Gender Differences in Prevalence of Common Mental Disorders

"Globalization" has also resulted in changes in the quality and quantity of the labour force and market. In the developed and developing world, many of the more traditional jobs have been replaced by new sources of employment. More women are working outside the home, leading to changes in the balance of power between men and women [2]. In many parts of the world, women have had to act in a dual role as breadwinners and housekeepers, putting strains on family life.

One of the most robust findings in the psychiatric epidemiology literature is the observation that the prevalence of depression is higher in women than men. This subject has been reviewed on a number of occasions and has led to a considerable debate about the possible causes. A recent WHO publication comprehensively reviewed the literature confirming the consistency of this relationship [56]. For example, the most recent large-scale community surveys carried out in the USA [57], the UK [58] and Australia [59] all found an increased risk of depression and anxiety in women. For example, in the UK data, the odds ratio for women compared with men was 1.76 (95% CI 1.57-1.97) [58] and this association persisted after adjustment for a number of other variables.

A similar pattern has been observed in less developed countries [60, 61]. For instance, in a large household survey of adults in Santiago, Chile, women were more than twice more likely to suffer from a neurotic disorder (OR: 2.37 [1.84-3.07]) [33]. At present, it is not clear whether the gender difference in prevalence of common mental disorders varies between countries. In some more traditional societies and in Mediterranean cultures some authors have found a similar male and female prevalence [56]. However, the possibility of a type 2 error has to be considered in these studies, especially when studying communities with a low prevalence of disorder that will reduce statistical power. It is also not known whether the difference between men and women is a consistent finding in many developing countries. The role of women in developing countries can be very different from that in the developed world and attitudes towards women show great cultural variation even with countries of similar economic development.

The OPCS National Survey of Psychiatric Morbidity has noted that the relationship with gender appeared to vary according to age. In older subjects the prevalence of common mental disorders was no higher in women than men in the UK [62]. In the Chile survey, older men were more likely to show depressive symptoms than women. These may have been chance findings, though the consistency of finding argues against this. This result has implications for the possible explanations of gender differences, though it cannot on its own argue either for or against hormonal or biological vulnerabilities.

There have also been other reports of no gender difference in prevalence of common mental disorders. These have mainly been when women and men in similar social roles have been compared. For example, Jenkins [63] compared male and female civil servants in the same grade in the British civil service, while Wilhelm et al. [64] studied students in Australia. These studies found that there was no difference in prevalence, though the sample sizes were probably rather too small to exclude the possibility of small effects.

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