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Why Women Are More Susceptible to Depression: An Explanation for Gender Differences

Christina M. Mulé
Rochester Institute of Technology

This review describes the gender differences associated with depression. On the basis of strong and consistent evidence, women appear to have higher rates of depression than do men. However, the explanation for this difference is not understood well. A series of topics further examined and analyzed, will provide possible explanations for these findings. The topics of focus will include biological differences (hormones), age prevalence of depression differences, sex-/gender-role identity differences, depression rate and recurrence differences, and comorbidity differences. In addition experiments will be introduced to accompany and further support possible explanations. The specific difference in depression between women and men cannot be easily explained. In conclusion it seems likely that women are more susceptible to depression because of gender differences in roles, which have led to differences in the experience of life events.

This article reviews evidence and findings related to the severe susceptibility of depression in women over men. Many different theories or potential explanations will be offered to better understand this phenomenon. These theories include: biological differences, age prevalence of depression differences, sex/gender- role identity differences, depression rate and recurrence differences, and comorbidity differences. (A brief glossary of terms used in this article appears in Table 1.) Although there are many theories that support why women are more susceptible to depression than men, consider that these are just theories, not facts.

The sex-/gender-role identity difference theory, can best answer why women are more susceptible to depression. In this theory gender, society, and parenting roles will illustrate that there are many gender differences influenced by environment which can lead to depression. Therefore it can be concluded that the susceptibility of depression, is largely affected by environmental roles and must be taken into account for when comparing women and men.

Biological Differences

The degree to which biological factors impinge on the severe susceptibility of depression in women over men is rather trivial; however it still provides a possible explanation for the occurrence. Hormones and heredity factors are taken into account and provide some evidence of truth when comparing depression susceptibility between women and men.

Hormonal regulation largely affects the rate of depression in women. Estrogen depletion, also known as menopausal symptoms, illustrates increased depressive rates and vasomotor instability (hot flashes). When including vasomotor instability rates as a cause of depression, rates of depression increased from 39% to 55% (Formanek & Gurian, 1987). The increase in depression rates can also be attributed to, women feeling less womanly. These thoughts can occur at menopausal stages because women become infertile and feel they have aged and are elderly. In addition it is true that men tend to value attractiveness and youth in their mates much more than do women. "Men prefer youthfulness because it is likely to be associated with higher fertility, reproductive potential, and health" (Ben Hamida, Mineka & Bailey, 1998). Following the rules of evolution after a woman becomes infertile she is less desired by men because the purpose in having intercourse is to produce offspring.

Both the many facts about hormones as well as the mind-set concerning menopause cause uncertainty as to what exactly produces the depression. The indistinctness remains unsolved because it is virtually impossible to perform an experiment of having women separate their feelings of depression from menopausal states. However, "depression may be a precursor rather than a consequence of emotional responses associated with menopause" (Denmark & Paludi, 1993).

To compare hormonal differences between men and women would be unfair. It is certain that women experience many more hormonal changes than do men (due to childbirth, premenstrual syndrome, menstruation, contraceptive drugs, postpartum period, and menopause). However, parallel to women, men do have symptoms similar to menopause, but are rather referred to as a "mid-life" crisis or depression. It is almost impossible to explain why women are more susceptible than men to depression when referring to biological differences. "Such a specific difference cannot be explained easily as a result of biology, particularly among women because rates of depression did not vary by parity" (Nazroo & Edwards, 1998).

Hereditarily speaking genetic transmission may cause women to be more susceptible to depression. In support of genetic transmission as an explanation for the sex differences there is reasonable evidence from twin and family studies that genetic factors are operating in the genesis of depression and affective disorders (Nazroo & Edwards, 1998). Two likely rationales will be given to support the hereditary theory and provide evidence that causes women to be more susceptible to depression.

One possible genetic explanation is x-linkage; that is, the position of the relevant locus on the x chromosome. If the gene for depression is located in the x chromosome and the trait is dominant, females, who have two x chromosomes, will be more often affected than males, who have only one x chromosome (Nazroo & Edwards, 1998). However, we must remember that this is just a hypothesis—a tentative explanation, not a concrete fact.

