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GENDER and DEPRESSION: typical and ATYPITCAL symptoms and SUICIDAL IDEATION IDEATION Dissertation Presented to the Faculty of the College of Health Sciences of Touro University International. 75% of those who sought professional help in an institution for suicide prevention were female.
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18648340 Male vs Female Depression Why Men Act Out and Women Act In
GENDER and DEPRESSION: typical and ATYPITCAL symptoms and SUICIDAL IDEATION IDEATION Dissertation Presented to the Faculty of the College of Health Sciences of Touro University International. 75% of those who sought professional help in an institution for suicide prevention were female.
GENDER and DEPRESSION: typical and ATYPITCAL symptoms and SUICIDAL IDEATION IDEATION Dissertation Presented to the Faculty of the College of Health Sciences of Touro University International. 75% of those who sought professional help in an institution for suicide prevention were female.
SYMPTOMS AND SUICIDAL SYMPTOMS AND SUICIDAL IDEATION IDEATION Dissertation Dissertation Presented to the Faculty of the College of Health Sciences Presented to the Faculty of the College of Health Sciences of Touro University International of Touro University International in Partial Fulfillment of the Requirements for the Degree of in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Health Sciences Doctor of Philosophy in Health Sciences By By Jed Diamond Jed Diamond March 14, 2008 March 14, 2008 Dissertation Chair: Mihaela Tanasescu MD, ScD Dissertation Chair: Mihaela Tanasescu MD, ScD Committee Member: Frank Gomez, PhD Committee Member: Frank Gomez, PhD Committee Member: Anne Maria Mller Committee Member: Anne Maria Mller--Leimkhler, PhD Leimkhler, PhD Significance and Rationale For Study Significance and Rationale For Study Women seek helpmen die. This conclusion was drawn from a study of suicide prevention by Angst & Ernst (1990). They found that 75% of those who sought professional help in an institution for suicide prevention were female. Conversely 75% of those who committed suicide in the same year were male. Since depression is a significant risk factor for suicide and men receive less treatment for depression than do women, it is vitally important that we have a better understanding of the way depression manifests itself in males. yAge ySocioeconomic status yChronic disease (heart disease, stroke, diabetes, cancer, other) yMarital status (and marital happiness) yPrevious depression yFamily history of depression and suicide yLoss, trauma, life changes yAlcohol use, etc. Suicidal Ideation Depression (Typical symptoms) Gender Atypical symptoms of depression CONCEPTUAL MODEL CONCEPTUAL MODEL Risk Factors Risk Factors Research Hypotheses Research Hypotheses There will be a significant positive relationship between typical There will be a significant positive relationship between typical depression (CES depression (CES--D) and atypical depression (DMDS). D) and atypical depression (DMDS). Depressed men will score significantly higher for atypical symptoms Depressed men will score significantly higher for atypical symptoms (DMDS) than depressed women. (DMDS) than depressed women. Non Non--depressed men will score significantly higher for atypical symptoms depressed men will score significantly higher for atypical symptoms (DMDS) than non (DMDS) than non--depressed women. depressed women. There will be a significant relationship between known depressive risk There will be a significant relationship between known depressive risk factors and atypical depression. factors and atypical depression. There will be a significant positive relationship between atypical There will be a significant positive relationship between atypical symptoms (DMDS) and suicide risk. symptoms (DMDS) and suicide risk. Atypical symptoms of depression will be positively related to suicide risk Atypical symptoms of depression will be positively related to suicide risk when controlled for typical depression. when controlled for typical depression. There will be a significant positive relationship between atypical There will be a significant positive relationship between atypical symptoms (DMDS) and scores on the Gotland scale. symptoms (DMDS) and scores on the Gotland scale. Demographics of Study Population Demographics of Study Population 323 females and 749 males (1072 total). 323 females and 749 males (1072 total). Age range 18 Age range 18--80, Mean 51, 58% over 50. 80, Mean 51, 58% over 50. 76% employed, 64% income > $50,000/year. 76% employed, 64% income > $50,000/year. 48% of the males and 40% of the females 48% of the males and 40% of the females depressed (CES depressed (CES--D 20). D 20). 53%, 1+ relatives have mood disorder. 