Around the world, women are typically diagnosed with depression twice as often as men. But a recent study published in JAMA Psychiatry looks at these disparities in a new way by considering alternative symptoms of depression typically attributed to men.

The researchers, led by Lisa A. Martin, Ph.D., analyzed data from a national mental health survey of 3,310 women and 2,382 men while also looking for alternative symptoms. They wanted to observe whether the sex differences in depression rates would disappear when these alternative symptoms were considered alongside more conventional ones.

Some of the alternative “male-type” symptoms included anger attacks, aggression, substance abuse and risk taking.

Results show that when both traditional and alternative symptoms are accounted for, men and women meet the criteria for depression in equal measures, with 30.6% of men and 33.3% of the women in the study classified as depressed.

The study authors note that most of the research exploring the sex differences in depression has focused on reasons for why women have a greater risk for developing it. But Lisa A. Martin says that “when men are depressed, they may experience symptoms that are different than what is included in current diagnostic criteria.”

Relying on men’s disclosure of traditional symptoms, note the researchers, could lead to men who are not properly diagnosed with depression. They say that medical professionals should contemplate other clues when diagnosing depression in men.

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Women are diagnosed with depression twice as often, but the study shows that men and women are equally affected.

According to the study, depression affects around 16% of the US population each year, which is just over 32 million people. Not just costly, the illness can be debilitating for those affected by it.

Though this is the first study to analyze male-type symptoms of depression in light of sex differences, the researchers note that future studies should try to understand “how masculinity and femininity influence depression rates rather than relying on sex alone as an indicator.”

Because the depression criteria today could be biased toward identifying symptoms that appear more frequently in women, researchers say that further study is needed to clarify the symptoms most associated with male depression.

They do note, however, that their findings show male-type symptoms of depression are also common in women. As a result, asking both men and women questions about irritability, anger and substance abuse is equally important.

The authors conclude the study by writing that “the results of this work have the potential to bring significant advances to the field in terms of the perception and measurement of depression.”