Gender issues in depression.

BACKGROUND: Gender differences in depression have been documented for many years and thought to be insignificant to treatment selection until recently. METHODS: This article reviews gender differences in the prevalence, presentation, etiology, and antidepressant treatment of depressive disorders. RESULTS: The high female to male sex ratio in the prevalence of depression, especially during the reproductive years, is one of the most replicated findings in epidemiology. Women more often have a seasonal component, anxious and atypical depression. Explanations for the differences include psychological, neurochemical, anatomic, hormonal, genetic, and personality factors. Gender differences in antidepressant treatment response have not been found consistently. Hormonal status may be an important variable in addition to the effects of the menstrual cycle, pregnancy, perimenopause and menopause. CONCLUSIONS: Women have higher rates of depression and can often present differently than do men. Further research can ascertain which combination of factors increase women's risk. The effect of pregnancy and the impact of the menstrual cycle on the course of all depressive disorders need increased attention. Large prospective randomized controlled trials with gender differences in treatment response as the primary endpoint are necessary in order to answer the now controversial question of gender differences in antidepressant treatment response.

Health-related quality-of-life assessment of prenatal diagnosis: chorionic villi sampling and amniocentesis.

This study assesses the health-related quality-of-life (HRQL) effects of chorionic villi sampling (CVS) and genetic amniocentesis (GA), including both process and outcomes of prenatal diagnosis. The HRQL of 126 women participating in a randomized controlled clinical trial of CVS versus GA in Toronto and Hamilton, Ontario, was assessed in four interviews at weeks 8, 13, 18, and 22 of pregnancy. Statistical analyses included analysis of variance, repeated measures analysis of covariance, chi-square, Fisher's exact test, Student's t-tests, and paired t-tests. Utility scores for patients undergoing CVS exceeded those for GA patients at week 18 (p = 0.04). Utility scores for hypothetical health states did not differ significantly by trial arm. CVS results in slightly improved HRQL during prenatal diagnosis. This advantage needs to be weighed against the high disutility patients attach to infrequent outcomes associated with pregnancy losses, equivocal diagnoses, and diagnostic inaccuracy.