Data from the American National Comorbidity Survey Replication (Martin et al., 2013; JAMA Psychiatry) - a nationally represented mental health survey - provides evidence that current diagnostic criteria for depression in men may be incomplete.

To conduct and present findings of a systematic review of the biological, psychological and social depression research literature relating to men.

(1) To provide a comprehensive summary of current knowledge about the expression of depression in men; (2) To examine the accuracy of current diagnostic criteria for identifying depression in men.

The PRISMA statement was used to guide a multiple database search in February and July 2012 and June 2013. Search terms included: ‘men’, ‘depression’, ‘signs’ or ‘symptoms’, ‘gender’, and ‘sex differences’. Initial database searches together with forward and backward searches found 15,966 studies that were assessed for eligibility. Thirty studies met selection criteria and were included in the review.

The review challenges findings that are commonly reported in the depression literature. The majority of studies in the review did not find significant differences between males and females in global depression rates, but instead, found significant differences between males and females in specific depressive symptoms that are expressed. Depressed men commonly reported alternative symptoms, including social withdrawal, functional impairment and sexual disturbance, together with maladaptive coping mechanisms.

Current diagnostic criteria may not accurately identify depression in men. Targeted research needs to further clarify which symptoms are required to accurately detect depression in men.