Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T09:34:27.751Z Has data issue: false hasContentIssue false
  • English
  • Français

Gender differences in outpatients with anxiety disorders: the Leiden Routine Outcome Monitoring Study

Published online by Cambridge University Press:  20 May 2015

L. Pesce ,
T. van Veen ,
I. Carlier ,
M. S. van Noorden ,
N. J. A. van der Wee ,
A. M. van Hemert  and
E. J. Giltay
L. Pesce*
Affiliation:
Dipartimento di Scienze della Salute, Università degli Studi di Milano, San Paolo Hospital, Milan, Italy Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
T. van Veen
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
I. Carlier
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
M. S. van Noorden
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
N. J. A. van der Wee
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
A. M. van Hemert
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
E. J. Giltay
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
*
*Address for correspondence: L. Pesce, Leiden University Medical Center Department of Psychiatry, B1-P PO Box 9600 2300 RC Leiden, The Netherlands. (Email: pesce.luisa@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Data from the general population show higher prevalence of different anxiety disorders in women as compared with men. We analysed gender differences in a naturalistic sample of outpatients with anxiety disorders in a mental healthcare setting.

Method.

Routine outcome monitoring data were collected from 1333 patients (age: 18–65; 63.3% women) fulfilling Diagnostic and Statistical Manual of Mental Disorders IV criteria of current anxiety disorder according to the Mini-International Neuropsychiatric Interview between 2004 through 2006. Data included Comprehensive Psychopathological Rating Scale, Brief Symptom Inventory (BSI), Short Form Health Survey (SF-36), Mood and Anxiety Symptom Questionnaire (MASQ). Chi-squared test and t-test were used to compare women with men for variables with parametric distributions, and Mann–Whitney test for non-parametric distribution. Adjustments for potential confounders (age, level of education, ethnicity and comorbidites) were made by logistic regression models (for discrete variables) or analysis of covariance.

Results.

The female-to-male ratio (i.e., 844 women, 489 men) for any anxiety disorder was 1.73 : 1 (95% confidence interval [CI]: 1.63–1.83), with the strongest skewness for post-traumatic stress disorder (2.80 : 1) and the smallest one for social phobia (1.18 : 1). Compared with men, women reported more severe self-rating scores on the BSI (on average, the scores were 12.3% higher on 3 of 9 subscales: somatisation, interpersonal sensitivity and anxiety), SF-36 (self-reported generic health status was lower on 5 of 8 subscales: physical functioning, social functioning, physical problems, vitality and bodily pain) and MASQ (on average, the scores were 6.6% higher on 4 of 5 subscales: anxious arousal, general distress, general distress depression, general distress anxiety). On the contrary, no gender difference was found in the severity of anxiety symptoms measured by the Brief Anxiety Scale. Women were more likely to suffer from comorbid depression and bulimia nervosa, and less likely from substance abuse.

Conclusions.

In a treatment-seeking population the prevalence rate of anxiety disorders was 1.7 times higher in female compared with men. Female outpatients were more severely affected on self-rated but not on observer-rated scales.