A second possible genetic explanation involves the phenotype (the observable physical or biochemical characteristics of an organism, as determined by both genetic makeup and environmental influences) of women. This explanation hypothesizes that genetics and environmental influences together may result in the depression of women. An example of this hypothesis would be: If a woman’s parent was depressed, she is more than likely to become depressed herself due to environment and genetic predisposition. Having a family member present who is depressed, becomes a chronic environmental strain, which refers to ongoing "background" stressors that tax one’s coping abilities and resources. The sources of chronic strain are myriad; examples include unstable or unsafe housing (Kimberling & Ouimette, 2002). Phenotypes affects men as well; however its affects are stronger in women. This occurs because women have a higher tendency of awareness of their surroundings and are typically closely interconnected with their family members.

It is evident that phenotypic traits influence the rate of depression. However, as stated previously, the phenotype theory is just a possible explanation for the susceptibility of depression in women. There can not be definite conclusions, based on theoretical hypotheses.

Gender Differences in Adolescent Depressive Symptoms

"Gender differences in depressive symptoms appear to emerge in early adolescence and then remains throughout the adult life span" (Nolen-Hoeksema, Larson, & Grayson, 1999). Consistent findings indicate that adolescent girls develop depressive symptoms at an earlier age than do adolescent boys. Emerging gender differences can be caused by individual vulnerability, life stress, and pubertal transitional challenge. Although girls and boys go through puberty at the relatively same age, it has been suggested that girls are more vulnerable to depression than boys even before adolescence (Ge & Conger, 2003). This hypothesis will be further examined through the careful analysis of research and experimentation.

The experiment had many hypotheses that were evaluated. The following hypotheses guided the analysis (Ge & Conger, 2003, pp. 4-5):

The choice of method was a 6-year longitudinal study of 451 families that lived in central Iowa. Interviewers visited each family at their homes for approximately 2 hours on each of two occasions. During the first visit, each of the family members was asked to independently complete a set of questionnaires focusing upon individual characteristics, emotions and life events experienced by family members. These independently reported emotions and events were used to come up with the conclusion (Ge & Conger, 2003).

The results found that early depressive symptoms carry forward to mid- and late adolescence and that the interaction between gender-linked vulnerabilities (diathesis) and the new biological and social challenges of early adolescence (stress) creates greater risk for depression for adolescent girls than boys (Ge & Conger, 2003). Studies have also found higher levels of depressive symptoms in girls than in boys as young as 12 years of age and have consistently found gender differences from then on out (Nolen-Hoeksema & Girgus, 1994). However, although this conclusion was found from the experiment, this has never been reported in earlier studies of adolescent depression.

Yet again, it is difficult to determine why women are more susceptible to depression. The experiment provides conclusions and theories that have never been proven prior. It is clear that girls are more susceptible to depression even in adolescence, but there is no concrete evidence to prove why. However, depressives (girls and boys) were found to come from families in which there was marked striving for prestige with the patient as the instrument of this need; the family showed marked concern for social achievement and the childhood background was characterized by envy and competitiveness (Weissman & Paykel, 1974).

Gender Stereotypes and Identity Roles

"The subtle influence of sex upon a person’s perceptions may vary with each observer and play both an unconscious and conscious role in influencing actions taken."
--Gesell, 1990
Recent evidence suggests that the higher prevalence of clinical and subclinical depression among females results because one subtype of depression, which is rooted in limitations placed upon women (Silberstein & Lynch, 1998). These limitations have been taken a long way, causing the likelihood of depression in women. Gender roles will be closely examined, and will provide examples of the limitations placed upon women. (Some explanations of why women become more depressed then men are illustrated in Table 2 and focus on status and gender identity.)

Many stereotypes that have been placed upon women help in the gender-related limitations. The stereotypes concerning women are endless. A catalog of different stereotypes between women and men is revealed in Table 3.

