Biopsychology memory paper

Psychological Bulletin What Did You Do Yesterday? A Meta-Analysis of Sex Differences in Episodic Memory Martin Asperholm, Nadja Högman, Jonas Rafi, and Agneta Herlitz Online First Publication, June 10, 2019. http://dx.doi.org/10.1037/bul0000197

CITATION Asperholm, M., Högman, N., Rafi, J., & Herlitz, A. (2019, June 10). What Did You Do Yesterday? A Meta-Analysis of Sex Differences in Episodic Memory. Psychological Bulletin. Advance online publication. http://dx.doi.org/10.1037/bul0000197

What Did You Do Yesterday? A Meta-Analysis of Sex Differences in Episodic Memory

Martin Asperholm, Nadja Högman, Jonas Rafi, and Agneta Herlitz Karolinska Institutet

To remember what one did yesterday is an example of an everyday episodic memory task, in which a female advantage has sometimes been reported. Here, we quantify the impact of sex on episodic memory perfor- mance and investigate whether the magnitude of the sex difference is modified by study-, task-, and sample-specific moderators. Analyses were based on 617 studies conducted between 1973 and 2013 with 1,233,921 participants. A 5-level random-effects meta-analysis showed an overall female advantage in episodic memory (g � 0.19, 95% CI [0.17, 0.21]). The material to be remembered affected the magnitude of this advantage, with a female advantage for more verbal tasks, such as words, sentences, and prose (g � 0.28, 95% CI [0.25, 0.30]), nameable images (g � 0.16, 95% CI [0.11, 0.22]), and locations (g � 0.16, 95% CI [0.11, 0.21]), and a male advantage in more spatial tasks, such as abstract images (g � �0.20, 95% CI [�0.35, –0.05]) and routes (g � �0.24, 95% CI [�0.35, –0.12]). Furthermore, there was a female advantage for materials that cannot easily be placed along the verbal-spatial continuum, such as faces (g � 0.26, 95% CI [0.20, 0.33]), and odor, taste, and color (g � 0.37, 95% CI [0.18, 0.55]). These differences have remained stable since 1973. For verbal episodic memory tasks, differences were larger in Europe, North America, Oceania, and South America than in Asia, and smaller in childhood and old age than for other ages. Taken together, results suggest that men may use their spatial advantage in spatially demanding episodic memory tasks, whereas women do well in episodic memory tasks that are verbalizable and tasks that are neither verbal nor spatial, such as remembering faces and odors/tastes/colors.

Martin Asperholm, Nadja Högman, Jonas Rafi, and Agneta Herlitz, Depart- ment of Clinical Neuroscience, Division of Psychology, Karolinska Institutet.

Jonas Rafi is now at the Department of Psychology, Stockholm University. Parts of the raw data, but no results presented in this meta-analysis, have been

used in an unpublished master thesis by Sanket Nagar. This research was sup- ported by grants awarded to Agneta Herlitz by the Swedish Research Council and FORTE. Agneta Herlitz came up with the idea for the study, Martin Asperholm and Agneta Herlitz designed the research, Martin Asperholm, Nadja Högman, and Jonas Rafi collected and prepared data, Martin Asperholm carried out the analysis, and Martin Asperholm and Agneta Herlitz wrote the manuscript; all authors read and commented on the manuscript. The large amount of data in this study was made available through work by Emelie von Vogelsang Antonsson, Hannes Bäckman, Lars Bäckman, Elin Frögéli, Amy R. Gordon, Erik Grimsby, Linnea Jesinkey, Maria Larsson, Catharina Lewin, Hillevi Johansson Lignell, Severin Lindskog, Sanket Nagar, Tone Nordling, Christian Plahn, Jenny Rehnman, Markus Söderqvist, and Marielouice Wänseth. Several authors have also upon our request shared unpublished data with us. We are very grateful for the following researcher’s generosity and willingness to contribute with important information: A. Toomela, A. Davey, A. Zanello, Å. Wahlin, A. Gow, A. Economou, A. Bielak, A. Maier, A. Haley, A. Buchmann, A. Leynes, A. Mayer, A. Hubley, A. Grahn, A. Schirmer, A. Latvala, A. Lin, A. Rapisarda, A. Carlesimo, A. Mecklinger, B. Segura, B. Lindquist, B. Meier, B. ørbeck, B. Baune, B. Müller, B. E. Snitz, B. Wang, B. Marx, B. Piper, B. Schwartz, B. Brochet, C. M. Allwood, C. Derby, C. Maruta, C. Boeke, C. Bearden, C. Fried, C. Gale, C. Aine, C. Ferguson, C. Till, C.-Y. Su, C. Segalàs Cosi, C. Rupp, C. Simons, C. Carnero, C. Renáta, D. Verbaan, D. Simplicio Torres, D. Woolley, D. Beversdorf, D. Schretlen, D. Aikins, D. D’Souza, D. Lehmann, D. Y. Lee, D. Terry, E. Hirata, E. Vieta, E. Savaskan, E. Daprati, E. Krumova, E. Bacon, E. Cashdan, E. Maylor, E. Bromberg, E. Wingbermühle, E. Coluccia, E. Mellet, E. Kim, E. Smith, E. Jonsson Laukka, E. Resmini, E.-J. Kim, F. Iasevoli, F. H. Santos, F. Nobili, F. Clerici, F. Maheu, F. Brown, F. Unverzagt, G. Goodman, G. Swan, G. Fillenbaum, G. Zucco, G. Anzures, G. Sánchez, G. Peavy, G. Backenroth, H. Wang, H. Comijs, H. G. Pope

Jr., H. Söderlund, H. Christensen, H. Kashyap, H.-X. Wang, I. Sue, I. Myin- Germeys, I. Uttner, I. van Oostrom, I. P. Martins, I. Cherney, J. Raber, J. Mathias, J. Onoye, J. Koerts, J. Reis, J. Kisser, J.-C. Marquié, J. Burns, J. Manly, J. Steeves, J. Zhang, J. Tian, J. Lucas, J. Simons, J. Meekes, J. Peña-Casanova, J. Cimadevilla Redondo, J. Ling, J. Hall, J. Fernandez-Mendoza, J. Drakeford, K. Vilberg, K. Cruickshanks, K. Slegers, K. Harrington, K. Lawrence, K. Burdick, K. Koenig, K. Hayden, K. Welsh-Bohmer, K. Mizuno, K. Matsuoka, K. McWilliams, K. Pickel, K. W. Kim, K. Felmingham, K. Brønnick, K. Janowski, K. Walhovd, L. Bracco, L. Espín López, L. Holsen, L. Kolehmainen, L. Mandolesi, L. Zahodne, L. Findlay, L. Tamm, S. Xu, L. Conde-Sala, L. Phillips, L. Passamonti, L. Huestegge, M. Bruck, M. Morales, M. Morrens, M. Lavoie, M. Lachman, M. Jehna, M. Pedersen, M. Begemann, M. Stijntjes, M. Valis, M. Elamin, M. Carter, M. Ganguli, M. Haan, M. Merema, M. Palmer, M. Kroneisen, M. Almela, M. Harrington, M. Hock, M. von Rhein, M. Wagner, M. Gummerum, M. Callisaya, M. Mielke, M. Phillips, M. Malek-Ahmadi, M. Williams, M.-J. Kim, M. Yassuda, M. Heller, N. Solowij, N. Santos, N. Donovan, N. Pedersen, N. Unsworth, N. Iqbal, N. Loskutova, N. Marchant, N. Ridout, N. Ruffieux, N. Dige, N. Ferree, N. Sousa, O. Wolf, O. Arisoy, P. Wilhelm, P. Woicik, P. Costa, P. Bangirana, P. Maruff, P. Pauli, P. Wicks, P. Rapeli, P. Hellström, P. Bayley, P. Schofield, P. Batterham, P. Schatz, P. Zoladz, P. Komulainen, R. Romano, R. Rauramaa, R. Grambaite, R. Chan, R. Schmidt, R. Spiegel, R. Lajiness-O’Neill, R. Goldstein, R. Astur, R. Chapman, R. Goeder, R. Kessels, R. Campbell, S.R. Veena, S. Campeanu, S. Harris, S. Vanhoutte, S. Eidelman, S. Köhler, S. Weirich, S. Cansino, S. Casella, S. Luzzi, S. Wagovich, S. Agrigoroaei, S. Bläsi, S. Fulda, S. DeKosky, S. Gao, T. Hing Lam, T. Lee, T. Minett, T. Ngandu, T. Salthouse, T. Iachini, T. Susilo, T. Zalla, T. Hellvin, T. Buchanan, V. Pavlik, V. Srikanth, V. Närhi, V. Anderson, V. Sweat, W. Schaie, W. Zhong, W. Sommer, X. Jenny Chai, X. Zhang, Y. Reijmer, and Y. V. Jiang.

Correspondence concerning this article should be addressed to Agneta Herlitz, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. E-mail: [email protected]

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Psychological Bulletin © 2019 American Psychological Association 2019, Vol. 1, No. 999, 000 0033-2909/19/$12.00 http://dx.doi.org/10.1037/bul0000197

1

Public Significance Statement When we attempt to remember what we did yesterday, we are using episodic memory. Here, we investigate sex differences in episodic memory and find a general female advantage in tasks that are predominantly verbal, which is lesser in those that also require some spatial processing, and a male advantage in tasks that require a large degree of spatial processing. These sex differences have remained stable since 1973, although they vary in magnitude across geographical region and, for verbal episodic memory, are smaller in childhood and old age than at other ages.

