Soc Psychiatry Psychiatr Epidemiol (2002) 37: 401–408
1007/s00127-002-0569-0
ORIGINAL PAPER
John Cairney · Terrance J. Wade
The influence of age on gender differences in depression
Further population-based evidence on the relationship
between menopause and the sex difference in depression
Accepted: 14 March 2002
■ Abstract Objective This study tests the hypothesis
that gender differences in depression diminish after
menopause (around the age of 55). Methods Using the
1994 National Population Health Survey, we examine the
relationship between age and gender on major depres-
sive disorder in relation to sociodemographic and social
covariates using contingency table analyses and multi-
variate logistic regression. Results Contingency table
and multivariate analyses identify significantly higher
rates of depression among women before and after the
age period associated with menopause. A series of mul-
tivariate analyses controlling for a broad array of social
factors also does not lead to any convergence in differ-
ences of rates of depression between males and females.
Hormone replacement therapy (HRT) does not have a
significant impact on these observed relationships. Dis-
cussion These findings are at odds with a recent study
that has identified menopause as a point where gender
differences in depression diminish. Further research is
required to address this inconsistency.
■ Key words major depressive disorder – depression –
menopause – gender – age – demographics –
psychosocial resources – health status – social stress
Dr. J. Cairney Ph.D. ()
Canadian Centre for Studies of Children at Risk
Department of Psychiatry and Behavioural Neuroscience
McMaster University
Patterson Building – Chedoke Site
1200 Main St. West
Hamilton, ON, Canada L8N 3Z5
E-Mail: cairnej@mcmaster.ca
and the
Department of Community Health Sciences
Brock University
St. Catherines, Canada
T. J. Wade, PhD
Institute for Health Policy and Health Services Research
and the Department of Psychiatry
University of Cincinnati Medical Center
Cincinnati, USA
DOI 10.
Introduction
One of the most robust findings in psychiatric epi-
demiology is that the prevalence of depression is greater
among women than men [1–2]. While both social and
biological factors have been suggested as etiological fac-
tors, neither perspective has been able to adequately ac-
count for the difference. One compelling line of inquiry
to understand this gender gap in depression concerns
examining changes in the sex ratio across the life course
[3]. For example, several studies have noted that gender
differences in depression do not emerge until after early
to mid-adolescence [4–9]. In fact, among prepubertal
children, some studies find the prevalence of depression
is actually higher among boys [10, 11]. Toward the op-
posite end of the life-span continuum, results from sev-
eral large scale epidemiologic investigations find that
the sex difference in depression diminishes and be-
comes non-significant among groups over the age of 50
[3, 12, 13]. In at least one case, older men report higher
levels of depressive symptomatology compared to
women [13]. This has largely been attributed to de-
creasing rates of depression in women while rates
among men remain stable or actually increase some-
what [14–16].
Taken together, this research suggests that the differ-
ential female to male ratio in the prevalence of depres-
sion originates in adolescence, and then ceases to exist,
or even reverses, in middle to early old age. The emer-
gence of the gender gap in depression during adoles-
cence, coupled with its observed decline after the age of
50 suggests the possibility that gender differences in de-
pression may be due to sex differences in endocrine
physiology [17]. Indeed, some researchers have attrib-
uted the onset of depression to hormonal changes asso-
ciated with puberty [17, 18]. If higher rates of depression
in females can be shown to exist in adolescence but not
in the period typically associated with the end of the
SPPE 569
natural reproductive interval (post menopause), then it
seems at least plausible that hormonal differences be-
402
tween men and women may be accounting for observed
gender differences in depression.
The most recent addition to the debate from Beb-
bington and his colleagues [3] examines the importance
of menopause in explaining gender differences in de-
pression using the National Household Survey of Psy-
chiatric Morbidity in Britain. Consistent with the hor-
monal explanation described above, they find that
gender differences cease to exist after the age of 55. Al-
though this research suggests that gender differences in
depression may be linked to the timing of menopause,
contradictory evidence is also available in the extant lit-
erature. Jorm [16], for example, in a meta-analysis of
studies of depression over the life-span, concludes that
the preponderance of evidence suggests that gender dif-
ferences do not diminish until well after the end of
menopause.A more recent study by Mirowsky [19] finds
that the gender gap in depression actually increases
across successively older cohorts after middle age.
