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Section 19
Gender Differences in Depression

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Although no consistent overall gender differences were found in the relations between subtypes of dysphoric experiences and problem behaviors, Leadbeater, Blatt, and Quinlan (1995) found gender differences when considering the likelihood of an individual being high (one standard deviation above the mean) on both interpersonal dysphoria and internalizing disorders or on both self-criticism and externalizing disorders. Females were six times more likely (13%) than males (2%) to be high on both interpersonal dysphoria and internalizing disorders. In contrast, no gender differences were found for elevated scores on both interpersonal dysphoria and externalizing disorders (4% of females and 2% of males). In terms of self-critical dysphoria, no gender differences were found in participants with elevated scores on both self-criticism and internalizing disorders (8% of females and 6% of males), but males were more than twice as likely (7%) as females (3%) to have elevated scores on both self-critical dysphoria and externalizing disorders. Thus, although the overall strength of the specific relations among type of dysphoria and problem behaviors does not differ by gender, the frequency of co-occurrence of more extreme levels of gender-congruent interpersonal vulnerabilities and internalizing disorders is substantially greater in females than in males, whereas the frequency of occurrence of more extreme levels of gender congruent self-critical vulnerability and externalizing disorders is greater in males (Leadbeater et a!., 1995; see also T. W. Smith et al., 1988, for another illustration of these gender congruent effects).

Research evidence indicates that girls have higher levels of internalizing disorders and are more likely to report anaclitic depressive symptoms that express somatic preoccupations, sad affect, and loneliness. Boys, on the other hand, are more likely to have externalizing disorders and to report introjective depressive symptoms that include antagonism, aggression, and an inability to work (Achenbach & Edelbrock, 1978; Achenbach et al., 1991; Leadbeater et al., 1999; Ostrov, Offer, & Howard, 1988). Considerable differences exist in the items endorsed by girls and boys on the YSR (Achenbach, 1991). Leadbeater et al. (1995) found that all 22 internalizing items on the YSR-including somatic problems (e.g., headaches, nausea, skin problems, weight problems, overtiredness, dizziness, and eating problems), depressed mood (e.g., sadness; crying; worrying; and feeling lonely, unloved, and self-conscious), and aggression against the self (e.g., suicidal thoughts, feeling persecuted, harming oneself)- were endorsed more frequently by girls. In contrast to these more anaclitic problems in girls, boys more frequently report introjective types of problem behaviors on 12 of the 19 YSR externalizing items related to aggression (e.g., destroys things, mean to others, threatens others, swears, brags, teases, thinks about sex) and delinquent acts (e.g., destroys things, disobeys at school, fights, has bad friends, sets fires, steals outside of home). In a community-based sample, Colton et al. (1991) also found more internalizing problems (anxiety, depression, and somatic problems) among girls and more externalizing behaviors (delinquency, problem behavior at school, and poor grades) among boys (Leadbeater et al., 1995).

The prevalence of problems in adolescents and adults also reflects these gender differences (e.g., A. V. Horwitz & White, 1987; Rhode et al., 1991) in what can be considered introjective (externalizing) and anaclitic (internalizing) disorders. As summarized by Leadbeater et al. (1995), men in the United States more frequently die from violent causes (accidental death, suicides involving hanging, and homicide) than do women (Kandel, Raveis, & Davies, 1991; U.S. Bureau of the Census, 1990; Wetzel, 1989). Antisocial behavior is also more frequent among men than among women (P. Graham, 1979) and generally begins at an earlier age for boys (median age of 10) than for girls (median age of 13; Kazdin, 1987). Girls, in contrast, make more suicide attempts (Wetzel, 1989), and have more frequent referrals for clinical depression (Kashani, Sherman, Parker, & Reid, 1990), and the vast majority of cases of anorexia and bulimia occur in women (McGrath et al., 1990). These gender differences in depression begin to emerge shortly after puberty, with girls having a higher incidence of depression than boys (Nolen-Hoeksema, 1990; Nolen-Hoeksema, Girgus, & Seligman, 1991; Petersen, Sarigiani, & Kennedy, 1991).

