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Sex Differences in the Prevalence and Detection of Depressive and Anxiety Disorders in General Health Care Settings
Report From the World Health Organization Collaborative Study on Psychological Problems in General Health Care
Richard Gater, MD;
Michele Tansella, MD;
Ailsa Korten, BSc;
Bea G. Tiemens, MA;
Venos G. Mavreas, MD, PhD;
Michael O. Olatawura, MD
Arch Gen Psychiatry. 1998;55:405-413.
Background Understanding the relevance of biological and social factors to sex differences in the prevalence and detection of depressive and anxiety disorders has been impaired by the lack of standardized research methods across cultures.
Method Prevalence rates of depressive and anxiety disorders were assessed using a 2-stage design from 26969 patients attending for primary care in 15 centers from 4 continents. Logistic regression analysis was used to examine sex differences in prevalence and detection across centers.
Results Odds ratios for women compared with men of current depression (1.60; 95% confidence interval [CI], 1.37-1.86) and agoraphobia or panic (1.63; 95% CI, 1.18-2.20) were consistent across centers. The odds ratio for generalized anxiety varied among centers: 3 groups of centers were identified with odds ratios of 0.46 (95% CI, 0.27-0.78), 1.34 (95% CI, 1.08-1.66), and 3.09 (95% CI, 1.60-5.89). There was no sex difference in the detection of depressive and anxiety disorders by physicians across centers.
Conclusions The absence of a sex-by-center effect for current depression and agoraphobia or panic disorder is consistent with biological and psychosocial factors, either interacting or working alone, that have a similar final effect across cultures. It does not support the idea that sex differences in prevalence are caused by local psychosocial factors that vary from country to country. The variation in the odds ratio for generalized anxiety disorder offers some support to the idea that there are local differences between the centers contributing to the sex difference in rates. Patients' sex does not appear to affect the likelihood of current depression and anxiety being detected by primary care physicians.
From the School of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, England (Dr Gater); the Institute of Psychiatry, Università di Verona, Verona, Italy (Dr Tansella); the National Health and Medical Research Council Psychiatric Epidemiology Research Centre, The Australian National University, Canberra, Australia (Ms Korten); the Department of Social Psychiatry, University of Groningen, Groningen, the Netherlands (Ms Tiemens); the University Mental Health Research Institute, Eginition Hospital, Athens, Greece (Dr Mavreas); and the Department of Psychiatry, University College Hospital, Ibadan, Nigeria (Dr Olatawura).
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