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Measuring depressive symptoms during adolescence: what is the role of gender?

  • C Bulhões (a1), E Ramos (a1) (a2), M Severo (a1) (a2), S Dias (a3) and H Barros (a1) (a2)...

Abstract

Aims.

The higher prevalence of depressive symptoms among females is well recognised but the reasons for this gender difference are not fully understood. There is growing evidence that current diagnostic criteria and instruments used to assess depression are less sensitive to depression in men, but studies about this issue among adolescents are scarce, especially in Latin countries. Our aim was to assess sex differences in the intensity of depressive symptoms, measured using the Beck Depression Inventory second edition (BDI-II), among Portuguese adolescents, at 13 and 17 years of age.

Methods.

Urban adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003–2004 (EPITeen study) completed the BDI-II at 13 and 17 years of age. The final sample included 1988 (52.2% girls) and 2131 (53.0% girls) adolescents at 13 and 17 years, respectively. Sex differences in the frequency of endorsing the statements on the 21 items of the BDI-II were examined using the χ2 test and effect sizes were estimated (Cohen's w). To examine whether responses were linked systematically to sex, we used a differential item functioning (DIF), based on the logistic regression approach. Option characteristic curves were estimated for items with differential endorsement and a new BDI-II score was computed excluding those items.

Results.

Girls and boys at the same level of depression expressed similar severity ratings for most of the depressive symptoms. We had four items with DIF at 13 and 17 years of age. At 13 years, two items provided lower scores (sadness and crying items) and two higher scores (punishment feelings and loss of interest in sex items) among boys, comparing with equally depressed girls. At 17 years, the four items with DIF provided lower scores among boys (sadness, crying, self-dislike and tiredness or fatigue items). After excluding these items the prevalence of depression remained higher among girls but at 17 years the difference between sexes was attenuated.

Conclusions.

Sex differences were found in the functioning of the BDI-II, more relevant at 17 years of age, which may lead to an overestimation of symptoms among girls as well as to lower reported rates of depression among boys. For a higher diagnostic accuracy it is important that the criteria and instruments used to assess depression adequately reflect female and male common symptoms and experiences of depression.

Copyright

Corresponding author

*Address for correspondence: C. Bulhões, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135, 4050-600 Porto, Portugal. (Email: claudiapbulhoes@gmail.com)

