Week 2- 1. Sex differences in depression = Less important
Kendler, K. S., & Gardner, C. O. (2014). Sex differences in the pathways to major depression: a study of
opposite-sex twin pairs.
Ae#ological: causing or contribu-ng to the development of a disease or condi-on.
Because women consistently have a higher rate of major depression than men, sex differences in ae-ological pathways
to major depression have o>en been explored. This study examined sex diffs in the ae-ological pathway to major
depression using a co-twin control design in opposite-sex dizygo-c twin pairs.
Who?
Of the 1057 male-female twin pairs in our sample, 837 were concordant (in agreement) for no episodes of major
depression in the past year. In 12 pairs, both members had depressive episodes.
Results can be examined in several ways. We illustrate 3 levels of analysis focused on sex diffs in
1) Individual paths
2) All ouPlow paths from risk variables
3) Total effect of risk variables on liability to major depression
Individual paths with substan#al sex diffs:
- Much stronger in males = paths from childhood sexual abuse to both conduct disorder and early-onset anxiety
disorders = much stronger in males.
- Much more robust in males = paths from drug use disorders to distal and dependent proximal stressful life
events were much more robust in males.
- Considerably stronger in males = paths from dependent proximal life events to past-year major depression.
Risk factors: ou?low that contribute more strongly to major depression pathway.
- Females: parental loss, neuro-cism, life-me traumas, divorce, social support and marital sa-sfac-on.
- Males: low self-esteem, drug use disorder, past history of major depression, and distal and dependent
proximal stressful life events.
Risk factors: total direct and indirect paths to major depression
Four variables in model had strong sex diffs:
- Females: social support and marital sa-sfac-on
- Males: distal and dependent proximal stressful life events.
Specific classes of stressful life events:
- Male affected: financial problems, work problems and legal problems.
- Female affected: rela-onship problems and serious illnesses in pp in the twin’s close social network.
Results are consistent with literature in social sciences Males have greater sensi-vity to the depressogenic
sta-ng that women derive a larger component of their effects of childhood sexual abuse and stressful life
sense of self and self-worth from interpersonal events occurring in the past year (sexual abuse in
rela-onships. Compared with men, women have larger females is much more frequently researched). Men are
social networks, are more in-mate with and emo-onally more emo-onally involved in occupa-onal and financial
involved with the members of their network and are more success and more likely to be both the perpetrators and
sensi-ve to adversi-es experienced by their network. the vic-ms of crime.
Simply put, our research shows that anacli#c depression While introjec#ve depression (denotes achievement
(involves excessive interpersonal (rela-ng to rela-onships) concerns and is characterized by a tendency towards
concerns, including feelings of loneliness, weakness, self-cri-cism and self-evalua-on) is linked to external
helplessness and abandonment fears) is connected to parents behavioral issues and is -ed to struggles in important
who lack nurturing care, and o>en arises from problems in tasks such as work achievements and fulfilling family
rela-onships like rejec-on or in-macy failures. responsibili-es.
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,Four poten#al methodological limita#ons.
Causal Rela#onship Assump#on:
- The model assumes a causal rela-onship between predictor and dependent variables.
- But some rela-onships are poten-ally bidirec-onal (A↔B) rather than unidirec-onal (A→B).
Recall Bias in Risk Factors:
- Risk factors were assessed using long-term memory, introducing the possibility of recall bias.
- Mi-ga-on efforts include using mul-ple reporters, relying on objec-ve events, and assessing key variables
prospec-vely, minimizing recall bias within the two-wave design.
Addi#vity and Linearity Assump#on:
- The model assumes that mul-ple independent variables act addi-vely and linearly in impac-ng the risk for major
depression.
- Acknowledges the poten-al non-linearity, as demonstrated by the sample showing that high levels of neuro-cism
amplify sensi-vity to the depressogenic effects of stressful life events.
-Sample Limita#ons:
- The study's sample consists of adult white twins born in Virginia, poten-ally limi-ng generalizability.
- Despite this, the sample's rates of psychopathology, par-cularly major depression, are noted to be comparable to
those reported in the Na-onal Comorbidity Survey for the general popula-on.
MarJn, L. A., Neighbors, H. W., & Griffith, D. M. (2013). The experience of symptoms of depression
in men vs women: analysis of the NaJonal Comorbidity Survey ReplicaJon
Typically, women are diagnosed with depression twice as o>en as men in almost every seang, incl. Western and most
non-Western community studies. So most research = focused on explaining why women are at greater risk for
developing depression.
More than 10 years ago, an alterna-ve approach came up: cri-quing the validity of the current diagnos-c criteria,
arguing that men may experience alterna've depression symptoms. In part because tradi-onal depressive symptoms
(e.g., sadness, crying) are at odds with societal ideals of masculinity, men may be reluctant to report experiencing these
symptoms. Also, men’s experiences of depression may manifest with symptoms that are not currently included in
tradi-onal diagnos-c criteria.
Addis: 4 conceptual frameworks within the exis-ng literature that address how gender shapes men’s experiences,
expressions, and reac-ons to depressions:
1. The sex differences framework assumes that depression is the same in both men and women, focusing on
inves-ga-ng differences in related factors like symptoms. However, a cri-que is that it relies on opposing
categories like "male depression" versus "female depression," overlooking the diversity within these groups.
