression are at a greater risk for homeostatic dysregulation than females, and may require specialized intervention.

Gender differences in general and specialty outpatient mental health service use for depression

BACKGROUND

This study ascertained gender-specific determinants of outpatient mental health (MH) service use for depression to highlight any gender disparities in barriers to care and explain how depressed men and women in need of care might differ in their help-seeking behaviour.

METHODS

Data used in this study came from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (CCHS 1.2) conducted by Statistics Canada in 2002 (N = 36,984). The sample was limited to respondents filling criteria for a probable major depression in the 12 months prior to the interview (n = 1743). Gender-specific multivariate logistic regression analyses were carried out.

RESULTS

The results showed that 54.3% of respondents meeting criteria for major depression had consulted for mental health reasons in the year prior to interview. When looking at type of outpatient mental health service use, males were more likely to consult a general practitioner and a mental health specialist in the past year as opposed to females. However, females were more likely to consult a general practitioner only as opposed to no service use than males. Gender specific differences in determinants associated with outpatient service use included for males, lower adjusted household income, and for females, a younger age, the presence of social support, self-reported availability barriers, the presence of self-reported suicidal thoughts or attempt and a poorer self- perceived mental health.

CONCLUSIONS

Continued efforts to promote access to mental health care are needed for men and women affected by depression, and this, to target specific vulnerable populations and increase utilization rates.

Sex differences in the construct overlap of frailty and depression: evidence from the Health and Retirement Study

OBJECTIVES

To determine the degree of diagnostic overlap between frailty and depression and to investigate whether sex differences in symptom endorsement influence this overlap.

DESIGN

Cross-sectional latent class analysis.

SETTING

Data were from the 2008 wave of the Health and Retirement Study, a nationally representative longitudinal survey of health characteristics of older adults.

PARTICIPANTS

Community-dwelling adults aged 65 and older completing a general health questionnaire and consenting to physical measurements (N = 3,665).

MEASUREMENTS

Frailty was measured using criteria developed in the Cardiovascular Health Study, and depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression scale.

RESULTS

Frailty and depression were best modeled as two distinct but highly correlated constructs with three and four classes of symptom response, respectively. Measurement overlap was high in men and women. Approximately 73% of individuals with severe depressive symptoms and 86% with primarily somatic depressive symptoms were categorized as concurrently frail. The degree of construct overlap between depression and frailty did not significantly vary according to sex, but women were significantly more likely to endorse all frailty and depressive symptoms.

CONCLUSION

Measures of depression and frailty identify substantially overlapping populations of older men and women. More-frequent endorsement of depressive symptoms, but not differential endorsement of somatic symptoms, may contribute to the higher prevalence of frailty in women. The symptom of exhaustion is particularly important to the correlation between these two conditions. Findings will inform clinician and researcher efforts to refine the definition of geriatric syndromes such as frailty and to develop effective interventions.

Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population

BACKGROUND

The nine-item depression module from the Patient Health Questionnaire (PHQ-9) is widely used as an open access screening instrument for depression in different health care and community settings; thus far, normative data from the general population are still scarce. The objectives of the study were to generate normative data and to further investigate the construct validity and factor structure of the PHQ-9 in the general population.

METHODS

Nationally representative face-to face household surveys were conducted in Germany between 2003 and 2008 (n=5018). The survey questionnaires included the PHQ-9, the Satisfaction with Life Scale, the 12-item Short Form Health Survey (SF-12) for the measurement of health-related quality of life and demographic characteristics.

RESULTS

Normative data for the PHQ-9 were generated for both genders (53.6% female) and different age levels [mean age (S.D.) of 48.9 (18.1) years]. Women had significantly higher mean (S.D.) scores compared with men [3.1 (3.5) vs. 2.7 (3.5)]. A prevalence rate of moderate to high severity of depressive symptoms of 5.6% was identified. Intercorrelations with depression were highest for the Mental Component Scale of the SF-12, followed by the Physical Component Scale of health-related quality of life, and life satisfaction. Results supported a one-factor model of depression.

CONCLUSIONS

The normative data provide a framework for the interpretation and comparisons of depression with other populations. Evidence supports reliability and validity of the unidimensional PHQ-9 as a measure of depression in the general population.

Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey

BACKGROUND

Few studies have investigated symptomatic subtypes of depression and their correlates by gender.

METHODS

Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression.

RESULTS

For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state.

LIMITATIONS

Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size.

CONCLUSIONS

The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.