Keywords: episodic memory, meta-analysis, sex differences, spatial, verbal

Supplemental materials: http://dx.doi.org/10.1037/bul0000197.supp

The familiar struggles to recall what happened last Saturday, to recollect a story told by your child, and to remember whether or not you took the prescribed medication earlier in the day are all examples of everyday tasks taxing episodic memory. The ability to remember episodes from one’s past is not only critical for functioning well in life; it is also among the most commonly assessed cognitive abilities, both in the laboratory and the clinic. Episodic memory is known to be a sensitive system, which starts to deteriorate relatively early in adulthood (e.g., Rönnlund, Nyberg, Bäckman, & Nilsson, 2005) and is negatively affected in individuals with, for example, sleep depriva- tion, depression, and preclinical dementia (Bäckman, Jones, Berger, Laukka, & Small, 2005; Lim & Dinges, 2010; McDermott & Ebmeier, 2009), and is routinely assessed in neuropsychological or neuropsychiatric evaluations of disorders such as ADHD, dementia, and traumatic brain injury. There is anecdotal evidence claiming that men do not remember people they have met, the location of misplaced objects, or who said what last Saturday to the extent that women do. These claims have received some support in studies examining sex1

differences in episodic memory (e.g., Borges & Vaughn, 1977; Her- litz, Nilsson, & Bäckman, 1997; Lachman et al., 2014; Voyer, Postma, Brake, & Imperato-McGinley, 2007), but no meta-analysis has yet examined the accuracy of this claim.

The demands on episodic memory are ceaseless and can take many forms. For example, they can require verbal (e.g., remembering a conversation), visual (e.g., remembering an image), or spatial (e.g., remembering a route) processing to a greater or lesser degree and can also be encoded with or without intention, be repeated, and be recalled with or without the support of retrieval cues. In this article, we investigate whether and to what extent sex influences episodic mem- ory performance, and we try to determine what factors affect the direction and magnitude of any sex differences. To investigate sex differences in episodic memory is not only important because it furthers our basic knowledge of cognitive abilities, but also because it could potentially help explain other sex differences, such as those seen in school grades (Voyer & Voyer, 2014), or the persistent gender segregation seen in educational fields (Ceci, Ginther, Kahn, & Wil- liams, 2014; Dekhtyar, Weber, Helgertz, & Herlitz, 2018; Stoet & Geary, 2018).

Episodic Memory

Theories of memory typically distinguish between working mem- ory, which holds memories for a brief period, and long-term memory, which maintains memories for longer periods. Long-term memory is in turn often divided into two subsystems, one mediating memories

expressed without awareness (i.e., nondeclarative memory) and the other mediating cognizant memories of events and facts (i.e., declar- ative memory). Declarative memory is further divided into semantic and episodic memory, with semantic memory referring to general world knowledge (e.g., facts, ideas, and meaning) and episodic mem- ory to recollection of unique personal experiences in terms of their content (what), temporal occurrence (when), and location (where; Tulving, 1972, 2002).

There is consensus that the medial temporal lobe, including the hippocampus, is important for the encoding and retrieval of epi- sodic memories. Early evidence comes from neuropsychology showing that patients with bilateral hippocampal lesions lose the ability to acquire new episodic memories, but also from brain imaging studies (e.g., Squire, 2004). Simplified, the encoding, storage, and retrieval of episodic memory are thought to involve primary sensory areas where individual aspects of an event are stored, whereas the hippocampus stores pointers to the locations distributed over the cortex. The process of consolidation stabilizes the memory traces of an event. At retrieval, a retrieval cue accesses the hippocampal pointers, giving simultaneous access to relevant cortical areas and thereby evoking the memory and the feeling of reexperiencing the remembered events (Tulving, 2002). Further- more, depending on the content of the stimulus material of the episodic memory, different locations along the hippocampal struc- ture are activated, with encoding of verbal material being associ- ated with more anterior activation, and pictorial-spatial material with more posterior hippocampal activation (Persson & Söderlund, 2015).

Sex Differences in Episodic Memory

Although the first comprehensive review of sex differences in cognition and in other psychological domains (Maccoby & Jacklin, 1975) did not report any differences in memory, several more recent studies have found sex differences favoring women in tasks assessing episodic memory (e.g., Gallagher & Burke, 2007; Her- litz, Reuterskiöld, Lovén, Thilers, & Rehnman, 2013; Kramer, Yaffe, Lengenfelder, & Delis, 2003). For instance, a population- based study of 1,000 adults aged 35–80 years found sex differ- ences favoring women in episodic memory tasks in which partic- ipants were told to remember newly acquired facts, objects, words,

1 We use the term sex rather than gender because it relates specifically to the construct underlying the dichotomy used here, whereas gender relates to a social construct that is not exclusive to women and men.

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2 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

or newly performed activities (Herlitz et al., 1997). In general, women performed at a higher level than men, the effect size varying between d � 0.05 and d � 0.34.2

Although some studies reveal a female advantage in episodic memory, there are also those that report that men perform at a higher level than women. For example, tasks requiring participants to remember a route walked in a maze, with little external support, yield large sex differences favoring men (e.g., d � �0.96; Astur, Ortiz, & Sutherland, 1998), whereas smaller or no sex differences are found in similar environments where verbal information may support memory of the route (e.g., d � 0.10; Lewin, Wolgers, & Herlitz, 2001).

The literature reviews of sex differences in episodic memory (i.e., Andreano & Cahill, 2009; Herlitz & Rehnman, 2008) have suggested that the magnitude of the differences may vary as a function of the material to be remembered and that women will consistently outperform men on tasks that require verbal process- ing, whereas there will be a male advantage on tasks requiring spatial processing. In addition, it has been hypothesized that the female advantage will extend into other episodic memory tasks requiring little or no verbal or spatial processing (Herlitz & Reh- nman, 2008). A systematic investigation of the accuracy of these impressions will be conducted in the present meta-analysis.

Cognitive Sex Differences in General

If sex differences in episodic memory vary as a function of the material to be remembered, this might mirror and be mediated by sex differences in other cognitive functions. An early meta- analysis of sex differences in verbal ability (Hyde & Linn, 1988) concluded that such differences were present in some but not all verbal tasks, with the difference being most pronounced in verbal fluency and verbal production tasks (d � 0.33). More recent large scale international studies have reported sex differences in adoles- cents across the world in other verbal tasks, such as reading comprehension (d � 0.14 to d � 0.76; Stoet & Geary, 2013, 2018), but also in verbal fluency tasks among adults (d � 0.15; Maylor et al., 2007). Given the diversity of cognitive processes required in the wide variety of verbal tasks, it is unsurprising that not all verbal tasks yield sex differences favoring women. Rather, there are typically no sex differences in tasks assessing vocab- ulary, and there may even be a male advantage in some verbal tasks, such as solving analogies (Hyde & Linn, 1988).

Turning to spatial, or visuospatial, ability, much research has been devoted to sex differences in such tasks, with most studies reporting a male advantage (Voyer, Voyer, & Bryden, 1995). As is the case with verbal tasks, the magnitude of these sex differences varies depending on the type of task. For example, tasks involving mentally rotating objects evoke the most substantial differences (d � �0.56), especially when timed and when the tasks involve 3D rather than 2D objects (Voyer et al., 1995; Voyer, 2011). In contrast, sex differences are typically less sizable in tasks involving spatial perception (d � �0.44) or in spatial visualization (d � �0.19; Voyer et al., 1995).

It has been proposed (Herlitz & Rehnman, 2008) that because women excel in some verbal tasks, especially verbal production tasks (Hyde & Linn, 1988), they may use this advantage when asked to remember events that can be verbally processed. Analo- gously, as men typically perform at a higher level in spatial tasks

(Voyer et al., 1995), they may be expected to outperform women in episodic memory tasks requiring spatial processing. Thus, the extent to which there is a male or female advantage on episodic memory tasks that require more or less verbal or spatial processing will be investigated in this meta-analysis, but also whether there is a general female episodic memory advantage for tasks requiring neither verbal nor spatial processing.

Possible Explanations for Observed Sex Differences

Although much remains to be determined with regard to expla- nations for the observed sex differences in verbal and spatial abilities, pre- and postnatal hormone exposures have been sug- gested as biological influences contributing to the differences (e.g., Miller & Halpern, 2014; Valla & Ceci, 2011). For example, prenatal androgen exposure early in gestation in girls with con- genital adrenal hyperplasia (CAH) has been found to influence not only play behavior, but also spatial performance (Puts, McDaniel, Jordan, & Breedlove, 2008), suggesting that androgens may affect the development of brain regions mediating spatial performance. Although prenatal androgen exposure in CAH girls has rarely been studied in relation to verbal performance, one study found that it may also negatively affect verbal performance (Hampson & Rovet, 2015). In line with this, recent studies have demonstrated that the early postnatal testosterone surge in infants, occurring around weeks 4–24, may be negatively associated with subsequent verbal performance in both boys and girls (Kung, Browne, Constanti- nescu, Noorderhaven, & Hines, 2016; Schaadt, Hesse, & Fried- erici, 2015). Furthermore, women with complete androgen insen- sitivity syndrome (CAIS), a congenital condition characterized by a nonresponding androgen receptor resulting in XY individuals having a female phenotype, have recently been found to perform on par with control women on an episodic memory task, suggest- ing a negative effect of prenatal androgens on episodic memory performance (Strandqvist et al., 2018).