2. The masked depression framework suggests that men may hide their emo-onal distress by expressing it in
ways other than direct sadness, as admiang vulnerability is socially unacceptable for them. However, a
cri-cism is that it is challenging to pinpoint these alterna-ve expressions of depression.
3. The masculine depression framework suggests that men, striving to conform to hegemonic (ruling/dominant
in poli-cal/social context) masculine norms, may be prone to a type of depression with outward signs. Instead
of showing sadness, they might display anger, engage in self-destruc-ve behavior, distract themselves, or use
substances to numb emo-onal pain. Some propose that irritability could be a key symptom linking men and
depression. Studies have found that men with depression may score higher on irritability, overreact to minor
annoyances, have anger afacks, lower impulse control, increased substance use, and more hyperac-ve
behavior compared to depressed women.
4. The gendered response framework explains that men's reac-ons to nega-ve emo-ons, like sadness and grief,
are influenced by their adherence to or rejec-on of hegemonic (ruling/dominant in poli-cal/social context)
masculinity. Gender socializa-on can lead some men to hold back or limit emo-onal expression, leaving them
with few ways to convey feelings of emo-onal pain and distress. As a result, clinicians may need to consider
alterna-ve signs to recognize depression in male pa-ents.
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, There are 2 scales that evaluate the presence of alterna-ve ‘male-type’ depression symptoms in groups of clinical
pa-ents: 1. The Gotland Male Depression Scale (GMDS) developed with a sample of men in treatment for substance
abuse and 2. Masculine Depression Scale (MDS), which is a self-report scale designed to capture alterna-ve symptoms
proposed in the literature to be more common in men’s presenta-on of depression, on this scale, men who scored high
on masculine norms adherence were less likely to endorse tradi-onal depression items.
The study in this ar-cle created two different scales:
1) A scale useful for analyzing a group of fewer than 250 people is the MSS. It was created to evaluate male-type
depression and covers 8 factors iden-fied in literature as outward signs of depression in men, such as irritability, anger
afacks, sleep disturbance, substance abuse, risk-taking behavior, hyperac-vity, stress, and loss of interest in
pleasurable ac-vi-es. Some MSS symptoms (sleep disturbance and loss of interest) are part of standard depression
measures but were included for their connec-on to outward ac-ons.
2) Another scale for male depression, the GIDS, includes all MSS symptoms and adds 7 tradi-onal depression
symptoms like sad mood, loss of vitality, -redness, ambivalence, anxiety, and complain-veness (feeling pathe-c).
Hypotheses
Hypothesis 1 suggests that the MSS and GIDS scales Hypothesis 2 predicts that male depression, as measured by
will show a strong posi-ve correla-on with MDE and the MSS, will be more prevalent among men than women. The
moderate correla-ons with alcohol abuse, drug MSS includes symptoms that depressed men might be more
abuse, and IED. This is based on the expecta-on that willing to admit to compared to tradi-onal depression
these new scales, if measuring depression, should symptoms. It is based on literature sugges-ng that men are
closely align with exis-ng depression measures. If more prone to irritability, hyperac-vity, violence, and soma-c
men use substance abuse to mask depression, as symptoms. While some women may endorse these atypical
suggested in literature, the scales should also be male-type symptoms, the expecta-on is that male depression,
posi-vely linked to alcohol and drug abuse. as captured by the MSS, should be more common among men.
Hypothesis 3 posits that the prevalence of male Hypothesis 4 suggests that men will endorse non-tradi-onal
depression, as measured by the GIDS, will not show symptoms more frequently than women. This hypothesis
gender differences. Unlike the MSS, the GIDS explores sex differences in specific items added as alterna-ve
combines male-type symptoms with tradi-onal expressions of depression. Previous literature reports mixed
depression symptoms, aiming to be inclusive of results on symptom endorsements, with some studies finding
both. This hypothesis assumes that male depression no differences, while others show that men with depression
is not a separate disorder but that the current may score higher on irritability, anger afacks, lower impulse
symptom profile lacks symptoms reflec-ng men's control, substance use, and hyperac-ve behavior compared to
experiences. If true, the GIDS should iden-fy an depressed women.
equal number of depression cases across sexes.
Results
There were significantly more women in the sample compared with men. Men’s mean and median incomes were
significantly higher than women’s.
Hypothesis 2 → supported: stated that depression would be more prevalent among men when assessed by the MSS.
The prevalence of depression in men was 26.3% but the prevalence in women was 21.9%, a significant difference. The
ar-cle observed diffs between the sexes in how they endorsed specific items in the MSS. Men showed significantly
higher rates of endorsement for anger afacks/aggression, substance abuse, and risk-taking behavior. On the other hand,
women endorsed four symptoms at significantly higher rates than men: stress, irritability, sleep problems, and loss of
interest in usual ac-vi-es like work, hobbies, and personal rela-onships.
Hypothesis 3 → supported: no sex diffs in the prevalence of depression as assessed by the GIDS. Both in the mild,
moderate and severe levels there were no significant sex diffs demonstrated.
Hypothesis 4 → mixed results: irritability was equally endorsed by both men and women. Examining the most endorsed
symptoms revealed similar paferns for both genders, with depressed mood being the primary symptom for both, and
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