Journal of Abnormal Psychology 1977, Vol. 86, No. 6, 605-614
Sex Differences in the Expression of Depressive Responses on the Beck Depression Inventory Constance L. Hammen and Christine A. Padesky University of California, Los Angeles Although epidenniological data have documented sex differences in depression, the nature and origins of the differences are unclear. Depression in a large sample of young, unmarried college students was measured and described by the Beck Depression Inventory. No sex differences were found in the degree of depression experienced by these students, and yet, discriminant function analysis of the responses of the most depressed scorers yielded a significant and interpretable sex difference in the patterns of symptom expression. Depressed men were more likely to report an inability to cry, loss of social interest, a sense of failure, and somatic complaints. Women were characterized by indecisiveness and self-dislike. These patterns were not the same as sex role stereotyped responding in the total, predominantly nondepressed, sample. Speculations were made about the consequences of sex differences in depressive responses, including hypotheses about sex differences in experience with help-seeking and labeling.
Sex differences in depression are widely acknowledged. In a report on the epidemiology of depression, Lehmann (1971) asserts, "It is well known that the female-to-male ratio is about 2 : 1 for depressive illness in Europe and North America" (p. 24). Weissman and Klerman (1977) thoroughly document sex differences in primary affective disorders, and in her monograph on the epidemiology of depression, Silverman (1968) concludes: There appear to be no exceptions to the generalization that depression is more common in females than males, whether it is the feeling of depression, neurotic depression or depressive psychosis, (p. 74)
In actuality, the phenomenon appears to be far more complex than the conclusions are uniform. It is unclear whether women are in fact more depressed than men, or whether male and female experiences with depression differ in ways that lead women to express symptoms, cope with, seek help, or receive The authors are greatly indebted to Lew Bank, Christopher Barker, Saul Shiftman, Tom Wickens, and Bruce Painton for their technical assistance. Requests for reprints should be sent to Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.
labels of depression in ways different from men. A consideration of this issue is vital for the further understanding of the various forms of depression, their treatment, and prevention. Among the provocative and competing explanations for the preponderance of female depression, several have elicited considerable recent interest. Historical-sociological approaches emphasize the influence of strains and limitations in the roles for women that eventuate in depression (Bart, 1974; Chesler, 1972; Radloff, 1975; Weissman & Klerman, 1977) or, indeed, certain forms of mental illness in general (Gove & Tudor, 1973). Other approaches identify psychological mechanisms that might favor the occurrence of depression in women as a result of traditional feminine socialization: anger turned inward (Freud, 1917/1957), learned helplessness (Seligman, 1974), reinforcement of depressive behaviors such as passivity and futility (Ferster, 1974), and self-deprecating and negativistic cognitions (Beck, 1967). From a different perspective, other researchers have suggested that differences in rates of male and female depression are "artifactual" consequences of various sex role socialization experiences and stereotypes, Sex differences in depression are viewed as sex
609
610
CONSTANCE L. HAMMEN AND CHRISTINE A. PADESKY
differences in the experience and expression of depression that make women more likely to identify it in themselves, seek help for it, overtly express affective complaints, or become psychiatrically labeled and/or treated as depressed. Men may be equally depressed but do not admit depression, do not seek help . for it, or fail to be labeled by professionals as depressed. Research evidence bearing on these assertions has thus far been limited, and the results are somewhat equivocal (Broverman, Broverman, Clarkson, Rosenkrantz, & Vogel, 1970; Clancy & Gove, 1974; Phillips, 1964; Weissman & Klerman, 1977; Zigler & Phillips, 1960). The present study attempts to explore several facets of the issue of sex differences in depression. Previous research has largely focused on adult populations where role enactments of men and women typically differ markedly. The current study explored sex differences in a fairly homogenous sample of young, unmarried college students, where presumably roles, values, and expectations for men and women are relatively more similar than in other populations. The first question, therefore, was whether sex differences in degree of depression would emerge under such conditions. A second aspect of the study is the investigation of patterns of depressive responses reported by depressed women and men. Multiple factors precede the report or clinical diagnosis of depression: the actual experience of distress; its mode of expression; coping activities, including help-seeking responses; and reactions of others, including those of mental health professionals. If men and women express different symptoms of depression, there are likely to be consequences affecting each of the other factors. Sex differences in the pattern of depressive responses could therefore eventuate in differential help-seeking and diagnosis for men and women. Men and women were given the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), a clinically validated self-report instrument that samples a range of symptoms of depression. Discriminant function analysis was employed to establish whether a particular combination of items statistically differentiated between men and
women in the most depressed subsample. A similar analysis was performed for the total sample to attempt to distinguish between sex differences that stem from sex role stereotyped responding in the total population and sex differences unique to depressed men and women. Method Participants There were 972 men and 1,300 women enrolled in introductory psychology courses who volunteered to participate as part of their course requirements. The vast majority of students were single and were 18-19 years old.