Differences in socialization may contribute to these gender differences in the expression of psychological distress, with girls showing an internalizing pattern and boys showing an externalizing pattern (Gjerde & Block, 1991; Gjerde, Block, & Block, 1988; Horwitz & White, 1987; Kandel & Davies, 1982; A. Kaplan, 1986; Nolen-Hoeksema, 1987; Radloff& Rae, 1979; M. M. Weissman & Klerman, 1977). Kandel and Davies (1982), for example, found that the total distribution of delinquent adolescents with or without depression was the same for boys and girls but that delinquency was higher for boys (68% vs. 57%), and depressed mood was higher for girls (56% vs. 36%). In a clinic-based sample of 13- to 18-year-olds, Kashani et al. (1990) found that girls reported more anaclitic symptoms, including affective blunting (e.g., sadness, hopelessness, etc.), more concerns about appearance, and more vegetative symptoms than boys did. In an item analysis of the BDI, J. Kaplan and Arbuthnot (1985) found that girls endorsed bodily concerns, such as feeling unattractive and trying to lose weight, more often than boys. In a study of 3rd- to 12th-grade students, Worchel, Nolan, and Wilson (1987) found that girls reported more internalizing items (e.g., sadness, loneliness, fatigue, concern about doing things wrong or having bad things happen, not liking themselves, and wanting more friends), whereas boys reported more externalizing items (e.g., getting into fights and having to be pushed to do homework). Using ratings on the California Adult Q-Sort (Block, 1978), Gjerde et al. (1988) found that dysphoric men were rated as more disagreeable, aggressive, and antagonistic than were nondysphoric men, whereas dysphoric women were seen as more ego brittle, unconventional, and ruminative than were nondysphoric women. Craighead (1991) found that more female adolescents scored high on both depression and anxiety, whereas more boys scored high on both depression and sociopathy. Nolen-Hoeksema (1990) argued that the more ruminative (internalizing) coping styles of women predispose them to longer and more frequent bouts of depression, whereas men's more performance-oriented (externalizing) efforts distract them from depressive feelings, leading to shorter and less frequent experiences of depression but also to more externalizing disorders and drug use (Leadbeater et al., 1995).

Research also indicates gender differences in subtypes of depression (i.e., interpersonal and self-critical depressive vulnerabilities). Adolescent girls are more likely to have interpersonal depressive preoccupations (feelings of loss or loneliness) than are boys, but girls also are equally likely to experience selfcritical depressive preoccupations (feelings of failure and lack of self-worth). Similar gender differences have been observed in adolescents' reactivity to stressful live events. Girls are particularly reactive to stressful interpersonal life events (e.g., illness in a family member) than to events that affect self-esteem (e.g., academic failure; Gore, Aseltine, & Colten, 1993; Wagner & Compas, 1990). However, girls are reactive to both types of stress, whereas boys react primarily to stressful events that affect their self-esteem. Differential vulnerabilities to interpersonal or self-critical depressive experiences, potentiated by congruent stressful life events involving either interpersonal issues or threats to self-esteem, may differentially predict higher levels of internalizing or externalizing problem behaviors in girls and boys, respectively (Leadbeater et al., 1995, 1999).

Henrich et al.'s (2001) recent findings concerning the social relations of early adolescent girls and boys indicate that girls are more vulnerable to interpersonal issues than boys are, especially in early adolescence (Brody, 1999; Gore et al., 1993; Leadbeater et al., 1995; Leadbeater et al., 1999; Zahn-Waxler, 1993). Important differences in interpersonal relationships of boys and girls suggest different possible pathways for the development of depressed affect. Research has documented the greater importance of connecteduess or relatedness in adolescent girls and of status or agency in adolescent boys (see review by Buhrmester, 1996). Compared with boys, girls interact more with their same-sex friends, self-disclose more, and think more about their relationships. Girls are also more reactive to interpersonal stresses (Leadbeater et al., 1995), and they have higher scores on both DEQ Neediness and Relatedness than do boys, as well as higher scores on measures of social functioning, suggesting a greater involvement in interpersonal issues. Boys typically discourage expressions of intimacy and emotional support. Henrich et al.'s findings also suggest a greater differentiation in the quality of interpersonal relatedness in early adolescent girls. Mature interpersonal relatedness in early adolescent girls on the DEQ is associated with competent social functioning, whereas neediness is associated with less interpersonal competence. Needy girls make excessive demands on friends for reassurance and sympathy and for an inclusivity in their friendships. This can lead to rejection and social isolation (Coyne, 1976b; Joiner, 1994). These findings suggest that it is important to include gender as a factor in studying the relationships among types of depression vulnerability and internalizing and externalizing expressions of dysphoria and depression (see, e.g., T. W. Smith et al., 1988).
- Blatt, Sidney, Experiences of Depression: Theoretical, Clinical, and Research Perspectives, American Psychological Association: Washington DC, 2004.

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Personal Reflection Exercise #7
The preceding section contained information about gender differences in depression. Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 19
Research evidence indicates that which group has higher levels of internalizing disorders and are more likely to report anaclitic depressive symptoms that express somatic preoccupations? Record the letter of the correct answer the Answer Booklet.