"Although women are usually socialized to be emotionally expressive, nurturing, and to direct their achievement through affiliation with others, men are usually socialized to be emotionally inhibited, assertive, and independent" (Kimberling & Ouimette, 2002). Through the analysis of these stereotypes, the belief that women are viewed as inferior to men is not far fetched. Women are conflicted to live up to these stereotypical roles and expectations of perfection everyday, no matter how many roles they take on in their everyday life.

A woman’s role as a wife, worker, mother, and caretaker contribute to the levels of everyday stress. The qualities of each of these roles are looked at differently through the eyes of women and men. In reference to marriage, it typically has value and merit if two partners love each other. However, the quality of marriage is more strongly related to home life satisfaction for women compared to men (Denmark & Paludi, 1993). This difference may be attributed to gender differences in the psychological purpose of marriage. Males may have more instrumental gains from marriage (e.g., in the form of services, such as housekeeping). Females, who have fewer alternatives, may invest more emotionally in their marital roles (Denmark & Paludi, 1993). From this it can clearly be stated that these differences may result in tension between two partners. And thus may result in depressive feelings for women that may leave them feeling as if they were servants to their husbands, not companions. Women reported higher rates of their partners as less caring and as more likely to be a depressogenic stressor (Wilhelm & Roy, 2002).

An additional role that women partake in that is parallel to marital roles is parental roles. These roles are very closely related, because marriage may be the main basis to raise children. Because women have been labeled in the past as child caretakers, this stereotype has been hard to break. There are very few families in our society that have males as the primary caretaker of their children. Women even if employed, spend about 70 hours a week with their children. On the opposite spectrum, fathers’ involvement with children average about 30 hours a week and do not significantly vary with wives’ employment (Denmark & Paludi, 1993). The average level of role strain for mothers who have careers was not greatly affected. However, women who are employed feel dissatisfaction with the amount of time they are allotted for their children and spouse. However, because of stereotypes and misconceptions women tend not to complain about their gender roles. Ratings by fathers revealed that the more time the mother spent, relative to him, in child care tasks, the greater his satisfaction with her work schedule and her overall time allocation (Denmark & Paludi, 1993). Similarly to that statement, men’s perceptions over sharing tasks appeared to depend only on how satisfied they were with the division of tasks. Thus, many men appear to be happy when they are not sharing in domestic tasks, and the fact that they know their wives are not happy about it does not lower their marital satisfaction (Denmark & Paludi, 1993).

Through the analysis of these two gender roles, it is evident that women are dissatisfied with their gender responsibilities. Women are faced with the problem of how to make their lives meaningful. With decreasing family size, increasing longevity, and increased self-expectation, the time over which the married woman undertakes other roles in addition to being a mother is becoming longer (Weissman & Paykel, 1974).

Correspondingly with gender roles; come gender identities. The gender stereotypes can be said to affect gender identities the most severely. Stereotypes that women should be beautiful and refined are ones that influence the American culture to such a great extent. Some researchers have suggested that information about physical appearance, and in particular physical attractiveness, might be more crucial to impression of women than of men (Denmark & Paludi, 1993). Girls show less satisfaction with their physical appearance than do boys, starting in third grade (Hankin & Abramson, 2001). In modern times the idea that "thin is beautiful" has become the socially accepted norm. The media publicizes what is beautiful; and more often than not women don’t seem to equate to these looks. Thus, these contributing factors if taken to the extreme can result in dangerous feelings and habits, such as depression and eating disorders. When in reference to women, these two disorders are extremely comorbid with each other. Eating disorders will be evaluated further in the section of comorbidity.

Comorbidity

As stated in Table 1, comorbidity is the presence of coexisting or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. "Depressive disorders show substantial comorbidity with other psychiatric disorder, especially anxiety, externalizing, and eating disorders" (Hankin & Abramson, 2001). The disorders that largely affect women include: eating disorders and anxiety.

Eating disorders result in mental and physical health problems. Two of the most widespread eating disorders are anorexia and bulimia. Symptoms of these eating disorders are: obsession with weight, frequent and long trips to the bathroom (often with running water), food rituals (shifting food around, cutting food into tiny pieces, or keeping utensils from touching lips, hiding food), hair loss, and pale or "gray" skin. "These symptoms can be linked with women, since more women have been diagnosed with lifetime histories of eating disorder than men" (Hankin & Abramson, 2001).