Procedure In small groups, participants were administered the 21-item BDI (Beck et al, 1961), a multiplechoice self-report measure of cognitive, affective, behavioral, and somatic aspects of depression.
Results Total Sample The overall male mean depression score was S.95 (S£> = 5.74), and the overall female mean was 6.34 (SD = S.58). The difference between means was not statistically significant. A stepwise discriminant function analysis was employed to determine maximum separation of the male and female groups. Using a minimum F ratio of 1.0 as the criterion for item entry into stepwise selection, a 16-variable function was derived. Since a function including 16 of 21 possible variables is difficult to interpret meaningfully, a more stringent stopping criterion, the significance level (p < .05) of the change in Rao's V, was employed. A 9-item function resulted that was statistically significant for the large sample [Wilks's lambda =.947, X 2 (9) = 121.68, p < .0011 and had a canonical correlation with sex of .23. The probability of correct classification by sex using the discriminant function is .59. The standardized coefficients of the items in the function are reported in Table 1. It appears that, by far, the strongest loading on the function is the indecision item,
MALE AND FEMALE DEPRESSION
suggesting that discriminability between men and women in the total sample is largely accounted for by the women's reports of having a relatively more difficult time making decisions compared with men.
Table 2 Items and Standardized Discriminant Function Coefficients for the Depressed
Sample
Depressed Sample To determine whether unique patterns of expression of depression occur for women and men and whether the patterns differ from sex differences in the general sample, a depressed subsample was identified. In order to have a large enough sample for meaningful discriminant analysis (Tatsuoka, 1970), the upper 9% of the distribution of depression scores was designated, corresponding to a score of IS or above. Such individuals may be considered mildly to moderately depressed, using the labels applied to psychiatrically diagnosed inpatients and outpatients in early validation studies of the BDI (Beck et al, 1961; Metcalfe & Goldman, 196S). The sampling procedure yielded highly similar distributions of scores for men and
611
Items included"
Coefficient11
F"
Crying spells Indecisiveness Social withdrawal Somatic preoccupation Sense of failure Self-dislike Weight loss Sleep disturbance
-.565 .452 -.389 -.320 -.314 .295 -.254 -.194
11.09 6.13 3.43 2.01 2.41 2.23 3.18 1.96
0
Item descriptions are from Beck (1967, p. 189). Male means are greater on those items with negative coefficients, while female means are greater on items with positive coefficients. ° The partial multivariate F ratio is a stepwise test of the discriminatory power of items. All items are significant at p < .001. b
women. The 82 depressed men had a mean score of 19.91 (SD - 4.76), and the 118 women had a mean of 19.01 (SZ) = 4.41); the difference was not significant. The percentage distributions of scores were nearly identical, and the Smirnov test of similarity Table 1 of distributions confirmed that no significant Items and Standardized Discriminant Function differences existed. Coefficients for the Total Sample Using an F ratio of 1.0 as the minimum requirement for entry into stepwise selection, a Items included" Coefficient11 Fc statistically significant 8-item function was Indecisiveness .692 46.39 obtained from the stepwise discriminant anal.386 10.60 Weight loss ysis procedure. The function that differenti,354 11.22 Fatigability ated depressed men from depressed women -.321 9.92 Loss of appetite had a Wilks's lambda = .85, X 2 (8) =30.83, Social withdrawal -.306 17.86 p < .001. The canonical correlation of the -.253 9.76 Pessimism -.249 Lack of satisfaction 5.76 function with sex was .385. The probability Distortion of of correct classification of depressed persons body image .246 4.97 by sex, using the obtained discriminant func-.220 5.97 Irritability tion, is .69. Standardized coefficients for the Note. The following items do not appear in the discriminating items are reported in Table 2. function: mood, sense of failure, guilty feeling, sense The crying-spells item has the highest loadof punishment, self-dislike, self-accusations, suicidal ing in the depressed sample discriminant wishes, crying spells, work inhibition, sleep disfunction. Men were more likely to score turbance, somatic preoccupations, and loss of libido. highly on this item. It should be noted, howa Item descriptions are from Beck (1967, p. 189). b Male means are greater on those items with nega- ever, that 43% of the depressed men—comtive coefficients, while female means are greater on pared with 14% of the depressed women-— items with positive coefficients. selected the most extreme response, indicating c The partial multivariate F ratio is a stepwise test of the discriminatory power of items. All items are that they could no longer cry even if they wished to cry. This response, although termed significant at p < .001.
