Depression is a common term that can refer to either one specific mental health condition—called major depression—or to a larger group of conditions known as depressive disorders. Current statistics indicate that women in the U.S. develop some form of depression much more often than men. However, according to the results of a new study published in August 2013 in the journal JAMA Psychiatry, current definitions for depression exclude many of the depression-related symptoms commonly found in men. When those nonstandard symptoms are taken into consideration, men apparently develop depression roughly as often as women.
In addition to isolated and recurring forms of major depression, the American Psychiatric Association (APA) officially recognizes depressive disorders called persistent depressive disorder (formerly called dysthymic disorder or dysthymia), premenstrual dysphoric disorder, disruptive mood dysregulation disorder, substance/medication-induced depressive disorder and depressive disorder due to another medical condition. The APA also lets doctors diagnose certain forms of damaging depression that don’t fit the criteria for any of these named conditions. In line with current guidelines, doctors base their diagnoses of depressive disorders on the presence of classic symptoms such as feelings of hopelessness or helplessness, feelings of emptiness or sadness, a loss of interest in pleasurable activities, sleep disturbances, changes in normal appetite, fatigue, disrupted or diminished thought processes, pain or other physical complaints, and suicide-related thinking, planning or action.
Depression in Women
When standard guidelines are used, women develop diagnosable depression anywhere from 70 percent to 100 percent more often than men. Mental health professionals and researchers have come up with several potential factors that might help explain this stark level of gender difference. Examples of these factors include differences in genetic tendencies between the genders, monthly fluctuations in women’s hormone levels, hormone changes associated with pregnancy, hormone changes associated with menopause and the strain placed upon women by gender-specific role and social demands.
Depression in Men
Significant numbers of researchers and mental health professionals have long believed that depressed men commonly behave in ways that don’t conform to either the general expectations for depression-related behavior or the specific symptoms outlined in the standard definitions for the officially recognized depressive disorders. In line with this belief, the authors of the study published in JAMA Psychiatry created two new depression scales, called the Male Symptoms Scale (MSS) and the Gender Inclusive Depression Scale (GIDS). The MSS is specifically designed to assess male-centric depression symptoms, most of which are not included in the American Psychiatric Association’s depression criteria. Examples of the previously excluded symptoms include increases in anger or aggression, increased participation in drug or alcohol abuse, unusual hyperactivity, increased involvement in high-risk behaviors, increased irritability and heightened stress levels. The GIDS combines the symptoms of the Male Symptoms Scale with the classic depression symptoms outlined by the American Psychiatric Association.
In the study published in JAMA Psychiatry, researchers from several U.S. universities and research institutions used the MSS and GIDS scales to measure levels of depression among male and female participants in a nationwide mental health project called the National Comorbidity Survey Replication. When only using the male-centric MSS to assess these participants, the researchers concluded that some form of depression affects roughly 26 percent of American men and roughly 22 percent of American women. When using the GIDS—which combines male-centric symptoms with classic symptoms—the researchers concluded that approximately 31 percent of U.S. men and 33 percent of U.S. women have some form of depression. In both cases, the compiled percentages are far more gender-equal than the traditional estimates of depression levels among men and women.
Significance and Considerations
The authors of the study published in JAMA Psychiatry point toward several factors to explain the unique manifestations of depression in men. These factors include the mental stresses associated with the need to conform to popular notions regarding masculinity and male social roles, specific social and cultural rules that prevent men from fully expressing their emotions, and a need for men to express their suppressed emotions in an alternate form. Since current depression guidelines don’t take these factors into account, many men in the U.S. (and in other countries) almost certainly have unrecognized and untreated depression-related symptoms. The study’s authors also emphasize the fact that many women are affected by the male-centric symptoms outlined in the Male Symptoms Scale. This means that significant numbers of women affected by depression also likely have unrecognized and unaddressed symptoms not classically associated with depressive illness.