This study adds to the current body of literature on
the subject by examining the gender gap in depression
during middle age using the Canadian National Popula-
tion Health Survey (NPHS). First, we assess whether the
same pattern reported by Bebbington and colleagues [3]
is present in a national sample of Canadians. Next, we
examine a broad array of sociodemographic and social
factors that have also been previously identified as im-
portant in the age-depression relationship [20, 21]. Fi-
nally, we examine the impact of hormone replacement
therapy on gender differences in depression. Given the
importance of examining the timing of menopause and
the prevalence of depression, this study provides further
examination of the influence of age on the gender gap in
depression.
Subjects and methods
The analyses are conducted using the 1994 National Population
Health Survey (NPHS) by Statistics Canada [22]. Using a multi-staged
stratified, random sampling procedure, 19,600 households across
Canada were surveyed. In each household, one person was selected to
provide detailed personal information for the health component of
the survey. People living on Native reverses, military bases, institu-
tions and some remote areas in Ontario and Quebec were excluded.
Of the 18,342 possible respondents aged 12 and older, 17,626 partici-
pated, resulting in a response rate of 96.1 %. Previous research with
this same data set confirmed that gender differences in depression
emerge by 15 [5]. Based on these results, we confine our analysis to
those aged 15 and older (N = 16,650).All analyses are computed using
the standardized weighting scheme suggested by Statistics Canada
[22]. Since the NPHS was intended to represent the population of
Canada, a numerical weighting factor was applied to the data for each
individual interviewed to provide estimates of the total population.
This weighting factor represents the reciprocal of the probability of
selection in the survey. For the calculation of statistical significance,
this weighting factor was re-scaled by dividing the weight by the mean
weight of the total sample. This procedure produces variance esti-
mates that would be expected from the total number of people inter-
viewed rather than the total number of people in the population.
■ Dependent variable
In the NPHS, depression is derived using the Composite International
Diagnostic Interview-Short Form (CIDI-SF) to provide 1-year popu-
lation prevalence rates of major depressive episode (MDE) [23]. This
instrument is a shortened version of the original CIDI, which assigns
a diagnosis of depressed mood on the basis of criteria from the DSM-
III-R and the ICD–10 [20, 21, 23, 24]. This diagnostic instrument pre-
dicts caseness based on two central dimensions of depression: feeling
sad, blue, or depressed and/or losing interest in most things. If re-
spondents reported experiencing either dimension at least most of
the day, almost every day, for a period of at least 2 weeks in the previ-
ous 12 months, they were prompted to answer “yes” or “no” to a series
of symptoms. Respondents answering “yes” to four or more symp-
toms in addition to one of the two primary stems had a probability of
caseness of 0.90 and were classified as having had an episode of ma-
jor depression. Field trials of the CIDI, conducted by the World Health
Organization, have documented good inter-rater reliability [25], test-
retest reliability [26], and validity for most diagnoses [27, 28]. A field
trial comparing the CIDI-SF to the full CIDI in a community study of
approximately 3,000 respondents found the negative predictive value
to be near perfect and a positive predictive value of approximately
75 % [29].
■ Independent variables
In the NPHS public data set, age is originally coded in 5-year intervals
(15–19, 20–24, etc) except for the last interval that included those aged
80 and over. Consistent with Bebbington et al. [3], we set age at 55 as
the cut-point for the termination of menopause, to contrast respon-
dents aged 54 and under (N = 12,445) to those aged 55 and older
(N = 4,205). Hormonal measures to document menopausal status are
not included in this survey. Appendix A presents a description of the
additional variables used in this analysis.
Results
We first conduct a stratified contingency table analysis
to examine sex differences in depression across both
young and older age groups (Table 1). While the rate of
depression drops considerably among those in the older
cohort, the drop is similar for both males and females.
For both groups, those under 55 and those aged 55 and
older, women are more than twice as likely to have had a
major depressive episode in the previous 12 months
compared to men.