612
CONSTANCE L. HAMMEN AND CHRISTINE A. PADESKY
crying spells, seems to indicate an inability to cry among depressed men. There is a minor overlap between the depressed subsample and total sample functions. Indecisiveness (for women) and social withdrawal (for men) appear in both the total and depressed group functions, but the only other common item, weight loss, contributes to the two functions in opposite directions. In order to compare the discriminating ability of the two functions in the depressed sample, the nine items in the total sample function were used to discriminate between men and women in the depressed subsample. In the resulting analysis, the function had a canonical correlation with sex of .288 compared with the canonical correlation of .385 yielded by the depressed sample function. Thus, despite some overlap of items, the depressed subsample function appeared to yield a pattern of sex differences that was not merely the result of sex differences in the total sample. Discussion BDI scores of men and women in the present sample did not differ significantly, and the distributions of scores were quite similar. However, statistically distinct patterns of depressive responses characterized the most depressed samples of men and women. The failure to find sex differences in degree of depressive symptomatology contrasts markedly with overall findings from most incidence and prevalence studies previously reported (Silverman, 1968; Weissman & Klerman, 1977). The results may represent an actual attenuation of sex differences that reflects change in historical trends owing to altered social conditions and attitudes. Changes in depression trends are conceivable, as evidenced by recent research that suggests that it may now be the young rather than the middle-aged or old who are most depressed (e.g., Markush & Favero, 1974; Secunda, 1973). On the other hand, it may be that the observed lack of sex differences in degree of depression reflects differences between the present sample and other samples. Recent research, for example, suggests that rates of
both clinical and mood depression may vary by marital status, age, social class, education, and work status—although the mode of effect of these factors is poorby understood (e.g., Gove & Tudor, 1973; Markush & Favero, 1974; Radloff, 1975). The present sample included young, unmarried, educated, and middle-class-aspiring men and women who presumably share similar roles, expectations, and sources of stress and depression. These factors may have interacted to limit the appearance of sex differences in depression level. In view of similarities in the male and female subjects' roles and stresses, it seems all the more noteworthy that significant differences in patterns of depressive symptoms emerged. The men in the depressed subsample were statistically distinguishable from depressed women by a combination of items that included an inability to cry, loss of interest in other people, a sense of failure, and a variety of somatic responses. Such a pattern of experience and expression of depression may lead to ways of coping with depression that are quite different for men and women. For example, the men's inability to cry, social withdrawal, and sense of failure may suggest a suppression of overt depressive responses and unwillingness to seek help, with consequent limitation of opportunities for the self and others to acknowledge and define the depressive nature of the behaviors. Moreover, the somatic reactions relatively more common in depressed male respondents in the sample may contribute to a greater focus on physical rather than affective discomfort, with helpseeking activities, if any, directed toward medical relief. Not only might men's selfdefinition and self-presentation regarding depression differ from those of women, but also differential labeling might follow from their possible medical help-seeking. Prather and Fidell (1975), for example, demonstrated that medical advertisements encourage physicians to regard symptoms of depression and anxiety differently for men and women patients: Men are depicted as needing psychotropic medications because of work pressures or organic illness, while women are portrayed as needing them for vague anxiety or depression. Such findings are consistent with results from a study by Calhoun, Cheney, and
MALE AND FEMALE DEPRESSION
Dawes (1974), who reported that women tended to hold themselves more responsible for unhappy moods than did men. Thus, women and men may present themselves differently and are responded to differently, even though their experiences of depression may be similar in intensity. Although it remains speculative, the hypothesis that different patterns of symptom expression may lead to different coping and help-seeking behaviors by men and women is partially supported by recent research pertinent to the issue. Padesky and Hammen (Note 1, Note 2) found significant sex differences in severity of depression required before seeking help from various sources: Men appeared to be much more reluctant to seek help for depression in general and were more likely to report that they would never seek psychotherapy for depression. Self-reports of actual experiences in coping with depression were consistent with the men and women subjects' attitudes. The issue of generalizability