In the search for biological factors influencing verbal perfor- mance and, hypothetically, sex differences, estradiol has also been proposed as a likely candidate, one reason being that expression of estradiol receptors is found in the temporal cortex and the hip- pocampus (e.g., Sundström Poromaa & Gingnell, 2014). The in- fluence of estradiol on cognition in relation to normal fluctuations in endogenous estradiol associated with puberty, menstrual cycle, and menopause has been investigated, one hypothesis being that women perform better or sex differences increase in verbal tasks when estradiol levels are high. Most studies, however, have failed to demonstrate an influence of endogenous estradiol fluctuations on verbal performance (Herlitz, Thilers, & Habib, 2007; Herlitz et al., 2013; Sundström Poromaa & Gingnell, 2014).

Environmental influences, such as living conditions (Weber, Skirbekk, Freund, & Herlitz, 2014), gender role identity (McGlone & Aronson, 2007), and activation of stereotype threat (Doyle & Voyer, 2016) have all been studied in relation to cognitive sex

2 Cohen’s d is defined as (Mwomen � Mmen)/SDtotal, with positive values of d indicating that women perform at a higher level than men and negative values that men perform at a higher level than women. The closer the value is to zero, the smaller the difference. For example, a d of 0.20 indicates that 58% of all women performed at a higher level than the average man. The corresponding percentages for d � 0.30 and d � 0.50 are 62% and 69%, respectively.

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3SEX DIFFERENCES IN EPISODIC MEMORY

differences. For example, there is evidence that activating the stereotype that men perform better than women in math, negatively influences women’s math performance (Doyle & Voyer, 2016). However, stereotype threat manipulations do not seem to influence women’s spatial performance (Doyle & Voyer, 2016). Whether such manipulations also affect men’s verbal performance remain unclear, as studies report conflicting results (Hartley & Sutton, 2013; Hausmann, Schoofs, Rosenthal, & Jordan, 2009). A lack of effect in an ability may suggest that stereotype activation does not contribute to sex differences therein, or that the stereotypes asso- ciated with that ability are not pronounced enough to exert an effect. In search of explanations for sex differences in cognitive abilities it should, however, be noted that distinguishing biological from environmental influences is difficult, as biological factors, such as prenatal androgens, can also influence environmental selection, which in turn can influence the plastic brain. Moreover, it is likely that future research will show that it is not one factor explaining the pattern of sex differences, but a combination of several.

Age

Sex differences in episodic memory performance, such as re- membering a word list, have been reported in children (e.g., Ardila, Rosselli, Matute, & Inozemtzeva, 2011; Kramer, Delis, Kaplan, O’Donnell, & Prifitera, 1997; Martins et al., 2005), ado- lescents (e.g., Boman, 2004; Herlitz et al., 2013), young adults (e.g., Chai & Jacobs, 2009), middle-aged adults (e.g., Pauls, Pe- termann, & Lepach, 2013), and old adults (e.g., de Frias, Nilsson, & Herlitz, 2006; Gerstorf, Herlitz, & Smith, 2006), but whether the magnitude of these differences varies as a function of age is less well researched.

Examining variation across the life span is of interest as it may relate to the explanation of sex differences. For instance, if a sudden change in the magnitude or direction of sex differences occurs at the same age as when major biological events associated with development and aging appear, this could suggest that these biological factors are important in accounting for the sex differ- ences. An example of such a biological event could be changes in sex hormone levels, which have been suggested to increase sex differences in cognition during puberty (Berenbaum & Beltz, 2011; Shangguan & Shi, 2009) and decrease them after menopause (e.g., Herlitz et al., 2007). On the other hand, results indicating that sex differences are smaller early and late in life than in other periods of life could suggest that environmental factors, such as expectations, acquired interests, and cohort differences, contribute to changing the magnitude of the differences. Although effects of age preferably should be examined in studies combining longitu- dinal and cross-sectional study designs to distinguish the true effect of age from cohort- and time-of-measurement effects, we investigate age differences in the magnitude of sex differences across episodic memory tasks.

Time and Region

Another important question is the extent to which sex differ- ences in episodic memory have changed over generations. Several studies have demonstrated improvements over time in perfor- mance in cognitive tasks and IQ tests. The improvement may be

somewhat larger in fluid abilities (i.e., to reason and solve novel problems independent of previous knowledge), such as episodic memory, than in crystallized abilities (i.e., to use skills, knowl- edge, and experience to reason and solve problems). In line with this, episodic memory performance has been reported to improve over generations (Rönnlund & Nilsson, 2005; Weber, Dekhtyar, & Herlitz, 2017). This effect, termed the Flynn effect (Flynn, 1984, 1987), has been ascribed to technological changes, smaller family sizes, and progress in education and nutrition (Pietschnig, Vo- racek, & Formann, 2011). Improvements in living conditions are typically associated with improvements in gender equality (World Economic Forum, 2015), with gender equality referring to struc- tural factors ensuring equal societal opportunities for men and women, such as equal access to education and policies countering discrimination. Both advances in living conditions and gender equality have been associated with the magnitude of sex differ- ences in cognitive performance (Guiso, Monte, Sapienza, & Zin- gales, 2008; Weber et al., 2014). More specifically, in cross- cultural studies, greater gender equality has been linked to smaller differences favoring boys in measures of mathematics and with larger differences favoring girls in reading comprehension (Guiso et al., 2008), although this pattern has not been consistently re- ported (Stoet & Geary, 2013, 2018).

Although sex differences in episodic memory have been re- ported in Europe (Weber et al., 2014), North America (Gur et al., 2012), Australia (Palmer, Brewer, & Horry, 2013), Africa (Owen & Lynn, 1993), South America (Mokri, Ávila-Funes, Meillon, Gutiérres Robledo, & Amieva, 2013), and Asia (Kim & Kang, 1999), to our knowledge, only two previous studies have system- atically investigated sex differences in episodic memory across several nations (Bonsang, Skirbekk, & Staudinger, 2017; Weber et al., 2014), both finding larger sex differences in nations with higher living conditions. Analyzing whether the magnitude of the sex differences changes over time and whether there are regional differences is of interest as it could demonstrate that these differ- ences are dynamic rather than static, and because it would suggest that they are modified by contextual factors, such as living con- ditions and gender equality.

Other Moderators

Many other factors might influence sex differences in episodic memory. Factors of interest are, for reasons specified below, emotionality of the material, intention to remember, repeated learning, associative aspects, and retrieval support.

Several studies have found sex differences in emotional pro- cessing. For example, women have been found to be better at perceiving nonverbal emotional cues (e.g., Hall, 1978), to use more emotional terms when describing life events (Bauer, Stennes, & Haight, 2003), and to have more intense affective experiences (Fujita, Diener, & Sandvik, 1991). These findings were corrobo- rated in a meta-analysis of sex differences in emotional intelli- gence, with differences being especially notable in emotion per- ception, emotion understanding, and emotion regulation (Joseph & Newman, 2010). In line with this, there are reports of sex differ- ences in performance in emotional episodic memory tasks (An- dreano & Cahill, 2009; Gavazzeni, Andersson, Bäckman, Wiens, & Fischer, 2012; Naveh-Benjamin, Maddox, Jones, Old, & Kilb, 2011), but also reports of no sex differences in such tasks (Venter

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4 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

& Louw, 2004). As the results are somewhat inconsistent, a systematic analysis of the findings is warranted.

In general, intentional learning has been found to be superior to incidental learning (e.g., Eagle & Leiter, 1964). This finding is typically attributed to the utilization of effective encoding strate- gies during intentional learning, which is less likely to occur spontaneously when one is not instructed to remember the material (i.e., incidental learning). Studies of aging often find that the difference between older and younger adults is magnified in inci- dental compared with intentional learning tasks, which is taken to indicate the need to utilize strategies at encoding among older individuals to compensate for age-related hippocampal deficits (Naveh-Benjamin et al., 2009). Some episodic memory tests in- corporate a procedure involving repeated learning (i.e., encoding) trials, each followed by a retrieval trial (e.g., California Verbal Learning Test; Delis, Kramer, Kaplan, & Ober, 1987). With this procedure, it is possible to derive learning curves, susceptibility to interference, and the use of encoding strategies. Finding larger or smaller sex differences as a function of incidental or intentional learning, or as a function of repeated or nonrepeated learning, might indicate more effective use of strategies by one of the sexes.

Within episodic memory, one can distinguish between remem- bering single items (e.g., a word, object, or name) and remember- ing associated items (e.g., word–word, face–name, object– location). Research has demonstrated that associative processes depend primarily on the anterior hippocampus, often lateralized to the left when the material tested is verbal and otherwise most often to the right (Cohen et al., 1999; Naveh-Benjamin et al., 2009; Olsen, Moses, Riggs, & Ryan, 2012; Persson & Söderlund, 2015). Distinguishing between associative and single-item type tasks is of interest as the associative process can be seen as being at the core of episodic memory, binding together the what, where, and when of an event. Differences in performance between associative and single-item tasks have been found between various groups. For example, whereas single-item memory seems to be relatively well preserved in normal aging, older adults’ associative memory per- formance is markedly impaired (Becker et al., 2015; Naveh- Benjamin et al., 2009; Old & Naveh-Benjamin, 2008). This has led researchers to attribute older adults’ impairments in episodic mem- ory, in part, to hippocampal alterations (Nyberg, 2017). Whether sex differences in episodic memory are associated with factors related to binding item and context information has, to our knowl- edge, not been addressed before.