Next, we perform a multivariate logistic regression
analysis regressing MDE on age, gender, age x gender,
Table 1 Differences in the 12-month prevalence of major depressive episode by
age and gender
Age 15–54 Age 55+
Male Female Male Female
Depression
Yes 244 (4.2) 536 (9.0) 32 (1.9) 87 (3.9)
No 5523 (95.8) 5426 (91.0) 1660 (98.1) 2120 (96.1)
Chi-square 106.96, 1 df, 13.61, 1 df,
p = 0.000 p = 0.000
Odds ratio 2.24 2.13
(Standard error) (0.080) (0.209)
95 % C. I. 1.91, 2.62 1.41, 3.21
 403

and a series of social covariates to assess other factors
that may account for any convergence in depression with
age. First, we compare men and women 20 years and
older. We limit this analysis to 20+ because some of the
social stress variables in the NPHS were not asked of
children aged 12–17. The convergence in the gender gap
after age 55 is tested by the age x gender interaction
term.
In Table 2, Model 1, both age and gender have a sig-
nificant effect on MDE. As expected from the previous
contingency table analysis, in Model 2, when the age x
gender interaction is inserted, it was not significant. The
inclusion of this interaction in Model 2 is equivalent to
a Mantel-Hanzel chi-square test for two independent
factors. The next model (Model 3) introduces a series of
sociodemographic factors including marital status, in-
come adequacy, education, region of the country, a
dummy variable for immigrant status, and two variables
for children in the home (5 and under and between 6 and
11 years of age). The inclusion of these variables has no
effect on the age x gender interaction. In the final model
(Model 4), we insert a series of social covariates identi-
fied previously as important factors influencing the re-
lationship between depression and age to assess whether
they account for any convergence in depression among
males and females. Specifically, we examine measures of
health status, psychosocial resources, and social stress.
Again, the interaction term failed to reach statistical sig-
nificance (p > 0.05) while both age and gender were sig-
nificant indicating that these social covariates also do
not contribute to any convergence in rates of depression
among males and females after age 54.
■ Hormone replacement therapy
and gender differences in depression
In the final part of the analysis, we explore the impact of
hormone replacement therapy (hereafter HRT) on gen-
der differences in depression. Specifically, we examine
whether women on HRT report higher or lower levels of
depression than women not on HRT. Then, we examine
whether excluding women on HRT from the total sam-
ple has any impact on the analysis presented in Table 2.
The relationship between HRT and depression is
complicated. In the context of this study, a declining sex
ratio after age 55 supports the hypothesis that estrogen
levels may be linked to gender differences in depression
[3]. If sex differences in depression are linked to hor-
monal differences, it is logical to assume that rates of de-
pression will remain higher for those women whose es-
trogen levels are maintained after the menopausal
period.
However, the literature in this area suggests the con-
trary. Several studies show that HRT may alleviate many
of the symptoms commonly associated with depression
[30–35]. On the basis of this research then, we would ex-
pect that HRT may actually lower levels of depression. In
addition, the composition of the HRT may also influence
depressive symptomatology among women. For exam-
ple, women on high-dose estrogen with progesterone
had more positive affect when compared with women
who received low-dose estrogen with progesterone [36].
Given that HRT clearly influences affect, we decided to
examine what, if any, impact HRT has on gender differ-
ences in depression. The NPHS included a self-reported
1-month use of HRT question. Unfortunately, it was not
possible to assess composition.

Table 2 Logistic regression of major depressive

episode on age, gender, sociodemographic and social Model 1 Model 2 Model 3 Model 4
predictors among males and females ln (OR) OR ln (OR) OR ln (OR) OR ln (OR) OR

Age –0.791*** 0.45 –0.736*** 0.48 –0.925*** 0.40 –0.815*** 0.44

Gender1 0.820*** 2.27 0.831*** 2.30 0.773*** 2.17 0.662*** 1.94
Age * Gender –0.076 0.93 –0.196 0.82 0.068 1.07
Income –0.168*** 0.85 0.090* 1.10
Education –0.009 0.99 0.125*** 1.13
Marital status2
Div/sep/wid 0.752*** 2.12 0.590*** 1.80
Single 0.355*** 1.43 0.364*** 1.44
Children < 6 0.147 1.16 0.110 1.12
Children 6–11 0.148 1.16 0.029 1.03
Immigrant 0.237* 1.27 0.166 1.18
Self-rated health –0.265*** 0.77
Health status –1.469*** 0.23
Mastery –0.076*** 0.93
Self-esteem –0.107*** 0.90
Social involve –0.029 0.97
Social support 0.020 1.02
Traumas 0.147*** 1.16
Life events 0.281*** 1.33
Chronic strain 0.086*** 1.09

* p < 0.05; ** p < 0.01; *** p < 0.001 (two-tailed test)

1
Categorical variable coded as 0 = male and 1 = female
2
Categorical variables with married as the reference group
404

A comparison of women who had taken HRT within
the past month vs. those that did not found that the fe-
males on HRT indeed had higher rates of depression;
however, this difference was not statistically significant
(OR = 1.24; 95 % C. I. = 0.72–2.13). Next, we ran a logistic
regression analysis (Table 3) comparing men to women
on HRT using the same covariates included in Table 2.