of the results arises with respect to the study of college students compared with clinically depressed persons. Validational research on the BDI in college students is not available; however, the depressed students scored similarly to diagnosed groups of inpatients and outpatients considered mildly to moderately depressed (Beck et al., 1961; Metcalfe & Goldman, 196S). Beck (1967) and others (e.g., Blatt, D'Afflitti, & Quinlan, 1976) have argued for continuity of depression in mild and severe forms. It would be highly instructive to follow men and women in the depressed sample for a period of years to learn whether they continue to experience depression, its severity, and how they label and cope with the problem. Another issue of the generalizability of the results and implications arises with the use of the BDI, which is only one of several available research and clinical instruments for the assessment of depression (although probably the one most extensively employed). An additional study by the same authors (Hammen & Padesky, Note 3) that used the D30 subscale of the Minnesota Multiphasic Personality Inventory, a unidimensional depression scale derived by Dempsey (1964), found
613
very similar results. Although college men and women did not differ in degree of depression, discriminant analysis of the responses of a depressed subsample yielded a function that included a male pattern of social withdrawal and somatic and cognitive complaints. In both the present study and the D30 study, observed sex differences in patterns of responses were not mere extensions of sex role stereotyped responses that occurred in the total nondepressed samples. There was some overlap in the functions, suggesting that depression as assessed by these instruments does tap some sex role stereotyped responding. However, for the most part, the patterns in the depressed subsamples appeared not to be accentuations of stereotyped responding, but rather reflected sex differences in the expression of depressive responses. The results of the present study of a large sample of depressed first-year college students reinforce efforts to clarify the origins of sex differences in depression that may occur at different points: in experience, expression, coping, help-seeking, and labeling. Viewed from this perspective, many of the alternative approaches for explaining sex differences are not necessarily incompatible, since each may contribute to the final outcome. In addition to the present results, which yielded a pattern of depressive responses suggestive of different consequences for the male or female individual, other research is underway to investigate additional aspects of the process. For example, Hammen and Peters (1977) found that the consequences of display of depression symptoms are more negative for men than women. Depressed men were judged more harshly and seen as more impaired than depressed women for display of the same behaviors. Such results, as well as those of the present study, suggest a complex set of factors that affect depressive responding—factors that appear to be well established even in the relatively young populations studied. Reference Notes 1. Padesky, C., & Hammen, C. Help-seeking for depression: Sex differences in college students. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.)
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CONSTANCE L. HAMMEN AND CHRISTINE A. PADESKY
2. Padesky, C., & Hammen C. Pattern of coping with depression. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.) 3. Hammen, C., & Padesky, C. Sex differences in depressive symptom expression among college students. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.)
References Bart, P. B. The sociology of depression. In P. Roman & H. Trice (Eds.), Explorations in psychiatric sociology. Philadelphia, Pa.: F. A. Davis, 1974. Beck, A. T. Depression: Clinical, experimental, and theoretical aspects. Philadelphia: University of Pennsylvania Press, 1967. Beck, A. T., Ward, C. H, Mendelson, M., Mock, J., & Erbaugh, J. An inventory for measuring depression. Archives oj General. Psychiatry, 1961, 4, 53-63. Blatt, S. J., D'Afflitti, J. P., & Quinlan, D. M. Experiences of depression in normal young adults. Journal of Abnormal Psychology, 1976, 85, 383389. Broverman, I., Broverman, D., Clarkson, F., Rosenkrantz, P., & Vogel, S. Sex role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 1970, 34, 1-7. Calhoun, L., Cheney, T., & Dawes, A. S. Locus of control, self-reported depression, and perceived causes of depression. Journal of Consulting and Clinical Psychology, 1974, 42, 736. Chesler, P. Women and madness. New York: Doubleday, 1972. Clancy, A., & Gove, W. Sex differences in mental illness: An analysis of response bias in self-reports. American Journal of Sociology, 1974, 80, 20S-216. Dempsey, P. A. A Unidimensional depression scale for the MMPL Journal of Consulting Psychology, 1964, 28, 364-370. Ferster, C. B. Behavioral approaches to depression. In R. J. Friedman & M. S. Katz (Eds.), The psychology oj depression: Contemporary theory and research. Washington, D.C.: Winston/Wiley, 1974. Freud, S. [Mourning and melancholia.] In J. Strachey (Ed. and trans.), Standard edition oj the complete psychological works oj Sigmund Freud (Vol. 14). London: Hogarth Press, 1957. (Originally published, 1917.)
