Research reportAl Ain community survey of psychiatric morbidity: II. Sex differences in the prevalence of depressive disorders
Introduction
Sex differences in the rates of depression have not been convincingly explained and this reflects a more general failure of research to provide a comprehensive aetiological account of depression (Bebbington, 1998). It is not even clear whether the determinants of this sex difference are predominantly biological or social. Although attractive, explanations in biological terms face a number of difficulties. If higher rates of depression in women are solely due to a biological vulnerability, the sex ratio ought to be unaffected by the socio–demographic status of the studied group. However, groups in which the social difference between men and women are minimised often show a reduced sex difference (Jenkins, 1985, Wilhelm and Parker, 1989). Marital status also affects the difference. It has been argued that being married brings more stress for women than for men (Weissman and Klerman, 1977, Paykel and Rowan, 1979, Weissman et al., 1984). In one Community Psychiatric Survey, single and divorced women had a lower prevalence of minor affective disorder than their male counterparts, while wives had over five times the prevalence of husbands (Bebbington et al., 1981a). However, marital status has different associations with affective disorder in different cultures. Married women at a low risk of disorder in Mediterranean countries (Mavreas et al., 1986, Va’zquez-Barquero et al., 1987), in rural New Zealand (Romans-Clarkson et al., 1988) and in British Orthodox Jews (Loewenthal et al., 1995). These societies all accord a high value to the home-making role. It is claimed that clinical depressive disorders are rare in childhood and show no female excess, perhaps even the reverse (Petersen et al., 1991, Angold and Rutter, 1992), although not all authors agree (Ruble et al., 1993). However, prevalence appears to rise sharply in late adolescence and early adulthood, particularly in females (Lewinsohn et al., 1994). Puberty may thus be linked to the emergence of the sex difference (Choquet and Menke, 1987, Cohen et al., 1993, Patton et al., 1996). In adulthood, the sex ratio tends to decline with age (Bebbington, 1998).
The interesting question is whether this can be related to the timing of the menopause. The recent British National Survey of Psychiatric Morbidity (Meltzer et al., 1995, Bebbington et al., 1998a) suggests that after age 55, the sex ratio changes, due mainly to a fall in female rates. Although, menopause was considered as a significant factor in the development of depression in women (Eagles and Whalley, 1985), there is very little epidemiological evidence of increased risk at this time (Der and Bebbington, 1987). Indeed, the recent large scale surveys using standardized instruments suggest the contrary. The ECCA surveys (Robins and Rigier, 1991) and the Edmonton DIS Survey (Bland et al., 1988) both suggest that only in younger subjects the F:M sex ratio is greater than unity. The purpose of this paper is to test the hypothesis as to whether sex ratio decline with age and whether also socio–demographic factors influence the sex differences in the rate of depression.
Section snippets
Materials and methods
The data stem from a community survey of adult population in Al-Ain city, United Arab Emirates. Subjects aged 18 years and over were systematically sampled from the general population in Al-Ain. One thousand three hundred and ninety-four subjects (n=1394) participated in this study. Only relevant information pertinent to this study will be included. Detailed methodology is reported in a paper that describes the prevalence of psychiatric disorders and their determinants (Abou-Saleh et al., 2001
Results
Eighty seven (19 males and 68 females) subjects were found to be suffering from various forms of depressive disorders. Their ages ranged from 18 to 70 years with a mean of 32.1±10.3 years. Approximately 19% were single, 61% married and the rest were either divorced, separated or widowed (postmaritals). Females accounted for 85 and 70% of the ICD-10 and minor depression groups, respectively, with no significant differences (χ2=2.07, df=1, P=0.08). Approximately 98% of subjects with ICD-10
Discussion
Sex differences in the prevalence rates of depression confirm the findings of previous community studies (Weissman and Myers, 1978, Robins et al., 1984, Bland et al., 1988, Wells et al., 1989, Canino et al., 1987). All those community studies may nevertheless have generated significant underestimates of life time prevalence, when the evidence of high rate of ‘forgetting’ earlier depressive episodes, particularly in community groups, is taken into account. Burke (1986) has reviewed the
References (58)
- et al.
Adversity and the nature of psychiatric disorder in the community
J. Affect. Disord.
(1981) - et al.
Development of self-perceived risk behaviour and psychosomatic symptoms in adolescents: a longitudinal approach
J. Adolesc.
(1987) - et al.
Course and outcome of depressive episodes: comparison between bipolar, unipolar and subthreshold depression
Psychiatry Res.
(2000) - et al.
Sex and Depression in the National Comorbidity Survey 11: cohort effects
J. Affect. Disord.
(1994) - et al.
Major depression in community adolescents: age at onset, episode duration, and time to recurrence
J. Am. Acad. Child Adolesc. Psychiatry
(1994) - et al.
Prevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care
J. Affect. Disord.
(1999) - et al.
The role of gender-related processes in the development of sex differences in self-evaluation and depression
J. Affect. Disord.
(1993) - et al.
Prevalence and correlates of depressive symptoms among older US adults
Am. J. Prevent. Med.
(1990) - et al.