53%, 1+ relatives have mood disorder. Factor Analysis of Diamond Male Factor Analysis of Diamond Male Depression Scale (DMDS) Depression Scale (DMDS) Factor 1: Emotional Acting Factor 1: Emotional Acting--In Depression, In Depression, Chronbachs alpha = .93 Chronbachs alpha = .93 Negative, withdrawn, stressed, numb. Negative, withdrawn, stressed, numb. Factor 2: Emotional Acting Factor 2: Emotional Acting--Out Depression, Out Depression, Chronbachs alpha = .89 Chronbachs alpha = .89 Short Short--fuse, impatient, irritable, angry. fuse, impatient, irritable, angry. Factor 3: Physical Acting Factor 3: Physical Acting--Out Depression Out Depression Chronbachs alpha = .73 Chronbachs alpha = .73 Alcohol abuse, reckless, explosive, violent. Alcohol abuse, reckless, explosive, violent. Correlation of Typical Depression (CES Correlation of Typical Depression (CES--D 20) D 20) with DMDS Factors with DMDS Factors Factor Pearson Correlation P-value Factor 1, Emotional Acting-In .700 < .001 Factor 2, Emotional Acting-Out .474 < .001 Factor 3, Physical Acting- Out .319 < .001 DMDS Factors in Depressed and Non DMDS Factors in Depressed and Non--Depressed Men and Women Depressed Men and Women Predicting Factor 1 Emotional Acting-In Unstandardized Coefficient P-value Depressed Men vs. Women 1.15 .208 Non-depressed Men vs. Women .47 .510 Predicting Factor 2 Emotional Acting-Out Depressed Men vs. Women 1.47 .002 Non-depressed Men vs. Women 1.19 .001 Predicting Factor 3 Physical Acting-Out Depressed Men vs. Women 1.52 < .001 Non-depressed Men vs. Women .86 .003 The second and third hypotheses-- Depressed men will score significantly higher for atypical symptoms (DMDS) than depressed women and non-depressed men will score significantly higher for atypical symptoms (DMDS) than non-depressed women was answered affirmatively for Factor 2 and Factor 3. Atypical Symptoms of Depression and Known Depressive Risk Factors Atypical Symptoms of Depression and Known Depressive Risk Factors There was a There was a negative negative relationship between atypical depression (DMDS) factors relationship between atypical depression (DMDS) factors and the following risk factors: and the following risk factors: Age ( Factor 1, p = < .001, Factor 2, p = < .001, Factor 3, p = < .001) Age ( Factor 1, p = < .001, Factor 2, p = < .001, Factor 3, p = < .001) Gross family income ( Factor 1, p = .015, Factor 2, p = .001, Gross family income ( Factor 1, p = .015, Factor 2, p = .001, Factor 3, was not significant). Factor 3, was not significant). Relationship happiness ( Factor 1, p = < .001, Factor 2, p = < .001, Relationship happiness ( Factor 1, p = < .001, Factor 2, p = < .001, Factor 3, p = < .001). Factor 3, p = < .001). There was a There was a positive positive relationship between atypical depression (DMDS) factors relationship between atypical depression (DMDS) factors and the following risk factors: and the following risk factors: Comorbid medical conditions ( Factor 1, p = < .001, Factor 2, p = .001, Comorbid medical conditions ( Factor 1, p = < .001, Factor 2, p = .001, Factor 3, p =.006). Factor 3, p =.006). Having relatives who were depressed ( Factor 1, p = .034, Having relatives who were depressed ( Factor 1, p = .034, Factor 2, p = .031, Factor 3, p =.002). Factor 2, p = .031, Factor 3, p =.002). The forth hypothesis, There will be a significant relationship between The forth hypothesis, There will be a significant relationship between known depressive risk factors and atypical depression, was answered known depressive risk factors and atypical depression, was answered affirmatively for the risk factors previously noted. affirmatively for the risk factors previously noted. Logistic Regression for DMDS Factors and Beck Suicide Risk Adjusted Logistic Regression for DMDS Factors and Beck Suicide Risk Adjusted for Psychiatric Diagnoses, Age, Gender, and Gross Family Income for Psychiatric Diagnoses, Age, Gender, and Gross Family Income 95.0% C.I. for Exp(B) P-value Odds Ratio Lower Upper Factor 1, Emotional Acting-In < .001 1.258 1.219 1.299 Factor 2, Emotional Acting-Out .221 .968 .919 1.020 Factor 3, Physical Acting-Out .560 .984 .933 1.038 Psychiatric diagnoses .714 1.031 .959 1.306 Age .075 1.013 .861 1.235 Gender .035 1.497 1.029 1.178 Gross family income .004 .804 .692 .933 R Squared = .563 The fifth hypothesis--There will be a significant positive relationship between atypical symptoms (DMDS) and suicide risk--was answered affirmatively for Factor 1, Emotional Acting-In, but not for Factor 2, Emotional Acting-Out, or for Factor 3, Physical Acting- Out. Logistic Regression for DMDS Logistic Regression for DMDS Factors and Beck Suicide Risk Adjusted Factors and Beck Suicide Risk Adjusted for Psychiatric Diagnoses, Age, Gender, Gross Family Income, and for Psychiatric Diagnoses, Age, Gender, Gross Family Income, and Typical Depression (CES Typical Depression (CES--D 20) D 20) 95.0% C.I. for Exp(B) P-value Odds Ratio Lower Upper Factor 1, Emotional Acting-In < .001 1.237 1.195 1.281 Factor 2, Emotional Acting-Out .316 .973 .924 1.026 Factor 3, Physical Acting-Out .506 .982 .931 1.036 Psychiatric diagnoses .917 1.010 .841 1.213 Age < .001 1.033 1.016 1.051 Gender .047 1.467 1.006 2.139 Gross family income .006 .809 .697 .940 CES-D 20 .027 1.547 1.050 2.281 R Squared = .566 The six hypothesis--Atypical symptoms of depression will be positively related to suicide risk when controlled for typical depression--was answered affirmatively for Factor 1, Emotional Acting-In, but not for Factor 2, Emotional Acting-Out, or for Factor 3, Physical Acting-Out. Gotland Scale Correlations and Gotland Scale Correlations and Factors 1, 2, and 3 of the DMDS Factors 1, 2, and 3 of the DMDS Factor Pearson Correlation P-value Factor 1, Emotional Acting- In .794 < .001 Factor 2, Emotional Acting- Out .584 < .001 Factor 3, Physical Acting- Out .393 < .001 The