Gove, W., & Tudor, J. Adult sex roles and mental illness. American Journal oj Sociology, 1973, 78, 812-835. Hammen, C., & Peters, S. D. Differential responses to male and female depressive reactions. Journal oj Consulting and Clinical Psychology, 1977, 45, 9941001. Lehmann, H. J. Epidemiology of depressive disorders. In R. Fieve (Ed.), Depression in the l°70's: Modern theory and research. Amsterdam, The Netherlands: Excerpta Medica, 1971. Markush, R. E., & Favero, R. V. Epidemiologic assessment of stressful life events, depressed mood, and psychophysiological symptoms—A preliminary report. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressjul lije events: Their nature and effects. New York: Wiley, 1974. Metcalfe, M., & Goldman, E. Validation of an inventory for measuring depression. British Journal of Psychiatry, 1965, 111, 240-242. Phillips, D. L. Rejection of the mentally ill: The influence of behavior and sex. American Sociological Review, 1964, 29, 679-687. Prattler, J., & Fidell, L. Sex differences in the content and style of medical advertisements. Social Science and Medicine, 1975, 9, 23-26. Radloff, L. Sex differences in depression: The effects of occupation and marital status. Sex Roles, 1975, 1, 249-265. Secunda, S. K. Special Report 1973: The depressive disorders. Rockville, Md.: Clinical Research Branch, National Institute of Mental Health, 1973. Seligman, M. E. P. Depression and learned helplessness. In R. J. Friedman & M. M. Katz (Eds.), The psychology oj depression: Contemporary theory and research. Washington, D.C.: Winston/Wiley, 1974. Silverman, C. The epidemiology oj depression. Baltimore, Md.: Johns Hopkins University Press, 1968. Tatsuoka, M. M. Selected topics in advanced statistics (No. 6 ) : Discriminant analysis. Champaign, 111.: Institute for Personality and Ability Testing, 1970. Weissman, M., & Klerman, G. Sex differences and the epidemiology of depression. Archives oj General Psychiatry, 1977, 34, 98-111. Zigler, E., & Phillips, L. Social effectiveness and symptomatic behavior. Journal oj Abnormal and Social Psychology, I960, 61, 231-238. Received September 17, 1976 Revision received September 3, 1977 »
Sex Differences in the Expression of Depressive Responses on the Beck Depression Inventory Constance L. Hammen and Christine A. Padesky University of California, Los Angeles Although epidenniological data have documented sex differences in depression, the nature and origins of the differences are unclear. Depression in a large sample of young, unmarried college students was measured and described by the Beck Depression Inventory. No sex differences were found in the degree of depression experienced by these students, and yet, discriminant function analysis of the responses of the most depressed scorers yielded a significant and interpretable sex difference in the patterns of symptom expression. Depressed men were more likely to report an inability to cry, loss of social interest, a sense of failure, and somatic complaints. Women were characterized by indecisiveness and self-dislike. These patterns were not the same as sex role stereotyped responding in the total, predominantly nondepressed, sample. Speculations were made about the consequences of sex differences in depressive responses, including hypotheses about sex differences in experience with help-seeking and labeling.
Sex differences in depression are widely acknowledged. In a report on the epidemiology of depression, Lehmann (1971) asserts, "It is well known that the female-to-male ratio is about 2 : 1 for depressive illness in Europe and North America" (p. 24). Weissman and Klerman (1977) thoroughly document sex differences in primary affective disorders, and in her monograph on the epidemiology of depression, Silverman (1968) concludes: There appear to be no exceptions to the generalization that depression is more common in females than males, whether it is the feeling of depression, neurotic depression or depressive psychosis, (p. 74)
In actuality, the phenomenon appears to be far more complex than the conclusions are uniform. It is unclear whether women are in fact more depressed than men, or whether male and female experiences with depression differ in ways that lead women to express symptoms, cope with, seek help, or receive The authors are greatly indebted to Lew Bank, Christopher Barker, Saul Shiftman, Tom Wickens, and Bruce Painton for their technical assistance. Requests for reprints should be sent to Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.
