Men just as likely to be depressed as women

LOS ANGELES — Depression can look very different in men and women. And many of its hallmarks — rage, risk-taking, substance abuse and even workaholism — can hide in plain sight.

Now researchers say that when these symptoms are factored into a diagnosis, the long-standing disparity between depression rates in men and women disappears.

That conclusion overturns long-accepted statistics indicating that, over their lifetimes, women are 70 percent more likely to have major depression than men. In fact, when its symptoms are properly recognized in men, major depression may be even more common in men than in women, according to a study published Wednesday by the journal JAMA Psychiatry.

The findings help unravel a mystery that has long puzzled mental health authorities: If men are so much less likely than women to be depressed, why are they four times more likely to commit suicide?

“When it comes to depression in men, to some extent we have blinders on,” said Dr. Andrew Leuchter, a psychiatrist who studies depression at UCLA. “We have not been asking about and taking into account a range of symptoms that may be gender-specific.”

Health policy researchers from the University of Michigan and Vanderbilt University set out to test the feasibility of two new checklists that might diagnose depression in men as well as women with greater accuracy.

In addition to familiar depression symptoms such as sadness, difficulty sleeping, feelings of guilt or worthlessness and loss of interest in pleasurable activities, the researchers expanded the list to include anger attacks, aggression or irritability, substance abuse, risk-taking behavior and hyperactivity. They devised two scales — one designed to be gender-neutral and one tuned toward the way the disease manifests itself in men.

The researchers tested these diagnostic criteria in a group of nearly 5,700 American adults who had been interviewed as part of a long-term study of mental health organized by researchers at Harvard Medical School; 41 percent of the participants were men.

The results of the analysis were striking.

When assessed using the “gender inclusive depression scale” that included widely recognized depressive symptoms such as sadness and hopelessness as well as symptoms commonly seen in men, 30.6 percent of men and 33.3 percent of women were found to have experienced a depressive episode at some point in their lives. In research terms, that gap between men and women was so narrow it may have been a statistical fluke.

And when the subjects were evaluated with the “male symptoms scale,” 26.3 percent of men and 21.9 percent of women were said to have experienced a major depressive episode in their lifetimes. That difference was large enough that it could not be due to chance, the researchers reported.

“Everything we think we know about depression is a reflection of how we defined it to begin with,” Leuchter said.

That bias, he added, may have fostered the perception that depression is predominantly a “woman’s disease” — and that men don’t need treatment for emotional suffering.

Sigmund Freud, the father of psychiatry, portrayed depression as rage turned inward. But for many men today, depression’s rage appears not so much directed at oneself as it is spat outward — at spouses, co-workers and friends.

While women may not feel shame in acknowledging their sadness and sagging self-esteem, mental health experts find that depressed men often respond to such feelings with actions that look like their opposite: They bluster and bully. They throw themselves into harm’s way. They numb themselves with sex, drugs and endless workdays.

If the emotional pain of many men is to be understood for what it is, depression’s definition should be expanded to include these “externalizing” symptoms — the opposite of “internalizing” symptoms that have long defined depression, some mental health professionals argue.

“These findings could lead to important changes in the way depression is conceptualized and measured,” the study authors concluded.

If psychiatrists update their official diagnostic criteria to reflect these gender differences, that would be only a first step, Leuchter said.

Doctors, including primary care physicians who now diagnose most depression, would have to be educated to look for an expanded set of symptoms, he said. Researchers would not only need to understand how seemingly separate diseases such as substance abuse and depression relate to each other, they would also need to assess whether the treatments currently available — antidepressants and talk therapy — would help men with these symptoms, he said.

For men as well as women, the checklists now in wide use to diagnose depression may fail to capture the experience and language of the emotional distress they feel, said study leader Lisa Martin, a health policy studies professor at the University of Michigan.

