Introduction
Women suffer from depression at higher rates than men. This difference is well established,
although a consolidated explanation remains elusive. This study examines the role
played by medications with depression or suicidality as a potential side effect in
explaining the sex difference in depression.
Methods
Data were analyzed for 224,810 U.S. adults aged ≥18 years from the 2008–2018 Medical
Expenditure Panel Survey. Linear and logistic regressions were used to assess the
sex differences in distress and depression while controlling for sociodemographic
characteristics, healthcare access, health conditions, and the use of medications
with depression or suicidality as a side effect.
Results
41% and 28% of women used ≥1 medication with depression and suicidality as a side
effect compared with 27% and 17% of men, respectively. When controlling for sociodemographic
characteristics, healthcare access, and health conditions, women were more likely
to report significant distress (OR=1.16, 95% CI=1.10, 1.24) and major depression (OR=1.12,
95% CI=1.07, 1.18) than men. In models that further adjusted for the use of medications
with depression or suicidality as a side effect, the sex differences became statistically
nonsignificant for both distress (OR=0.97, 95% CI=0.91, 1.03) and depression (OR=0.97,
95% CI=0.92, 1.02). Nonhormone medications (rather than hormone medications) with
such side effects helped explain the sex differences in distress and depression.
Conclusions
Findings suggest a significant sex difference in pharmaceutical treatment and the
potential consequences of pharmaceutical side effects on distress and depression.
These results highlight the importance of pharmaceutical side effects in understanding
health and health disparities.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms.Psychol Bull. 2017; 143: 783-822https://doi.org/10.1037/bul0000102
- The ABCs of depression: integrating affective, biological, and cognitive models to explain the emergence of the gender difference in depression.Psychol Rev. 2008; 115: 291-313https://doi.org/10.1037/0033-295X.115.2.291
- Biological and social contributions to negative affect in young adolescent girls.Child Dev. 1989; 60: 40-55https://doi.org/10.1111/j.1467-8624.1989.tb02693.x
- Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model.Arch Gen Psychiatry. 2000; 57: 21-27https://doi.org/10.1001/archpsyc.57.1.21
- Effects of age and pubertal status on depression in a large clinical sample.Dev Psychopathol. 1992; 4: 5-28https://doi.org/10.1017/S0954579400005538
- Epidemiology of women and depression.J Affect Disord. 2003; 74: 5-13https://doi.org/10.1016/S0165-0327(02)00426-3
- Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.Arch Gen Psychiatry. 1994; 51: 8-19https://doi.org/10.1001/archpsyc.1994.03950010008002
- Hormonal contraception and depression: a survey of the present state of knowledge.Arch Obstet Gynaecol. 2012; 286: 231-236https://doi.org/10.1007/s00404-012-2298-2
- Emotional and cognitive functional imaging of estrogen and progesterone effects in the female human brain: a systematic review.Psychoneuroendocrinology. 2014; 50: 28-52https://doi.org/10.1016/j.psyneuen.2014.07.025
- Association of hormonal contraception with depression.JAMA Psychiatry. 2016; 73: 1154-1162https://doi.org/10.1001/jamapsychiatry.2016.2387
- Current contraceptive status among women aged 15‒49: United States, 2017‒2019.NCHS Data Brief. 2020; (Accessed November 24, 2020): 1-8
- Hormonal contraceptives and mood: review of the literature and implications for future research.Curr Psychiatry Rep. 2019; 21: 57https://doi.org/10.1007/s11920-019-1034-z
- Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill–a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive.Psychoneuroendocrinology. 2013; 38: 1133-1144https://doi.org/10.1016/j.psyneuen.2012.11.006
- Oestrogens, progestins and mood.in: Steiner M Yonkers KA Ericson E Mood Disorders in Women. Taylor & Francis, Oxfordshire, United Kingdom2000: 207-232 (Accessed July 15, 2021.)
- Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States.JAMA. 2018; 319: 2289-2298https://doi.org/10.1001/jama.2018.6741
- Trends in prescription drug use among adults in the United States from 1999-2012.JAMA. 2015; 314: 1818-1831https://doi.org/10.1001/jama.2015.13766
- Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: National Health and Nutrition Examination Survey 2005-2006.BMC Psychiatry. 2011; 11: 130https://doi.org/10.1186/1471-244X-11-130
- Sex differences in medical care utilization: an empirical investigation.J Health Soc Behav. 1982; 23: 106-119https://doi.org/10.2307/2136508
- Sex differentials in health and mortality.Women Health. 1987; 12: 103-145https://doi.org/10.1300/J013v12n02_07
IPUMS Health Surveys: Medical Expenditure Panel Survey. University of Minnesota. https://meps.ipums.org/meps/index.shtml. Updated September 2, 2021. Accessed January 20, 2021.
- MEPS HC036: 1996-2018 pooled linkage file for common variance structure.Agency for Healthcare Research and Quality, Rockville, MDJuly 2020 (PublishedAccessed January 22, 2022)
- Screening for serious mental illness in the general population.Arch Gen Psychiatry. 2003; 60: 184-189https://doi.org/10.1001/archpsyc.60.2.184
- Study of the Discriminative Validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care.Perspect Psychiatr Care. 2009; 45: 216-227https://doi.org/10.1111/j.1744-6163.2009.00224.x
- Implications of the accuracy of MEPS prescription drug data for health services research.Inquiry. 2011; 48: 242-259https://doi.org/10.5034/inquiryjrnl_48.03.04
- Pain and depression: a systematic review.Harv Rev Psychiatry. 2018; 26: 352-363https://doi.org/10.1097/HRP.0000000000000198
- Mediation analysis with intermediate confounding: structural equation modeling viewed through the causal inference lens.Am J Epidemiol. 2015; 181: 64-80https://doi.org/10.1093/aje/kwu239
- Polypharmacy among adults aged 65 years and older in the United States: 1988-2010.J Gerontol A Biol Sci Med Sci. 2015; 70https://doi.org/10.1093/gerona/glv013
- Trends in the use of medications with insomnia side effects and the implications for insomnia among U.S. adults.J Sleep Res. 2020; 29: e13075https://doi.org/10.1111/jsr.13075
- Utilization of medications with cognitive impairment side effects and the implications for older adults’ cognitive function.J Aging Health. 2020; 32: 1165-1177https://doi.org/10.1177/0898264319895842
- Pharmaceutical side effects and mental health paradoxes among racial-ethnic minorities.J Health Soc Behav. 2020; 61: 4-23https://doi.org/10.1177/0022146519899115
- Trends in mail-order pharmacy use in the U.S. from 1996 to 2018: an analysis of the Medical Expenditure Panel Survey.Am J Prev Med. 2021; 61: e63-e72https://doi.org/10.1016/j.amepre.2021.02.017
- The twain meet: empirical explanations of sex differences in health and mortality.J Health Soc Behav. 1989; 30: 282-304https://doi.org/10.2307/2136961
Article Info
Publication History
Published online: April 08, 2022
Identification
Copyright
© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
