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

PLoS One. 2020 Sep 14;15(9):e0238701. doi: 10.1371/journal.pone.0238701. eCollection 2020.

Abstract

Objective: Little 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.

Methods: A 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).

Results: Gender 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.

Conclusions: We 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Depression / psychology*
  • Female
  • Femininity
  • Gender Identity*
  • Humans
  • Male
  • Masculinity
  • Personality
  • Sex Characteristics*
  • Sex Factors

Grants and funding

The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement [https://www.vr.se/english/about-us/organisation/advisory-groups-and-administrative-offices/office-for-alf.html] (ALF 716681, ALF715841), the Swedish Research Council [https://www.vr.se/] (11267, 825-2007–7462, 825–2012–5041, 521–2013–2699, RAM 2013–8717, 2015–02830, 2016–01590), Swedish Research Council for Health, Working Life and Welfare [https://forte.se/en/] (no 2001–2835, 2004–0145, 2006–0596, 2008–1111, 2008–1229, 2010–0870, 2012–1138, 2013–1202, 2016–2016–07097, AGECAP 2013–2300, 2013–2496, 2013–0475, Epilife 2006–1506), Sahlgrenska University Hospital (ALF), Gun & Bertil Stohnes forskningsstipendium [https://www.stohnesstiftelse.se/], Fredrik & Ingrid Thurings stiftelse [http://www.thuringsstiftelse.com/], Wilhelm & Martina Lundgrens foundation [http://www.wmlundgren.se/], Hjalmar Svensson Foundation [https://www.stiftelsemedel.se/stiftelsen-handlanden-hjalmar-svenssons-forskningsfond/], Irisstipendiet [https://www.irisstipendiet.se/], Konung Gustav och Drottning Victorias Frimurarstiftelsen [https://frimurarorden.se/en/], Söderström-König Foundation [https://www.sls.se/vetenskap/sok-anslag/stift.-soderstrom/], and Stiftelsen Ragnhild & Einar Lundströms minne [https://lindhes.se/stiftelseforvaltning/]. This study was accomplished while first author Therese Rydberg Sterner was affiliated with the Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), which is funded by the Swedish Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.