Keywords

Epidemiologygender differencesoutpatient psychiatrypanic disorderpost-traumatic stress disorder
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 3 , June 2016 , pp. 278 - 287
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alnaes, R, Torgersen, S (1988). DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population. Acta Psychiatrica Scandinavica 78, 348–355.Google Scholar
Altemus, M (2006). Sex differences in depression and anxiety disorders: potential biological determinants. Hormones and Behavior 50, 534–538.Google Scholar
Bekker, MH, Van Mens-Verhulst, J (2007). Anxiety disorders: sex differences in prevalence, degree, and background, but gender-neutral treatment. Gender Medecine 4(Suppl. B), S178–S193.Google Scholar
Bijl, RV, Ravelli, A, Van Zessen, G (1998). Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 33, 587–595.Google Scholar
Bogetto, F, Venturello, S, Albert, U, Maina, G, Ravizza, L (1999). Gender-related clinical differences in obsessive-compulsive disorder. European Psychiatry 14, 434–441.Google Scholar
Breslau, N, Davis, GC, Andreski, P, Peterson, EL, Schultz, LR (1997). Sex differences in posttraumatic stress disorder. Archives of General Psychiatry 54, 1044–1048.Google Scholar
Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626–632.Google Scholar
Burger, H, Neeleman, J (2007). A glossary on psychiatric epidemiology. Journal of Epidemiology and Community Health 61, 185–189.CrossRefGoogle ScholarPubMed
Carballo, JJ, Baca-Garcia, E, Blanco, C, Perez-Rodriguez, MM, Arriero, MA, Artes-Rodriguez, A, Rynn, M, Shaffer, D, Oquendo, MA (2010). Stability of childhood anxiety disorder diagnoses: a follow-up naturalistic study in psychiatric care. European Child and Adolescent Psychiatry 19, 395–403.Google Scholar
Casper, RC, Belanoff, J, Offer, D (1996). Gender differences, but no racial group differences, in self-reported psychiatric symptoms in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 35, 500–508.Google Scholar
Castle, DJ, Deale, A, Marks, IM (1995). Gender differences in obsessive compulsive disorder. Australian and New Zealand Journal of Psychiatry 29, 114–117.Google Scholar
Clark, LA, Watson, D (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology 100, 316–336.Google Scholar
Cuijpers, P, Li, J, et al. (2010) Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clin Psychol Rev. 30(6), 768–78.Google Scholar
De Beurs, E, Den Hollander-Gijsman, ME, Van Rood, YR, Van Der Wee, NJ, Giltay, EJ, Van Noorden, MS, Van Der Lem, R, Van Fenema, E, Zitman, FG (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology and Psychotherapy 18, 1–12.Google Scholar
De Graaf, R, Ten Have, M, Van Gool, C, Van Dorsellaer, S (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology 47, 203–213.CrossRefGoogle ScholarPubMed
Derogatis, LR, Melisaratos, N (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine 13, 595–605.CrossRefGoogle ScholarPubMed
Endermann, M (2005). The Brief Symptom Inventory (BSI) as a screening tool for psychological disorders in patients with epilepsy and mild intellectual disabilities in residential care. Epilepsy and Behavior 7, 85–94.CrossRefGoogle ScholarPubMed
Goekoop, JG, et al. (1992). Multidimensional ordering of psychopathology. A factor-analytic study using the Comprehensive Psychopathological Rating Scale. Acta Psychiatrica Scandinavica 86(4), 306–312.Google Scholar
Goekoop, JG, De Beurs, E, Zitman, FG (2007). Four-dimensional structure underlying scales for depression anxiety and retardation: emergence of trapped anger and scale improvements. Comprehensive Psychiatry 48(2), 192–198.CrossRefGoogle ScholarPubMed
Gum, AM, King-Kallimanis, B, Kohn, R (2009). Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. American Journal of Geriatric Psychiatry 17, 769–781.Google Scholar
Katerndahl, DA, Realini, JP (1993). Lifetime prevalence of panic states. American Journal of Psychiatry 150, 246–249.Google ScholarPubMed
Kennedy, CA, Skurnick, JH, Foley, M, Louria, DB (1995) Gender differences in HIV-related psychological distress in heterosexual couples. AIDS Care 7(Suppl. 1), S33–S38.Google Scholar
