Sex Differences in Depression

The existence of sex differences in depression, while undeniable, is a bit more complex than might be represented by the media and popular literature. For example, it is an oversimplification of the data to generalize women as more prone to developing depressive symptoms, as this can result from diagnostic bias. Current data does not support a biological underpinning for sex differences in depression, meaning that inherent, sex-linked genetic factors have not been identified (Zhao et al., 2020). Interestingly, women are much more likely to experience childhood trauma than men (Haahr-Pederson et al., 2020). These early experiences likely play a role in later development of chronic mental illness, including depression.  

Developmental Factors

One meta-analysis found that age plays a role in sex differences in depressive symptomatology, such that a sex gap became most apparent during adolescence, and of any variable, age most strongly predicted effect size of sex differences (Salk et al., 2107). However, in understanding this data point it is necessary to consider contributing social structures. Sex differences in depression may result from sex role socialization that may impact adolescents navigating a stage of psychosocial development characterized by either further developing their identity or falling into role confusion. During this developmental phase, adolescents are solidifying a mental model of their place in society, and this is influenced by behaviors, attitudes, and values that particular society finds acceptable. 

Sociocultural and Behavioral Factors

How do these factors tie into depressive symptomatology? In Western culture, it is generally more acceptable for women to exhibit outward symptoms commonly associated with depression, such as crying, sadness, and depressed mood. A patient presenting for depression treatment with these symptoms is more likely to be female, and is more likely to have those symptoms properly recognized as depression. Women are more likely to receive a depression diagnosis than men, even when both groups report similar symptoms and score similarly on measures of depression symptoms (WHO, 2021). 

Male adolescents may be more likely to act out when depressed, and receive a diagnosis of a behavioral disorder, which penalizes distressed behavior and leaves underlying depression untreated. Adult men with depression may demonstrate reluctance to seek help due to perceived challenges to masculinity (Keohane & Richardson, 2017).  Given these factors, it is of utmost importance to interpret research findings from a sociocultural framework that takes sex roles into account. 

EEG and Sex Differences

Assessment via EEG has the potential to increase precision through limiting diagnostic bias resulting from sociocultural norms. In contrast to the lack of conclusiveness of genetic or specifically sex-based differences, EEG research findings may suggest that sex differences in depression do exist on a neurobiological level. However, due to potential confounding factors and lack of conclusiveness, additional research is needed. In a sample assessing men and women with similar scores on a self-report measure of symptoms, one study found that depression was associated with frontal asymmetry, but only for women. Further, the direction of the asymmetry was opposite to what might be expected based on predictions of the EEG asymmetry-depression hypothesis (Jesulola et al., 2017). Other EEG research suggested that men and women use different brain networks to process emotional stimuli, including depressing and sad material (Goshvarpour & Goshvarpour, 2019).Your blog post content here…

References

Goshvarpour, A., & Goshvarpour, A. (2019). EEG spectral powers and source localization in depressing, sad, and fun music videos focusing on gender differences. Cognitive Neurodynamics, 13(2), 161–173. https://doi.org/10.1007/s11571-018-9516-y

Jesulola, E., Sharpley, C. F., & Agnew, L. L. (2017). The effects of gender and depression severity on the association between alpha asymmetry and depression across four brain regions. Behavioral Brain Research, 321(15), 232-239. https://doi.org/10.1016/j.bbr.2016.12.035

Keohane, A., & Richardson, N. (2018). Negotiating Gender Norms to Support Men in Psychological Distress. American Journal of Men's Health, 12(1), 160–171. https://doi.org/10.1177/1557988317733093

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102

World Health Organization. 2021. Gender and women’s mental health. Retrieved from https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/gender-and-women-s-mental-health

Zhao, L., Han, G., Zhao, Y., Jin, Y., Ge, T., Yang, W., Cui, R., Xu, S., & Li, B. (2020). Gender Differences in Depression: Evidence From Genetics. Frontiers in Genetics, 11, 562316. https://doi.org/10.3389/fgene.2020.562316

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