We limit this analysis to men and women 30 and older
for this analysis because HRT was only asked of women
in this age range. The results were very similar to the
original analysis. Age and gender have significant inde-
pendent effects on MDE but when we include the age x
gender interaction term (Model 2) it is not significant.
With the inclusion of the sociodemographic indicators
in Model 3, the age x gender interaction is still non-sig-
nificant and it remains non-significant after we insert
the series of health status, psychosocial resources and
social stress variables (Model 4). Thus, consistent with
the bivariate analyses, there is no evidence of a conver-
gence in the gender-depression relationship by age even
after controlling for these covariates. Together, these
findings suggest that HRT does not have a significant
impact on gender differences in depression or in differ-
ences in depression between women.
Discussion
Using a large, nationally representative sample of Cana-
dians and a validated diagnostic instrument to measure
major depressive episodes, we find no evidence of con-
vergence in the gender gap in depression after age 54.
Even with the introduction of a broad array of both so-
ciodemographic and social factors, gender differences
in depression persist independent of age. Therefore, we
conclude, that these data do not support the hypothesis
that the gender gap in depression ceases to exist after
age 55 (post menopause) as suggested by some research
[3]. Rather, our findings support previous research that
shows a persistence in sex differences in depression well
after age 55 [16, 19]. It is important to note that while the
sex ratio remains essentially constant, the prevalence of
depression does decline sharply for both older men and
women even after controlling for sociodemographic
factors. Also, we find no evidence in these data that
changes in sex differences in depression are the result of
increases in depression among older men as some re-
search has shown [13].
In this study, we were also able to examine the impact
of HRT on depression, albeit in a very limited way, both
between women (those on HRT vs. those not) and be-
tween men and women. We find no significant differ-
ences in rates of depression among women controlling
for HRT. Moreover, removing women on HRT from the
total sample had no appreciable effect on our multivari-
ate analysis. However, it is important to note that the
measure for HRT in this study is limited and these find-
ings should be interpreted with caution.
There are several limitations with this analysis that
need to be addressed in future work. First, these data are
cross-sectional and, therefore, we cannot disentangle
aging from period and cohort effects. This is of special
importance concerning the menopause-depression
question since the hypothesized mechanism is, by defi-
nition, an aging effect. Moreover, since retrospective in-
formation on history of depression was not collected in
this survey, we cannot tell whether the higher rates of de-
pression observed in women after age 55 are the result

Table 3 Logistic regression of major depressive

episode on age, gender, sociodemographic and social Model 1 Model 2 Model 3 Model 4
predictors comparing males to females not on hor- ln (OR) OR ln (OR) OR ln (OR) OR ln (OR) OR
mone replacement therapy
Age –0.770*** 0.46 –0.721*** 0.49 –0.940*** 0.39 –0.852*** 0.43
Gender1 0.745*** 2.11 0.759*** 2.14 0.723*** 2.06 0.639*** 1.90
Age * Gender –0.072 0.93 –0.245 0.78 0.001 1.00
Income –0.172*** 0.84 0.112* 1.12
Education 0.008 1.01 0.118*** 1.13
Marital status2
Div/sep/wid 0.818*** 2.27 0.663*** 1.94
Single 0.510* 1.67 0.514*** 1.67
Children < 6 0.158 1.17 –0.003 0.99
Children 6–11 0.198 2.68 0.080 1.08
Immigrant 0.223 3.44 0.199 1.22
Self-rated health –0.326*** 0.72
Health status –1.161*** 0.31
Mastery –0.087*** 0.92
Self-esteem –0.108*** 0.90
Social involve –0.034 0.97
Social support 0.038 1.04
Traumas 0.162*** 1.18
Life events 0.206*** 1.23
Chronic strain 0.093** 1.10

* p < 0.05; ** p < 0.01; *** p < 0.001 (two-tailed test)

1
Categorical variable coded as 0 = male and 1 = female
2
Categorical variables with married as the reference group

of gender differences in onset, recurrence, or chronic de-
pression. Perhaps, for example, women have higher rates
of depression after age 55 because they are more likely
to suffer from recurrent episodes of depression. In fact,
there is some evidence to suggest that gender differences
in recurrence may account for the elevated rates of de-
pression observed in women in the 45–54 age group
[37]. Unfortunately, we cannot examine the issue of on-
set vs. recurrence with these data. However, evidence
suggests that gender differences in 12-month prevalence
rates of depression are most likely the result of a greater
risk of first onset in women [38]. Therefore, it is unlikely
that the gender differences observed here are purely the
result of differences in recurrence.