The importance of how humans retrieve previously learned information has long been known. Recognition, requiring simple recognition decisions of familiarity, typically results in more re- membered information compared with free and cued recall that tax recollective processes. Again, using aging as an example, the finding of a more marked difference between older and younger adults in free recall than in recognition has been interpreted to indicate that the aging deficit is partly related to retrieval rather than encoding problems (e.g., Craik & McDowd, 1987). Similarly, finding a sex difference in recall but not in recognition may suggest a female advantage in retrieval operations.

The Current Meta-Analysis

In this article, we summarize and quantify sex differences re- ported in 40 years of research into episodic memory. We identify

and analyze data from a total of 617 studies published between 1973 and 2013, representing a total of 1,233,921 individuals. The main objectives were, first, to descriptively determine the presence and magnitude of sex differences in episodic memory tasks and, second, to improve our understanding and explanations of these differences by investigating whether their magnitude varies as a function of the material to be remembered (e.g., verbal, spatial, faces), the encoding and retrieval contexts (e.g., repeated learning, retrieval support), and the details of the participants examined (e.g., age, geographical region, year). Additionally, we assembled a large number of previously unpublished data, enabling us to reliably test potential effects of publication bias.

Method

Study Selection

Two, rather than one, database search and abstract reading phases were performed, as work was interrupted following the first phase (see Figure 1 for an overview of the study selection and exclusion process). The first search was performed in PsycINFO and Medline covering January 1972 to September 2001 using the search terms “memory” and “sex OR gender.” “Sex OR gender” was included to limit the number of hits, as an unlimited search for “memory,” resulted in more than 65,000 abstracts. The term “ep- isodic” has not been used consistently in the literature and was therefore excluded from the search. The search resulted in 2,425 abstracts that were screened for further inclusion. Articles were retrieved for examination in full text if the abstract indicated that males and females had been compared in terms of episodic mem- ory. Whenever we were in doubt regarding the content of an article, it was retrieved for further inspection. This resulted in 750 articles being retrieved and examined in full text.

The second search was performed in PubMed and PsycINFO covering September 2001 to 25 November 2013,3 using the search terms “memory” and “humans” and “sex OR gender.” This search resulted in 7,386 abstracts that were reviewed for possible inclu- sion in the meta-analysis. The criteria to select articles to be examined in full text was more inclusive in the second search than in the first. In the second search, articles were retrieved if it was suspected that the study could contain samples of men and women who had likely participated in an episodic memory task, which enabled us to subsequently investigate publication bias by contact- ing authors to request unpublished data. A total of 2,581 articles were retrieved and examined in full text from the second search. Data were recorded from the articles identified in the two database searches by the same individuals during the same time period.

Data were retrieved from published articles, open-access data sources linked to published articles, and previously unreported data provided by the authors of published articles. For an article to be included in the analysis, the following four criteria had to be met: (a) The study contained original, empirical data and was, to ensure high quality of the studies included, published in a peer-

3 Some studies with publication dates after 2013 were included in this meta-analysis because they either had been prepublished online or because they are reference articles for open-access data sources available before 2014.

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5SEX DIFFERENCES IN EPISODIC MEMORY

reviewed scientific journal with full text available in English (i.e., meta-analyses, conference proceedings, book chapters, disserta- tions, and articles in other languages were excluded); (b) The study sample consisted of males and females who were not influenced in any way that may have affected their cognitive performance (e.g., by a drug or a stressful experimental condition) and who were not selected based on any diagnosis, disease, or disorder. Groups characterized as “healthy control group” were included, whereas samples selected based on a certain characteristic (e.g., “smokers”) were excluded; (c) The task assessed episodic memory in which the encoding phase was conducted by the experimenters (e.g., assessments of autobiographical memory were excluded). Further- more, the encoding phase was the same for all participants, mean- ing that the amount of information, type of material, and study time could not differ between participants within a sample. Also, if the quantity of material to be remembered was small, there had to be a time interval (with or without a distractor task) between the encoding and retrieval phases to avoid assessing primarily working memory performance; (d) The dependent measure was memory performance (accuracy), thereby excluding indirect performance measures such as time to completion and age-corrected measures.

From the first database search (1972–2001), 130 studies were included in the meta-analysis, providing 771 effect sizes from 253

independent samples. Excluded articles were not categorized in this phase. From the second database search (2001–2013), 487 studies were included, providing 3,400 effect sizes from 1,117 independent samples. Abstracts and full-text articles were ex- cluded for the following reasons in this phase: four were animal studies, 361 were not peer-reviewed (e.g., dissertations), 27 were unretrievable in full-text, 184 were duplicates or overlapped with other studies, 170 were not about episodic memory, 203 contained nonvalid samples (e.g., participants selected on the basis of diag- nosis), 61 involved unusable data (e.g., different encoding condi- tions within a sample or age corrected outcomes), and 1,103 included no valid measures (a list of excluded publications can be found in Table S3 in the supplemental online material).

Among the 2,581 articles from the second database search examined in full-text, 1,047 articles were published during or after 2004 (i.e., within 10 years of our data collection) in which incom- plete or no data on sex differences were presented. The corre- sponding authors of these articles were contacted by e-mail with requests for data and/or additional information. In some instances, we were informed that this information had been published in other articles not identified in any of the database searches. The articles with insufficient information were then replaced with the articles with sufficient information. For 246 (23%) of the studies

4805 articles excluded

1313 articles excluded

1675 articles excluded

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with requests for data

2425 abstracts examined

7386 abstracts examined

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2581 full-texts examined

130 articles included

487 articles included

617 articles included

Final data set

Figure 1. Flowchart depicting the study selection and exclusion process. Two database search and abstract reading phases were conducted (1972–2001 and 2001–2013).

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6 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

for which additional data were requested, the authors generously provided unpublished data on males’ and females’ episodic mem- ory performance.4 Sometimes, the numbers of participants covered by the previously unreported data received from the authors dif- fered slightly from the samples described in the published articles. In those cases, numbers provided by the authors were used. In some instances, data were retrieved directly from open-access project databases (i.e., Börsch-Supan, 2016a, 2016b, 2016c, 2016d; Kowal et al., 2012; Sonnega et al., 2014; Steptoe, Breeze, Banks, & Nazroo, 2013) rather than from specific articles. To avoid participant overlap, if the same data were presented in several publications, the one with the largest sample size was selected. Furthermore, in studies presenting longitudinal informa- tion, when given a choice, only information from the earliest available testing occasion was included. We avoided including more than one study from the same longitudinal project.

The final data set (see Table S2) covered 617 studies with 4,171 effect sizes, 1,370 independent samples, and a total of 1,233,921 participants (564,433 males and 669,488 females), ranging in age from infants to 100-year-olds.

Measure of Between-Group Effect Sizes

In most studies, the results were reported using mean scores for males and females along with variance measures. However, other measures were also reported, such as Pearson’s r or results of ANOVAs or t tests. All data points were converted to Hedges’ g5

and variances for these scores using the R package compute.es (Version 0.2–4; Re, 2013). When converting from r, conversions were first made to Cohen’s d, which in turn were converted to Hedge’s g using a correction factors described in Borenstein, Hedges, Higgins, and Rothstein (2009, p. 27). Comparing con- verted (n � 136) and nonconverted (n � 4,041) effect sizes using a moderator analysis (described in Statistics) showed that con- verted effect sizes (g � 0.28, 95% CI [0.20, 0.36]) were signifi- cantly larger than nonconverted effect sizes (g � 0.18, 95% CI [0.16, 0.20]; p � .05).

Moderator Variables

Besides collecting information on all statistics relevant to the magnitude of sex differences, the following information about the studies, tasks, and samples was collected and analyzed as moder- ators.

Study variables. Data source comprised information on whether data were taken directly from publications or were previously unre- ported data obtained from authors. Study objective comprised infor- mation on whether or not an explicit objective of the study was to investigate potential sex differences.

Task variables. The primary categorization of episodic mem- ory tasks was conducted based on aspects related to the material to be remembered, along a continuum ranging from highly verbal to highly spatial, with words, sentences, and prose placed at one end and spatial routes at the other; with images of objects, movies, abstract forms, and location of objects falling in between the two; and faces, odor, taste, and color falling outside this continuum. For this variable, labeled type of material, nine categories were iden- tified, which are briefly described below and exemplified in Table S1: Verbal – words, sentences, facts, conversations, or narrative

content; Images – images, concrete objects and abstract forms; Movies – movie clips with or without sound; Locations – locations of objects; Routes – routes through space; Faces – single or paired faces (paired with names/facts/verbal information); Sensory – odors, tastes, and colors. Finally, Remaining – the material could not be categorized as any of the above, or consisted of composite measures of the above categories.

In addition, information about other aspects of the material and the encoding and retrieval conditions was recorded as follows (see Table S1 for further information): Nameable material – whether the material was nameable (e.g., common everyday objects) or non-nameable (e.g., inkblots); Emotional material – whether the material or the context in which it was presented could be classi- fied as emotionally negative, neutral, positive, or sexual; Paired material – whether the material involved remembering associa- tions between single items (e.g., a name associated with a face or a word pair) or not, labeled paired and single, respectively; Re- peated learning – whether the material was presented once (non- repeated) or multiple times (repeated) before being recalled; In- tentional learning – whether participants were explicitly instructed to remember the content (intentional learning) or not (incidental learning); Retrieval support – whether the material had to be retrieved by means of free recall, cued recall, or recognition; Delayed recall – whether there was a delay (delayed) between the end of the encoding phase and the start of the retrieval phase or not (immediate).

