Geschlechtsspezifische Aspekte bei depressiven Erkrankungen

Leitthema

Zusammenfassung

Die Depression zählt zu den häufigsten Krankheiten und geht mit einer erheblichen Beeinträchtigung der Lebensqualität einher. In der vorliegenden Übersichtsarbeit sollen geschlechtsspezifische Unterschiede bei der Depression im Symptommuster, Erkrankungsverlauf, hinsichtlich der Komorbidität, bei biologischen und psychosozialen Faktoren, im Einfluss der Geschlechterrolle, im Hilfesuchverhalten und der Emotionsregulierung sowie der Arzt-Patient-Kommunikation dargestellt werden. Frauen erkranken im Vergleich zu Männern fast doppelt so häufig an einer Depression. Der Verlauf ist schwerer. Auch leiden Frauen häufiger unter begleitenden Ängsten. Andererseits sind die Suizidraten für Männer um das 3- bis 5-Fache erhöht, und bei ihnen zählt Alkoholabusus zu den häufigsten Begleiterkrankungen. Bei Männern und Frauen gibt es verschiedene Symptommuster der Depression. Hinweise auf eine männer- und eine frauenspezifische Depression sind allerdings bisher widersprüchlich. Die sozial vermittelten Geschlechterrollen, die mit biologischen Faktoren auf komplexe Weise interagieren, beeinflussen bei Männern und Frauen das Erkrankungsrisiko, das Krankheitsverhalten und die Bewältigung der Depression. Die Bedeutung von Gender für die Definition und den Umgang mit der Depression und die gendersensiblen Anforderungen, die sich für das Gesundheitssystem daraus ergeben, werden bisher zu wenig beachtet.

Schlüsselwörter

Depression Gender Geschlechtsspezifische Unterschiede Geschlechterrollen 

Gender differences in depression

Abstract

Depression is one of the most prevalent and debilitating diseases. In recent years there has been increased awareness of sex- and gender-specific issues in depression. This narrative review presents and discusses differences in prevalence, symptom profile, age at onset and course, comorbidity, biological and psychosocial factors, the impact of sexual stereotyping, help-seeking, emotion regulation and doctor–patient communication. Typically, women are diagnosed with depression twice as often as men, and their disease follows a more chronic course. Comorbid anxiety is more prevalent in women, whereas comorbid alcohol abuse is a major concern in men. Sucide rates for men are between three and five times higher compared with women. Although there are different symptom profiles in men and women, it is difficult to define a gender-specific symptom profile. Socially mediated gender roles have a significant impact on psychosocial factors associated with risk, sickness behavior and coping strategies. In general, too little attention has been paid to the definition and handling of depression and the gender-related requirements it makes on the healthcare system.

