490 Chapter 13widowed. As discussed in Chapter 11, this is
largely because rates of depression increase
among men more than women following
widowhood.
The sex difference in depression emerges
during adolescence and is fairly consistent
across the life span. A meta-analysis of sex dif-
ferences in depression showed that girls are
slightly less likely than boys to be depressed
prior to age 13 but that girls’ depression in-
creases after age 13, creating the sex difference,
as shown in Figure 13.2 (Twenge & Nolen-
Hoeksema, 2002). After this, the sex difference
in depression remains stable over the life span.
We may wonder whether the same
women and men remain depressed through-
out their lives or if, at any given point,
women are twice as likely as men to become
depressed. No evidence suggests that depres-
sion is more chronic in women or that de-
pression is more likely to recur in women
than men (Kessler, 2000; Nolen-Hoeksema,
2004). Once women and men sustain an epi-
sode of major depression, they are equally
likely to experience a recurrence. In a large-
scale study of adults ages 48 to 79, 60% of
both women and men who had had onethat the female to male odds ratio exceeds 1.0
in all cases, signifying higher rates in women
than men. In the United States, women were
1.6 times as likely as men to be clinically de-
pressed. This study also showed that countries
in which the female gender role has become
less traditional (as measured by female edu-
cation and participation in the labor force)
showed a decrease in the sex difference in de-
pression over time. However, it is not clear if
the smaller sex difference is due to a lowered
rate of depression in females or an elevated
rate of depression in males. Interestingly, there
is no overall sex difference in bipolar disorder
(more commonly known as manic-depressive
illness). See Sidebar 13.1 for a brief discussion.
There is other cross-cultural support
for sex differences in depression. Women are
two to three times more likely than men to
be depressed in the majority of Islamic coun-
tries (Alansari, 2006). In some populations,
sex differences in depression are less likely
to be found. For example, sex differences in
depression are often not found in homoge-
neous populations, such as college students
(Grant et al., 2002). Another population that
shows no sex difference in depression is theSIDEBAR 13.1: Bipolar Disorder
Bipolar disorder includes both manic and depressive symptoms. The disorder takes different
forms in women and men. Depressive symptoms predominate in women, whereas manic symp-
toms predominate in men (Kawa et al., 2005). Men are more likely than women to have mania
at the onset of disorder. Bipolar disorder is also more likely to take place in the context of alco-
hol abuse, drug abuse, and conduct disorders among males, and more likely to take place in the
context of eating disorders and panic disorder among females (Baldassano et al., 2005; Benedetti
et al., 2007; Carter et al., 2005). The incidence of bipolar disorder peaks during the ages of 16
to 25, during which time it is more common among males than females (Kennedy et al., 2005).
After age 25, bipolar disorder decreases among both males and females, but the decrease is larger
for males. Thus, throughout adulthood, females have higher rates of bipolar disorder than males.M13_HELG0185_04_SE_C13.indd 490 6/21/11 12:55 PM