Kessler, RC (2007). Psychiatric epidemiology: challenges and opportunities. International Review of Psychiatry 19, 509–521.Google Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.Google Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Kessler, RC, Demler, O, Frank, RG, Olfson, M, Pincus, HA, Walters, EE, Wang, P, Wells, KB, Zaslavsky, AM (2005 b). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 2515–2523.Google Scholar
Kim, KA, Moser, DK, Garvin, BJ, Riegel, BJ, Doering, LV, Jadack, RA, Mckinley, S, Schueler, AL, Underman, L, Mcerlean, E (2000). Differences between men and women in anxiety early after acute myocardial infarction. American Journal of Critical Care 9, 245–253.Google Scholar
Klose, M, Jacobi, F (2004). Can gender differences in the prevalence of mental disorders be explained by sociodemographic factors? Archives of Women's Mental Health 7, 133–148.Google Scholar
Kringlen, E, Torgersen, S, Cramer, V (2001). A Norwegian psychiatric epidemiological study. American Journal of Psychiatry 158, 1091–1098.Google Scholar
Lecrubier, Y, , SD, Weiller, E, et al. (1997). The mini international neuropsychiatric interview (mini). A short diagnostic structured interview: Reliability and validity according to the cidi. European Journal of Psychiatry 12, 224–231.CrossRefGoogle Scholar
Mchorney, CA, Ware, JE Jr., Raczek, AE (1993). The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care 31, 247–263.Google Scholar
McLean, CP, Anderson, ER (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical Psychology Review 29, 496–505.Google Scholar
McLean, CP, Asnaani, A, Litz, BT, Hofmann, SG (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research 45, 1027–1035.Google Scholar
Montgomery, SA, Asberg, M. A. R. I. E. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134(4), 382–389.CrossRefGoogle ScholarPubMed
Moser, DK, Dracup, K, Mckinley, S, Yamasaki, K, Kim, CJ, Riegel, B, Ball, C, Doering, LV, An, K, Barnett, M (2003). An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosomatic Medicine 65, 511–516.Google Scholar
Pigott, TA (1999). Gender differences in the epidemiology and treatment of anxiety disorders. Journal of Clinical Psychiatry 60(Suppl. 18), 4–15.Google Scholar
Regier, DA, Narrow, WE, Rae, DS (1990). The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. Journal of Psychiatric Research 24(Suppl. 2), 3–14.CrossRefGoogle ScholarPubMed
Schulte-Van Maaren, YWM, Carlier, IVE, Zitman, FG, Van Hemert, AM, De Waal, MWM, Van Noorden, MS, Giltay, EJ (2012). Reference values for generic instruments used in routine outcome monitoring: the leiden routine outcome monitoring study. BMC Psychiatry 12, 203.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59(Suppl. 20), 22–33; quiz 34–57.Google Scholar
Turk, CL, Heimberg, RG, Orsillo, SM, Holt, CS, Gitow, A, Street, LL, Schneier, FR, Liebowitz, MR (1998). An investigation of gender differences in social phobia. Journal of Anxiety Disorders 12, 209–223.Google Scholar
Tyrer, P, Owen, RT, Cicchetti, DV (1984). The brief scale for anxiety: a subdivision of the comprehensive psychopathological rating scale. Journal of Neurology Neurosurgery and Psychiatry 47, 970–975.CrossRefGoogle ScholarPubMed
Van Vliet, IM, Leroy, H, Van Megen, HJGM (2000). M.I.N.I. Plus: M.I.N.I. Internationaal Neuropsychiatrisch Interview: Nederlandse versie 5.0.0.Google Scholar
Vesga-Lopez, O, Schneier, FR, Wang, S, Heimberg, RG, Liu, SM, Hasin, DS, Blanco, C (2008). Gender differences in generalized anxiety disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry 69, 1606–1616.Google Scholar
Ware, JE Jr. (2000). SF-36 health survey update. Spine (Phila Pa 1976) 25, 3130–3139.Google Scholar
Weissman, MM, Bland, RC, Canino, GJ, Greenwald, S, Hwu, HG, Lee, CK, Newman, SC, Oakley-Browne, MA, Rubio-Stipec, M, Wickramaratne, PJ (1994). The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. Journal of Clinical Psychiatry 55(Suppl.), 5–10.Google Scholar
World Health Organisation (1990). The Composite International Diagnostic Interview (CIDI). Authorized Core Version 1.O. Geneva: World Health Organisation.Google Scholar
Zlotnick, C, Zimmerman, M, Wolfsdorf, BA, Mattia, JI (2001). Gender differences in patients with posttraumatic stress disorder in a general psychiatric practice. American Journal of Psychiatry 158, 1923–1925.Google Scholar