Keywords

Depression Gender Gender differences Sexual stereotyping 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Karger gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg) (2009) für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression-Langfassung, 1. Aufl. DGPPN, ÄZQ, AWMF, BerlinGoogle Scholar
  2. 2.
    Wittchen H-U, Jacobi F, Rehm J et al (2011) The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21:655–679PubMedCrossRefGoogle Scholar
  3. 3.
    Busch MA, Maske UE, Ryl L, Schlack R, Hapke U (2013) Prävalenz von depressiver Symptomatik und diagnostizierter Depression bei Erwachsenen in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 56:733–739CrossRefGoogle Scholar
  4. 4.
    Vos T, Flaxman AD, Naghavi M et al (2013) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Bertakis KD, Helms LJ, Callahan EJ, Azari R, Leigh P, Robbins JA (2001) Patient gender differences in the diagnosis of depression in primary care. J Womens Health Gend Based Med 10:689–698PubMedCrossRefGoogle Scholar
  7. 7.
    Piccinelli M, Wilkinson G (2000) Gender differences in depression. Critical review. Br J Psychiatry 177:486–492PubMedCrossRefGoogle Scholar
  8. 8.
    Kuehner C (2003) Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr Scand 108:163–174PubMedCrossRefGoogle Scholar
  9. 9.
    Addis ME (2008) Gender and depression in men. Clin Psychol Sci Pract 15:153–168CrossRefGoogle Scholar
  10. 10.
    Baumeister H, Parker G (2012) Meta-review of depressive subtyping models. J Affect Disord 139:126–140CrossRefGoogle Scholar
  11. 11.
    Saß H, Wittchen HU, Zaudig M, Houben J (2003) Diagnostisches und Statistisches Manual Psychischer Störungen-Textrevision (DSM-IV-TR). Hogrefe, GöttingenGoogle Scholar
  12. 12.
    Parker G (2005) Beyond major depression. Psychol Med 35:467–474PubMedCrossRefGoogle Scholar
  13. 13.
    Schuch JJ, Roest AM, Nolen WA, Penninx BW, de Jonge P (2013) Gender differences in major depressive disorder: results from the Netherlands study of depression and anxiety. J Affect Disord 156:156–163Google Scholar
  14. 14.
    Rodgers S, Grosse Holtforth M, Müller M, Hengartner MP, Rössler W, Ajdacic-Gross V (2013) Symptom-based subtypes of depression and their psychosocial correlates: a person-centered approach focusing on the influence of sex. J Affect Disord 156:92–103Google Scholar
  15. 15.
    Marcus SM, Young EA, Kerber KB et al (2005) Gender differences in depression: findings from the STAR* D study. J Affect Disord 87:141–150PubMedCrossRefGoogle Scholar
  16. 16.
    Essau CA, Lewinsohn PM, Seeley JR, Sasagawa S (2010) Gender differences in the developmental course of depression. J Affect Disord 127:185–190PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Kessler RC (2003) Epidemiology of women and depression. J Affect Disord 74(1):5–13PubMedCrossRefGoogle Scholar
  18. 18.
    Rutz W, von Knorring L, Pihlgren H, Rihmer Z, Wålinder J (1995) Prevention of male suicides: lessons from Gotland study. Lancet 345:524PubMedCrossRefGoogle Scholar
  19. 19.
    Cochran SV, Rabinowitz FE (2000) Men and depression: clinical and empirical perspectives. Academic, San Diego, CAGoogle Scholar
  20. 20.
    Möller-Leimkühler AM (2009) Männer, Depression und „männliche Depression“. Fortschr Neurol Psychiatr 77:412–422PubMedCrossRefGoogle Scholar
  21. 21.
    Innamorati M, Pompili M, Gonda X et al (2011) Psychometric properties of the Gotland Scale for Depression in Italian psychiatric inpatients and its utility in the prediction of suicide risk. J Affect Disord 132:99–103PubMedCrossRefGoogle Scholar
  22. 22.
    Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM (2013) Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men. J Affect Disord 151:950–958PubMedCrossRefGoogle Scholar
  23. 23.
    Möller-Leimkühler AM, Yücel M (2010) Male depression in females? J Affect Disord 121:22–29PubMedCrossRefGoogle Scholar
  24. 24.
    Hunt K, Sweeting H, Keoghan M, Platt S (2006) Sex, gender role orientation, gender role attitudes and suicidal thoughts in three generations. Soc Psychiatry Psychiatr Epidemiol 41:641–647PubMedCrossRefGoogle Scholar
  25. 25.