The epidemiology of depression: an update on sex differences in rates
J. Affect. Disord.
(1984) - et al.
Effects of age and pubertal status on depression in a large clinical sample
Dev. Psychopathol.
(1992)
Al Ain community survey of psychiatric morbidity. I: Prevalence and sociodemographic correlates
Soc. Psychiatry Psychiatr. Epidemiol.
An investigation into the observed sex difference in prevalence of unipolar depression
J. Abnorm. Psychol.
Sex and depression
Psychol. Med.
The social epidemiology of clinical depression
Psychiatric disorders in selected immigrant groups in Camberwell
Social Psychiatry
Adversity in groups with an increased risk of minor affective disorder
Br. J. Psychiatry
The Dubai Community Psychiatric Survey: IV. Life events, chronic difficulties and psychiatric morbidity
Soc. Psychiatry Psychiatr. Epidemiol.
The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity
Psychol. Med.
The risk of minor depression before age 65: results from a community survey
Psychol. Med.
Lifetime prevalence of psychiatric disorders in Edmonton
Acta Psychiatr. Scand.
Symptoms of depression among older African–Americans: an analysis of gender differences
Gerontologist
Crises and life changes and the onset of schizophrenia
J. Health Social Behav.
Social Origins of Depression: A Study of Psychiatric Disorders in Women
Diagnostic categorization by the Diagnostic Interview Schedule (DIS): a comparison with other methods of assessment
Sex differences and depression in Puerto Rico
Psychol. Women Quart.
An epidemiological study of disorders in late childhood and adolescence. II. Persistence of disorders
J. Child Psychol. Psychiatry
The importance of stressful life events
Br. J. Psychiatry
The rationale, development and reliability of a new screening psychiatric instrument
Soc. Psychiatry Psychiatr. Epidemiol.
Depression in inner London: a register study
Social Psychiatry
Cited by (30)
Developing a gender sensitive women's mental health service in Qatar: A rewarding challenge
2022, Asian Journal of PsychiatryCitation Excerpt :Additionally, the mental health overall in Arab world has traditionally been a neglected parameter of health and women have experienced a proportionally worse experience of mental health care and access (James-Hawkins et al., 2019). This exaggerated gender difference in mental health outcomes in the MENA region has been ascribed to the difference in the social status position and empowerment between men and women (Daradkeh et al., 2002). More specifically, mental health outcomes for women in the MENA region have been associated with patriarchal cultures that impact social position, economic independence and autonomy for women (James-Hawkins et al., 2019; Douki et al., 2007).
Women's empowerment and generalized anxiety in minya, egypt
2014, Social Science and MedicineCitation Excerpt :Mental health is “a state of well-being in which [a person] realizes his or her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization [WHO], 2007, p.1). In Arab Middle Eastern settings, women more often than men have had poorer mental health in some domains, including anxiety disorders (such as generalized anxiety), mood disorders (such as depression), and attempted suicide (Afifi, 2007; Alansari, 2006; Yount & Smith, 2012; Daradkeh, Ghubash, & Abou-Saleh, 2002; Douki, Zineb, Nacef, & Halbreich, 2007; Ghanem, 2004). In Arab and other populations, anxiety disorders and mood disorders may co-occur with overlapping symptoms (Bener, Ghuloum, & Abu-Saleh, 2012) and may have culturally-specific representations (Marques, Robinaugh, LeBlanc, & Hinton, 2011).
Screening for depression in a sample of Egyptian secondary school female students
2012, Journal of Affective DisordersCitation Excerpt :This stress is thought to increase the expression of depressive symptoms (Fergusson, 2005). In other Arab countries, several studies reported similar rates amongst mixed gender (10.3%) samples in Emirates (Daradkeh et al., 2002), and adolescent female samples in Emirates (15.6%), and 11% in Sudan (Shaaban and Baashar, 2003; Swadi and Issa, 1995). In other Islamic cultures, the rates in adolescent school female appear to be much higher.
The epidemiology of anxiety disorders in the Arab world: A review
2009, Journal of Anxiety DisordersCitation Excerpt :It was remarkable that in the large community-based survey of psychiatric disorders in Al Ain (UAE), the lifetime prevalence rate of bipolar disorders was nil in men, vs. a rate of 0.7% in women (Abou-Saleh et al., 2001). An observation that was confirmed when a sub-group of these men were re-interviewed a year later (Daradkeh, Ghubash, & Abou-Saleh, 2000) and contributed to the very high female to male ratio of prevalence of depression of 3.7% (Daradkeh, Ghubash, & Abou-Saleh, 2002). The overall validity of the data reported could be threatened by religious norms concerning alcohol or substance use in general and sexuality and its practice outside marriage.
Prevalence, pattern and determinants of mental disorders in rural Bangladesh
2007, Public HealthCitation Excerpt :This study found that depressive disorders were the most common type of mental disorder, which is consistent with other surveys studies conducted in countries such as India and Pakistan.21,22 Proportionately more females suffered from depression, which is also consistent with previous studies.8,23,24 Even in a small rural community of Brazil, the authors found depression, especially among older women, to be a major problem.25