Depression in relation to sex and gender expression among Swedish septuagenarians-Results from the H70 study.

Therese Rydberg Sterner,Nazib Seidu,Silke Kern,Hanna Wetterberg,Margda Waern,Ingmar Skoog,Robert Sigström,Lina Rydén,Anna Zettergren,Pia Gudmundsson,Svante Östling,Hanna Falk,Felicia Ahlner,Karen B Schmaling

doi:10.1371/journal.pone.0238701

Therese Rydberg Sterner, Nazib Seidu + Show 12 more

Open Access

https://doi.org/10.1371/journal.pone.0238701

Copy DOI

Abstract

ObjectiveLittle is known about the role of gender expression (femininity, masculinity, or androgyny) in relation to sex differences in depression. This study tested if gender expression was associated with depression and burden of depressive symptoms in a 70-year-old population.MethodsA cross-sectional population-based sample of 70-year-olds from The Gothenburg H70 Birth Cohort Study (n = 1203) was examined in 2014–16. Data were collected using psychiatric examinations and structured questionnaires, including the Positive-Negative Sex-Role Inventory to assess gender expression. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders criteria, and symptom burden was assessed with Montgomery Åsberg Depression Rating Scale (MADRS).ResultsGender expression was related to MADRS score and depression diagnosis. In fully adjusted models, feminine traits with low social desirability (FEM-) were associated with a higher MADRS score (R2 0.16; B 0.16; CI 0.1–0.2), while androgyny (t ratio) (R2 0.12; B 0.42; CI 0.1–0.7) and masculine traits with high social desirability (MAS+) (R2 0.13; B -0.06; CI -0.1–-0.01) were associated with a lower MADRS score. Also, feminine traits with low social desirability (FEM-) were positively associated with depression (OR 1.04; CI 1.01–1.1). No associations between depression and masculinity or androgyny were observed in adjusted models. There were no interactions between sex and gender expression in relation to depression or MADRS score, indicating that the effects of gender expression were similar in men and women.ConclusionsWe found that gender expression was associated to both depression and burden of depressive symptoms. More specifically, we found that femininity was associated to higher levels of depression, irrespective of biological sex. In addition, masculinity and androgyny were associated with lower levels of depression. These results highlight the importance of taking gender expression into consideration when studying sex differences in depression among older populations in future studies.

Highlights

The Lancet series ‘Gender Equality, Norms, and Health’ [1] highlights the importance of treating sex and gender as distinct, not interchangeable, entities in medical research
There were no interactions between sex and gender expression in relation to depression or MADRS score, indicating that the effects of gender expression were similar in men and women
We found that gender expression was associated to both depression and burden of depressive symptoms

Summary

Introduction

The Lancet series ‘Gender Equality, Norms, and Health’ [1] highlights the importance of treating sex and gender as distinct, not interchangeable, entities in medical research. Since the launching of the term ‘gender expression’ [1], studies are able to distinguish between the interrelated terms gender expression (femininity, masculinity, androgyny) and gender roles This disentanglement is advantageous as gender roles comprise a wider concept of socially constructed roles based on societal gender-related norms (e.g. family obligations, work-family conflict or life style activities) [4]. Giving attention to both sex and gender perspectives is critical for valid scientific research on population health, especially within psychopathology research [7]. Sex and gender entities (e.g. gender expression, gender roles) are connected, they need to be differentiated in order to improve our understanding of disease etiology, which can inform the development of appropriate assessments [7] and strategies for prevention and treatment [8]

Methods

Results

Conclusion