CASE REPORT

Gender Relationship with Depressive Disorder

Basem Abbas Al Ubaidi

Consultant Family Physician, Ministry of Health, Arabian Gulf University, Kingdom of Bahrain

ABSTRACT

Depression rate is more prevalence in female than in males. There are many hypotheses for gender differences in depression,
but still, there is no conclusive theory to explain it fully. Depression in men manifest as more acting out the depression
symptoms to the surroundings, while the depressed women keeps the symptoms for themselves.

Key words: Cognitive behavioral therapy, depression, emotional distress, gender difference, health professional, mental health
problem, stress

INTRODUCTION widowed and divorced, living alone, and having a recent

crises event.[8,9]

T
he two most common psychiatric diseases in primary
care are depression and anxiety neurosis, which are Depressed men manifest as acting out their depression
more common among women. However, substance symptoms to the surroundings, such as increase irritability,
use disorders and antisocial personality disorders are more hostility, anger, withdrawn, fatigue, and drink more alcohol,
common among men.[1] with loss of interest in the work, family, and even hobbies.
However, males are less likely to seek early help for
depression.[6] In contrary, depression in females manifests
Depression is the most prevalent non-communicable chronic
more in the patient, such as over-thinking, sadness, eating
disease (15–20%) in the developed and developing countries
and sleeping disorder. Fortunately, females are more likely to
with high comorbidity and mortality.[2,3] Females showed a
seek early help for depression.[9]
higher prevalence of depression than males (2:1 ratio), due to
biologic, hormonal, or psychosocial factors,[4] yet more males
Case history 1
are committing suicidal attempts (4–18 times).[1] Treatment A 45-year-old female presents with a history of poor sleep and
for depression in males is less efficient due to compliance and irritable mood for 1-month duration, in the setting of current
denial factors, and depression is less likely to be diagnosed in divorce and ongoing custody battle with her previous husband
males than in females.[5,6] over their three teenage children. She has also just had a
corrupt performance review at work due to her incapability to
The two crucial screening questions for depression judgment meet deadlines and is dreadful of losing her job. She explained
depend on the presence of two cardinal symptoms within that her work problems had arisen because she was unable
the past 2 weeks’ duration: (1) Persistent and pervasive low to keep her concentration focused on work. She expressed
mood and (2) loss of interest or pleasure in usual activities.[7] feelings of worthlessness and sometimes wondered what the
point of living was. She had to force herself to stay engaged
Although most depressed patients are not committed suicidal in her children’s activities, and she lost interests that she used
attempt, most suicidal people are depressed and came to to enjoy. She felt “just going through the motions.” She had
the clinics for emotional crises. The risk factors for suicidal a comparable episode after the birth of her second child, but
attempts are hopelessness, previous suicide attempts, she cured by itself after several months. There was a family

Address for correspondence:

Basem Abbas Al Ubaidi, Consultant Family Physician, Ministry of Health, Arabian Gulf University, Kingdom of Bahrain.
E-mail: bahmed1@health.gov.bh
https://doi.org/10.33309/2638-7719.010206 www.asclepiusopen.com
© 2018 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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 Al Ubaidi: Gender and depressive disorder

