The Psychology of Gender 4th Edition

492 Chapter 13

to detect depression in men compared to

women, and in African Americans and His-

panics compared to Caucasians (Borowsky

et al., 2000). That is, more of men’s than

women’s depression went undetected by phy-

sicians. However, another study asked pri-

mary care physicians to review vignettes of

elderly patients with depression and showed

that physicians correctly classified the pa-

tients as depressed in 85% of the cases, and

equally so for males and females (Kales et al.,

2005). Although physicians are more likely

to prescribe antidepressants and antianxi-

ety drugs to women than to men, even when

they have similar diagnoses (Simoni-Wastila,

1998), this may not be the case among phy-

sicians who specialize in mental illness—

psychiatrists. Psychiatrists may be less vulner-

able than primary care physicians to biases.

One study showed that psychiatrists were

equally likely to diagnose similar symptoms

as depression in women and men and pre-

scribed drugs and psychotherapy with equal

frequency to women and men (Olfson et al.,

2001). Conduct Do Gender 13.1 to see if your

Methodological Artifacts

Some investigators have contested these

seemingly indisputable data that a sex differ-

ence in depression exists. Three sets of meth-

odological problems or artifacts could explain

why women “appear” to be more depressed.

First, there may be a bias on the part of clini-

cians, such that depression is overdiagnosed

among women and underdiagnosed among

men. Second, there may be a response bias

on the part of depressed persons; men may be

less likely than women to admit depression

or to seek help for depression. Third, women

and men may manifest depression in differ-

ent ways, and instruments are biased in the

direction of tapping female depression.

Clinician Bias

One source of bias is the clinician’s judg-

ment. Perhaps clinicians are more likely to

interpret a set of symptoms as depression

when the patient is female than male. Why

might this be? First, clinicians are undoubt-

edly aware of the sex difference in depres-

sion. Thus clinicians’ mental illness schema

for a female patient is more likely to contain

depression than their mental illness schema

for a male patient. When a female patient

comes into the office, depression-related

schemas are more likely to be activated. Am-

biguous symptoms such as feeling tired or

lacking energy can be indicators of a variety

of health problems. Clinicians may be more

likely to interpret such symptoms as depres-

sion in a female patient and cardiac disease

in a male patient.

The evidence for clinician bias is equiv-

ocal. In a study that compared primary care

physicians’ detection of mental health prob-

lems among over 19,000 patients to an inde-

pendent screening, physicians were less likely

DO GENDER 13.1

Is This Depression?

Create a description of a depressed person.

Make the symptoms subtle. Do not say

the person is depressed. Use items from

Tables 13.1 and 13.2 to help you. Create

two versions of this description, one with

a female name and one with a male name.

Randomly distribute one of the two ver-

sions to 20 people. Ask each respondent to

identify the person’s problem.

Compare the percentages of people

who identify depression in the female and

male vignettes.

M13_HELG0185_04_SE_C13.indd 492 6/21/11 12:55 PM