Gender differences in symptomatic profiles of depression: Results from the São Paulo Megacity Mental Health Survey

Background: Few studies have investigated symptomatic subtypes of depression and their correlates by gender. Methods: Data are from the São Paulo Megacity Mental Health Survey. Symptom profiles of 1207 subjects (864 women; 343 men) based upon symptoms of the worst depressive episode in lifetime were examined through latent class analysis. Correlates of gender-specific latent classes were analyzed by logistic regression. Results: For both men and women, a 3-class model was the best solution. A mild class was found in both genders (41.1% in women; 40.1% in men). Gender differences appeared in the most symptomatic classes. In women, they were labeled melancholic (39.3%) and atypical (19.5%), differing among each other in somatic/vegetative symptoms. The melancholic class presented inhibition and eating/sleeping symptoms in the direction of decreasing, whereas the atypical class had increased appetite/weight, and hypersomnia. For men, symptoms that differentiate the two most symptomatic classes were related to psychomotor activity: a melancholic/psychomotor retarded (40.4%) and agitated depression (19.6%). The highest between-class proportion of agitation and racing thoughts was found among men in the agitated class, with similarity to bipolar mixed state. Limitations: Analyses were restricted to those who endorsed questions about their worst lifetime depressive episode; the standardized assessment by lay interviewers; the small male sample size. Conclusions: The construct of depression of current classifications is heterogeneous at the symptom level, where gender different subtypes can be identified. These symptom profiles have potential implications for the nosology and the therapeutics of depression.