Depression has increased over the last two years of pandemic, and as mental health in general has worsened recently, the different reactions of some sub-groups in our population were highlighted.
Depression has always affected men and women differently -both in terms of numbers and symptoms. The reason behind is broad, and rooted in thousands of years of differences in the treatment and social role of men and women.
This issue is no different today. But what exactly is the main difference, and why is it important to talk about it?
When we say “depression” everyone has a general idea what we mean. The sadness, the fatigue, the hopelessness... But what we call depression in popular culture is actually systematically divided into three separate disorders:
Disruptive Mood Dysregulation Disorder (DMDD)
Major Depressive Disorder (MDD)
Persistent Depressive Disorder (PDD)
Number one is a lesser known Depressive Disorder. DMDD is defined by frequent temper outbursts, verbal and physical aggression, and out of proportion reactions to the situation or provocation. DMDD affects about 2-5% of children and adolescents, and is more common in boys and men, while it also often reduces with age. As the disorder is almost purely diagnosed in males, some interesting diagnostic issues show up, as other mood-regulation related disorders, such as Bipolar Disorder, do not show the same difference in numbers between genders.
MDD and PDD are both defined by low mood, feeling of emptiness and hopelessness, low self-esteem, no interest or joy in activities, tiredness, unusual amount of sleep or insomnia, under- or overeating leading to weight change, being overly slow or fidgety, feeling worthless or guilty, loss of concentration, and thoughts of suicide. Women are affected about 1.5 to 3 times as often as men. Persistent Depressive Disorder may be diagnosed if these symptoms last for 2 years or more without a break.
Male depression may present itself very differently from our typical idea of a depressed person. Recent research identified something called Male Depressive Syndrome. The Syndrome consists of symptoms like irritability, aggressiveness, risk-taking, escaping behaviour, antisocial behaviour, substance abuse, or even becoming overly sexually active and engaging in meaningless affairs that provide no pleasure.
Alcoholism is a particular issue affecting men with depression, as there is a three times higher-level of alcohol-dependence in males with Major Depressive Disorder than in females with the same diagnosis.
Studies have shown that typical masculine ideals are stopping men from expressing visible signs of sadness, and from having general emotional awareness. Men are expected to show independence, competitiveness, emotional stoicism, and self-control, which often go against expressing emotions.
From a young age, boys learn to dissociate from real emotions and experience shame, which triggers anger and control-oriented responses as a defence-mechanism.
The emotionless sexual encounters stem from a man’s effort to show sexual prowess to feel adequate again and avoid intimacy that could reveal vulnerability. These defence-mechanisms and acting-out symptoms mask typical depressive symptoms. However, this eventually fails and worsens the stage of the disorder.
Suicide attempts rates are similar between men and women with depression. However, men’s success rate is 4 to 7 times higher. Men tend to use more lethal approaches, and their warning signs are masked better. This is made worse by men having limited social support networks compared to women. Men are also less likely to communicate their issues, while other men are less likely to pick up on emotional distress in their social circles than women, which reduces the chance of them intervening.
Boys are simply socialised to internalise pain, avoid emotional awareness and taught less communicational skills. For this reason, opening up is uncomfortable and unnatural.
Men report to be even more uncomfortable to appear vulnerable in the presence of other men, than in the presence of women. This could be due to men feeling like they’re in competition with one another, and expecting men to be less likely to relate to being emotional in public.
Finally, researchers have linked levels of gender inequality to depression. These findings have shown that depression is closely connected to power and powerlessness. Feeling powerlessness and a lack of control over our lives are well-known risk factors for depression. For this reason, the role of women in society and feeling unequal, oppressed and powerless are strong factors in female depression. This research may highlight the importance in terms of cause of depression in the different genders: different causes may also trigger different responses.
To sum up, the three different categories of Depressive Disorders and their prevalence in men and women already highlight how much we tend to diagnose men and women differently according to their symptoms. However, Male Depressive Syndrome shows us even more insight into the neglected areas of symptoms of depression that are all correlated to social roles, levels of equality and gender norms.
While a progressive approach to mental health in terms of genders is important, we can’t help but see how much our old-fashioned gender stereotypes are still affecting us as deeply as symptoms of a disorder. Spotting these symptoms within our own social circles, as well as in medical circles will help us treat more men effectively and save lives.
American Psychiatric Association, & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA.
Möller-Leimkühler, A. M., Bottlender, R., Strauß, A., & Rutz, W. (2004). Is there evidence for a male depressive syndrome in inpatients with major depression?. Journal of affective disorders, 80(1), 87-93.
Ogrodniczuk, J. S., & Oliffe, J. L. (2011). Men and depression. Canadian Family Physician, 57(2), 153-155.
Van de Velde, S., Huijts, T., Bracke, P., & Bambra, C. (2013). Macro‐level gender equality and depression in men and women in Europe. Sociology of health & illness, 35(5), 682-698.