Sample variables. Age comprised information about mean age or, if lacking, the middle value of a range (e.g., 25 in an age-range of 10–40), of the participants included in each sample. Geographical region comprised information regarding the country where the study was conducted. If this information was not ex- plicitly stated in the article, it was derived from the affiliation(s) of the authors. Data originating from 48 different countries were retrieved and categorized into six continents: Africa, Asia, Europe, North America, Oceania, and South America. Sampling of subjects comprised information on whether the sample could be considered a population-based or convenience-based sample. A sample was considered population-based if it was indicated that the sample was randomly selected from the population. Year comprised in- formation regarding year of publication.

Interrater Reliability

To ensure concordant coding among raters, we analyzed inter- rater reliability (IRR) in k � 28 randomly selected studies. The proportion of agreement on five different variables was .85 (302 items agreed upon out of 355), and the resulting kappa, � � .66, indicated substantial agreement (Cohen, 1960; Landis & Koch, 1977) between raters on these variables. The individual variables were: number of effect sizes to include from the study (� � .75), effect size values (� � .85), study objective (� � .31), number of male and female participants for each effect size (� � .63), and

4 See the author note for a list of these individuals. Entries in Table S2 and the reference list are marked to indicate studies for which authors provided us with previously unpublished data.

5 Hedge’s g is similar to Cohen’s d, but it is less likely to overestimate the effect for small samples. For two means, Hedge’s g is derived by d · �1 � 34�n1 � n2� � 1�. For small values of n1 and n2, d and g will differ slightly, while the correction factor will go towards 1 as the sample size increases.

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7SEX DIFFERENCES IN EPISODIC MEMORY

mean age of participants for each effect size (� � .73). Inconsis- tencies were discussed and resolved among the raters.

Statistics

Most of the articles included had several samples (e.g., age groups), participating in more than one episodic memory task (e.g., word list and images of objects), some with more than one depen- dent measure (e.g., free and cued recall of a word list, and imme- diate and delayed recognition of images; see Figure S1 for a concrete example of this structure). To account for the hierarchical structure of the data, all meta-analytic analyses performed, unless otherwise noted, were five-level random-effects meta-analyses, carried out using the rma.mv function in the R package metafor (Viechtbauer, 2010).

The data were analyzed in several steps: First, an overall meta- analysis was performed, using no moderators. Next, moderator meta- analyses of database search, data source, and study objective were performed. Then, a moderator meta-analysis on the type of material variable (i.e., Verbal, Images, Movies, Locations, Routes, Faces, Sensory, and Remaining) was performed. Because of a lack of infor- mation of task content or highly diverse task content in Remaining, this level was excluded from further analyses. This was also the case for Sensory as it was based on nine articles only. Finally, we per- formed moderator meta-analyses of the remaining factors listed under the section Moderator variables except for year and age where metaregressions were performed on each material category, based on our hypotheses, using a linear model for year and a quadratic model for age. These analyses were performed within each of the material categories (i.e., Verbal, Images, Movies, Locations, Routes, and Faces). Furthermore, we computed I2 to quantify the amount of dispersion that likely is attributable to true differences, with a value of 0% indicating no observed heterogeneity and larger values indicating increasing heterogeneity (Higgins & Thompson, 2002). To ensure reliable estimates, omnibus tests were only performed for analyses with two or more levels with k � 5. Post hoc tests were carried out for geographical region with Bonferroni adjusted pairwise comparisons.

Results

Main Result

The results of our overall analysis of 617 studies, 1,370 inde- pendent samples (1,233,921 participants), and 4,171 effect sizes, indicate a significant female advantage in episodic memory (g � 0.19, 95% CI [0.17, 0.21], p � .001). A funnel plot of the complete dataset can be found in Figure S2 in the online supplemental material. A substantial portion of the variance may be explained by differences between studies, rather than by random error, as indi- cated by I2 � 91%, thereby motivating moderator analyses. Funnel plot and results from metaregression showing no asymmetry can be found in Figure S2 in the online supplemental material.

Reliability

To ensure that data from the two database searches (1972–2001 and 2001–2013) were comparable in spite of slight differences in selection procedures, this variable was subjected to a moderator analysis, which indicated that the two database searches yielded comparable effect size estimates (1972–2001, g � 0.19; 2001– 2013, g � 0.19; see Table 1). To address the file-drawer problem, we compared effect sizes retrieved directly from publications and those received upon e-mail request from authors, finding that the effect size estimates were similar (retrieved from publications, g � 0.20; received from authors, g � 0.18; see Table 1). To ensure that the data were not biased because of the main research goal of the study, a moderator analysis of study objective was performed. The result of this analysis indicated no significant differences for study objective (sex differences, g � 0.18; other objectives, g � 0.19; see Table 1).

Task-Specific Moderators

Next, we investigated whether type of material to be remem- bered affected the magnitude of the effect size estimates. Results indicated that the effect sizes varied significantly (p � .001) as a function of type of material (see Figure 2). Females performed at

Table 1 Results of the Moderator Analysis With the Study-Specific Variables Database Search, Data Source, and Study Objective as Moderators

Moderator–level g 95% CI k p I2

Database search 617 .96 90% 1972–2001 .19 [.14, .24] 130 <.001 2001–2013 .19 [.16, .22] 487 <.001

Data source 617 .36 90% Retrieved from publications .20 [.17, .23] 366 <.001 Received from authors .18 [.14, .21] 251 <.001

Study objective 617 .69 90% Sex differences .18 [.15, .22] 262 <.001 Other objectives .19 [.16, .22] 355 <.001

Note. The first row of each moderator denotes omnibus tests with H0 that the moderator does not influence the size of the sex difference. Consecutive rows show whether effect sizes are reliably different from 0. g � Hedge’s g; 95% CI � the 95% confidence interval; k � number of studies; p � the p value where values �.05 are in bold; I2 � statistic denoting the percentage of variation across studies that is attributable to heterogeneity rather than to chance.

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8 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

a significantly higher level than males in most task categories (Verbal, g � 0.28; Movies, g � 0.12; Locations, g � 0.16; Faces, g � 0.26; Sensory, g � 0.37; Remaining, g � 0.13), except for Routes (g � �0.24), where males performed at significantly higher level than females, and Images (g � 0.02), where there was no significant sex difference. Funnel plots for each type of material can be found in Figures S3 to S10 in the online supplemental material.

To investigate potential moderating effects of task-specific vari- ables on type of material, moderator analyses were performed with the variables nameable material, emotional material, paired ma- terial, repeated learning, intentional learning, retrieval support, and delayed recall. Moderator analyses of the variable nameable material were performed in three task material categories (i.e., Images, Locations, and Routes) to investigate how verbal aspects of the material affected the outcome. The other task categories could not be differentiated on this aspect and were therefore excluded from analyses. The results indicated significant differ- ences for Images, but not for Routes and Locations. For Images and the overall effect (Total), results indicated that the female advantage was larger when the material could be named than when it could not be named (see Table 2).

Next, moderator analyses of the variable emotional material were performed to investigate whether effect sizes vary as a function of the emotionality of the material or the emotional context in which it was presented. The results (see Table 2) revealed no such difference. Further, moderator analyses of the variable paired material were computed. These analyses demon- strated that for the Verbal category, there was an attenuated female advantage when the material was remembered in an associative fashion (see Table 2).

To investigate whether presenting the material once or repeated times affected the results, analyses of the variable repeated learn- ing were performed. The results (see Table 3) indicated that the female advantage was greater when the items to be remembered were presented more than once for Verbal material. For Images, repeated learning yielded a female advantage, whereas there was no sex difference for nonrepeated images. Furthermore, moderator analyses of intentional learning for the overall effect, Total, dem- onstrated a greater female advantage on intentional learning than incidental learning (see Table 3).

The investigation of retrieval support (i.e., free recall, cued recall, and recognition) produced significant effects for the mate- rial categories Verbal and Locations, in different directions (see Table 3). For Verbal, free recall yielded a greater female advan- tage than did cued recall, followed by recognition. For Locations, there was a female advantage in cued recall and recognition, but not in free recall. Moderator analyses were also conducted for the delayed recall variable to investigate whether having a delay between encoding and retrieval would affect the results. Results indicated that it only did so for Movies, where there was a female advantage for immediate but not delayed recall (see Table 3).

Sample-Specific Moderators

Moderator analyses of the variables age, geographical region, sampling of subjects, and year were performed (see Table 4). Metaregressions showed that age was related to the magnitude of sex differences for Verbal, Images, and Total. A sensitivity anal- ysis showed that the effect of age disappeared once the verbal tasks were excluded from Total. As can be seen in Figure 3a, the effect for Verbal was quadratic with somewhat smaller effects at younger and older ages than for other ages. For Images, the omnibus test and linear effect were significant, while the exponential effect was not. Omitting the exponential part revealed a negative correlation between effect size and age (see Figure 3b).

For geographical region, there was a significant effect for the overall data set as well as for the category Verbal. Bonferroni adjusted follow-up pairwise comparisons showed that for Verbal, the magnitude of sex differences was smaller in Asia than in other examined continents (Europe, North America, Oceania, and South America; p � 0.005). For the overall effect, the magnitude was smaller in Asia than in North America and South America (p � 0.003). To investigate whether the representativeness of the par- ticipants affected the outcome, moderator analyses of the variable sampling of subjects were performed and was found to not be significant, that is, the effect sizes were of equal magnitude for convenience-based and population-based samples. Finally, run- ning metaregressions with the variable year as predictor revealed no significant associations with year of publication.

