Male vs.

Female Depression:  
Why Men "Act Out" and
Women "Act In."

Jed Diamond, Ph.D., LCSW

Kaiser Permanente San Jose

October 27-28, 2010
 “Women seek help—men die.”
This conclusion was drawn from a study of suicide prevention
by Angst & Ernst (1990). They found that 75% of those who
sought professional help in an institution for suicide prevention
were female. Conversely 75% of those who committed suicide
in the same year were male.

Since depression is a significant risk factor for suicide and

men receive less treatment for depression than do women, it is
vitally important that we have a better understanding of the
way depression manifests itself in males.
Estimated Annual Suicide Rate per 100,000
by Age and Gender
Age Range Men Women Male :
Female

15-19 18.5 3.7 6.08

20-24 27.2 4.0 7.35
25-64 25.6 6.1 4.20
65-85 49.4 5.1 9.68
85+ 75.0 5.0 15.00

Reported in Sam V. Cochran and Fredric E. Rabinowitz. Men and Depression:

Clinical and Empirical Perspectives. San Diego, California: Academic Press,
2000, 141.
 My Own Journey With
Depression
On the day after my 5th birthday my father
took an overdose of sleeping pills.
Although his suicide attempt wasn’t
successful, our lives were never the same.
Standard Depression Questions
 1. I did not feel like eating; my appetite was
poor.
 2. I felt that I could not shake off the blues.
 3. I felt hopeless about the future.
 4. I had crying spells.
 5. I talked less than usual.
 6. I felt sad.
 7. I felt that people disliked me.
 The Center for Epidemiologic
Studies Depression Screen
(CES-D 20)

Well established assessment instrument for

determining whether someone is
depressed.
 Diamond Male Depression Scale
(DMDS)

I developed a 51 question scale, the

Diamond Male Depression Scale, which
included atypical symptoms thought to be
associated with male-type depression.
Demographics of Study Population
 323 females and 749 males (1072 total).

 Age range 18-80, Mean 51, 58% over 50.

 76% employed, 64% income > $50,000/year.

 48% of the males and 40% of the females

depressed (CES-D 20).

 53%, 1+ relatives have mood disorder.

 Factor Analysis of Diamond Male
Depression Scale (DMDS)
Factor 1: Emotional Acting-In Depression,
Chronbach’s alpha = .93
Negative, withdrawn, stressed, numb.

Factor 2: Emotional Acting-Out Depression,

Chronbach’s alpha = .89
Short-fuse, impatient, irritable, angry.

Factor 3: Physical Acting-Out Depression

Chronbach’s alpha = .73
Alcohol abuse, reckless, explosive, violent.
 Factor 1: Emotional Acting-In
Depression
 I feel I’d like to get away from it all.
 I feel like things are stacked against me.
 People I count on disappoint me.
 I feel stressed out.
 I feel emotionally numb and closed down.
 I feel sorry for myself.
 I feel burned out.
Factor 2: Emotional Acting-Out
Depression
 I flare up quickly.
 I have trouble controlling my temper.
 I am easily annoyed, become grumpy, or
impatient.
 Other people “drive me up the wall.”
 When others disagree with me I get very upset.
 It doesn’t take much to set me off.
 I have difficulty maintaining self-control.
 Factor 3: Physical Acting-Out
Depression
 I have hit someone when I was provoked.
 I work longer hours because going home is stressful.
 I gamble with money I have set aside for other things.
 I drive fast or recklessly as a way of letting off steam.
 If I'm feeling low, I'll use sex as a pick me up.
 I have felt I should cut down on my drinking or drug
use.
 I get so jealous or possessive I feel like I could explode.
 DMDS Factors in Depressed and Non-Depressed Men and Women
Predicting Factor 1 Emotional Acting-In Unstandardized P-value
Coefficient
Depressed Men vs. Women 1.15 .208
Non-depressed Men vs. Women .47 .510

Predicting Factor 2 Emotional Acting-Out

Depressed Men vs. Women 1.47 .002

Non-depressed Men vs. Women 1.19 .001

Predicting Factor 3 Physical Acting-Out

Depressed Men vs. Women 1.52 < .001

Non-depressed Men vs. Women .86 .003
 Male-Type Depression and
Andropause

 Loss of sexual desire for marital partner.

 Problems with erections.
 Irritability and anger.
 Fatigue and low energy.
 Marital and family conflict.
 Depression.
 Social Context Today
 End of 150 years of cheap fossil fuels.
 Global warming
 Economic dislocations

Results: Increasing stress, scarcity,

aggression and depression.
Treatment Options for Men:

1. Exercise
2. Omega-3 fatty acid supplements
3. Light Exposure
4. Anti-Rumination strategies
5. Social Support
6. Sleep Hygiene
7. Energy Psychology
 Energy Psychology
Energy Psychology is proving to be the perfect tool
for a great many men.
• It is action oriented.

• Talking is not required.

• There are no pills to take.

• No need to re-live painful experiences from the

past.
• Relief is often immediate.

• And results are lasting.

 Psychology of the Future

According to Dawson Church, Ph.D., one of

the field’s leading researchers, “I believe
that Energy Psychology has a potential for
the alleviation of human suffering that
rivals any advance in psychology or
medicine in the last five centuries.”
 Energy Psychology at Kaiser
 Randomized Trial of Tapas Acupressure
Technique for Weight Loss Maintenance
 Charles Elder, M.D., M.P.H.

Kaiser Permanente Center for Health

Research, Portland, OR 97227
 E-mail: Charles.R.Elder@kp.org
Recommendations for Future Research

Future research will be needed to validate the results of the

study and to develop numerical scores for evaluating
depression and suicide risk using the DMDS.

It would be helpful to conduct research with a general

population to see if results were consistent in a population
representative of the general community. Particular attention
should be focused on including men and women from different
ethnic groups, cultural backgrounds, economic levels, and age
groups.
 Thank You!

If you’d like more information on my work

you can contact me:

E-Mail: Jed@MenAlive.com

Web: www.MenAlive.com