While it's likely that lifestyle and biological issues account for some differences in depression among the sexes, many experts question the reliability of the statistics. They contend that if studies accounted for differences in how men and women express and cope with their emotions, the apparent gap in depression rates would diminish or possibly disappear.
Typically, men are more likely to shy away from talking about their feelings, and doctors may bring up emotional topics less often with men. Depression in men may be obscured behind a variety of physical complaints, such as low energy, aches and pains, a loss of appetite, or trouble sleeping. Or the problem may come out as substance abuse or anger. Even if other symptoms of depression are present, some men don't feel sad. All of this makes depression difficult to diagnose in men.
In addition, many men don't feel comfortable acknowledging the need for help, making them less likely to seek assistance than women are. And if a loved one raises the subject, they may not be willing to admit the possibility that they are depressed. Yet when such men receive treatment for depression, their symptoms often disappear, and in retrospect they may concede that they were, in fact, depressed.
Differences Between the Sexes
Depression is so common that it should be considered as much a problem for men as it is for women. In fact, men are more at risk for the worst outcome of depression — suicide.
All over the world, depression is much more common in women than in men. In the United States, the ratio is two to one, and depression is the main cause of disability in women. One out of eight American women will have an episode of major depression at some time in her life. Women also have higher rates of seasonal affective disorder, depressive symptoms in bipolar disorder, and dysthymia.
Why are women so disproportionately affected? Many theories have been advanced to explain this difference. Some experts believe that depression is underreported in men, perhaps because men may be less likely to talk about feelings and seek help for mood disorders. There may also be other, more complex reasons for women's greater vulnerability to depression. Stress, genes, and hormones appear to play a role.
Studies have found that women are more likely to report that they are stressed, more likely to become depressed in response to a stressful event, and more likely to be subjected to certain kinds of severe stress — particularly child sexual abuse, adult sexual assaults, and domestic violence.
Everyday experiences as well as traumatic ones may provoke stress, leading to depression in women. Typically women are raised to care for others and tend to work longer hours doing housework, raising children, and assisting older relatives. Another kind of stress is poverty. Women are on average poorer than men — especially single mothers with young children, who have a particularly high rate of depression.
On the other hand, in this culture, male self-esteem often depends on success at work and physical skill or power. If a man's capacity in any of those areas is diminished — for example, if he loses a job — it may help trigger depression.
Researchers have identified certain genetic mutations that are linked to severe depression — some of which are found only in women. These biological differences could account for some of the difference in the rates of depression between men and women.
Hormonal changes that accompany menstruation can bring on mood changes. Women with premenstrual syndrome (PMS) may feel sad, anxious, irritable, and angry. They may also suffer from crying spells, trouble concentrating, and a feeling of being overwhelmed or out of control. Sometimes PMS is mistaken for depression and vice versa. In either case, it's important to talk to your doctor about mood fluctuations and treatment.
Some women report feeling depressed during perimenopause, a time of transition that occurs in the months or years before menstruation stops. As a result, researchers are investigating whether hormones play a role in depression around the time of menopause.