Figure 2. Forest plot of estimated effect sizes from a meta-analysis with type of material as a moderator (Omnibus p � .001; I2 � 89). Each row shows whether effect sizes are reliably different from 0. Estimate for Total is based on a meta-analysis using no moderators. g � Hedge’s g; CI � the 95% confidence interval; k � number of studies; p � the p value; I2 � statistic denoting the percentage of variation across studies that is due to heterogeneity rather than to chance.

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10 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

Discussion

This meta-analysis sought to summarize and quantify findings concerning sex differences in episodic memory, focusing on the impact of the material to be remembered (e.g., verbal, spatial, faces), the encoding and retrieval context (e.g., intentional learning, retrieval support), and the details of the participants examined (e.g., age, geographical region, study year). We based our analysis on 617 studies, comprising data from a total of 1,233,921 participants, and found an overall female episodic memory advantage (g � 0.19) that was reliably greater than zero. As expected, the material to be remem- bered affected the magnitude of this advantage, with a female advan- tage for more verbal tasks, Verbal (g � 0.28) and nameable Images (g � 0.16), as well as for less verbal tasks such as Movies (g � 0.12), and Locations (g � 0.16), and a male advantage in more spatial tasks, such as remembering non-nameable Images (g � �0.20) and Routes (g � �0.24). Finally, there was a female advantage for the categories that cannot easily be placed on the verbal-spatial continuum, namely Faces (g � 0.26) and Sensory (g � 0.37; i.e., odor, taste, color), and for the category containing uncategorizable or composite measures, Remaining (g � 0.13). Although time did not moderate the effect, and sex differences in verbal episodic memory existed in all geographical regions examined and across the life span, the magnitude varied among regions and was smaller in childhood and old age than in other ages. Furthermore, several factors relating to the material and the task qualified the effect, the most consistent of which were whether or not the material was nameable and whether there were repeated learning epi- sodes. By contrast, the magnitude of the effect sizes was not modified by publication bias or by intent to investigate sex differences. The details of these results and their implications will be discussed.

Reliability of Results

We found no publication bias or “file drawer effect”; the magnitude of effect sizes originating from published results

(g � 0.20) did not reliably differ from those of studies using previously unreported data obtained directly from authors (g � 0.18, see Table 1). In other words, those studies in which the effect, for lack of information, would have been assumed to be nonexistent, did in fact show sex differences very similar to those reporting data separately for men and women. To arrive at this conclusion, we contacted authors of a large number of articles (n � 1,047) in which men and women had participated, but in which no comparison between men and women was made. Although the response rate was only 23% (n � 246), it is reasonable to conclude that no publication bias existed, as it is unlikely that the authors retrieving data for us would have obtained qualitatively different results than those who did not respond to our query.

Adding to our confidence that there was no publication bias, the magnitude of the female advantage in episodic memory was not moderated by whether the main objective of the study was to study sex differences (g � 0.18) or not (g � 0.19). Further- more, the overwhelming majority of the studies in our data set used convenience-based rather than population-based samples, which could jeopardize generalizations of the results to the general population. However, when comparing the results of studies using population-based samples (g � 0.18) with those using convenience-based samples (g � 0.19), no differences were found. Taken together, these results strengthen the gener- ality of our findings and indicate that detected sex differences in episodic memory did not result from a bias to study or report sex differences, or from using selective samples.

The Material

We found a female advantage in most, but not all, episodic memory tasks. The female advantage was especially noticeable for the category Verbal and reversed for Routes (where males had an

Table 4 Results From the Moderator Analyses With the Sample-Specific Variables Age, Geographical Region, Sampling of Subjects, and Year as Moderators

Moderator–level

Verbal Images Movies Faces

g 95% CI k p I2 g 95% CI k p I2 g 95% CI k p I2 g 95% CI k p I2

Age 329 <.001 87% 165 <.01 84% 17 .76 35% 51 .90 76% Intercept .014 [�.069, .098] .73 .194 [.054, .334] <.01 .100 [�.271, .471] .60 .216 [�.087, .519] .16 Age .014 [.010, .017] <.001 �.009 [�.016, �.001] <.05 .003 [�.023, .028] .83 .004 [�.014, .021] .69 Age2 .000 [.000, .000] <.001 .000 [.000, .000] .11 .000 [.000, .000] .71 .000 [.000, .000] .65

Geographical region 365 <.001 87% 189 .07 84% 19 .77 56% 54 .57 76% Africa 0 2 0 Asia .12 [.04, .20] 36 <.01 �.09 [�.24, .07] 16 .28 1 2 Europe .29 [.24, .33] 153 <.001 .01 [�.06, .09] 67 .74 .17 [�.12, .47] 6 .25 .26 [.14, .38] 28 <.001 North America .30 [.25, .34] 147 <.001 .04 [�.02, .10] 91 .19 .12 [�.02, .27] 13 .10 .31 [.19, .43] 26 <.001 Oceania .37 [.26, .47] 24 <.001 �.23 [�.44, �.02] 9 <.05 1 2 South America .33 [.21, .46] 8 <.001 .13 [�.09, .35] 6 .24 0 0

Sampling of subjects 363 .06 88% 181 .39 85% Convenience-based .29 [.26, .33] 318 <.001 .00 [�.04, .05] 169 .86 22 54 Population-based .22 [.16, .29] 47 <.001 .05 [�.05, .15] 13 .36 0 4

Year 371 .96 88% 189 .11 85% 23 .46 52% 59 .13 74% Intercept .278 [.158, .398] <.001 .136 [�.020, .292] .09 .215 [�.104, .534] .19 .468 [.192, .744] <.001 Year .000 [�.004, .004] .96 �.004 [�.009, .001] .11 �.011 [�.039, .018] .46 �.006 [�.015, .002] .13

Note. The first row of each moderator denotes omnibus tests with H0 that the moderator does not influence the size of the sex difference. Consecutive rows show whether effect sizes are reliably different from 0. Subset analyses performed for each level of type of material as well as the result from the total data set are presented. g � Hedge’s g; 95% CI � the 95% confidence interval; k � number of studies; p � the p value where values �.05 are in bold; I2 � statistic denoting the percentage of variation across studies that is due to heterogeneity rather than to chance. Age and Year are metaregressions with intercepts at 0 and 1973, respectively.

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11SEX DIFFERENCES IN EPISODIC MEMORY

advantage). The importance of verbal abilities for the female advantage in episodic memory was magnified when tasks that could be categorized as either nameable or non-nameable were contrasted. This is particularly clear for Images, where women perform at a higher level than men on nameable images and where

men perform at a higher level on non-nameable images. While the verbal-spatial dimension runs through many of the categories, Faces and Sensory can be assumed to require less verbal or spatial processing, and in both categories women performed at a higher level than men. Importantly, these results may indicate that sex

Table 4 (continued)

Moderator–level

Locations Routes Total

g 95% CI k p I2 g 95% CI k p I2 g 95% CI k p I2

Age 58 .17 96% 22 .79 77% 534 <.001 90% Intercept .145 [.041, .250] <.01 �.214 [�1.045, .617] .61 .006 [�.061, .072] .87 Age �.003 [�.007, .001] .19 �.018 [�.076, .040] .55 .010 [.007, .013] <.001 Age2 .000 [.000, .000] .36 .000 [�.001, .001] .50 .000 [.000, .000] <.001

Geographical region 58 .08 88% 22 .25 73% 612 <.01 89% Africa 2 0 .05 [�.09, .20] 9 .48 Asia 5 0 .09 [.02, .15] 57 <.01 Europe .09 [�.01, .19] 28 .09 �.22 [�.56, .13] 8 .22 .19 [.15, .23] 241 <.001 North America .18 [.09, .28] 31 <.001 �.47 [�.72, �.22] 14 <.001 .21 [.17, .25] 267 <.001 Oceania 2 2 .19 [.10, .29] 32 <.001 South America 3 0 .25 [.15, .36] 15 <.001

Sampling of subjects 603 .89 90% Convenience-based 65 23 .19 [.16, .21] 549 <.001 Population-based 1 1 .18 [.12, .24] 57 <.001

Year 67 .80 97% 24 .52 74% 617 .50 91% Intercept .162 [�.132, .456] .28 �.523 [�.964, �.083] <.05 .221 [.127, .314] <.001 Year �.002 [�.013, .010] .80 .010 [�.020, .039] .52 �.001 [�.004, .002] .50

a b

Figure 3. Scatterplot of the relation between Hedge’s g and age of participants in single data points for (a) Verbal and (b) Images. The size of each data point is scaled relative to its squared variance. In (a), the solid line shows the estimate and the dotted lines the 95% confidence interval of a metaregression with a quadratic function (see Table 4). In (b), the solid line shows the estimate and the dotted lines the 95% confidence interval of a linear metaregression (Omnibus: k � 165, p � .01, I2 � 86; Intercept (set at 0): g � 0.103, CI � 0.017/0.189, p � .05; Age: g � �0.003, CI [�0.004, �0.001], p � .01).

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12 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

differences in episodic memory are not only a function of sex differences in verbal and spatial processing, but that there is a general female episodic memory advantage.

