Gender differences in clinical features of depressed outpatients: Preliminary evidence, for subtyping of depression?

Background: Gender differences in depression are usually associated with prevalence, severity, and sometimes with specific syndromes or subtypes. However, a lack of differentiation exists between these factors.

Aims: To disentangle depression severity and the specific items endorsed by men and women and thus explore the presence of gender-specific subtypes.

Method: A group of 963 men and women treated for depression in the period 1993-2002 were matched on demographic characteristics. This resulted in a group of 353 men and 453 women (N = 806) on which all subsequent analyses were performed: Five instruments were used: the Hamilton Depression Rating Scale (HAM-D), SCL-90 subscales for depression (DEP), anxiety (ANX) and somatic complaints (SOMC), and the Quality of Life Depression Scale (QLDS). Total scores and individual-item scores were compared for men and women using ANOVA. A cluster analysis was performed on the three SCL-90 subscales. The distribution of gender over the clusters was tested with Pearson Chi-square.

Results: No gender differences were found in depression severity on the HAM-D. Women reported more symptoms on the DEP and the SOMC (p <0.01). No gender differences were found on the QLDS. Of the SOMC items, 58% differentiated between men and women, whereas 31% of the DEP items and 30% of the ANX items detected gender differences. Using cluster analysis, a five-cluster solution was found with good face validity and reliability. Men and women were distributed differently over the five clusters such that women were overrepresented in those clusters in which the SOMC was high, while men were overrepresented in clusters in which SOMC was low (P <0.01).

Conclusions: It may be useful to delineate syndrome of somatic complaints in the context of depression that is more prevalent among women.