seventh hypothesis--There will be a significant positive relationship between atypical symptoms (DMDS) and scores on the Gotland scale--was answered affirmatively Implications for Theory Implications for Theory This study adds to the body of knowledge regarding This study adds to the body of knowledge regarding gender and depression. By evaluating a larger set of gender and depression. By evaluating a larger set of atypical depression symptoms (DMDS) than had atypical depression symptoms (DMDS) than had previously been used by Rutz (1999) with the Gotland previously been used by Rutz (1999) with the Gotland Scale for Assessing Male Depression, the study added to Scale for Assessing Male Depression, the study added to our understanding of male our understanding of male--type depression. type depression. The study expands our understanding of the The study expands our understanding of the relationship between gender and atypical symptoms for relationship between gender and atypical symptoms for depression. It addressed a gap in the research literature depression. It addressed a gap in the research literature on gender and depression by clarifying three separate on gender and depression by clarifying three separate factors or subscales that are associated with depression factors or subscales that are associated with depression and suicide risk. and suicide risk. Potential Bias Potential Bias There were selection biases since the study population was recruited through websites that were focused on people with an interest in gender issues and depression and thus not representative of the general population. There were measurement biases since assessment of important variables such as depression and suicide risk were based on respondents answers to an on-line questionnaire. No outside, professional assessments were conducted. Subjects were rated as being depressed or non-depressed based on their answers to a traditional depression scale (CES-D). Since one of the theoretical assumptions of the study was that depressed males might be missed using a traditional scale, this may have introduced additional measurement bias. Recommendations for Future Research Recommendations for Future Research Future research will be needed to validate the results of the Future research will be needed to validate the results of the study and to develop numerical scores for evaluating study and to develop numerical scores for evaluating depression and suicide risk using the DMDS. depression and suicide risk using the DMDS. It would be helpful to conduct research with a general It would be helpful to conduct research with a general population to see if results were consistent in a population population to see if results were consistent in a population representative of the general community. Particular attention representative of the general community. Particular attention should be focused on including men and women from different should be focused on including men and women from different ethnic groups, cultural backgrounds, economic levels, and age ethnic groups, cultural backgrounds, economic levels, and age groups. groups. Recommendation for Clinical Practice Recommendation for Clinical Practice The belief that depression is a disease primarily affecting women has left too The belief that depression is a disease primarily affecting women has left too many males undiagnosed and untreated. many males undiagnosed and untreated. Many clinicians believe that depressed males are undiagnosed because the Many clinicians believe that depressed males are undiagnosed because the evaluation scales being used do not address the symptoms of depression that evaluation scales being used do not address the symptoms of depression that are more common in men. are more common in men. Based on the results of the present study, it is recommended that clinicians Based on the results of the present study, it is recommended that clinicians use scales that include atypical symptoms such as those found on the DMDS use scales that include atypical symptoms such as those found on the DMDS and Gotland Scales. and Gotland Scales. Surprises Surprises Though the study was originally designed for U.S. clients, men and Though the study was originally designed for U.S. clients, men and women from 44 other countries participated. women from 44 other countries participated. Based on clinical experience it was expected that it would be Based on clinical experience it was expected that it would be difficult to recruit depressed males. This was not the case. difficult to recruit depressed males. This was not the case. Only Factor 1, Emotionally Only Factor 1, Emotionally--Acting In, was significantly related to Acting In, was significantly related to suicide risk when all three factors were used together. suicide risk when all three factors were used together. There was actually a negative relationship between suicide risk and There was actually a negative relationship between suicide risk and Factors 2 and 3, though the relationship was not significant. Factors 2 and 3, though the relationship was not significant. Thank You! Thank You! The three of you, each in your own way, The three of you, each in your own way, have made this study much better than it have made this study much better than it would have been. would have been.