SEX-DIFFERENCES IN THE PREVALENCE AND DETECTION OF DEPRESSIVE AND ANXIETY DISORDERS IN GENERAL HEALTH-CARE SETTINGS - REPORT FROM THE WORLD-HEALTH-ORGANIZATION COLLABORATIVE STUDY ON PSYCHOLOGICAL-PROBLEMS IN GENERAL HEALTH-CARE

Background: Understanding the relevance of biological and social facto rs to sex differences in the prevalence and detection of depressive an d anxiety disorders has been impaired by the lack of standardized rese arch methods across cultures. Method: Prevalence rates of depressive a nd anxiety disorders were assessed using a 2-stage design from 26 969 patients attending for primary care in 15 centers from 4 continents. L ogistic regression analysis was used to examine sex differences in pre valence and detection across centers. Results: Odds ratios for women c ompared with men of current depression (1.60; 95% confidence interval [CI], 1.37-1.86) and agoraphobia or panic (1.63; 95% CI, 1.18-2.20) we re consistent across centers. The odds ratio for generalized anxiety v aried among centers: 3 groups of centers were identified with odds rat ios of 0.46 (95% CI, 0.27-0.78), 1.34 (95% CI, 1.08-1.66), and 3.09 (9 5% CI, 1.60-5.89). There was no sex difference in the detection of dep ressive and anxiety disorders by physicians across centers. Conclusion s: The absence of a sex-by-center effect for current depression and ag oraphobia or panic disorder is consistent with biological and psychoso cial factors, either interacting or working alone, that have a similar final effect across cultures. It does not support the idea that sex d ifferences in prevalence are caused by local psychosocial factors that vary from country to country. The variation in the odds ratio for gen eralized anxiety disorder offers some support to the idea that there a re local differences between the centers contributing to the sex diffe rence in rates. Patients' sex does not appear to affect the likelihood of current depression and anxiety being detected by primary care phys icians.