A 4-year longitudinal study of community adolescent girls found the peak risk for the onset of binge eating to occur at 16 and the peak onset for purging to occur at age 18 (Hankin & Abramson, 2001). These eating disorders seem to be age appropriate, because at these times girls are very aware of their appearances. The awareness or sensitivity may be caused between the ages of 16 and 18, because it is a prime time to prepare for physical relationships with the opposite sex. Girls fear rejection so much that they are willing to put the needs, interests, and desire of others above their own (Smolak & Fairman, 2002). Women most obviously want to be desired by the opposite sex and in result go to great lengths to appear attractive. The extent to which women are concerned with their appearances may become quiet frightening and create severe depressive cognitions.

The depressive thoughts of being unattractive may eventually lead to obsessive thoughts of being beautiful, resulting in compulsions such as working out and dieting. One theory is that depression, eating disorders and obsessive compulsive disorders (anxiety disorder) are all interconnected. There is certain proof that OCD (obsessive compulsive disorder) is comorbid with depression, but well known documented studies have not been completed to show the affects of this comorbidity on women.

Anxiety disorders, such as generalized anxiety disorder (GAD), social phobia, panic disorder, obsessive-compulsive disorder (OCD), and specific phobia, have been largely and functionally linked to depressive thoughts that affect women and adolescent girls. Though research in this area is limited the comorbidity between anxiety disorders and depression will help provide a solution as to why it is that women are more susceptible to depression over men. In this section of comorbidity, the focus will be directed to social phobia consequently due to the large affects on women.

"Statistics prove that girls develop anxiety disorders earlier and at a faster rate than boys, such that by age 6, twice as many girls have experienced an anxiety disorder" (Hankin & Abramson, 2001). A potential reason for the susceptibility of depression in girls and women is that they are at a much higher risk for the potential to be raped or sexually assaulted in our society. It is common for victims of interpersonal traumas, such as rape and domestic violence to experience shame about their environment in the traumatic experience and to be rejected or blamed by others. Rejection and blame from others will occur because people believe that women subject themselves to situations that can lead to no good. Shame and interpersonal rejection have also been theoretically linked to the development of social phobia, raising the possibility of shared etiology for the two disorders (Kimberling & Ouimette, 2002).

Social phobia comorbid with depression is likely to be one of the most difficult disorders to treat. Depressed men and women comorbid with social phobia may pose distinct treatment challenges because they may be less likely to accept referral into a therapy group given their fear of being exposed to the scrutiny of others and speaking in front of a group (Kimberling & Ouimette, 2002).

The cumulative burden of multiple diagnoses (comorbidity) may be that it has been strongly associated with decreased well-being, compromised health and quality of life, and poor psychosocial adjustment (Kimberling & Ouimette, 2002). These obstacles are just additives to all the gender stereotypes and identity roles that women already deal with.

Although women are diagnose with comorbidity of anxiety disorders and depression twice as often as men, the rates and pattern of comorbid disorders seem quite similar across the genders (Kimberling & Ouimette, 2002). Nevertheless, it is a reminder that the comorbidity theory is just a possible reason behind why women are more susceptible to depression.

Recurrence Rates

Recurrence is a new occurrence of a disorder after a period of remission of symptoms lasting for over a period of 2 months. Recurrence may be easily detected in some cases. Evident characteristics include: attempted suicide (para-suicide), family troubles, and social inabilities.

The recurrence hypothesis states that equal proportions of males and females will experience at least one episode of depression (the first episode), but that more females than males will go on to have greater than one lifetime episode (Hankin & Abramson, 1998). This hypothesis is later proven to be incorrect by substantial data gathered. 74% of males had only one lifetime depressive episode compared to 74% of females, whereas 26% of males had greater than one depressive episode compared to 26% of females (Hankin & Abramson, 1998). However this study is only a small sample of a population, so therefore this information should not be interpreted as a population recurrence rate.

Though the hypothesis that women have higher recurrence rates then men has been found to be incorrect--it is still fact that recurrence increases depressive cognitions. Thus resulting in a probable cause of susceptibility.

