Male vs. female depression: Why men "act out" and women "act in"

Background: Based on his research on the Swedish island of Gotland in the 1980s, Rutz postulated a “male depressive syndrome” with atypical symptoms that differ from common depressive symptoms found in females. Recent studies assessing the link between gender and depression symptoms using the Gotland scale have been contradictory.

Aims: To investigate whether a new scale (Diamond Male Depression Scale) including atypical symptoms of depression would be useful in distinguishing between depressed males and depressed females and to assess whether suicide risk is predicted by atypical symptoms of depression.

Method : A total of 1072 individuals (323 females and 749 males) filled out the on-line questionnaire including questions assessing typical depression (Center for Epidemiologic Studies Depression Screen), atypical depression ( Diamond Male Depression Scale; Gotland Male Depression Scale) and suicide risk.

Results: Three Factors from the Diamond Male Depression Scale--Emotional Acting-In, Emotional Acting-Out, and Physical Acting-Out--were identified. Both depressed and non-depressed men scored significantly higher than depressed and non-depressed women on Factor 2, Emotional Acting-Out and Factor 3, Physical Acting-Out. There was a significant relationship between suicide risk and Factor 1, Emotional Acting-In.

Conclusions: The study adds credence to the concept of a “male depressive syndrome” with atypical symptoms that relate to depression and suicide risk. The three factor Diamond Male Depression Scale may be a useful tool for assessing depression and suicide risk. This is important since men are under-diagnosed for depression and suicide risk is much higher in men. Further research is needed to validate the scale.