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      Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population

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          Abstract

          The Lundby Study is a prospective mental health survey in a community population ( N = 3563), in which data were collected in 4 waves of field-work between 1947 and 1997. We investigated gender differences during the follow-up in overall first incidence rates, ages of onset, and incidence by age of onset patterns, in different subtypes of depression. The overall incidence rate in females was higher than males for most subtypes of depression. However, for depression with melancholic and/or psychotic features, the overall first incidence rate did not differ significantly between the genders. The mean age of onset did not differ significantly between females and males in any of the depressive subtypes. Nevertheless, females and males had different first incidence rates by age of onset patterns for unipolar non-melancholic DSM-IV mood disorder and major depressive disorder (MDD), with a consistent gender incidence gap across all ages, but with the most conspicuous gender gap in middle age. The first incidence rates by age of onset patterns for DSM-IV MDD with melancholic and/or psychotic features did not differ significantly between the genders. The findings support that females are more prone than males to develop depression with medium severity, but no gender differences were found in melancholic and/or psychotic depression. The findings may support that unipolar non-melancholic depression and melancholic and/or psychotic depression represents different disorders. Tentative explanations for this are discussed.

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          Most cited references38

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          Diagnostic and statistical manual of mental disorders

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            The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression.

            In adulthood, twice as many women as men are depressed, a pattern that holds in most nations. In childhood, girls are no more depressed than boys, but more girls than boys are depressed by ages 13 to 15. Although many influences on this emergent gender difference in depression have been proposed, a truly integrated, developmental model is lacking. The authors propose a model that integrates affective (emotional reactivity), biological (genetic vulnerability, pubertal hormones, pubertal timing and development) and cognitive (cognitive style, objectified body consciousness, rumination) factors as vulnerabilities to depression that, in interaction with negative life events, heighten girls' rates of depression beginning in adolescence and account for the gender difference in depression.
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              Gender differences in depression.

              It is commonly suggested that a female preponderance in depression is universal and substantial. This review considers that proposition and explanatory factors. The view that depression rates are universally higher in women is challenged with exceptions to the proposition helping clarify candidate explanations. 'Real' and artefactual explanations for any such phenomenon are considered, and the contribution of sex role changes, social factors and biological determinants are overviewed. While artefactual factors make some contribution, it is concluded that there is a higher order biological factor (variably determined neuroticism, 'stress responsiveness' or 'limbic system hyperactivity') that principally contributes to the gender differentiation in some expressions of both depression and anxiety, and reflects the impact of gonadal steroid changes at puberty. Rather than conclude that 'anatomy is destiny' we favour a diathesis stress model, so accounting for differential epidemiological findings. Finally, the impact of gender on response to differing antidepressant therapies is considered briefly.
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                Author and article information

                Contributors
                +46 70-994 13 02 , mats.bogren@med.lu.se
                Journal
                Eur Arch Psychiatry Clin Neurosci
                Eur Arch Psychiatry Clin Neurosci
                European Archives of Psychiatry and Clinical Neuroscience
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0940-1334
                1433-8491
                18 March 2017
                18 March 2017
                2018
                : 268
                : 2
                : 179-189
                Affiliations
                GRID grid.411843.b, Division of Psychiatry, Department of Clinical Sciences, , Lund University Hospital, ; 221 85 Lund, Sweden
                Author information
                http://orcid.org/0000-0002-1146-9547
                Article
                778
                10.1007/s00406-017-0778-x
                5809533
                28315937
                a62b3002-f573-4f70-933c-939ed0ce0480
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 25 May 2016
                : 6 March 2017
                Funding
                Funded by: The Ellen and Henrik Sjöbring Foundation
                Funded by: The Division of Psychiatry, Lund University
                Categories
                Original Paper
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2018

                Neurosciences
                community survey,incidence,age of onset,depression,melancholia,gender gap
                Neurosciences
                community survey, incidence, age of onset, depression, melancholia, gender gap

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