Summary of Women's Susceptibility

The noting of widespread gender differences in rates of depression now dates back two decades, with women consistently reported as having a twofold lifetime prevalence of depression, and a greater likelihood of seeking help for depression than men (Wilhelm & Roy, 2002). Though this is true, it is still not clearly evident as to why women are more susceptible to depression than men. In the course of this review article, there are many possibilities given to solve this indefinite difference. The possibilities of biological differences, age prevalence, gender stereotypes and identity roles, comorbidity, and recurrence rates, were all given. However none provided concrete evidence to solve such a phenomenon. From the evidence given, I can only conclude that the susceptibility of depression in women is so high, because of environmental factors. The environmental factors include the gender stereotypes and identity roles. The experiences women go through in life are much different than the experiences that men do. Therefore, the life events for women and men vary across the board; there is no way to possibly detect what exactly causes the large difference in susceptibility of depression.

Table 1. Definitions of Key Terms

Gender Typing--The process of developing the behaviors, thoughts, and emotions associated with a particular gender.

Depression--A psychiatric disorder characterized by an inability to concentrate, insomnia, loss of appetite, anhedonia, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts of death. Also called clinical depression.

Gender Role--The accepted behaviors, thoughts, and emotions of a specific gender based upon the views of a particular society or culture.

Biology--The science of life and of living organisms, including their structure, function, growth, origin, evolution, and distribution.

DSM-IV--Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

Comorbidity--The presence of coexisting or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.

Externalization--To project or attribute (inner conflicts or feelings) to external circumstances or causes.

Social Roles--Accepted behaviors associated with a particular position within a group.

Susceptibility--The capacity to be affected by deep emotions or strong feelings; sensitivity.

Table 2. Explanations for the Increased Rates of Depression in Women (Formanek & Gurian, 1987, p. 8)

A. Artifact
Differences in reporting stress and distress
  • Women are under more stress.
  • Women weigh events as more stressful
  • Women are more willing to acknowledge symptoms      
  • Women seek help more often
  • Men use more alcohol
  • Men are more often into legal difficulties

B. Real
Psychosocial
  • Disadvantage of women’s social status
  • Learned helplessness
  • Demographic changes
  • Genetic Transmission
  • Female endocrine physiology

Table 3. Gender Stereotypes

Characteristics of the Female Stereotype      
  • Affectionate
  • Gullible
  • Cheerful
  • Childlike
  • Compassionate
  • Does not use harsh language
  • Eager to soothe hurt feelings
  • Feminine
  • Flatterable
  • Gentle
  • Loves children
  • Loyal
  • Sensitive to the needs of others
  • Shy
  • Soft-spoken
  • Sympathetic
  • Tender
  • Understanding
  • Warm
  • Yielding

Characteristics of the Male Stereotype
  • Acts as a leader
  • Aggressive
  • Ambitious
  • Intelligent
  • Assertive
  • Athletic
  • Competitive
  • Defends own beliefs
  • Dominant
  • Forceful
  • Has leadership abilities
  • Independent
  • Individualistic
  • Makes decisions easily
  • Masculine
  • Self-reliant
  • Self-sufficient
  • Strong personality
  • Willing to take a stand
  • Willing to take risks

Peer Commentary

It's Not Easy Being Male Either

Josiah P. Allen
Rochester Institute of Technology

In "Why Women Are More Susceptible to Depression: An Explanation for Gender Differences," by Christina M. Mulé, points were made that gloss over the issue of depression in men. This commentary is by no means an attempt to start a gender battle but is an honest look at certain points in which faulty assumptions were made by the author to support her arguments.

Near the end of her discussion on biological differences, the author casually explained that women were more aware of their surroundings and therefore were more prone to feel depressed around other depressed individuals. Where this idea came from is unclear, and what arguments could support it is also unclear. One can easily argue the opposite. Men are by general stature more athletic, and a large part of athleticism is being constantly aware of the situation. Men are bred to be competitive and thus are always watching for possible threats or rivals, etc. The author also seemed to state that women were more closely interconnected with family members. Again this statement did not seem to have any merit, given that she declined to argue the point and assumed that men were more often cold and distant in relation to their family.