labels of depression in ways different from men. A consideration of this issue is vital for the further understanding of the various forms of depression, their treatment, and prevention. Among the provocative and competing explanations for the preponderance of female depression, several have elicited considerable recent interest. Historical-sociological approaches emphasize the influence of strains and limitations in the roles for women that eventuate in depression (Bart, 1974; Chesler, 1972; Radloff, 1975; Weissman & Klerman, 1977) or, indeed, certain forms of mental illness in general (Gove & Tudor, 1973). Other approaches identify psychological mechanisms that might favor the occurrence of depression in women as a result of traditional feminine socialization: anger turned inward (Freud, 1917/1957), learned helplessness (Seligman, 1974), reinforcement of depressive behaviors such as passivity and futility (Ferster, 1974), and self-deprecating and negativistic cognitions (Beck, 1967). From a different perspective, other researchers have suggested that differences in rates of male and female depression are "artifactual" consequences of various sex role socialization experiences and stereotypes, Sex differences in depression are viewed as sex
609
610
CONSTANCE L. HAMMEN AND CHRISTINE A. PADESKY
differences in the experience and expression of depression that make women more likely to identify it in themselves, seek help for it, overtly express affective complaints, or become psychiatrically labeled and/or treated as depressed. Men may be equally depressed but do not admit depression, do not seek help . for it, or fail to be labeled by professionals as depressed. Research evidence bearing on these assertions has thus far been limited, and the results are somewhat equivocal (Broverman, Broverman, Clarkson, Rosenkrantz, & Vogel, 1970; Clancy & Gove, 1974; Phillips, 1964; Weissman & Klerman, 1977; Zigler & Phillips, 1960). The present study attempts to explore several facets of the issue of sex differences in depression. Previous research has largely focused on adult populations where role enactments of men and women typically differ markedly. The current study explored sex differences in a fairly homogenous sample of young, unmarried college students, where presumably roles, values, and expectations for men and women are relatively more similar than in other populations. The first question, therefore, was whether sex differences in degree of depression would emerge under such conditions. A second aspect of the study is the investigation of patterns of depressive responses reported by depressed women and men. Multiple factors precede the report or clinical diagnosis of depression: the actual experience of distress; its mode of expression; coping activities, including help-seeking responses; and reactions of others, including those of mental health professionals. If men and women express different symptoms of depression, there are likely to be consequences affecting each of the other factors. Sex differences in the pattern of depressive responses could therefore eventuate in differential help-seeking and diagnosis for men and women. Men and women were given the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), a clinically validated self-report instrument that samples a range of symptoms of depression. Discriminant function analysis was employed to establish whether a particular combination of items statistically differentiated between men and
women in the most depressed subsample. A similar analysis was performed for the total sample to attempt to distinguish between sex differences that stem from sex role stereotyped responding in the total population and sex differences unique to depressed men and women. Method Participants There were 972 men and 1,300 women enrolled in introductory psychology courses who volunteered to participate as part of their course requirements. The vast majority of students were single and were 18-19 years old.
Procedure In small groups, participants were administered the 21-item BDI (Beck et al, 1961), a multiplechoice self-report measure of cognitive, affective, behavioral, and somatic aspects of depression.
Results Total Sample The overall male mean depression score was S.95 (S£> = 5.74), and the overall female mean was 6.34 (SD = S.58). The difference between means was not statistically significant. A stepwise discriminant function analysis was employed to determine maximum separation of the male and female groups. Using a minimum F ratio of 1.0 as the criterion for item entry into stepwise selection, a 16-variable function was derived. Since a function including 16 of 21 possible variables is difficult to interpret meaningfully, a more stringent stopping criterion, the significance level (p < .05) of the change in Rao's V, was employed. A 9-item function resulted that was statistically significant for the large sample [Wilks's lambda =.947, X 2 (9) = 121.68, p < .0011 and had a canonical correlation with sex of .23. The probability of correct classification by sex using the discriminant function is .59. The standardized coefficients of the items in the function are reported in Table 1. It appears that, by far, the strongest loading on the function is the indecision item,
MALE AND FEMALE DEPRESSION
suggesting that discriminability between men and women in the total sample is largely accounted for by the women's reports of having a relatively more difficult time making decisions compared with men.
