The three-year persistence of depressive symptoms in men and women

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Abstract

Little is known about sex differences in the course of depression. The results of the few surveys of the general population are inconsistent. Furthermore, the generalizability of most of these findings is limited. First, only a handful of studies of the general population use a prospective design to estimate the persistence of depression in women and men. Second, in some studies only particular subgroups of the general population are sampled, and finally, depression persistence is often measured using unconventional short time-intervals. Using data from five waves of the Flemish subsample of the Panel Study of Belgian Households (PSBH) — a probability sample of 1168 (52.5%) women and 1055 (47.5%) men — we tried to go beyond these shortcomings. Depression persistence is estimated using a self-report inventory on four occasions separated by intervals of one year (1993, 1994, 1995, 1996). Results show a significant influence of sex, other sociodemographic characteristics, and depression severity at baseline on three-year depression persistence. Women experience more chronicity, a difference that can be partially ascribed to sex differences in employment status, education and marital status. Persistence in linked to marital status in women. In men persistence is associated with level of education and with employment status. Depression severity at baseline, however, largely explains the influence of these social conditions on depression persistence.

Introduction

The sex difference in depression is well known. Women report more symptoms of depression than men (Nolen-Hoeksema, 1990, Weissman and Klerman, 1992). The prevalence of depression among women is approximately twice that found among men. Recent epidemiological research confirms this general conclusion (Lépine et al., 1997). Due to a lack of longitudinal studies of the general population, less is known, however, both about the course of depression and about sex differences in the persistence of depressive behavior. The purpose of this article is to, partially, fill this gap. Using information from interviews at five occasions separated by intervals of one year (1992 to 1996) sex differences in the course of depression are examined. Furthermore, the stability of the findings over several social categories are investigated. Attention is given to the mediating role of family related characteristics, such as marital status and work related characteristics, such as employment status and level of education. Although the aim of this study, the determination of a sex difference in depression persistence, is mainly descriptive the results of the analyses are not without theoretical significance. In the discussion section, these theoretical implications are given some consideration.

Section snippets

Previous research

Follow-up studies of former patients have yielded a less favorable outcome (or higher chronicity) in women (Amenson and Lewinshon, 1981, Dunn and Skuse, 1981, Mann et al., 1981, Ceroni et al., 1984, Angst and Dobler-Mikola, 1985, Frank et al., 1988) or the absence of sex differences in recovery (Keller and Shapiro, 1981). However, only a minority of women and men with depression receives treatment. Furthermore, sex differences in the use of treatment facilities are well known, with women

Subjects

The panel study of Belgian Households (PSBH) was designed to produce longitudinal data for a broad range of socioeconomic and family-related sociological items. The 8744 participants in the first wave of the PSBH (1992) were selected using a stratified multistage area probability sample of private households. All adults (aged 16 or older) of 4439 households were included. Residents of collective households — e.g. institutionalized persons — were excluded. Subsequent interviews were collected at

Results

In Table 2a data on persistence by sex, educational level, marital status, age, and employment status are presented.

Women show more depression persistence. The sex difference in chronicity is significant, independent of the time interval used. Using logistic regression the sex ratio is estimated at 2.28 (χ2=14.9, d.f..=1, p<0.001) for one-year depression persistence, 2.08 (χ2=8.4, d.f..=1, p=<0.001) for two-year persistence, and 3.5 (χ2=14.5, d.f..=1, p<0.001) for three-depression persistence.

Depression persistence, sociodemographic characteristics and T1-depression severity: logistic regression analysis

To evaluate the independent contribution of the sociodemographic and clinical characteristics a series of logistic regression analysis was performed. The results of the estimation of the first model in Table 4 confirm the existence of a sex difference in three-year depression persistence. The parameter estimate is highly significant, leading to an estimated odds ratio of 3.48. This ratio is substantially higher than the aforementioned sex ratios of one-year and two year depression chronicity,

Discussion and conclusion

To date, only a handful of studies of the general population use a prospective design to estimate the persistence of depression in women and men (Surtees et al., 1986, Sargeant et al., 1990, Ernst and Angst, 1992, Kawakami et al., 1995, Bracke, 1998). The results of the investigations of Surtees et al., 1986, Ernst and Angst, 1992, Kawakami et al., 1995 are limited because only particular subgroups of the general population are sampled. In contrast, Sargeant et al., 1990, Bracke, 1998 use

Acknowledgements

The data for this study were provided by the Steunpunt Gezinsdemografisch Panel: PSBH/golf1 (1992), PSBH/golf2 (1993), PSBH/golf3 (1994), PSBH/golf4 (1995), PSBH/golf5 (1996).

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