    Martin LA, Neighbors HW, Griffith DM (2013) The experience of symptoms of depression in men vs women: analysis of the national comorbidity survey replication. JAMA Psychiatry 70:1100–1106PubMedCrossRefGoogle Scholar
  26. 26.
    Sullivan PF, Neale MC, Kendler KS (2000) Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 157:1552–1562PubMedCrossRefGoogle Scholar
  27. 27.
    Miller LJ (2002) Postpartum depression. JAMA 287(6):762–765PubMedCrossRefGoogle Scholar
  28. 28.
    Noble T (2005) Depression in women. Metabolism 54(Suppl 1):49–52PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson JM, Nachtigall LB, Stern TA (2013) The effect of testosterone levels on mood in men: a review. Psychosomatics 54:509–514PubMedCrossRefGoogle Scholar
  30. 30.
    McEwen BS (2003) Mood disorders and allostatic load. Biol Psychiatry 54:200–207PubMedCrossRefGoogle Scholar
  31. 31.
    Kudielka BM, Kirschbaum C (2005) Sex differences in HPA axis responses to stress: a review. Biol Psychol 69:113–132. Zugegriffen 17. März 2014PubMedCrossRefGoogle Scholar
  32. 32.
    Müters S, Hoebel J, Lange C (2013) Diagnose Depression: Unterschiede bei Frauen und Männern. (Hrsg. Robert-Koch-Institut Berlin) GBE kompakt.http://www.rki.de/gbe-kompakt
  33. 33.
    Dalgard OS, Dowrick C, Lehtinen V et al (2006) Negative life events, social support and gender difference in depression. Soc Psychiatry Psychiatr Epidemiol 41:444–451PubMedCrossRefGoogle Scholar
  34. 34.
    Schlack R, Rüdel J, Karger A, Hölling H (2013) Körperliche und psychische Gewalterfahrungen in der deutschen Erwachsenenbevölkerung – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 56(5/6):755–764CrossRefGoogle Scholar
  35. 35.
    Caldwell JE, Swan SC, Woodbrown VD (2012) Gender differences in intimate partner violence outcomes. Psychol Violence 2(1):42–57CrossRefGoogle Scholar
  36. 36.
    Beydoun HA, Beydoun MA, Kaufman JS, Lo B, Zonderman AB (2013) Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: a systematic review and meta-analysis. Soc Sci Med 75:959–975CrossRefGoogle Scholar
  37. 37.
    Middlebrooks JS, Audage NC (2008) The effects of childhood stress on health across the lifespan. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, AtlantaGoogle Scholar
  38. 38.
    Egeland JA, Hostetter AM (1983) Amish Study: I. Affective disorders among the Amish 1976–1980. Am J Psychiatry 140(1):56–61Google Scholar
  39. 39.
    Luy M (2003) Causes of male excess mortality: insights from cloistered populations. Popul Dev Rev 29:647–676CrossRefGoogle Scholar
  40. 40.
    Steins G (2010) Handbuch Psychologie und Geschlechterforschung. VS, Verlag für Sozialwissenschaften, WiesbadenGoogle Scholar
  41. 41.
    Kasten H (2003) Weiblich-männlich. Reinhardt, MünchenGoogle Scholar
  42. 42.
    Courtenay WH (2000) Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 50:1385–1401PubMedCrossRefGoogle Scholar
  43. 43.
    Smiler AP (2004) Thirty years after the discovery of gender: psychological concepts and measures of masculinity. Sex Roles 50:15–26CrossRefGoogle Scholar
  44. 44.
    Bem SL (1981) Gender schema theory: a cognitive account of sex typing. Psychol Rev 88:354CrossRefGoogle Scholar
  45. 45.
    O’Neil JM, Good GE, Holmes S (1995) Fifteen years of theory and research on men’s gender role conflict: new paradigms for empirical research. In: Levant RF, Pollack WS (Hrsg) A new psychology of men. Basic Books, New York, S 164–206Google Scholar
  46. 46.
    Martire LM, Stephens MAP, Townsend AL (2000) Centrality of women’s multiple roles: beneficial and detrimental consequences for psychological well-being. Psychol Aging 15:148PubMedCrossRefGoogle Scholar
  47. 47.
    Lademann J, Kolip P (2005) Gesundheit von Frauen und Männern im mittleren Lebensalter. Robert-Koch-Institut, BerlinGoogle Scholar
  48. 48.
    Layte R, Maître B, Whelan CT (2010) Second European quality of life survey: living conditions, social exclusion and mental well-being. European Foundation for the Improvement of Living and Working Conditions, BrüsselGoogle Scholar
  49. 49.
    Galdas PM, Cheater F, Marshall P (2005) Men and health help‐seeking behaviour: literature review. J Adv Nurs 49:616–623PubMedCrossRefGoogle Scholar
  50. 50.