Table 2 Items and Standardized Discriminant Function Coefficients for the Depressed
Sample
Depressed Sample To determine whether unique patterns of expression of depression occur for women and men and whether the patterns differ from sex differences in the general sample, a depressed subsample was identified. In order to have a large enough sample for meaningful discriminant analysis (Tatsuoka, 1970), the upper 9% of the distribution of depression scores was designated, corresponding to a score of IS or above. Such individuals may be considered mildly to moderately depressed, using the labels applied to psychiatrically diagnosed inpatients and outpatients in early validation studies of the BDI (Beck et al, 1961; Metcalfe & Goldman, 196S). The sampling procedure yielded highly similar distributions of scores for men and
611
Items included"
Coefficient11
F"
Crying spells Indecisiveness Social withdrawal Somatic preoccupation Sense of failure Self-dislike Weight loss Sleep disturbance
-.565 .452 -.389 -.320 -.314 .295 -.254 -.194
11.09 6.13 3.43 2.01 2.41 2.23 3.18 1.96
0
Item descriptions are from Beck (1967, p. 189). Male means are greater on those items with negative coefficients, while female means are greater on items with positive coefficients. ° The partial multivariate F ratio is a stepwise test of the discriminatory power of items. All items are significant at p < .001. b
women. The 82 depressed men had a mean score of 19.91 (SD - 4.76), and the 118 women had a mean of 19.01 (SZ) = 4.41); the difference was not significant. The percentage distributions of scores were nearly identical, and the Smirnov test of similarity Table 1 of distributions confirmed that no significant Items and Standardized Discriminant Function differences existed. Coefficients for the Total Sample Using an F ratio of 1.0 as the minimum requirement for entry into stepwise selection, a Items included" Coefficient11 Fc statistically significant 8-item function was Indecisiveness .692 46.39 obtained from the stepwise discriminant anal.386 10.60 Weight loss ysis procedure. The function that differenti,354 11.22 Fatigability ated depressed men from depressed women -.321 9.92 Loss of appetite had a Wilks's lambda = .85, X 2 (8) =30.83, Social withdrawal -.306 17.86 p < .001. The canonical correlation of the -.253 9.76 Pessimism -.249 Lack of satisfaction 5.76 function with sex was .385. The probability Distortion of of correct classification of depressed persons body image .246 4.97 by sex, using the obtained discriminant func-.220 5.97 Irritability tion, is .69. Standardized coefficients for the Note. The following items do not appear in the discriminating items are reported in Table 2. function: mood, sense of failure, guilty feeling, sense The crying-spells item has the highest loadof punishment, self-dislike, self-accusations, suicidal ing in the depressed sample discriminant wishes, crying spells, work inhibition, sleep disfunction. Men were more likely to score turbance, somatic preoccupations, and loss of libido. highly on this item. It should be noted, howa Item descriptions are from Beck (1967, p. 189). b Male means are greater on those items with nega- ever, that 43% of the depressed men—comtive coefficients, while female means are greater on pared with 14% of the depressed women-— items with positive coefficients. selected the most extreme response, indicating c The partial multivariate F ratio is a stepwise test of the discriminatory power of items. All items are that they could no longer cry even if they wished to cry. This response, although termed significant at p < .001.
612
CONSTANCE L. HAMMEN AND CHRISTINE A. PADESKY
crying spells, seems to indicate an inability to cry among depressed men. There is a minor overlap between the depressed subsample and total sample functions. Indecisiveness (for women) and social withdrawal (for men) appear in both the total and depressed group functions, but the only other common item, weight loss, contributes to the two functions in opposite directions. In order to compare the discriminating ability of the two functions in the depressed sample, the nine items in the total sample function were used to discriminate between men and women in the depressed subsample. In the resulting analysis, the function had a canonical correlation with sex of .288 compared with the canonical correlation of .385 yielded by the depressed sample function. Thus, despite some overlap of items, the depressed subsample function appeared to yield a pattern of sex differences that was not merely the result of sex differences in the total sample. Discussion BDI scores of men and women in the present sample did not differ significantly, and the distributions of scores were quite similar. However, statistically distinct patterns of depressive responses characterized the most depressed samples of men and women. The failure to find sex differences in degree of depressive symptomatology contrasts markedly with overall findings from most incidence and prevalence studies previously reported (Silverman, 1968; Weissman & Klerman, 1977). The results may represent an actual attenuation of sex differences that reflects change in historical trends owing to altered social conditions and attitudes. Changes in depression trends are conceivable, as evidenced by recent research that suggests that it may now be the young rather than the middle-aged or old who are most depressed (e.g., Markush & Favero, 1974; Secunda, 1973). On the other hand, it may be that the observed lack of sex differences in degree of depression reflects differences between the present sample and other samples. Recent research, for example, suggests that rates of