Mulé strongly argued that gender stereotypes play a significant role in how women are perceived and thus perceive themselves. She did not bother, however, to discuss any possible stress in the lives of men. Mulé stated, "Women are expected to live up to these stereotypical roles and expectations of perfection everyday…," thus implying that men are not conflicted by social stereotypes and expectations. She completely ignored the fact that social roles could play an equal part in depression in both sexes. Men are socialized to be independent and inhibited, which often leads to loneliness and inability to communicate, which can lead to severe depression. Mulé did not try to enlighten readers on why men did not get depressed in their daily roles as compared with women, and this fact severely limited her arguments for why depression was more common in women.

Later in the topic Mulé discussed how parental roles affect depression and how women are more often than not the primary caretakers of children. Here is where I believe the author could have made a bold point about the cognitive failures of women to manage their stress, given the fact that women often have a larger workload then men, because they choose to, whether they acknowledge it or not. She based her argument on Denmark and Paludi's (1993) work, which one can assume is valid, but the results are obvious. Of course men are satisfied with less work, just as women would be. Beck's cognitive theory states that depression is caused by negative thoughts and dysfunctional beliefs, and the belief that women must agree to a larger role in the household would be a strong addition to her point. She simply concluded, however, that women in general were not happy with their responsibilities.

Mulé’s work seemed to have an insistence that on average life is harder for women, without bothering to look at the conflicts and stresses of men. The author stated, "Women are faced with the problem of how to makes their lives meaningful." And men do not have this problem? This may be one of the largest contributors to male depression, especially during the common male mid-life crisis. Mulé’s work is indeed admirable, but by ignoring the plight of men for empirical comparison, it is still hard to pinpoint a strong cause for the relatively high rates of female depression.

Peer Commentary

Don't Throw the Baby Out With the Bathwater

Joshua M. Rosenberg
Rochester Institute of Technology

Mulé's paper offered several interesting explanations for the demonstrated increased rate of depression in women, but it glossed over the biological basis for the difference. Under the very first heading on Biological Differences, she claimed several times that biological factors are "rather trivial," while offering no effective backing for the statement. The one article she cited (Nazroo & Edwards, 1998) had an essentially invalid conclusion. In this study, the authors concluded that women are only at a greater risk for depression following serious "life events." This study specifically excluded all couples who did not experience such an event, so this finding is baseless. Using this article as the only support for her position that biological factors are trivial does not do a particularly good job of convincing me.

Similarly Mulé claimed that studies of depression in early adolescence cannot explain why women are more susceptible to depression, even though the research did show that they were more depressed and provided likely causes for the depression. This claim would be fine if Mulé did not do an about face in the very next section on gender stereotypes and identity roles, using theories that have spotty support as a basis for a sweeping claim that sociocultural influences are to blame for the gender disparity. Although there is some evidence for the theory in her references, there was equally valid evidence discounted earlier. Alhtough Mulé's points are not intrinsically flawed or necessarily wrong, it is obvious that author bias clouds the decision making process where she evaluates competing theories.

Pointing out that girls have had twice the rate of anxiety disorders by age 6 would seem to weaken Mulé's subsequent arguments, because I highly doubt that the average 6 year old girl would worry about sexual assault, interpersonal trauma, or other stresses any more than a boy. This finding seems to be an argument for a difference that exists from birth, rather than a socially ingrained response.

Aside from issues with author bias, Mulé's paper is well done. I recommend evaluating her sources oneself to get a better idea of their results, given that the quotes are often not directly related to the studies' primary focus. The points Mulé made on the sociocultural origins of female depression rates are often quite interesting. In the future, providing clear and valid support for the arguments would be a good idea. Attempting to evaluate all of the disparate theories rather than rejecting them out of hand would lend authority to the paper. Trying to pin the blame on sociocultural influences alone, while rejecting the other possible rationales, is reactionary, painting an incomplete picture of the issue. Either acknowledge the opposing validity of the other viewpoints, or come up with convincing evidence that they are flawed.

