女性的忧郁比率较高是个迷思?


  【24drs.com】一般认为女性的忧郁症比率高于男性,但是,新研究显示,当考量忧郁的其它症状和传统症状时,就没有这些性别差异了。
  
  美国密西根大学Lisa A. Martin博士等研究者写道,这个性别差异的架构在于男性和女性的忧郁组成因素是一样的,只是在症状等相关变项上探讨性别差异。
  
  虽然这已经是目前流行的作法,但往往仅根据「男性忧郁」相对于「女性忧郁」的二分法进行评论,而无法真正知道两性之间的异质性。
  
  这篇研究在线登载于8月28日的JAMA Psychiatry期刊。研究目的在于,探讨把传统的忧郁症状之外的其它症状也纳入考量时,忧郁症的性别差异是否会消失。
  
  研究者使用「National Comorbidity Survey Replication (NCS-R)」这项全国代表性调查的资料,美国讲英语成人的心智异常发生率和盛行率。
  
  这项调查包括3,310名女性和2,382名男性,平均年纪45.2岁,73.4%是非西班牙裔白人、51.6%教育程度在高中以上,平均家庭年收入是59,575美元,男性平均收入是63,365美元,女性是49,327美元。
  
  研究者发展出两个量表,第一,男性症状量表(Male Symptoms Scale,MSS),包括其它的男性类型忧郁症状,如烦躁、愤怒攻击/侵略、睡眠障碍、酒精或药物滥用、冒险行为、过动、紧张、丧失对愉快活动之兴趣;第二个量表是性别包容性忧郁量表(Gender Inclusive Depression Scale,GIDS),包括所有的MSS症状,加上7个传统忧郁症状:悲伤/心情郁闷、失去活力、疲倦、矛盾、焦虑/不安、频感抱怨或可悲。
  
  根据包括了其它非传统男性忧郁症状的MSS量表,研究者发现男性的忧郁症盛行率(26.3%)高于女性(21.9%) (P = .007);男性的愤怒攻击/侵略、滥用药物、冒险行为比率显著高于女性;另一方面,女性的紧张、烦躁不安、睡眠问题、以及对原本喜欢的东西,如工作、爱好、和个人关系等失去兴趣的比率则显著较高。
  
  使用包括传统和非传统忧郁症状的GIDS评估之后,忧郁盛行率并无性别差异,根据此量表,符合忧郁准则的男性比率为30.6%、女性为33.3%。
  
  就忧郁严重度而言,研究者发现,63.2%的男性和62.0%的女性属于轻微型,表示他们只有1-4个症状;28.3%的男性和28.9%的女性属于中度型,有5-9个症状;8.5%的男性和9.1%的女性属于严重型,有10-15个症状。研究者报告指出,任何严重度都没有显著的性别差异。
  
  作者们写道,这些结果认为,仅依赖男性的传统症状会导致男性的忧郁症未被诊断,医师评估男性忧郁时应考虑其它线索。
  
  他们也指出,尽管这篇报告有重要发现,但是仍有限制。限制之一是,该研究并未包括过度工作、过度运动、改变他们的性行为、或赌博等男性之症状,此外,用来评估掌握机会或产生鲁莽行为的项目和情绪状况并无关;研究者认为,后续研究应纳入评估这些被排除的行为等项目。
  
  他们结论表示,他们的研究结果有潜力为忧郁症的感知和测量带来重大进步,这些研究结果可能在忧郁症的概念与测量方法上带来重要改变。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7005&x_classno=0&x_chkdelpoint=Y
  

Higher Depression Rates in Women a Myth?

By Fran Lowry
Medscape Medical News

Women have long been thought to have much higher rates of depression than men, but when alternative and traditional symptoms of depression are considered, these sex disparities disappear, new research shows.

"The sex differences framework is rooted in the idea that the construct of depression is the same in men and women and seeks to investigate sex differences in a range of related variables, including symptoms," investigators led by Lisa A. Martin, PhD, from the University of Michigan, Dearborn, write.

"Although this has been a popular approach to date, it is often critiqued for relying on oppositional binaries that understand 'male depression' only as it is contrasted with 'female depression,' which fails to acknowledge the heterogeneity that exists within these groups."

The study is published online August 28 in JAMA Psychiatry.

More Anger, Aggression in Men

The aim of the study was to explore whether sex disparities in depression rates disappear when other symptoms besides conventional depression symptoms are considered.

The researchers used data from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the incidence and prevalence of mental disorders among English-speaking adults in the United States.

The survey included 3310 women and 2382 men. Their mean age was 45.2 years, 73.4% were non-Hispanic white, and 51.6% had some education beyond high school. The mean annual household income was $59,575. The mean income for men was $63,365, and for women, it was $49,327.

The researchers developed 2 scales. The first, the Male Symptoms Scale (MSS), included alternative male-type symptoms of depression, including irritability, anger attacks/aggression, sleep disturbance, alcohol or drug abuse, risk-taking behavior, hyperactivity, stress, and loss of interest in pleasurable activities.

The second scale, the Gender Inclusive Depression Scale (GIDS), included all of the MSS symptoms, plus 7 traditional symptoms of depression, including sad/depressed mood, loss of vitality, tiredness, ambivalence, anxiety/uneasiness, and complaintiveness or feeling pathetic.

Using the MSS scale that included alternative, male-type symptoms of depression, the researchers found a higher prevalence of depression in men (26.3%) than in women (21.9%) (P = .007).

The researchers also found that men reported significantly higher rates of anger attacks/aggression, substance abuse, and risk-taking behavior compared with women.

More Stress, Irritability in Women

Women, on the other hand, reported significantly greater rates of stress, irritability, sleep problems, and loss of interest in things they usually enjoyed, such as work, hobbies, and personal relationships.

No sex difference in the prevalence of depression as assessed by the GIDS that included alternative and traditional depression symptoms was found. According to that scale, 30.6% of men and 33.3% of women met criteria for depression.

In terms of severity of depression, the researchers found that 63.2% of men and 62.0% of women fell into the mild category, meaning that they had 1 to 4 symptoms; 28.3% of men and 28.9% of women fell into the moderate category, with 5 to 9 symptoms; and 8.5% of men and 9.1% of women fell into the severe category, with 10 to 15 symptoms. No significant sex differences were demonstrated at any severity level, they report.

"These results suggest that relying only on men's disclosure of traditional symptoms could lead to an underdiagnosis of depression in men and that clinicians should consider other clues when assessing depression in men," the authors write.

They also point out that "despite the significant findings reported in this study, there are noteworthy limitations."

One limitation was that the study did not include symptoms among men such as overworking, overexercising, changing their sexual behavior, or gambling. Also, items that assessed taking chances or reckless behavior were not linked to an emotional condition. Future studies should include items that assess the excluded behaviors, the authors suggest.

They conclude that the results of their study have the potential to bring "significant advances to the field in terms of the perception and measurement of depression. These findings could lead to important changes in the way depression is conceptualized and measured."

The investigators have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online August 28, 2013.

    
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