It has been widely documented that there are gender differences in depression prevalence, with women experiencing major depression more often as men. This risk exists independent of race or ethnicity. One large-scale 2017 study found that these gender differences emerge starting at age 12, with girls and women being twice as likely as men to experience depression.
Given that the peak onset of depressive disorders in women coincides with their reproductive years (between the ages of 25 to 44 years of age), hormonal risk factors may play a role. Estrogen and progesterone have been shown to affect neurotransmitter, neuroendocrine, and circadian systems that have been implicated in mood disorders.
The fact that women often undergo mood disorders associated with their menstrual cycle, such as premenstrual dysphoric disorder (PMDD), a mood disorder characterized by depressive symptoms that occur prior to the start of the menstrual cycle, also points to a relationship between female sex hormones and mood.
Research has shown that PMDD is linked to a gene alteration that increases a woman’s sensitivity to the reproductive hormones estrogen and progesterone.
In addition, the hormonal fluctuations associated with childbirth are a common trigger for mood disorders. The onset of postpartum depression is thought to be linked to the dramatic hormonal changes that take place immediately after giving birth.
Although menopause is a time when a woman’s risk of depression declines, the perimenopausal period is a time of increased risk for those with a history of major depression. Other hormonal factors that may contribute to a woman’s risk for depression are sex differences related to the hypothalamic-pituitary-adrenal (HPA) axis and to thyroid function.
Researchers have found that gender differences in socialization could play a role as well. Girls are socialized to be more nurturing and sensitive to the opinions of others, while little boys are encouraged to develop a greater sense of mastery and independence in their lives.
Masculine gender socialization emphasizes norms such as stoicism, toughness, and the avoidance of anything perceived as feminine, including displays of emotion. Some researchers suggest that this type of socialization may cause depression to manifest differently in men.
It has also been theorized that women who become housewives and mothers may find their roles devalued by society while women who pursue a career outside the home may face discrimination and job inequality or may feel conflicts between their role as a wife and mother and their work.
The socialization of gender roles and gender traits has been associated with how well people cope with stress and the effects that stress has on health. Researchers have found that such socialization benefits men in terms of overall health.
Studies show that women tend to use a more emotion-focused, ruminative coping style, mulling their problems over in their minds, while men tend to use a more problem-focused, distracting coping style to help them forget their troubles.
It has been hypothesized that this ruminative coping style could lead to longer and more severe episodes of depression and contribute to women’s greater vulnerability to depression.
Stressful Life Events
Evidence suggests that, throughout their lifetimes, women may experience more stressful life events and have a greater sensitivity to them than men.
Adolescent girls tend to report more negative life events than boys, usually related to their relationships with their parents and peers, and to experience higher levels of distress related to them.
Studies of adult women have found that women are more likely than men to become depressed in response to a stressful life event and to have experienced a stressful event within six months prior to a major depressive episode.
However, depression prevalence rates also tend to be fairly consistent globally, which may suggest that biological influences play the largest role and that factors such as socioeconomic status, education, race, diet, and culture.
Researchers have also suggested that there may actually be no difference in prevalence between men and women. These researchers have proposed the idea that it may actually be that women seek help more often than men or report their symptoms differently, leading to them being diagnosed more often than men.
Some research indicates that not only may men experience depression differently than women do, but depression among men may also be underdiagnosed. Men tend to experience symptoms such as anger, irritability, sleep disturbances, and substance use. They are also more likely to describe depressive symptoms as “stress” rather than feelings of sadness.
One study published in JAMA Psychiatry found that when depression was measured with these so-call “male symptoms,” men actually had somewhat higher rates of depression (26.3% for men and 21.9% for women).