女性的憂鬱比率較高是個迷思?


  【24drs.com】一般認為女性的憂鬱症比率高於男性,但是,新研究顯示,當考量憂鬱的其他症狀和傳統症狀時,就沒有這些性別差異了。
  
  美國密西根大學Lisa A. Martin博士等研究者寫道,這個性別差異的架構在於男性和女性的憂鬱組成因素是一樣的,只是在症狀等相關變項上探討性別差異。
  
  雖然這已經是目前流行的作法,但往往僅根據「男性憂鬱」相對於「女性憂鬱」的二分法進行評論,而無法真正知道兩性之間的異質性。
  
  這篇研究線上登載於8月28日的JAMA Psychiatry期刊。研究目的在於,探討把傳統的憂鬱症狀之外的其他症狀也納入考量時,憂鬱症的性別差異是否會消失。
  
  研究者使用「National Comorbidity Survey Replication (NCS-R)」這項全國代表性調查的資料,美國講英語成人的心智異常發生率和盛行率。
  
  這項調查包括3,310名女性和2,382名男性,平均年紀45.2歲,73.4%是非西班牙裔白人、51.6%教育程度在高中以上,平均家庭年收入是59,575美元,男性平均收入是63,365美元,女性是49,327美元。
  
  研究者發展出兩個量表,第一,男性症狀量表(Male Symptoms Scale,MSS),包括其他的男性類型憂鬱症狀,如煩躁、憤怒攻擊/侵略、睡眠障礙、酒精或藥物濫用、冒險行為、過動、緊張、喪失對愉快活動之興趣;第二個量表是性別包容性憂鬱量表(Gender Inclusive Depression Scale,GIDS),包括所有的MSS症狀,加上7個傳統憂鬱症狀:悲傷/心情鬱悶、失去活力、疲倦、矛盾、焦慮/不安、頻感抱怨或可悲。
  
  根據包括了其他非傳統男性憂鬱症狀的MSS量表,研究者發現男性的憂鬱症盛行率(26.3%)高於女性(21.9%) (P = .007);男性的憤怒攻擊/侵略、濫用藥物、冒險行為比率顯著高於女性;另一方面,女性的緊張、煩躁不安、睡眠問題、以及對原本喜歡的東西,如工作、愛好、和個人關係等失去興趣的比率則顯著較高。
  
  使用包括傳統和非傳統憂鬱症狀的GIDS評估之後,憂鬱盛行率並無性別差異,根據此量表,符合憂鬱準則的男性比率為30.6%、女性為33.3%。
  
  就憂鬱嚴重度而言,研究者發現,63.2%的男性和62.0%的女性屬於輕微型,表示他們只有1-4個症狀;28.3%的男性和28.9%的女性屬於中度型,有5-9個症狀;8.5%的男性和9.1%的女性屬於嚴重型,有10-15個症狀。研究者報告指出,任何嚴重度都沒有顯著的性別差異。
  
  作者們寫道,這些結果認為,僅依賴男性的傳統症狀會導致男性的憂鬱症未被診斷,醫師評估男性憂鬱時應考慮其他線索。
  
  他們也指出,儘管這篇報告有重要發現,但是仍有限制。限制之一是,該研究並未包括過度工作、過度運動、改變他們的性行為、或賭博等男性之症狀,此外,用來評估掌握機會或產生魯莽行為的項目和情緒狀況並無關;研究者認為,後續研究應納入評估這些被排除的行為等項目。
  
  他們結論表示,他們的研究結果有潛力為憂鬱症的感知和測量帶來重大進步,這些研究結果可能在憂鬱症的概念與測量方法上帶來重要改變。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7005&x_classno=0&x_chkdelpoint=Y
  

Higher Depression Rates in Women a Myth?

By Fran Lowry
Medscape Medical News

Women have long been thought to have much higher rates of depression than men, but when alternative and traditional symptoms of depression are considered, these sex disparities disappear, new research shows.

"The sex differences framework is rooted in the idea that the construct of depression is the same in men and women and seeks to investigate sex differences in a range of related variables, including symptoms," investigators led by Lisa A. Martin, PhD, from the University of Michigan, Dearborn, write.

"Although this has been a popular approach to date, it is often critiqued for relying on oppositional binaries that understand 'male depression' only as it is contrasted with 'female depression,' which fails to acknowledge the heterogeneity that exists within these groups."

The study is published online August 28 in JAMA Psychiatry.

More Anger, Aggression in Men

The aim of the study was to explore whether sex disparities in depression rates disappear when other symptoms besides conventional depression symptoms are considered.

The researchers used data from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the incidence and prevalence of mental disorders among English-speaking adults in the United States.

The survey included 3310 women and 2382 men. Their mean age was 45.2 years, 73.4% were non-Hispanic white, and 51.6% had some education beyond high school. The mean annual household income was $59,575. The mean income for men was $63,365, and for women, it was $49,327.

The researchers developed 2 scales. The first, the Male Symptoms Scale (MSS), included alternative male-type symptoms of depression, including irritability, anger attacks/aggression, sleep disturbance, alcohol or drug abuse, risk-taking behavior, hyperactivity, stress, and loss of interest in pleasurable activities.

The second scale, the Gender Inclusive Depression Scale (GIDS), included all of the MSS symptoms, plus 7 traditional symptoms of depression, including sad/depressed mood, loss of vitality, tiredness, ambivalence, anxiety/uneasiness, and complaintiveness or feeling pathetic.

Using the MSS scale that included alternative, male-type symptoms of depression, the researchers found a higher prevalence of depression in men (26.3%) than in women (21.9%) (P = .007).

The researchers also found that men reported significantly higher rates of anger attacks/aggression, substance abuse, and risk-taking behavior compared with women.

More Stress, Irritability in Women

Women, on the other hand, reported significantly greater rates of stress, irritability, sleep problems, and loss of interest in things they usually enjoyed, such as work, hobbies, and personal relationships.

No sex difference in the prevalence of depression as assessed by the GIDS that included alternative and traditional depression symptoms was found. According to that scale, 30.6% of men and 33.3% of women met criteria for depression.

In terms of severity of depression, the researchers found that 63.2% of men and 62.0% of women fell into the mild category, meaning that they had 1 to 4 symptoms; 28.3% of men and 28.9% of women fell into the moderate category, with 5 to 9 symptoms; and 8.5% of men and 9.1% of women fell into the severe category, with 10 to 15 symptoms. No significant sex differences were demonstrated at any severity level, they report.

"These results suggest that relying only on men's disclosure of traditional symptoms could lead to an underdiagnosis of depression in men and that clinicians should consider other clues when assessing depression in men," the authors write.

They also point out that "despite the significant findings reported in this study, there are noteworthy limitations."

One limitation was that the study did not include symptoms among men such as overworking, overexercising, changing their sexual behavior, or gambling. Also, items that assessed taking chances or reckless behavior were not linked to an emotional condition. Future studies should include items that assess the excluded behaviors, the authors suggest.

They conclude that the results of their study have the potential to bring "significant advances to the field in terms of the perception and measurement of depression. These findings could lead to important changes in the way depression is conceptualized and measured."

The investigators have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online August 28, 2013.

    
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