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11/1/2017 Yuzu: Psychology of Gender: Fourth Edition

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FIGURE 13.2CDI (depression) scores for girls and boys. Prior to age 13, boys have slightly higher scores than girls. After age 13, females’ rates of depression substantially increase leading to a sex difference in depression that persists across the lifespan. Source: Twenge and Nolen-Hoeksema (2002).

There is a higher prevalence of some mental health problems among gay and lesbian people compared to heterosexuals. A meta-analytic review of the literature showed that sexual minorities have more anxiety, depression, and substance abuse problems than heterosexuals (Meyer, 2003). More recent studies have confirmed these findings (Coker, Austin, & Schuster, 2010). However, a majority of studies in this area focus on younger samples—adolescents and college students. Because adults have more time to adjust to their sexual orientation, fewer differences may be found. Among adults, the difference in mental health problems between sexual minorities and heterosexuals is less clear. It also is not clear whether the difference is larger for males or females. One study of mood disorders (anxiety and depression) indicated that the difference between gay men and heterosexual men is larger than the difference between lesbians and heterosexual women (Bostwick et al., 2010), whereas two other studies found just the opposite (Bybee et al., 2009; Cochran et al., 2007).

There are several reasons why sexual minorities have elevated mental health problems compared to heterosexuals. One is the impact of discrimination. A second, and related, reason is lack of social support (Spencer & Patrick, 2009). Finally, sexual minorities may internalize society’s negative attitudes toward them. One study showed that explicit measures of antigay attitudes were not related to mental health problems among sexual minorities, but implicit attitudes were (Hatzenbuehler et al., 2009). Over a 10-day period, stigma-related stress was associated with more distress but only among sexual minorities who held implicit antigay attitudes.

TAKE HOME POINTS

Females are more likely than males to report depressive symptoms as well as major depressive disorder. Sex differences persist across a variety of cultures but are not observed in some homogenous populations, such as college students and the widowed. The sex difference in depression is related to the onset of depression—not recurrence. There are elevated rates of mental health problems among sexual minorities.

METHODOLOGICAL ARTIFACTS Some investigators have contested these seemingly indisputable data that a sex difference in depression exists. Three sets of methodological problems or artifacts could explain why women “appear” to be more depressed. First, there may be a bias on the part of clinicians, such that depression is overdiagnosed among women and underdiagnosed among men. Second, there may be a response bias on the part of depressed persons; men may be less likely than women to admit depression or to seek help for depression. Third, women and men may manifest depression in different ways, and instruments are biased in the direction of tapping female depression.

Clinician Bias One source of bias is the clinician’s judgment. Perhaps clinicians are more likely to interpret a set of symptoms as depression when the patient is female than male. Why might this be? First, clinicians are undoubtedly aware of the sex difference in depression. Thus clinicians’ mental illness schema for a female patient is more likely to contain depression than their mental illness schema for a male patient. When a female patient comes into the office, depression-related schemas are more likely to be activated. Ambiguous symptoms such as feeling tired or lacking energy can be indicators of a variety of health problems. Clinicians may be more likely to interpret such symptoms as depression in a female patient and cardiac disease in a male patient.

The evidence for clinician bias is equivocal. In a study that compared primary care physicians’ detection of mental health problems among over 19,000 patients to an independent screening, physicians were less likely to detect depression in men compared to women, and in African Americans and Hispanics compared to Caucasians (Borowsky et al., 2000). That is, more of men’s than women’s depression went undetected by physicians. However, another study asked primary care physicians to review vignettes of elderly patients with depression

11/1/2017 Yuzu: Psychology of Gender: Fourth Edition

https://reader.yuzu.com/#/books/9781317345046/cfi/6/44!/4/2/2/12/4/2@0:0 2/2

and showed that physicians correctly classified the patients as depressed in 85% of the cases, and equally so for males and females (Kales et al., 2005). Although physicians are more likely to prescribe antidepressants and antianxiety drugs to women than to men, even when they have similar diagnoses (Simoni-Wastila, 1998), this may not be the case among physicians who specialize in mental illness—psychiatrists. Psychiatrists may be less vulnerable than primary care physicians to biases. One study showed that psychiatrists were equally likely to diagnose similar symptoms as depression in women and men and prescribed drugs and psychotherapy with equal frequency to women and men (Olfson et al., 2001). Conduct Do Gender 13.1 to see if your peers are predisposed to identify depression in a female more than a male.

DO GENDER 13.1 Is This Depression?

Create a description of a depressed person. Make the symptoms subtle. Do not say the person is depressed. Use items from Tables 13.1 and 13.2 to help you. Create two versions of this description, one with a female name and one with a male name. Randomly distribute one of the two versions to 20 people. Ask each respondent to identify the person’s problem.

Compare the percentages of people who identify depression in the female and male vignettes.