We also found that the type of retrieval used to remember an event affected the magnitude of the sex difference, with a greater female advantage for verbal material that was freely recalled rather than retrieved with cues or recognized. This suggests that retrieval problems may contribute to the male disadvantage in verbal epi- sodic memory, as females may benefit from their advantage in producing verbal content when asked to recall material freely. The verbal production advantage has been demonstrated to exist in tasks assessing speech production (d � .33; Hyde & Linn, 1988) and verbal fluency (d � 0.15; Maylor et al., 2007), with the differences in verbal fluency being reported across a large number of countries (Maylor et al., 2007).

The female advantage is, as mentioned, not limited to episodic memory tasks that are more verbal in nature. Instead, the sex difference favoring women in tasks involving face recognition is similar in magnitude (g � .26) to that of the Verbal category (g � 0.28). Although it could be hypothesized that women may benefit from the possibility of verbalizing faces (e.g., “young, freckled, with a large nose”), this notion has not been supported (Lewin & Herlitz, 2002). Instead, a meta-analytic review (Herlitz & Lovén, 2013) concluded that the female advantage in face recognition (d � .36) is largely because women remember more female faces than men do. That is, women display an own-gender bias (i.e., remembering more female than male faces), whereas men remem- ber male and female faces equally well. The reasons for women’s own-gender bias and men’s lack thereof are unclear, though it has been argued that the female advantages in face processing and episodic memory contribute to the sex differences in face recog- nition, and that the female own-gender bias may stem from an early perceptual expertise for female faces, which in turn may be strengthened by reciprocal interactions and psychological pro- cesses directing women’s interest toward other females (Herlitz & Lovén, 2013). The magnitude of the sex difference in face recog- nition found in the present meta-analysis (g � .26) was somewhat smaller than that previously reported (d � .36; Herlitz & Lovén, 2013). Although the reason for this discrepancy is unclear, it may reflect the broader search strategy and more complete coverage of studies used here.

There was a rather large female advantage in the Sensory category (g � .37) examining memory for odor, taste, and color. Six of the nine studies in this category investigated memory for odors. Sex differences have systematically been reported for odor identification (e.g., Doty & Cameron, 2009) and odor recognition (Öberg, Larsson, & Bäckman, 2002), whereas the findings for odor memory are more mixed. Although the female advantage in the Sensory category is large and reliable, it should be noted that it is based on comparatively few studies. Further research is therefore warranted.

The sex differences in Movies and Locations were reliable but small (g � 0.12, g � 0.16, respectively). Tasks in these categories generally involve some degree of spatial processing, but often require verbal processing as well. We found that the magnitude of the sex difference in Locations was affected by type of retrieval with a female advantage for cued recall and recognition, but not for free recall. Others have also reported variations in the magnitude of the sex differences in remembering object locations (Voyer et

al., 2007). An inspection of some of the tasks in the Locations category suggests that freely recalling information may demand more spatial processing (e.g., Miller & Santoni, 1986) than retriev- ing information using cues (e.g., Kessels, Nys, Brands, van den Berg, & Van Zandvoort, 2006) or making recognition decisions (e.g., Lewin et al., 2001; see task descriptions in Table S1). Such a pattern would be predicted from sex differences in spatial and verbal abilities (Hyde & Linn, 1988; Voyer et al., 2007).

Men performed at a higher level than women in tasks that required remembering a route. Most of these tasks clearly demand spatial processing and put relatively few demands on verbal pro- cessing, as evidenced by the few Routes that could be classified as nameable in our analysis. The male advantage in spatial processing may also explain why there was a male advantage in remembering non-nameable images; a typical non-nameable task in the Images category involves some spatial processing (e.g., inkblots and ab- stract pictures).

Summary. Taken together, the current results suggest that women will have a greater advantage in tasks that are clearly verbal and a lesser advantage in those that also require some spatial processing (e.g., Locations), whereas men will have an advantage in tasks that require spatial processing to a large degree (e.g., Routes). It is therefore likely that the explanation of sex differences in verbal and spatial episodic memory tasks to some degree, but not fully, overlap with the explanations of sex differ- ences in other verbal and spatial tasks. That is, women seem to also have an advantage on episodic memory tasks that are neither verbal nor spatial, such as Faces, possibly indicating a general advantage in episodic memory. Although factors such as pre- and postnatal hormone exposure, brain differences, societal expecta- tions, and activation of stereotype threat have been hypothesized to contribute to the differences seen with regard to verbal and spatial abilities, a full understanding of the likely many reasons for these sex differences is still lacking, not least in respect to episodic memory (e.g., Miller & Halpern, 2014).

Age

We were interested in whether the sex differences in episodic memory were modified by age, as it relates to the underlying origins of the differences. Our results showed that, for most task categories (Movies, Faces, Locations, Routes), there were no ef- fects of age on the size of the sex differences. However, there was a quadratic effect of age for Verbal (see Figure 3a) and a negative linear effect of age for Images (see Figure 3b). Although a female advantage was found throughout the life span for the Verbal category, analyses suggested smaller sex differences early and late in life than in other periods of life.

It has long been suggested that endogenous sex hormones can affect cognitive performance, with evidence of prenatal androgens influencing spatial performance in girls with CAH (Puts et al., 2008), and that endogenous estradiol is associated with memory performance (e.g., Hara, Waters, McEwen, & Morrison, 2015). If postnatal endogenous sex hormones affect memory performance, this should become evident in periods when there is a substantial change in hormonal levels. The adolescent period is associated with such hormonal changes: The levels of both estradiol and testosterone are relative similar in prepubescent boys and girls, but become markedly different during adolescence. Our statistical

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analysis suggests that sex differences in verbal episodic memory increase across childhood, adolescence, and early adulthood, which would be in line with a hormonal hypothesis. On the other hand, it could also be taken to indicate that environmental effects, such as expectations and acquired interests, influence the magni- tude of the difference. Furthermore, our analyses found the largest sex differences in verbal episodic memory around 50 years of age and smaller sex differences in older ages. Because menopause, taking place around 50 years of age, is characterized by a loss of ovarian hormone production, with levels of estradiol starting to decrease some years before the final menstrual period, reaching barely detectable levels after the final period, our results are in line with endogenous postnatal hormones affecting episodic memory. The linear negative effect of age on sex differences for Images, however, is difficult to reconcile with the same hormonal expla- nation predicting an increase and decrease of sex differences across the life span.

Age effects analyzed in meta-analyses should, however, be interpreted with caution, one reason being that the age of the sample may be unspecific. This is the case in the present analysis in which we determined the sample age by the mean or, if lacking, the middle value of a sometimes wide age range. Furthermore, age differences are confounded with cohort differences in cross- sectional studies, which means that age differences also reflect differences in numerous factors across generations, rather than changes across age. Previous research has reported that sex dif- ferences favoring women in episodic memory are larger in later generations than in earlier generations and larger in regions with better living conditions and educational opportunities than in re- gions with worse conditions and opportunities (Weber et al., 2014, 2017). Applied to the present results, this suggests that the age effects seen in later life for Verbal and Images could result from cohort differences in living conditions and educational opportuni- ties rather than from effects of endogenous hormones.

Taken together, for most episodic memory categories we found no effects of age on the magnitude of the sex differences. Although some of our results are in line with the hypothesis that the changes in endogenous sex hormones taking place around puberty and menopause influence sex differences in verbal episodic memory tasks, alternative explanations of cumulative environmental effects in childhood and cohort effects in later adulthood are equally likely. Further longitudinal studies are therefore needed before firm conclusions on this topic can be drawn.

Time and Region

We also examined the extent to which sex differences in epi- sodic memory exist across geographical regions, and whether the magnitude of sex differences have changed over time or vary across regions.

Regarding the first question, whether sex differences in episodic memory exist in all regions examined, some continents lacked studies for certain categories, limiting the analyses that could be conducted. With this limitation in mind, we found a female ad- vantage in the overall measure of episodic memory in all conti- nents, except Africa, where the effect was small and unreliable. Similarly, there was a female advantage in verbal episodic memory in all continents that could be examined (thereby excluding Af- rica). These findings are in line with those of earlier studies

reporting sex differences across countries, albeit with variations in the magnitude, in spatial abilities (Lippa, Collaer, & Peters, 2010), school grades (Voyer & Voyer, 2014), reading comprehension (Guiso et al., 2008; Stoet & Geary, 2018), mathematics (Else- Quest, Hyde, & Linn, 2010; Guiso et al., 2008; Stoet & Geary, 2018), and episodic memory (Bonsang et al., 2017; Weber et al., 2014). Thus, women’s and men’s general patterns of cognitive strengths appear resistant to cultural variation between geograph- ical regions, although the magnitude of the sex differences may vary.

Previous studies have found greater differences favoring girls in reading comprehension and episodic memory to be associated with improved living conditions and gender equality (Bonsang et al., 2017; Guiso et al., 2008; Weber et al., 2014). The larger effect sizes favoring females in some tasks (i.e., reading comprehension and episodic memory) have been coupled with smaller effect sizes in cognitive tasks favoring males (i.e., math; Guiso et al., 2008; Stoet & Geary, 2013; Weber et al., 2014). These findings are in line with recent result showing that the Flynn effect is larger in women than in men (Weber et al., 2017), suggesting that women gain more than men from improved living conditions. Based on these findings, we hypothesized that the magnitude of sex differences in episodic memory may vary across regions and change over time, assuming that living conditions improve with time (Guiso et al., 2008; Stoet & Geary, 2013; Weber et al., 2014). We noted a variation across geographical regions in the magnitude of sex differences in the overall measure of episodic memory, and also for Verbal in that Asia had a smaller female advantage than any of the other continents both for the overall measure as well as for Verbal. When examining varia- tion across time, our results indicated that the magnitude of the sex difference did not change from 1973 to 2013, neither in the overall measure of episodic memory nor in any of the material categories.