The issue of aging vs. cohort effects has been ad-
dressed using retrospective data from the National
Comorbidity Study (NCS) in the United States [44, 45].
This work suggests that lifetime prevalence of depres-
sion has increased in recent birth cohorts for both men
and women. There has not been, however, a significant
change in the sex ratio over the 40-year retrospective pe-
riod examined in the survey. There is also evidence that
the emergence of the sex difference in depression has
changed over time. For example, among the oldest birth
cohort in the NCS (1936–1945), the sex difference did
not emerge until the mid–20s. In the earliest birth co-
hort, the emergence of sex differences in depression oc-
curred in early adolescence. Assuming that this change
is not attributable to recall problems in the oldest co-
hort, then the evidence is contrary to biological expla-
nations that attribute the gender gap in depression to
hormonal differences. Although we cannot examine co-
hort effects with these data in the same manner as in the
NCS, the failure to find a convergence in the sex differ-
ence after age 55 in these data provides further evidence
against the hormonal explanation for gender differences
in depression.
A second potential limitation with this analysis con-
cerns the cut-point used to define the post-menopausal
period. Specifically, we dichotomized age on the as-
sumption that most women will have completed
menopause by age 55. While this age cut-off was based
on work by Bebbington et al. [3] that did identify a con-
vergence in gender differences, it is still prone to mis-
specification of respondents. Some women younger
than 55 may have already been menopausal placing false
negatives in the younger cohort while others 55 and
older may have not yet entered menopause placing false
positives in the older cohort. A prospective study that
specifically identifies and follows women through pre-
and post-menopause is required to resolve the contra-
dictory findings across studies. In addition to this prob-
lem, our analysis was also limited by a lack of detailed
information on reproductive status in general (e. g. his-
tory of ovariectomy prior to age 50). Such information
would be valuable for future work to assess the potential
405
impact of endocrine functioning on depression in
women.
Differences in our findings with the Bebbington et al.
[3] study may be due to the composition of the depen-
dent variable. Unlike their outcome measure that com-
bines individuals with depression and anxiety, our mea-
sure captures only episodes of major depression. This
may be responsible for some of the divergence in find-
ings between the two studies. It is important to note,
however, that we find identical results when the CIDI
measure for depression is replaced by a measure of gen-
eralized distress that includes symptoms of both de-
pression and anxiety. Mean levels of distress (anxiety
and depressive symptoms) remained significantly
higher in women well past age 55. While this scale is not
a diagnostic measure, the robustness of the findings
suggests that the convergence in rates after age 55 is not
simply an artifact of measurement.
Finally, although not explicitly a limitation, a note re-
garding our decision to use income and education over
occupation is warranted. We did not include a measure
of occupation or employment status in these analyses
because a significant number of individuals in our sam-
ple fall outside of the typical age range for labour force
participation. The measure of occupational status avail-
able in the NPHS is more appropriate for working-age
adults rather than those over the age of 65 because it
does not capture lifetime occupational attainment.
Specifically, for retired individuals, the last job held by
the person prior to retirement is used for purposes of
classification in the hierarchy. Despite this limitation, it
is important to consider employment status as a predic-
tor of depression [3]. Therefore, we re-ran all multivari-
ate analyses including a dichotomous variable for em-
ployment status (analysis not shown).We also re-ran the
analysis reported in Table 2 on a sub-group of the total
sample (working-age adults aged 20–64) with a measure
for occupational prestige in addition to income and ed-
ucation. The results are identical to those reported in
this paper without these measures.
