Gender and Psychological Distress

Gender and Psychological Distress

You have probably got here because you know me, or know of this blog. However, there is just a chance you got here after a search engine search and were hoping for something helpful. So here are some links out to places that might help. My top four audience sources appear to be the UK, the USA, Russia, and France. I couldn't find an English language site in Russia and have added a world wide one instead.

UK Help https://www.samaritans.org/
USA Help https://suicidepreventionlifeline.org/
France Help http://www.soshelpline.org/ 

Worldwide https://www.befrienders.org/

I am going to start by extracting some charts from the Adult Psychiatric Morbidity Survey for England, data collection done in 2014, published in 2016. It is worth just thinking about the strengths and weaknesses of the survey.

We used to get data for the UK, but now there are different data collection and reporting regimes in the consituant countries of the UK.

It is a household survey, so various groups of people are excluded from the sample, for example prisoners, homeless people, some members of the armed forces, students living in halls of residence, people in hospital.

This is not the same as people who have accessed services, and while the survey is carefully carried out, and there is good training for the people carrying out the survey, it is not quite the same as people going through a diagnostic process.

The survey uses proper sampling techniques, so the sample is not self selecting, and with the caveats I have already mentioned is representative of the population of England.

You might want to look at the earlier examples of the survey to get some idea of trends, but be aware there are differences between precise questions asked and what categories are used.

GAD is generalised anxiety disorder, OCD is obsessive-compulsive disorder, CMD-NOS is common mental disorder not otherwise specified. Statisitical significance in the difference between men and women is found for GAD, phobias, panic disorder and CMD-NOS. The question was about symptoms in the past week.

A third (35.6%) of people identified by the survey as currently having a CMD had never been diagnosed with one. I could not see (but they may be there) any gender breakdown on that figure, which is a shame as one commonly held belief is that men are less likely to seek diagnosis.

Any sex/gender effects are much smaller than the following

Post Traumatic Stress Disorder

Overall, 3.0%of adults screened positive for current PTSD. While men were more likely than women to have experienced a trauma; there was no significant difference by sex in rates of screening positive for current PTSD (2.6%of men, 3.3%of women).

Suicide attempts

Previous surveys had  reported self harm and suicide attempts together, the current survey recognises that people self harm without intent to kill themselves.

 

This is attempts ever. I will note that women attempt suicide more often than men, and perhaps, while of course it is important that men are more likely to successfully commit suicide, the public frameworking that suicide is a male problem is perhaps unhelpful.

Explanations

There are some researchers who persue the idea that, compared to men, women are biologically vulnerable to psychological distress. Wiener et al (2014)  doi:10.1016/j.eurpsy.2013.05.006, outline this idea

“Studies have consistently shown that oxidative stress is a common feature across major psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD)”

They go on to analyse their data, finding a sex difference in oxidative stress, but their analysis led them to conclude that was not the cause of gender differences in diagnosis.

There has been work on social factors, while the paper I cite is quite old is, in my opinion, an excellent example of the genre.

Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal Of Personality And Social Psychology, 77(5), 1061-1072. doi:10.1037/0022-3514.77.5.1061

They have an impressive sample size, they used a community based (i.e. not in-patients) sample of 1,100 people aged 25-75. They were measuring depressive symptoms, not diagnosed depression.

“The results of this study suggest that women carry a triad of vulnerabilities to depressive symptoms compared to men: more chronic strain, a greater tendency to ruminate when distressed, and a lower sense of their mastery over their lives. In turn, these variables contribute to each other. So what is a depressed woman, under chronic strain and ruminating or lacking a belief that she can control her life, to do? Helping women achieve a greater sense of control over their circumstances and engage in problem solving rather than ruminating should be useful. Changing the social circumstances that many women face so that they do not have so much to ruminate about is equally important.” p1071

Taking a step back from the individual with psychological distress there are other things going on. The criteria for depression may not include the behaviours that (at least some) men engage in when depressed. Men who seek help may not get a diagnosis, with the normal caveats about memory being unreliable, when I saw a GP aged 17 because a school teacher was worried I may be depressed the GP told me that young men don't get depression, something I found very unhelpful. Less anecdotally GPs may be more likely to diagnose women, and less likely to diagnose men (Lyons and Janca 2009).

So in summary. There are differences between men and women with regard to psychological distress. In the survey cited above there is not a statistically significant difference in depression. Trying to unpick cause and effect is really difficult.