“Word choice matters,” she said.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

A firefighter stands in silence before a panel bearing the names of L. John Regelbrugge and Kris Regelbrugge during the ten-year remembrance of the Oso landslide on Friday, March 22, 2024, at the Oso Landslide Memorial in Oso, Washington. (Ryan Berry / The Herald)
‘Flood of emotions’ as Oso Landslide Memorial opens on 10th anniversary

Friends, family and first responders held a moment of silence at 10:37 a.m. at the new 2-acre memorial off Highway 530.

Julie Petersen poses for a photo with images of her sister Christina Jefferds and Jefferds’ grand daughter Sanoah Violet Huestis next to a memorial for Sanoah at her home on March 20, 2024 in Arlington, Washington. Peterson wears her sister’s favorite color and one of her bangles. (Annie Barker / The Herald)
‘It just all came down’: An oral history of the Oso mudslide

Ten years later, The Daily Herald spoke with dozens of people — first responders, family, survivors — touched by the deadliest slide in U.S. history.

Victims of the Oso mudslide on March 22, 2014. (Courtesy photos)
Remembering the 43 lives lost in the Oso mudslide

The slide wiped out a neighborhood along Highway 530 in 2014. “Even though you feel like you’re alone in your grief, you’re really not.”

Director Lucia Schmit, right, and Deputy Director Dara Salmon inside the Snohomish County Department of Emergency Management on Friday, March 8, 2024, in Everett, Washington. (Ryan Berry / The Herald)
How Oso slide changed local emergency response ‘on virtually every level’

“In a decade, we have just really, really advanced,” through hard-earned lessons applied to the pandemic, floods and opioids.

Ron and Gail Thompson at their home on Monday, March 4, 2024 in Oso, Washington. (Olivia Vanni / The Herald)
In shadow of scarred Oso hillside, mudslide’s wounds still feel fresh

Locals reflected on living with grief and finding meaning in the wake of a catastrophe “nothing like you can ever imagine” in 2014.

Everett mall renderings from Brixton Capital. (Photo provided by the City of Everett)
Topgolf at the Everett Mall? Mayor’s hint still unconfirmed

After Cassie Franklin’s annual address, rumors circled about what “top” entertainment tenant could be landing at Everett Mall.

Everett
Everett man sentenced to 3 years of probation for mutilating animals

In 2022, neighbors reported Blayne Perez, 35, was shooting and torturing wildlife in north Everett.

Dorothy Crossman rides up on her bike to turn in her ballot  on Tuesday, Aug. 1, 2023 in Everett, Washington. (Olivia Vanni / The Herald)
Everett leaders plan to ask voters for property tax increase

City officials will spend weeks hammering out details of a ballot measure, as Everett faces a $12.6 million deficit.

Starbucks employee Zach Gabelein outside of the Mill Creek location where he works on Friday, Feb. 23, 2024 in Mill Creek, Washington. (Olivia Vanni / The Herald)
Mill Creek Starbucks votes 21-1 to form union

“We obviously are kind of on the high of that win,” store bargaining delegate Zach Gabelein said.

Lynnwood police respond to a collision on highway 99 at 176 street SW. (Photo provided by Lynnwood Police)
Southbound lanes on Highway 99 reopen after crash

The crash, on Highway 99 at 176th Street SW, blocked traffic for over an hour. Traffic was diverted to 168th Street SW.

The view of Mountain Loop Mine out the window of a second floor classroom at Fairmount Elementary on Wednesday, Jan. 10, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
County: Everett mining yard violated order to halt work next to school

At least 10 reports accused OMA Construction of violating a stop-work order next to Fairmount Elementary. A judge will hear the case.

Imagine Children's Museum's incoming CEO, Elizabeth "Elee" Wood. (Photo provided by Imagine Children's Museum)
Imagine Children’s Museum in Everett to welcome new CEO

Nancy Johnson, who has led Imagine Children’s Museum in Everett for 25 years, will retire in June.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.