Notwithstanding these limitations, the sample used
in this analysis was very similar to the National House-
hold Survey of Psychiatric Morbidity used by Bebbing-
ton et al. [3]. It was a representative sample of all ten
Canadian provinces that included respondents across
the entire adult life span to allow examination across a
broad age spectrum. These findings, then, cannot be due
to circumstance unique to a particular region of the
country or to a selective age group. It is also not biolog-
ically plausible that any convergence of the gender gap
in depression attributable to the menopausal transition
and changes in hormones would be country-specific. As
such, further work is required to address the current re-
search dissonance on the gender gap in depression
across the life span.
406
Appendix 1 Description of additional independent
measures
Variable
Socio-demographic indicators
Marital status
Educational attainment
Household income
Presence of children
Immigrant status
Description
Marital status consists of two vari-
ables comparing married, single,
and other (separated, divorced, and
widowed) where married is the ref-
erence group.
Education is based on an item in-
volving a combination of qualita-
tive and ordinal categories. The
original item was a 12-category
variable reflecting different levels
of education attainment. While
some categories appeared to be or-
dered, others did not. Thus, the
original variable was re-coded into
eight categories: (1) no formal
schooling, (2) elementary level ed-
ucation, (3) some secondary level
education, (4) high school diploma,
(5) some education beyond high
school, (6) college diploma or trade
certificate, (7) undergraduate uni-
versity degree, and (8) graduate de-
gree (M. A. or Ph. D) or a degree in
medicine. For multivariate analy-
sis, this measure was treated as a
continuous variable.
Income is composed of five levels
indicating increasing income and
was calculated by adjusting data on
total household income by house-
hold size. The criterion for each cat-
egory is based on Statistics Canada
low-income cut-offs (37, 38). For
example, the lowest category for
households of fewer than five peo-
ple was a total household income of
less than $10,000. If five or more
people lived in the household, the
cut-off was $15,000. The next cate-
gory was between $10,000 and
$14,999 for one or two persons,
$10,000 and $19,999 for three or
four persons, and $15,000 and
$29,999 for five or more people.
Higher categories increased with
respect to the number of people in
the household with the highest cat-
egory for one or two persons at
$60,000 or greater, and for three or
more persons at $80,000 or greater.
Presence of children is measured
using two variables. The first vari-
able indicates the presence of one
or more children 5 years old or
younger currently living in the
household. The second variable in-
dicates the presence of one or more
children between 6 and 11 years of
age currently living in the house-
hold.
Immigrant status indicates
whether the respondent was born
outside of Canada.
Health Status indicators
General health status The derived measure of general
health is composed of a generic
health status index that synthesizes
both quantitative and qualitative
dimensions of health to provide a
score of the respondent’s overall
functional health. This measure in-
corporates eight different dimen-
sions of health including vision,
hearing, speech, mobility, dexterity,
cognition, pain and discomfort,
and emotion.
Self-rated health Self-rated health is a single 5-point
item asking respondents to rate
their physical health from poor (1)
to excellent (5).
Psychosocial resources
Mastery Mastery refers to the extent to
which individuals view themselves
to be in control of their own lives.
This construct is measured using
Pearlin and Schooler’s (39) seven-
item scale. Respondents were asked
how strongly they agreed or dis-
agreed with each item on a five-
point scale (α = 0.76).
Self-esteem Self-esteem is a subset of 6 items
from Rosenberg’s original 10-item
scale that measures one’s percep-
tion of self (40, 41). The items were
scored using a 5-point Likert scale
to indicate how strongly one agrees
or disagrees with a series of ques-
tions measuring one’s personal
self-worth. The derived 6-item self-
esteem scale used in the NPHS had
an internal consistency of α = 0.85.
Social contact The average frequency of contact is
a derived variable that measures
the average number of contacts that
the respondent has had in the pre-
vious 12 months with family mem-
bers and friends who do not live
with the respondents, and with
neighbours. Average contact was
then calculated by dividing contact
(a value that indicates the total
number of contact for each of the
eight categories listed above) by the
size of the respondent’s social net-
work (a value that represents the
total number of possible persons
determined by positive responses
to each category like “yes” to grand-
parents). Higher numbers indicate
more contacts.
Social involvement Social involvement is measured us-
ing two items both of which reflect
the frequency of participation and
attendance at association and reli-
gious services respectively during
the previous year. Higher scores in-
dicate a greater level of social in-
volvement (0–8).