Peer Commentary

The Power of Gender Biases

Irina V. Sokolova
Rochester Institute of Technology

This is a commentary on C. M. Mulé's paper titled "Why Women Are More Susceptible to Depression: Explanation for Gender Differences." In her paper, Mulé explored the gender differences associated with depression. She claimed that women tend to be more prone to get depressed than men for various reasons. The reasons include biological or hormonal differences, age prevalence, sex-/gender-roles, rates of depression, comorbidity, and recurrence. After exploring each of the possible causes, she stated that it is unclear exactly what causes depression. She reviewed several theories about those causes and supported them with studies. There are several factors we need to explore, however, which might help us to understand some biases in gender-related stereotypes.

On the basis of strong evidence, women appear to have higher rates of depression than men. Therefore, one would expect clinicians to see more depressed females than depressed males. It is also possible that gender-related bias exists in clinical identification of depression, because women are stereotyped to be more prone to be depressed. Two studies (Verbrugge & Steiner, 1981; Wallen, Waitzkin, & Stoechle, 1979) were based on medical records and physicians' self-reports. The results showed that medical clinicians were more likely to attend to psychological problems in women than in men. Another study by Loring and Powell (1988) provided sufficient evidence that psychiatric diagnosis is affected by a patient’s gender. These finding suggest that depression is more likely to be identified in women than in men with equivalent symptoms. Therefore, depression may be underdetected in men and overdetected in women. These tendencies may contribute to inflated female depression rates. Women are more prone to seek help than men, and they may be more likely to be diagnosed with depression. Depressed women are also more prone to express their symptoms than men who view depression as unproductive and self-indulgent and deny it.

In research by S. Nolen-Hoeksema, she advances her own theory: that men and women respond to depressing life events differently, and that whereas men tend to cut off the depression before it ramifies, women tend to remain focused on their depressed mood in ways that prolong its duration and extend its impact.

In another study, Zamarripa, Wampold, and Gregory (2003) proposed to investigate the generality of the gender role conflict constructs (success, power, and competition; restrictive emotionality; restricted affection between men; and conflicts between work and family) to women in terms of the presence of the conflict in men and in terms of the relation of the constructs to the mental health of women. In terms of generality, three possibilities existed. The first possibility was that men and women manifest equal levels of the various conflicts, and that these conflicts are similarly related to mental health. For example, in this scenario, levels of restricted emotionality would be comparable for men and women, and moreover would be comparably related to depression and anxiety; that is, restricted emotionality would be detrimental to the mental health of both men and women. This outcome would provide evidence against gender specific effects and would not support a socialization explanation.

The second possibility was that the correlations between the conflicts and mental health are invariant across genders but that mean differences exist. For example, it may be that men restrict emotions to a greater extent than women, but that restricted emotionality is detrimental to both (i.e., restricted emotionality is correlated with depression and anxiety for men and women) (Zamarripa, Wampold & Gregory, 2003).

The third possibility was that there are mean and correlational differences, indicating, for instance, that men are less expressive and that restricted emotionality is more detrimental for men than for women. Also according to a socialization explanation, men are socialized to be less expressive, and this creates particular intrapsychic conflicts for men that lead to symptoms of depression and anxiety (Zamarripa, Wampold & Gregory, 2003).

Indeed, studies have found that gender role conflict in men is negatively related to mental health. Men who emphasized success, power, and competition as a measure of their personal worth or value and men who restricted their emotional expression tended to be more anxious and depressed regardless of age (and were also less likely to seek psychological help) than women. Such men also reported higher anxiety and decreased social intimacy. Restrictive emotionality, as part of gender role conflict, was associated with interpersonal insensitivity, paranoia, psychoticism, and depression (Zamarripa, Wampold & Gregory, 2003).