References

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Ambrosini, PJ, Metz, C, Bianchi, MD, Rabinovich, H & Undie, A (1991). Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 30, 5157.
Angold, A & Costello, EJ (2006). Puberty and depression. Child and Adolescent Psychiatric Clinics of North America 15, 919937, ix.
Angold, A, Costello, EJ, Worthman, CM (1998). Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychological Medicine 28, 5161.
Bares, C, Andrade, F, Delva, J, Grogan-Kaylor, A, Kamata, A (2012). Differential item functioning due to gender between depression and anxiety items among Chilean adolescents. International Journal of Social Psychiatry 58, 386392.
Bebbington, PE, Dunn, G, Jenkins, R, Lewis, G, Brugha, T, Farrell, M, Meltzer, H (1998). The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Psychological Medicine 28, 919.
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corp.
Bennett, DS, Ambrosini, PJ, Kudes, D, Metz, C, Rabinovich, H (2005). Gender differences in adolescent depression: do symptoms differ for boys and girls? Journal of Affective Disorders 89, 3544.
Breslau, J, Javaras, KN, Blacker, D, Murphy, JM, Normand, SL (2008). Differential item functioning between ethnic groups in the epidemiological assessment of depression. Journal of Nervous and Mental Disease 196, 297306.
Brooks, GR (2001). Masculinity and men's mental health. Journal of American College Health 49, 285297.
Brownhill, S, Wilhelm, K, Barclay, L, Schmied, V (2005). 'Big build': hidden depression in men. Australian and New Zealand Journal of Psychiatry 39, 921931.
Carnevale, T (2011). An integrative review of adolescent depression screening instruments: applicability for use by school nurses. Journal of Child and Adolescent Psychiatric Nursing 24, 5157.
Castro, SM, Curi, M, Torman, VB, Riboldi, J (2015). Differential item functioning in the beck depression inventory. Revista Brasileira de Epidemiologia 18, 5467.
Chaplin, TM, Gillham, JE, Seligman, ME (2009). Gender, anxiety, and depressive symptoms: a longitudinal study of early adolescents. Journal of Early Adolescence 29, 307327.
Coelho, R, Martins, A, Barros, H (2002). Clinical profiles relating gender and depressive symptoms among adolescents ascertained by the Beck Depression Inventory II. European Psychiatry 17, 222226.
Cohen, J (1992). A power primer. Psychological Bulletin 112, 155159.
Dick, B, Ferguson, BJ (2015). Health for the world's adolescents: a second chance in the second decade. Journal of Adolescent Health 56, 36.
George, MS, Ketter, TA, Parekh, PI, Herscovitch, P, Post, RM (1996). Gender differences in regional cerebral blood flow during transient self-induced sadness or happiness. Biological Psychiatry 40, 859871.
Hankin, BL (2006). Adolescent depression: description, causes, and interventions. Epilepsy & Behavior 8, 102114.
Kaltiala-Heino, R, Kosunen, E, Rimpela, M (2003). Pubertal timing, sexual behaviour and self-reported depression in middle adolescence. Journal of Adolescence 26, 531545.
Kessler, RC, McGonagle, KA, Swartz, M, Blazer, DG, Nelson, CB (1993). Sex and depression in the National Comorbidity Survey. I: lifetime prevalence, chronicity and recurrence. Journal of Affective Disorders 29, 8596.
Khan, AA, Gardner, CO, Prescott, CA, Kendler, KS (2002). Gender differences in the symptoms of major depression in opposite-sex dizygotic twin pairs. American Journal of Psychiatry 159, 14271429.
Kovacs, M (2001). Gender and the course of major depressive disorder through adolescence in clinically referred youngsters. Journal of the American Academy of Child and Adolescent Psychiatry 40, 10791085.
Kuehner, C (2003). Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica 108, 163174.
Martin, LA, Neighbors, HW, Griffith, DM (2013). The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 70, 11001106.
Masi, G, Favilla, L, Mucci, M, Poli, P, Romano, R (2001). Depressive symptoms in children and adolescents with dysthymic disorder. Psychopathology 34, 2935.
Myers, K, Winters, NC (2002). Ten-year review of rating scales. II: scales for internalizing disorders. Journal of the American Academy of Child and Adolescent Psychiatry 41, 634659.
Naninck, EF, Lucassen, PJ, Bakker, J (2011). Sex differences in adolescent depression: do sex hormones determine vulnerability? Journal of Neuroendocrinology 23, 383392.
Newmann, JP (1986). Gender, life strains, and depression. Journal of Health and Social Behavior 27, 161178.
Osman, A, Barrios, FX, Gutierrez, PM, Williams, JE, Bailey, J (2008). Psychometric properties of the Beck Depression Inventory-II in nonclinical adolescent samples. Journal of Clinical Psychology 64, 83102.
Ramos, E, Barros, H (2007). Family and school determinants of overweight in 13-year-old Portuguese adolescents. Acta Paediatrica 96, 281286.
Rice, SM, Fallon, BJ, Aucote, HM, Moller-Leimkuhler, AM (2013). Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men. Journal of Affective Disorders 151, 950958.
Roberts, RE, Lewinsohn, PM, Seeley, JR (1991). Screening for adolescent depression: a comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry 30, 5866.
Roberts, RE, Lewinsohn, PM, Seeley, JR (1995). Symptoms of DSM-III-R major depression in adolescence: evidence from an epidemiological survey. Journal of the American Academy of Child and Adolescent Psychiatry 34, 16081617.
Rochlen, AB, Paterniti, DA, Epstein, RM, Duberstein, P, Willeford, L, Kravitz, RL (2010). Barriers in diagnosing and treating men with depression: a focus group report. American Journal of Men's Health 4, 167175.
Romans, SE, Tyas, J, Cohen, MM, Silverstone, T (2007). Gender differences in the symptoms of major depressive disorder. Journal of Nervous and Mental Disease 195, 905911.
Rutz, W, Walinder, J, Von Knorring, L, Rihmer, Z, Pihlgren, H (1997). Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland study. International Journal of Psychiatry in Clinical Practice 1, 3946.
Salokangas, RK, Vaahtera, K, Pacriev, S, Sohlman, B, Lehtinen, V (2002). Gender differences in depressive symptoms. An artefact caused by measurement instruments? Journal of Affective Disorders 68, 215220.
Santor, DA, Ramsay, JO, Zuroff, DC (1994). Nonparametric item analyses of the Beck Depression Inventory: evaluating gender item bias and response option weights. Psychological Assessment 6, 255270.
Siegel, JM, Yancey, AK, Aneshensel, CS, Schuler, R (1999). Body image, perceived pubertal timing, and adolescent mental health. Journal of Adolescent Health 25, 155165.
Stehouwer, RS, Bultsma, CA, Blackford, IT (1985). Developmental differences in depression: cognitive-perceptual distortion in adolescent versus adult female depressives. Adolescence 20, 291299.
Stockings, E, Degenhardt, L, Lee, YY, Mihalopoulos, C, Liu, A, Hobbs, M, Patton, G (2015). Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility. Journal of Affective Disorders 174, 447463.
Swaminathan, H, Rogers, HJ (1990). Detecting differential item functioning using logistic regression procedures. Journal of Educational Measurement 27, 361370.
Thapar, A, Collishaw, S, Pine, DS, Thapar, AK (2012). Depression in adolescence. Lancet 379, 10561067.
van Beek, Y, Hessen, DJ, Hutteman, R, Verhulp, EE, van Leuven, M (2012). Age and gender differences in depression across adolescence: real or ‘bias’? Journal of Child Psychology and Psychiatry and Allied Disciplines 53, 973985.
Wang, YP, Gorenstein, C (2013). Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Revista Brasileira de Psiquiatria 35, 416431.
Weller, EB, Kloos, A, Kang, J, Weller, RA (2006). Depression in children and adolescents: does gender make a difference? Current Psychiatry Reports 8, 108114.
Williams, DG, Morris, GH (1996). Crying, weeping or tearfulness in British and Israeli adults. British Journal of Psychology 87(Pt 3), 479505.
Young, MA, Scheftner, WA, Fawcett, J, Klerman, GL (1990). Gender differences in the clinical features of unipolar major depressive disorder. Journal of Nervous and Mental Disease 178, 200203.
Zierau, F, Bille, A, Rutz, W, Bech, P (2002). The Gotland Male Depression Scale: a validity study in patients with alcohol use disorder. Nordic Journal of Psychiatry 56, 265271.

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Measuring depressive symptoms during adolescence: what is the role of gender?

  • C Bulhões (a1), E Ramos (a1) (a2), M Severo (a1) (a2), S Dias (a3) and H Barros (a1) (a2)...

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