Sources of social stress
Chronic stress This summative measure is based
on 16 questions in which the re-
spondent was asked whether cer-
tain situations were perceived as
stressful or not. These items are a
subset of larger scale developed by
Wheaton (42). The 16-item index
used here is adjusted and standard-
ized to account for the number of
situations applicable to each re-
spondent. For example, those who
are married and/or have children
answered more questions than oth-
ers.
Recent life events This is a summative measure to in-
dicate the number of stressful
events the respondent experienced
in the previous twelve months. The
set of 10 items asked in the NPHS is
a subset of a life event inventory
used in the Toronto Co-morbidity
(43).
Traumatic events Traumatic childhood and adult
events is a count of seven severe
events that respondents may have
been exposed to over their lifetime
(43).
References
1. Nolen-Hoeksema S (1987) Sex differences in unipolar depres-
sion: evidence and theory. Psychol Bull 101: 259–282
2. Weissman MM, Klerman GL (1977) Sex difference in the epi-
demiology of depression. Arch Gen Psychiatry 34: 98–111
3. Bebbington PE, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M,
Meltzer H (1998) The influence of age and sex on the prevalence
of depressive conditions: report from the National Survey of Psy-
chiatric Morbidity. Psychol Med 28: 9–19
4. Nolen-Hoeksema S, Girgus JS (1994) The emergence of gender
differences in depression during adolescence. Psychol Bull 115
(3): 424–443
5. Cairney J (1998) Gender differences in the prevalence of depres-
sion among Canadian adolescents. Cana J Public Health 89 (3):
181–182
6. Allgood-Merron B, Lewinsohn PM, Hyman H (1990) Sex differ-
ence and adolescent depression. J Abnorm Psychology 99: 55–63
7. Kandel DB, Davies M (1986) Adult sequelae of adolescent de-
pressive symptoms. Arch Gen Psychiatry 43 (3): 255–262
8. Peterson AC, Sarigiani PA, Kennedy RE (1991) Adolescent de-
pression: Why more girls? J Youth Adolesc 20: 247–271
9. Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell
KE (1998) Development of depression from preadolescence to
young adulthood: emerging gender differences in a 10-year lon-
gitudinal study. J Abnorm Psychology 107 (1): 128–140
10. Nolen-Hoeksema S, Girgus JS, Seligman ME (1991) Sex differ-
ences in depression and explanatory style in children. J Youth
Adolesc 20 (2): 2333–2345
11. Anderson JC, Williams SM, McGee R, Silva PA (1987) DSM-III
disorders in preadolescent children: prevalence in a large sample
from the general population. Arch Gen Psychiatry 44 (1): 69–76
12. Robins LN, Regier DA (1991) Psychiatric disorders in America.
Free Press, New York
13. Bland RC, Newman SC, Orn H (1988) Period prevalence of psy-
chiatric disorders in Edmonton. Acta Psychiatr Scand 338
(suppl): 33–43
407
14. Weissman MM, Myers JK (1978) Affective disorders in a US ur-
ban community. Arch Gen Psychiatry 35: 1304–1311
15. Copeland JR, Dewey ME, Wood N, et el. (1987) Range of mental
illness among the elderly in the community. Prevalence in Liver-
pool using the GMS-AGECAT Package. Br J Psychiatry 150:
815–823
16. Jorm AF (1987) Sex and age differences in depression: a quanti-
tative synthesis of published research. Aust N Z J Psychiatry 21
(1): 46–53
17. Angold A, Wortman CW (1993) Puberty onset of gender differ-
ences in rates of depression: a developmental, epidemiologic and
neuroendocrine perspective. J Affective Disorders 29: 145–158
18. Susman EJ, Nottelmann ED, Inoff-Germain G, Dorn L, Chrousos
GP (1987) Hormonal influences of aspects of psychological de-
velopment during adolescence. J Adolesc Health Care 8: 492–504
19. Mirowsky J (1996) Age and the gender gap in depression.J Health
Soc Behav 37 (4): 362–80
20. Wade TJ, Cairney J (1997) Age and depression in a nationally rep-
resentative sample of Canadians: a preliminary look at the Na-
tional Longitudinal Health Survey. Cana J Public Health 88 (5):
