Gender differences in unipolar depression: A general population survey of adults between age 18 to 64 of German nationality

Background: Several studies from different epidemiological backgrounds have shown that unipolar depression is more prevalent in females than in males. This study examines gender differences in depression in a sample of 4075 probands recruited representatively from the general population in the northern German epidemiological catchment area of Lübeck. Methods: Probands were interviewed with M-CIDI by lay interviewers. Results: Being married only seems to increase the female depression risk when having children, while higher education reduced female excess; both male and female risk for depression raised sharply in separated, divorced and widowed probands. Not being employed was associated with an increased risk in male depression whereas in females risk was nearly unchanged. The gender ratio increased with the minimum number of depressive symptoms. Female excess was not reduced by a higher degree of subjective impairment or melancholic features. Females also predominated in longer episode durations. Female excess in the total group emerged beginning from adolescence with a tendency for a male excess in the prepubescent ages. No birth cohort effect was observed. Limitations: The cross-sectional design of this study precluded causal analysis of reported associations and some retrospective assessments are error-prone because of recall bias. Conclusions: We support previous findings of variations in gender differences in depression, however observed social parameter influences underline the need for a more detailed analysis of subgroups and underlying psychological mechanisms.