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Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis

Cavanagh, Anna BA; Wilson, Coralie J. PhD; Kavanagh, David J. PhD; Caputi, Peter PhD

doi: 10.1097/HRP.0000000000000128

Objective While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression.

Methods PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender.

Results The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges’s g = 0.26 [95% confidence interval (CI), 0.11–0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47–0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = −0.20 [95% CI, −0.33 to −0.08]), appetite disturbance/weight change (g = −0.20 [95% CI, −0.28 to −0.11]), and sleep disturbance (g = −0.11 [95% CI, −0.19 to −0.03]).

Conclusions Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.

Supplemental digital content is available in the text.

From the School of Psychology (Ms. Cavanagh and Dr. Caputi), Illawarra Health & Medical Research Institute, Graduate School of Medicine (Dr. Wilson), and Centre for Health Initiatives (Dr. Caputi), University of Wollongong; Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology (Dr. Kavanagh) (all Australia).

Supported by an Australian Postgraduate Award from the University of Wollongong (Ms. Cavanagh).

Original manuscript received 5 November 2015; revised manuscript received 21 April 2016, accepted for publication 25 May 2016.

Correspondence: Anna Cavanagh, School of Psychology, University of Wollongong, Northfields Ave., Wollongong, New South Wales 2522, Australia. Email:

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2017 President and Fellows of Harvard College
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