    Albani C, Blaser G, Rusch B-D, Brähler E (2013) Einstellungen zu Psychotherapie. Psychotherapeut 58:466–473CrossRefGoogle Scholar
  51. 51.
    Plant EA, Hyde JS, Keltner D, Devine PG (2000) The gender stereotyping of emotions. Psychol Women Q 24:81–92CrossRefGoogle Scholar
  52. 52.
    Ciarrochi J, Hynes K, Crittenden N (2005) Can men do better if they try harder: sex and motivational effects on emotional awareness. Cogn Emot 19:133–141CrossRefGoogle Scholar
  53. 53.
    Zahn-Waxler C, Shirtcliff EA, Marceau K (2008) Disorders of childhood and adolescence: gender and psychopathology. Annu Rev Clin Psychol 4:275–303PubMedCrossRefGoogle Scholar
  54. 54.
    Joseph DL, Newman DA (2010) Emotional intelligence: an integrative meta-analysis and cascading model. J Appl Psychol 95:54PubMedCrossRefGoogle Scholar
  55. 55.
    Tamres LK, Janicki D, Helgeson VS (2002) Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev 6:2–30CrossRefGoogle Scholar
  56. 56.
    Else-Quest NM, Higgins A, Allison C, Morton LC (2012) Gender differences in self-conscious emotional experience: a meta-analysis. Psychol Bull 138:947PubMedCrossRefGoogle Scholar
  57. 57.
    Park CL, Levenson MR (2002) Drinking to cope among college students: prevalence, problems and coping processes. J Stud Alcohol Drugs 63:486Google Scholar
  58. 58.
    Nolen-Hoeksema S (2012) Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol 8:161–87PubMedCrossRefGoogle Scholar
  59. 59.
    Hammen C (1991) Generation of stress in the course of unipolar depression. J Abnorm Psychol 100:555PubMedCrossRefGoogle Scholar
  60. 60.
    Liu RT, Alloy LB (2010) Stress generation in depression: a systematic review of the empirical literature and recommendations for future study. Clin Psychol Rev 30:582–593PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Roter DL, Hall JA, Aoki Y (2002) Physician gender effects in medical communication: a meta-analytic review. JAMA 288:756–764PubMedCrossRefGoogle Scholar
  62. 62.
    Sandhu H, Adams A, Singleton L, Clark-Carter D, Kidd J (2009) The impact of gender dyads on doctor – patient communication: a systematic review. Patient Educ Couns 76:348–355PubMedCrossRefGoogle Scholar
  63. 63.
    Roter DL (2014) Talking about depression: an analogue study of physician gender and communication style on patient disclosure. Manuscript under reviewGoogle Scholar
  64. 64.
    Flanagan EH, Blashfield RK (2005) Gender acts as a context for interpreting diagnostic criteria. J Clin Psychol 61:1485–1498PubMedCrossRefGoogle Scholar
  65. 65.
    Lyons Z, Janca A (2009) Diagnosis of male depression – does general practitioner gender play a part? Aust Fam Physician 38:743PubMedGoogle Scholar
  66. 66.
    Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A (2007) Recognition of depression by non psychiatric physicians. A systematic literature review and meta-analysis. J Gen Intern Med 23(1):25–36PubMedCentralPubMedCrossRefGoogle Scholar
  67. 67.
    Oliffe JL, Phillips MJ (2008) Men, depression and masculinities: a review and recommendations. J Mens Health 5:194–202CrossRefGoogle Scholar
  68. 68.
    Teuber N (2011) Das Geschlecht der Depression. „Weiblichkeit“ und „Männlichkeit“ in der Konzeptualisierung depressiver Störungen. Transcript, BielefeldGoogle Scholar
  69. 69.
    Karger A (2012) Sind Männer anders depressiv? Ärztl Psychother Psychosom Med 7:224–229Google Scholar
  70. 70.
    Mahalik JR, Locke BD, Ludlow LH et al (2003) Development of the conformity to masculine norms inventory. Psychol Men Masc 4:3CrossRefGoogle Scholar
  71. 71.
    Wålinder J, Rutz W (2001) Male depression and suicide. Int Clin Psychopharmacol 16:S21–S24Google Scholar
  72. 72.
    Grace SL, Yee J, Reid RD, Stewart DE (2013) Measurement of depressive symptoms among cardiac patients: should sex differences be considered? J Health Psychol 19(7):943–952Google Scholar
  73. 73.
    Möller Leimkühler A, Heller J, Paulus N-C (2007) Subjective well-being and male depression in male adolescents. J Affect Disord 98:65–72PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinisches Institut für Psychosomatische Medizin und PsychotherapieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

Personalised recommendations