297–302
21. Wade TJ, Cairney J (2000) The effect of sociodemographics, so-
cial stressors, health status and psychosocial resources on the
age-depression relationship.Cana J Public Health 91 (4): 307–312
22. Statistics Canada (1996) National Population Health Survey.
Public use microdata file user documentation
23. Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U
(1998) The World Health Organization Composite International
Diagnostic Interview-Short Form (CIDI-SF). Interna J Methods
in Psychiatr Res 7: 171–185
24. Beaudet MP (1996) Depression. Health Reports 7 (4): 11–22
25. Semier G, von Cranach M, Wittchen H-U (eds) (1987) Compari-
son between the Composite International Diagnostic Interview
and the Present State Examination. Report to the WHO/
ADAMHA Task Force on Instrument Development: February
1987. Geneva, Switzerland
26. Wittchen H-U, Robins LN, Cottler LB, Sartorius N, Burke JD,
Regier DA, and participants in the Multicentre WHO/ADAMHA
Field Trials (1991) Cross-cultural feasibility, reliability and
sources of variance in the Composite International Diagnostic
Interview (CIDI). Br J Psychiatry 159: 653–658
27. Janca A, Robins LN, Cottler LB, Early TS (1992) Clinical observa-
tion of CIDI assessments: an analysis of the CIDI field trials –
wave II at the St. Louis site. Br J Psychiatry 160: 815–818
28. Farmer AE, Katz R, McGuffin P, Bebbington P (1987) A compar-
ison between the Present State Examination and the Composite
International Diagnostic Interview. Arch Gen Psychiatry 44:
1064–1068
29. Patten SB, Brandon-Christie J, Devji J, Sedmak B (2000) Perfor-
mance of the Composite International Diagnostic Interview-
Short Form for major depression in a community sample.
Chronic Diseases in Canada 21 (2): 68–72
30. Dennerstein L, Burrows GD, Hyman GJ, et al. (1979) Hormone
therapy and affect. Maturitas 1: 247–259
31. Ditkoff EC, Crary WG, Cristo M, et al. (1991) Estrogen improves
psychological function in asymptomatic postmenopausal
women. Obstet Gynecol 78: 991–995
32. Montgomery JC, Appleby L, Brincat M, et al. (1987) Effect of es-
trogen and testosterone implants on psychological disorders in
the climacteric. Lancet 1: 297–299
33. Sherwin BB (1988) Affective changes with estrogen and andro-
gen replacement therapy in surgically menopausal women. J Af-
fect Disorders 14: 177–187
34. Sherwin BB, Gelfand MM (1985) Sex steroids and affect in the
surgical menopause: a double-blind, cross-over study. Psy-
choneuroendocrinology 10: 325–335
35. Weisbader H, Kurzrok R (1983) The menopause: a consideration
of the symptoms, etiology and treatment by means of estrogen.
Endocrinology 3: 32–38
36. Sherwin BB (1991) The impact of different doses of estrogen and
progestin on mood and sexual behavior in postmenopausal
women. J Clin Endocrinol Metab 72: 336–343
408
37. Statistics Canada (1980) Income distributions by size in Canada.
Statistics Canada, Supply and Services Canada, Ottawa
38. Statistics Canada (1983) Rebasing low cut-offs to 1978. Technical
Reference Paper (Cat No. 8-3302-519). Minister of Supply and
Services, Ottawa, Canada
39. Pearlin LI, Schooler C (1978) The structure of coping. J Health
Soc Behav 19: 2–21.
40. Rosenberg M (1965) Society and the adolescent self-image.
Princeton University Press, Princeton, NJ
41. Rosenberg M (1979) Conceiving of self. Basic Books, New York
42. Wheaton B (1994) Sampling the stress universe. In: Avison WR,
Gotlib IH (eds) Stress and mental health: contemporary issues
and prospects for the future. Plenum Press, New York, pp. 77–114
43. Turner RJ, Wheaton B (1990). Psychiatric distress and disorder
and the use of alcohol and drugs. Grant proposal. National
Health and Welfare Canada, Ottawa
44. Kessler RC, McGonagle KA, Nelson CB, Hughes M, Swartz M,
Blazer DG (1994) Sex and depression in the National Comorbid-
ity Survey II: Cohort Effects. J Affective Disorders 30: 15–26
45. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB
(1993) Sex and depression in the National Comorbidity Survey I:
lifetime prevalence, chronicity and recurrence. J Affective Disor-
ders 29: 85–96