both clinical and mood depression may vary by marital status, age, social class, education, and work status—although the mode of effect of these factors is poorby understood (e.g., Gove & Tudor, 1973; Markush & Favero, 1974; Radloff, 1975). The present sample included young, unmarried, educated, and middle-class-aspiring men and women who presumably share similar roles, expectations, and sources of stress and depression. These factors may have interacted to limit the appearance of sex differences in depression level. In view of similarities in the male and female subjects' roles and stresses, it seems all the more noteworthy that significant differences in patterns of depressive symptoms emerged. The men in the depressed subsample were statistically distinguishable from depressed women by a combination of items that included an inability to cry, loss of interest in other people, a sense of failure, and a variety of somatic responses. Such a pattern of experience and expression of depression may lead to ways of coping with depression that are quite different for men and women. For example, the men's inability to cry, social withdrawal, and sense of failure may suggest a suppression of overt depressive responses and unwillingness to seek help, with consequent limitation of opportunities for the self and others to acknowledge and define the depressive nature of the behaviors. Moreover, the somatic reactions relatively more common in depressed male respondents in the sample may contribute to a greater focus on physical rather than affective discomfort, with helpseeking activities, if any, directed toward medical relief. Not only might men's selfdefinition and self-presentation regarding depression differ from those of women, but also differential labeling might follow from their possible medical help-seeking. Prather and Fidell (1975), for example, demonstrated that medical advertisements encourage physicians to regard symptoms of depression and anxiety differently for men and women patients: Men are depicted as needing psychotropic medications because of work pressures or organic illness, while women are portrayed as needing them for vague anxiety or depression. Such findings are consistent with results from a study by Calhoun, Cheney, and
MALE AND FEMALE DEPRESSION
Dawes (1974), who reported that women tended to hold themselves more responsible for unhappy moods than did men. Thus, women and men may present themselves differently and are responded to differently, even though their experiences of depression may be similar in intensity. Although it remains speculative, the hypothesis that different patterns of symptom expression may lead to different coping and help-seeking behaviors by men and women is partially supported by recent research pertinent to the issue. Padesky and Hammen (Note 1, Note 2) found significant sex differences in severity of depression required before seeking help from various sources: Men appeared to be much more reluctant to seek help for depression in general and were more likely to report that they would never seek psychotherapy for depression. Self-reports of actual experiences in coping with depression were consistent with the men and women subjects' attitudes. The issue of generalizability of the results arises with respect to the study of college students compared with clinically depressed persons. Validational research on the BDI in college students is not available; however, the depressed students scored similarly to diagnosed groups of inpatients and outpatients considered mildly to moderately depressed (Beck et al., 1961; Metcalfe & Goldman, 196S). Beck (1967) and others (e.g., Blatt, D'Afflitti, & Quinlan, 1976) have argued for continuity of depression in mild and severe forms. It would be highly instructive to follow men and women in the depressed sample for a period of years to learn whether they continue to experience depression, its severity, and how they label and cope with the problem. Another issue of the generalizability of the results and implications arises with the use of the BDI, which is only one of several available research and clinical instruments for the assessment of depression (although probably the one most extensively employed). An additional study by the same authors (Hammen & Padesky, Note 3) that used the D30 subscale of the Minnesota Multiphasic Personality Inventory, a unidimensional depression scale derived by Dempsey (1964), found
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very similar results. Although college men and women did not differ in degree of depression, discriminant analysis of the responses of a depressed subsample yielded a function that included a male pattern of social withdrawal and somatic and cognitive complaints. In both the present study and the D30 study, observed sex differences in patterns of responses were not mere extensions of sex role stereotyped responses that occurred in the total nondepressed samples. There was some overlap in the functions, suggesting that depression as assessed by these instruments does tap some sex role stereotyped responding. However, for the most part, the patterns in the depressed subsamples appeared not to be accentuations of stereotyped responding, but rather reflected sex differences in the expression of depressive responses. The results of the present study of a large sample of depressed first-year college students reinforce efforts to clarify the origins of sex differences in depression that may occur at different points: in experience, expression, coping, help-seeking, and labeling. Viewed from this perspective, many of the alternative approaches for explaining sex differences are not necessarily incompatible, since each may contribute to the final outcome. In addition to the present results, which yielded a pattern of depressive responses suggestive of different consequences for the male or female individual, other research is underway to investigate additional aspects of the process. For example, Hammen and Peters (1977) found that the consequences of display of depression symptoms are more negative for men than women. Depressed men were judged more harshly and seen as more impaired than depressed women for display of the same behaviors. Such results, as well as those of the present study, suggest a complex set of factors that affect depressive responding—factors that appear to be well established even in the relatively young populations studied. Reference Notes 1. Padesky, C., & Hammen, C. Help-seeking for depression: Sex differences in college students. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.)
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2. Padesky, C., & Hammen C. Pattern of coping with depression. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.) 3. Hammen, C., & Padesky, C. Sex differences in depressive symptom expression among college students. Unpublished manuscript, 1977. (Available from Constance L. Hammen, Department of Psychology, University of California, Los Angeles, California 90024.)
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