history of depression in her mother. Her examination was activities; they lose their interests among the things they used
notable for poor eye contact and many tears. Her test results, to enjoy before.[12,15,16]
including thyroid-stimulating hormone (TSH), were standard.
A depressed male needs good, understanding support system of
The partner feels that his home became with unrelenting low the emotional recognition of his distress repression [Table 1].
mood because of his wife pessimistic view. The partner also Depression in men is starting from avoidant behavior and
notices that his wife have a high level of anxiety with deep ending to conscious self-harm. Depressed men may have high
psychic pain. She was desperate with hopelessness feeling comorbidity and mortality such as hypertension, heart disease,
causing her to withdraw from social activity. He mentioned sudden cardiac death, and decreased cognitive performances.[17,18]
that she was sleep and eat a lot and she was always frustrated
and grumblings from general simple matters. Depression in males is manifested by an increase in acting
out the distress at home, work, against friends or relatives; it
Case history 2 might lead to IMS and burnout. Males with failure to fulfil
A 42-year-old woman presents with a 1-month history of poor the role of the main source of income are associated with
sleep and irritable mood, in the setting of recent work problems higher depression and marital conflict.[19, 23]
for the last 1 year. He was an infrequent patient attender to local
health care; also he had a history of lost interest in daily gems. He The barrier to seek help in depressed males is many including
has just had a bad performance review at work and many work the feeling of weak masculine males figure, fear of breach
mistakes because he has been unable to keep his concentration confidentiality, and personal males’ denial depression
focused on work. He had a history of many anger spells in diagnosis.[19]
the family and during labor. He used alcohol and smoking to
display his symptoms. He seemed frustrated, irritable, and The males are more suffering from irritable male syndrome
angry, and his test results, including TSH, were standard. He (IMS), which is a state of four acted out, cardinal symptoms
blamed “the corporate control of publishing companies” for not (hypersensitivity, anxiety, frustration, and chronic anger),
giving him a chance to demonstrate his talents. and due to biochemical, hormonal changes, overstress, and
loss of male identity.[20]
The spouse feels as if she is walking on eggshells when she
talks to him, he is ready to explode, and nothing pleases him.
Table 1: The “big build:” Escalating effects of
He has a terrible temper and a high level of unrealistic anxieties
emotional repression on and “depressive men.”[19]
about sex drive, job insecurity, and relationship problems.
The partner also notices that he was always frustrated and Avoiding “it.” (Avoidant behavior)
grumblings and feeling of annoyance at being hindered or Overinvolvement with work
criticized. He feels easily frustrated by his relationships The adverse effect of stress in men
with family, friends, and coworkers. The partner stated that Sickness absence
her husband has a strong feeling of displeasure or hostility,
Numbing “it.” (Self‑medication)
irritability, aggression, and violence, expressed as hateful
words, hurtful actions, or stony silence. Self‑medication, withdrawal, watching TV
Escaping “it.” (Escape behavior)
DISCUSSION Sexual affairs/encounters
Drug and alcohol abuse also increase the risk of anxiety
Major depression is more frequently seen in females because and depressive symptoms
they are more aware and efficiently expressed their emotions. Gambling
Major depression in males is mainly due to many predisposing
Binge drinking
factors (unemployment, single, socially disadvantaged,
substance abuse, medical comorbidity, and presence of heart Hating me, hurting you (Feelings of aggression toward self
and others)
disease).[10-13]
Effect on the mental health of men’s partners
Males are less likely to self- expressing and hinder their Increase in amount or frequency of angry outbursts, rage,
depressive symptoms, unable to discuss their distress, and and violence toward the self
infrequently help seeking; accordingly, they have more risk Moreover, others, strongly associated with substance use
behaviours such as road rage, drug and alcohol abuse.[14] Stepping over the line (deliberate self‑harm)
Suicidal ideation/attempt, deliberate self‑harm
The studies showed that males have different depression
expression, they less likely cry, overeat, and less likely talk Aggression and alcohol abuse as significant predictors of
about it. In contrary, females are not enjoying their children’s the severity of suicidal ideation

42 Journal of Community and Preventive Medicine   •  Vol 1  •  Issue 2  •  2018

 Al Ubaidi: Gender and depressive disorder

IMS may be triggered by low levels of serum testosterone insecure, overwhelmed with high anxiety, hopelessness, and
and low level of brain serotonin (e.g., sleep disturbances, guilty feelings.
high protein intake, low carbohydrate diet, and high alcohol
consumption).[21-23 While the physician can recognises depressed males when
they blames others for their problems. They have a history
The males often use self-destructiveness way to mask their of persistent irritability, unforgiving thinking, and more sleep
depression states (e.g., drug abuse, gambling, womanizing, disorder. They have more suspicious and guarded feelings,
and workaholic).[20] being overtly or covertly hostile, and could attack others
when feels threatened. The depressed males hidding their
While the effects of depression on the other partner are symptoms and acts-out behaviours through the inappropriate
many such as, increase in amount or frequency of couple’s emotion on the world set up to fail them. As a result, they
angry outbursts, rage, and violence toward themselves feel continuously restless, agitated, losing anger control and
(deliberate self‑harm). Moreover, others strongly associated may have sudden attacks of rage. Furthermore, they will have
with substance or alcohol abuse and increased their suicidal different symptoms such as blunted numb feelings. They will
ideation.[20] put themselves in rigid boundaries, push others out, feels
ashamed of whom they are? Besides, they feels frustrated if
The females often “act-in,” while males often act-out their they are not praised enough to cover their weaknesses and
depression symptoms as a result of gender rule, while the self- doubts.
presence of persistent feelings of hopelessness, helplessness,
and worthlessness, are the hallmarks of depression in both Correspondingly, they fear from any failure attempt. They
genders.[24] tried to feel safe, by using more alcohol, watching TV, indulge
in heavy sports, and practice unsafe sex for self-medicate.
Depression should be one of the primary care diseases which They believe that their difficulties could be solved if only
need attention; it has both the psychological symptoms such their spouse, coworker, parent, and friend treat them better.
as feelings of sadness, loneliness, irritability, worthlessness,
hopelessness, agitation, and emotional guilt feelings. Also,
it has physical symptoms as fatigue, insomnia, body pain,
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