Women

08.03.13

Does Depression Hit Women Harder?

In their new book "The Stressed Sex," Daniel and Jason Freeman dig into the mental health issues that plague men and women differently.

Women are more likely than men to suffer from depression. Women are more likely to suffer from anxiety, too, and sleep disorders, as well as a host of other emotional and medical problems. On the other end of the spectrum, men suffer more often from substance abuse issues and autism. But as it turns out, mental health issues do not scale up measure for measure on both sides—for women are more likely than men to struggle under the weight of many emotional disorders.

Such are the findings of The Stressed Sex: Uncovering the Truth about Men, Women, and Mental Health, a new book by Daniel and Jason Freeman, out from Oxford University Press. Authored by two brothers—one a clinical psychologist, the other a writer—the book explores the how and why behind the finding that mental health problems plague men and women to different degrees. Daniel Freeman, a psychologist and Oxford professor, says that he and his brother came across the topic indirectly. While working on a previous book on mental health problems, they noticed differences in the rates in which different emotional disorders affected the sexes. It suggests, he says, “a major public health issue.”

Mental health can be a controversial subject—even defining what an emotional disorder is can be contentious—and looking at it through the lens of gender differences is more controversial still. (And not everyone agrees with the conclusions expressed in the first paragraph of this article—as the book points out, the World Health Organization says that women and men are about equally affected by emotional disorders.) Freeman concedes that the optics of the book jacket was a concern: “The obvious danger,” he says, “was that we’d be viewed as two men labeling women as crazy.” (On the contrary, science-minded readers of both sexes will likely find the book fascinating, as I did, not simply because of the gender element, but because of the way it unpacks a complex subject.)

To write the book, the Freemans went to the “evidence base” and looked for literature on the topic. They examined 12 national mental-health surveys, and found that in eight of them, there were distinct differences between women and men when it came to rates of disorders. A German survey showed that, in the year before the survey was conducted, 25 percent of men had suffered from an emotional disorder; for women, the number was 37 percent. In the United States, according to the U.S. National Comorbidity Survey Replication, those numbers were 29.9 percent and 34.7 percent, respectively. For depression specifically, according to the same U.S. survey, in the year before the research was done, 4.9 percent of men had experienced depression, while the number for women was nearly double at 8.6 percent. (Three of the 12 surveys the authors examined “suggest there are no major differences between the sexes,” as the book puts it.)

But the big-picture takeaway from all this research, Freeman says, is that “in the current environment women are bearing the brunt of mental health problems.”

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So the big question is why? The answer: it’s complicated. Emotional disorders are not usually caused by one thing, but instead by many different factors—environment, psychology, biology—working together. The biggest likely factor? “The environment above all,” says Freeman. “And it’s stress. And it’s stress that’s from the social roles that women have”—such as domestic work—“all while these roles are typically less valued and less rewarded and the person has less control. It’s all of this combined with the pressures to look good, I think, that really affect women’s self-esteem.” And poor self-esteem is, not surprisingly, connected with depression.

But, Freeman, adds, “It is more complicated than that.” There are a host of other issues discussed in the book, including how women and men process stress; the differences between seeing the world optimistically or pessimistically and the toll that worry and rumination can take on mental health; how much value is placed on interpersonal relationships; the likelihood of a traumatic event, like sexual abuse, happening as a child; and more. The authors also suggest that “it may be that women have a slightly greater genetic vulnerability to depression than men,” though note that for that factor “the evidence is weakest.”

Could men simply be underreporting their emotional problems? The book tackles that conundrum and concludes that while it is a variable, they don’t think it can solely explain the differences between the genders.

Another male-related issue is autism, which affects more men than women; in England, for example, 1.8 percent of men are on the “autism spectrum”—and that idea is itself a subject of controversy—while only 0.2 percent of women are. It’s also a condition that has a very strong genetic and biological component. The book examines the work of autism expert Simon Baron-Cohen, who has proposed a theory that looks at autism through a gendered lens. Someone who is autistic is very poor at empathizing, but very good at “systematizing”—they’re probably more interested in how a system of some kind works than understanding someone’s feelings. The book summarizes Baron-Cohen’s theory this way: “We’re seeing in autism, he argues, an ‘extreme form of the male brain.’” And if you proceed under the assumption that women are better empathizers than men, which the book argues there is evidence for, then this theory could make some sense, or at least be provocative. But Freeman, while noting that Baron-Cohen’s work on autism was “ground-breaking,” expressed reservations about the theory. “I think the theory is”—and here he paused to make sure he worded his thoughts with care—“it’s certainly not, in terms of applying in this way… I don’t think there’s enough evidence to support it; it’s probably pushing things a bit too far.”

But there’s one thing that the book, and Freeman, are clear on: there needs to be more investigation and research on the subject of gender and emotional disorders. “I think we need to understand more what are the most pernicious factors in the environment” that can lead to emotional disorders, says Freeman. Women are less likely to say they are happy than men are, he adds. “If we do see these differences, that’s extraordinary actually, isn’t it? We need to be doing something about that.”