The focus of gender role conflict in men, factors such as restricted emotionality or conflict between work and family, are simply aspects of personhood that are associated with mental health. There are, however, factors of socialization and expectations placed on men by society. With regard to the gender role conflict variables, mean differences appeared as expected. Men showed higher levels of appropriate success, inappropriate success, and restrictive emotionality than did women, consistent with a hypothesis that suggested that men are socialized to emphasize success at the expense of emotionality. There were no differences between men and women with regard to conflict between work and family, a result that confirms findings in the management literature. The means for restricted affection were arrayed as expected, with men's affection toward other men most restricted, followed by men's affection toward women and women's affection toward other women, and women's affection toward men the least restricted (Zamarripa, Wampold & Gregory, 2003).

Whereas the means for the various gender role conflict variables showed expected gender differences, for the most part, the relation between these variables and depression and anxiety revealed few gender differences. For men, consistent with previous research, restricted emotionality was related to depression; nevertheless, restricted emotionality was not related to anxiety. A similar pattern emerged for women, indicating that the detrimental effects of restricted emotion operate similarly in men and women (Zamarripa, Wampold & Gregory, 2003).

It was hypothesized that only inappropriate success would lead to depression and anxiety, but the results marginally supported a significant relation between inappropriate success and depression only for women. Generally, however, appropriate success produced less depression and anxiety, whereas inappropriate success produced more depression and anxiety, as predicted. The relation between success and depression and anxiety did not differ by gender. These results contradict the notion posited by some that aspects of power and competition are uniquely detrimental to men and suggest that there are components of achievement that cannot be considered harmful in any way and may be protective (Zamarripa, Wampold & Gregory, 2003).

Conflict between work and family was related to depression and anxiety in both men and women. Clearly, the increase in women in the workforce has changed the role of women from supporting men's career progress to having to balance work and family roles. There is some evidence, however, that women's experience of the conflict is problematic because they feel more responsible for family commitments and home tasks than do men (Zamarripa, Wampold & Gregory, 2003).

As can be seen, the topic of depression in men and womed is controversial. More studies should be conducted to find an exact and definite answer to the question of gender differences in depression.

Author Response

Multiple Possible Causes, None Definitive

Christina M. Mulé
Rochester Institute of Technology

Perhaps this paper seems a bit gender biased; however, I can assure readers that the information used in this paper was well researched. I in no way wanted to create a "war of the sexes" theme for this paper, but males seemed to be defensive in my saying that women are more susceptible to depression than are men.

Allen made many good points in his peer commentary. In response to his criticism that I mentioned no stressors from the male's perspective, it would have been virtually impossible for me to compare and contrast the stressors in each gender's lives. This paper was written in a timely fashion, but the number of pages could have exceeded a book's length. I accept, however, the criticism that having this information would have made for a stronger paper overall.

Rosenberg wrote, "Trying to pin the blame on sociocultural influences alone, while rejecting the other possible rationales, is reactionary, painting an incomplete picture of the issue." I feel that the paper continuously stated that all given explanations for the susceptibility of depression in women were just possible explanations. They offered no concrete answers, their purpose was merely suggestive. There is no possible way to pinpoint one matter as the cause of depression. There can be multiple reasons for the susceptibility to depression in women, and that is the message that I tried to convey in my paper.

Lastly, Sokolova gave the impression that the paper was well written but that the issue should be further researched and evaluated. She concluded that a "definite answer to the question of gender differences in depression" should be found. I can assure readers that this will never happen. As stated before, there is no way to pinpoint why there is such a gender difference in depression.

This controversial issue will probably last a lifetime, and men will more than likely be offended by the standpoint that I proposed in this paper. In my defense, in almost every psychology textbook or reference, you will find that other researchers believe that women are more susceptible to depression than are men. (And these researchers include men.)

References

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Smolak, L., & Fairman, B. (2002). The relationship of gender and voice to depression and eating disorders. Psychology of Women Quarterly, 26, 1-15.

Weissman, M. M., & Paykel, E. S. (1974). The depressed woman. Chicago: University of Chicago Press.

Wilhelm, K., & Roy, K. (2003). Gender differences in depression risk and coping factors in a clinical sample. Acta Psychiatrica Scandinavica, 106, 45-53.

Zamarripa, M. X., Wampold, B. E., & Gregory, E. (2003). Male gender role conflict, depression and anxiety: Clarification and generalizability to women. Journal of Counseling Psychology. 50, 167-174.

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