For years we have been told that research shows that women are more likely to experience depression than men. But those of us that study masculinity and mental health suspected that this was an artifact of the way depression is typically measured. Traditional masculinity with its emphasis on emotional toughness is at odds with expressing depression as sadness and crying. Mental health professionals (and people watching the Sopranos) noticed that in some boys and men, depression manifested in forms consistent with hegemonic masculinity such as aggressiveness, risk-taking, and alcohol and drug abuse.
A study published in JAMA Psychiatry last week supports the idea that we need to broaden our conceptions of depression. This is a mental health issue because some people, especially men, may have depressive symptomatology that includes anger, aggression, self-destructive behavior, irritability, and substance abuse. Common definitions and assessments do not reflect this. The matters because it means many people may suffer from undiagnosed and untreated depression.
The study, by researchers Martin, Neighbors, and Griffith, is receiving media attention for finding gender differences in depression. When the researchers measured depression with alternate “male symptoms” like irritability, sleep disturbance, alcohol/drug abuse, and anger attacks/aggression, men showed slightly higher rates of depression than women (26.3% and 21.9% respectively).
But a closer look reveals that the study findings support gender similarity more than gender difference and it is a mistake to consider these “new” symptoms as “male symptoms.” Note that although it is statistically significant, the difference is not large (4.4%). Also important is that when these alternate symptoms were combined with traditional symptoms in a gender inclusive measure, women and men did not differ in their rates of depression. The top endorsed symptoms for both genders were the same: depressed mood, anger attacks/aggression, stress, irritability, and anxiety/uneasiness (a combination of traditional symptoms and those hypothesized to be “male” symptoms). However, it is true that men were more likely to say their depression manifested as anger attacks/aggression, substance abuse, hyperactivity, and risk-taking.
This study doesn’t tell us much about the relationship between gender and depression. It was part of a larger data collection that limited the researchers’ ability to study how gender influences the experience and expression of depression. They did not measure how much participants accepted and conformed to the gender norms and roles that might lead to gender differences in depression. This is important because the gender experience varies widely based on age, culture, religion, sexual identity, personal experiences, individual differences, etc., so the interaction of gender with mental health variables is anything but uniform. Being a woman or being a man means different things to different people and that means that the relationship between gender and mental health widely across individuals and depends on a number of other factors.
Don’t get me wrong. Gender matters when it comes to depression. For example, women experience far higher rates of sexual and interpersonal violence than men do, both of which contribute to depression. And in some groups, masculine gender norms portray depression as weak and feminine; men are expected to suck up their emotions while they suck up alcohol, and aggression is accepted as a form of catharsis. How good a fit your culture’s gender norms and roles are for you personally may also affect depression (those “forced” to conform to gender norms that are a poor fit often experience depression).
But research does not support the existence of two types of depression (a “male type” and a “female type”). Supposed “male type” symptoms are also common in women with depression (so perhaps we shouldn’t call them “male symptoms”) and vice versa. As the authors emphasize, the main thing this study tells us is that depression is diverse and irritability, anger, and substance abuse should be included as possible symptoms.
If you are thinking that maybe you’d rather be dead, call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor. Or, call your doctor, dial 911, or go to the emergency room. For a detailed booklet on depression and its treatment, go to: http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml