Long established has been the fact that females, starting in adolescence, have higher rates of depression than do males — about twice as high — and this difference seems to persist across the lifespan into older age. Various hypotheses have been offered for these gender differences. The first is that there is a true gender difference and that females do suffer from depression at higher rates. The second has to do with help-seeking, that males and females have similar rates, but that females are more likely to admit that they feel depressed and seek help for it. In contrast, males may be reluctant to appear weak and reveal that they are depressed, thus not getting the help they need. A third hypothesis is that males and females show depression symptoms in different ways, and the male presentation is not recognized as depression per se.
This latter hypothesis was examined in a study entitled “The Experience of Symptoms of Depression in Men Versus Women,” which was undertaken by Lisa Martin and her research colleagues at the University of Michigan. They used data from the National Comorbidity Survey Replication, a national study of mental health disorders and symptoms in the U.S. The researchers created two new measures of depression and cross-checked them against the diagnosis of Major Depressive Disorder. The first, the Male Symptoms Scale, involved items that addressed what might be male presentation of depression, including irritability, anger/aggression, substance use, and risk-taking. The second measure, the Gender Inclusive Depression Scale, included the items from the Male Symptoms Scale but also mixed them with traditional depression items, such as feeling depressed and sad.
Findings were that while men endorsed the traditional depression items, such as insomnia, withdrawal from social activity, and complaints of feeling depressed and sad, they were more likely to report anger, irritability, substance use, and risk-taking. Additionally, when using the Gender Inclusive Depression Scale, men and women had equal rates of depression, and the disparity between them was no longer seen.
These results therefore indicate that men may show a different presentation of depression that includes anger, irritability, substance use, and risk-taking. The researchers concluded that the rate of depression is underrepresented in men, and that clinicians should consider these other types of symptoms when asking about depression in men.
Source: Martin, L., Neighbors, H., & Griffith, D. (2013). The experience of symptoms of depression in men versus women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry, 70, 1100-1106.