Overall, our hypothesis that the effect sizes would become larger over time and be larger in continents with better living conditions and gender equality was only weakly supported. These findings should, however, be treated with caution because of the limited number of studies available from some regions, but also because country- and time-specific indicators of regional develop- ment and gender equality likely are needed to determine potential associations.

Other Moderators

Besides analyzing the moderating effect of the type of test material, we investigated whether emotionality, intention to re- member, associative aspects, and repeated learning influence the magnitude of the sex differences in episodic memory. Many of these moderators could only reliably be evaluated for the Verbal and Images categories, and for the overall measure. In general, relatively few factors moderated the effect, and none changed the direction of the effect size.

Based on research finding sex differences in emotional process- ing (e.g., Hall, 1978), it has been hypothesized that women would gain more than men from emotionally valenced material (Andre- ano & Cahill, 2009). However, we could not corroborate this when comparing neutral and negatively valenced material for the Verbal category. For the overall measure, effect sizes for neutrally, neg-

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14 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

atively, positively, and sexually valenced materials were of similar magnitude, with reliable sex differences for negative, neutral and positive materials but not for sexual. The latter finding should be interpreted with caution, as relatively few studies examined sexu- ally valenced material.

For Verbal, the magnitude of the effect sizes was affected by whether the material to be remembered was presented as a single item or as an associative memory task, with larger differences for single items (g � 0.32) than for paired items (g � 0.20). Brain imaging work has demonstrated that the anterior hippocampus is especially implicated in the formation and retrieval of associations between items, whereas parahippocampal activity is more linked to item memory (e.g., Buckner, Kelley, & Petersen, 1999; Mayes, Montaldi, & Migo, 2007; Persson & Söderlund, 2015; Simons & Spiers, 2003). The smaller sex difference observed in associative than single-item verbal episodic memory tasks suggest that brain regions other than hippocampus may merit investigation in relation to sex differences in episodic memory.

The female advantage in many episodic memory tasks seems to increase when there is a possibility of repeated learning or addi- tional exposure to the material. This effect was not only seen in the overall measure, but also for the Verbal and Images categories. Although it is unclear why women do especially well when re- peated encoding opportunities are given, one possibility is that it enables the use of learning strategies and that women utilize such strategies more than men. This would be in line with our results showing that intentional learning yields a larger female advantage than incidental learning for the overall measure, as intentional learning would facilitate the use of strategies. Alternatively, the advantage women have when items are presented only once likely persists in consecutive presentations, increasing the overall advan- tage in an additive manner when several encoding opportunities are given.

Limitations

Although the present meta-analysis has several strengths, such as relying on a large number of studies and effect sizes, directly testing for publication bias, and thoroughly analyzing the qualita- tive aspects of the episodic memory tasks, it also has some limi- tations.

First, the inclusion of the terms “sex OR gender” in the database searches may have biased the results toward studies reporting sex differences. However, the fact that there were no differences in the magnitude of effect sizes between the published data and the data provided by authors, and between studies having and not having the explicit aim of examining sex differences, suggests that includ- ing “sex OR gender” in the search terms did not affect the results.

Second, it may sometimes be difficult to distinguish an episodic memory task from a working memory task, as immediate tests of episodic memory at least partly involve working memory. To minimize this confounding, we decided that if the quantity of material to be remembered was small, there needed to be a delay between encoding and retrieval for the task to be included. It remains unclear whether this delay was enough in all cases, but we found no differences in magnitude between immediate and delayed measures of episodic memory, indicating that a potential con- founding between working memory and episodic memory in some instances would not influence our results.

Third, articles were searched for and selected at two different time points (i.e., 2001 and 2013), with the second search procedure being slightly more inclusive than the first one. Although data collection from all articles was conducted at the same time and by the same individuals, having two search and selection phases is suboptimal as possible discrepancies in procedures could bias the effects. To address this concern, we could have conducted and presented all analyses separately from the two search and selection phases. We decided not to do so, as it would have further restricted the analyses that could be performed and reduced the power of these analyses. We made this decision based on the finding of no significant difference between the overall effect sizes stemming from the first and second database searches, which showed only very minor differences between the two search and selection phases.

Fourth, in an ideal dataset, each moderator level would be represented within each task, sample and/or study. In that sense, our dataset is neither ideal nor unique. To avoid the potential risk of systematic biases or increased statistical noise, only data where all levels of a moderator are represented should be used. As this would reduce the overall power of the analyses and limit the research questions that could be addressed, we decided against it.

Fifth, the approximately 3% of effect sizes that were converted from F, r, and t to g were larger than those computed from means and standard deviations. We decided to keep the converted effect sizes in the analyses because an exclusion of them only marginally modified the overall effect size and because it is in each specific case not clear why the converted effect size is larger, or on what grounds they should be excluded. However, the large number of studies used in the current meta-analysis should minimize the risk for systematic biases.

Sixth, to thoroughly investigate patterns in our data, we per- formed a considerable number of statistical tests, increasing the risk of producing spurious findings. To avoid reaching incorrect conclusions by presenting potentially unreliable findings, we de- cided to include only levels with more than five data points available in our analyses, focus on the significant effects that are in line with the theoretically based hypotheses and/or are system- atic over tasks, and disregard other effects. The result suggesting a difference between immediate and delayed recall for Movies, are outcomes that may be spurious and should be treated with caution until replicated.

Finally, although an important purpose of studying psycholog- ical processes in the laboratory is to be able to generalize to real-life human behavior, the extent to which sex differences in typical episodic memory laboratory tasks (e.g., recalling words in a word list) are generalizable to real-world episodic remembering (e.g., recalling what we did yesterday) is a question not directly assessed here. The fact that we find sex differences in the expected direction and magnitude in studies mimicking real-life memory tasks (Herlitz et al., 1997; Lewin et al., 2001; Mast & Hall, 2006) suggests that our results are generalizable to real-world remem- bering. More research specifically investigating this issue is needed before conclusions can be drawn.

Conclusions and Implications

The present meta-analysis makes several important contribu- tions to the literature. First, it is the first comprehensive meta-

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15SEX DIFFERENCES IN EPISODIC MEMORY

analysis of sex differences in episodic memory. We have summa- rized results from four decades of research, finding a general female advantage, which is modified by the material to be remem- bered; along a continuum ranging from highly verbal to highly spatial, there is a female advantage found in tasks in which verbal abilities can be utilized, whereas there is a male advantage in tasks relying more fully on spatial processing. In addition, there is a female advantage on tasks assessing memory for faces and sensory information (odor, taste, and color). These sex differences are seen across the life span, and have remained stable since 1973, although they appear to vary in magnitude both across geographical regions and the life span.

Second, besides providing descriptive information about the existence and magnitude of sex differences in episodic memory, our results also improve our understanding of the nature of these differences. As we find that the type of material to be remembered modifies the magnitude of the differences, most notably when contrasting verbal and spatial material, it is likely that the sex differences in verbal and spatial episodic memory share, to some extent, an explanation with those seen in other tasks requiring verbal and spatial processing. However, the female episodic mem- ory advantage does not appear to be merely a function of sex differences in verbal and spatial abilities, as we also show that women perform at a higher level than men on tasks falling outside this continuum, possibly indicating a more general episodic mem- ory advantage. The finding that the sex differences for verbal episodic memory tasks are smaller in childhood and old age than during other age periods, may indicate that fluctuating endogenous sex hormones contribute to the variation, but could also be an indication of accumulating environmental influences and cohort effects. Whereas we find sex differences in verbal episodic mem- ory tasks in all examined regions, pointing to the generality and robustness of the effect, we also note that the magnitude of the differences is modified by the geographical region in which the data were collected. The latter observation is in line with the notion that women may gain more than men from improvements in education, living conditions, and gender equality, resulting in greater female advantage in some cognitive abilities and smaller male advantages in others (Guiso et al., 2008; Weber et al., 2014), while still not altering the general pattern of men’s and women’s relative cognitive advantages.

Third, many studies examined in this meta-analysis used verbal episodic memory tasks, often with single-item presentation and repeated learning, a task commonly used to assess episodic mem- ory, both in the laboratory and the clinic. According to our results, women should be expected to have a non-negligible advantage over men on such tasks. Therefore, when episodic memory tasks are used to assess and compare individuals, the relative disadvan- tage of men as a group should be taken into account when eval- uating performance in these commonly used tasks.

Even though the female advantages in verbally based episodic memory tasks are reliable, they can still be considered small. Can small differences in basic cognitive abilities have cumulative im- pact on everyday life, or are these differences unimportant? Can the requirement of remembering verbal information contribute to the sex differences observed in most school subjects (Dekhtyar et al., 2018; Voyer & Voyer, 2014)? Can the relatively minor sex differences in episodic memory and other cognitive functions contribute to the observed sex segregation in educational choices,

as has been suggested (Dekhtyar et al., 2018; Jonsson, 1999; Stoet & Geary, 2018)? Although there are no definite answers at present, these questions clearly merit further research attention.

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18 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

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26 ASPERHOLM, HÖGMAN, RAFI, AND HERLITZ

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27SEX DIFFERENCES IN EPISODIC MEMORY

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Received February 22, 2018 Revision received March 15, 2019

Accepted March 17, 2019 �

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