School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia.
Int Rev Psychiatry. 2010;22(5):429-36. doi: 10.3109/09540261.2010.492391.
It is commonly suggested that a female preponderance in depression is universal and substantial. This review considers that proposition and explanatory factors. The view that depression rates are universally higher in women is challenged with exceptions to the proposition helping clarify candidate explanations. 'Real' and artefactual explanations for any such phenomenon are considered, and the contribution of sex role changes, social factors and biological determinants are overviewed. While artefactual factors make some contribution, it is concluded that there is a higher order biological factor (variably determined neuroticism, 'stress responsiveness' or 'limbic system hyperactivity') that principally contributes to the gender differentiation in some expressions of both depression and anxiety, and reflects the impact of gonadal steroid changes at puberty. Rather than conclude that 'anatomy is destiny' we favour a diathesis stress model, so accounting for differential epidemiological findings. Finally, the impact of gender on response to differing antidepressant therapies is considered briefly.
普遍认为，女性在抑郁症中的优势是普遍存在且显著的。本综述考虑了这一观点及其解释因素。有人认为，女性的抑郁率普遍更高，但也有一些例外情况，这些例外情况有助于澄清候选解释。本文考虑了“真实”和人为解释因素，并综述了性别角色变化、社会因素和生物决定因素的作用。虽然人为因素有一定的影响，但结论是，存在一个更高阶的生物因素（不同程度的神经质、“应激反应性”或“边缘系统过度活跃”），主要导致了某些抑郁和焦虑表现的性别差异，反映了青春期性腺类固醇变化的影响。我们不赞成“解剖即命运”的观点，而是赞成易感性-应激模型，从而解释不同的流行病学发现。最后，简要讨论了性别对不同抗抑郁治疗反应的影响。
