Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria

  • Abiodun O. Adewuya
  • Olurotimi A. Coker
  • Olayinka Atilola
  • Bolanle A. Ola
  • Mathew P. Zachariah
  • Tomilola Adewumi
  • Olufemi Olugbile
  • Adedolapo Fasawe
  • Olajide Idris
Original Article


It is still unclear whether the gender difference in the rate of depression cuts across cultures or is specific to some depressive symptoms. This study evaluated the gender difference in current prevalence, symptoms, comorbidity, and correlates of depression in Lagos, Nigeria. A total of 11,246 adult participants (6525 females and 4712 males) in a face-to-face household survey were assessed for symptoms of depression. They were also assessed for symptoms of anxiety, somatic symptoms, alcohol and substance use disorders, and disability. The difference between the point prevalence for symptoms of depression in females (6.3%, s.e 0.3) and males (4.4%, s.e 0.3) was significant (OR 1.28, 95% CI 1.14–1.59). Compared to males, females had significantly higher rates for anhedonia (OR 1.20), hypersomnia (OR 2.15), fatigue (OR 1.49), guilt/worthless feeling (OR 1.41), poor concentration (OR 1.32), psychomotor retardation (OR 1.51), and suicidal ideation (OR 1.32). However, poor appetite (OR 0.69) and comorbidity with alcohol use (OR 0.25) was significantly lower in females compared to males. The significantly higher rates for depression in females were only restricted to below 45 years and higher socioeconomic status. Our study further contributed to the growing literature suggesting that the gender differences in rates of depression not only cut across many cultures, but most pronounced with atypical symptoms, not affected by recall bias and seems to disappear with increasing age. These need to be considered when formulating mental health policies for equitable and acceptable health services.


Gender difference Depression Comorbidity Prevalence Sub-Saharan Africa 


Compliance with ethical standards

The International Guidelines for Ethical Review of Epidemiological Studies was followed throughout the project. The Ethics and Research Committee of the Lagos State University Teaching Hospital (LASUTH) gave the ethical approval for the project. Written informed consent was obtained from the participants before the questionnaire was administered.

Conflict of interest

Author 1 (Adewuya) received funding for the LSMHS from the Lagos State Ministry of Health. Authors 8 and 9 (Fasawe and Idris) work for the Lagos State Ministry of Health. Authors 2–7 (Coker, Atilola, Ola, Zachariah, Adewumi, and Olugbile) declare that they have no conflict of interest.


  1. Adewuya AO (2005) Validation of the alcohol use disorders identification test (audit) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol Alcohol 40:575–577CrossRefPubMedGoogle Scholar
  2. Adewuya AO, Ola BA, Afolabi OO (2006) Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord 96:89–93CrossRefPubMedGoogle Scholar
  3. Alexandrino-Silva C, Wang YP, Carmen Viana M, Bulhões RS, Martins SS, Andrade LH (2013) Gender differences in symptomatic profiles of depression: results from the São Paulo Megacity Mental Health Survey. J Affect Disord 147:355–364CrossRefPubMedGoogle Scholar
  4. Amoran OE, Ogunsemi OO, Lasebikan VO (2012) Assessment of mental disorders using the patient health questionnaire as a general screening tool in western Nigeria: a community-based study. J Neurosci Rural Pract 3:6–11CrossRefPubMedPubMedCentralGoogle Scholar
  5. Angst J, Gamma A, Gastpar M, Lépine JP, Mendlewicz J, Tylee A (2002) Depression Research in European Society Study. Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. Eur Arch Psychiatry Clin Neurosci 252:201–209Google Scholar
  6. Angst J, Gamma A, Benazzi F, Silverstein B, Ajdacic-Gross V, Eich D, Rössler W (2006) Atypical depressive syndromes in varying definitions. Eur Arch Psychiatry Clin Neurosci 256:44–54CrossRefPubMedGoogle Scholar
  7. 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 Psychiatry Morbidity. Psychol Med 28:9–19CrossRefPubMedGoogle Scholar
  8. Bogner HR, Gallo JJ (2004) Are higher rates of depression in women accounted for by differential symptom reporting? Soc Psychiatry Psychiatr Epidemiol 39:126–132CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, de Graaf R, Demyttenaere K, Hu C, Iwata N, Karam AN, Kaur J, Kostyuchenko S, Lépine JP, Levinson D, Matschinger H, Mora ME, Browne MO, Posada-Villa J, Viana MC, Williams DR, Kessler RC (2011) Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 9:90CrossRefPubMedPubMedCentralGoogle Scholar
  10. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 158:1789–1795CrossRefPubMedGoogle Scholar
  11. Davidson KM, Ritson EB (1993) The relationship between alcohol dependence and depression. Alcohol Alcohol 28:147–155PubMedGoogle Scholar
  12. Delisle VC, Beck AT, Dobson KS, Dozois DJ, Thombs BD (2012) Revisiting gender differences in somatic symptoms of depression: much ado about nothing? PLoS One 7:e32490CrossRefPubMedPubMedCentralGoogle Scholar
  13. Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ (1989) The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatr Scand 79:163–178CrossRefPubMedGoogle Scholar
  14. Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, Wondimagegn D, Lemenih A, Fann JR, Stoep AV, Zhou XH (2013) Diagnostic validity of the composite international diagnostic interview (CIDI) depression module in an East African population. Int J Psychiatry Med 46:387–405CrossRefPubMedPubMedCentralGoogle Scholar
  15. Grant BF, Harford TC (1995) Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey. Drug Alcohol Depend 39:197–206CrossRefPubMedGoogle Scholar
  16. Gureje O, Lasebikan VO, Kola L, Makanjuola VA (2006) Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. Br J Psychiatry 188:465–471CrossRefPubMedGoogle Scholar
  17. Gutiérrez-Lobos K, Scherer M, Anderer P, Katschnig H (2002) The influence of age on the female/male ratio of treated incidence rates in depression. BMC Psychiatry 2:3CrossRefPubMedPubMedCentralGoogle Scholar
  18. IBM Corp (2013) IBM SPSS Statistics for Windows, Version 22.0. Armonk: IBM CorpGoogle Scholar
  19. Kelly MM, Tyrka AR, Price LH, Carpenter LL (2008) Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depress Anxiety 25:839–846CrossRefPubMedPubMedCentralGoogle Scholar
  20. Kessler RC, Bromet EJ (2013) The epidemiology of depression across cultures. Annu Rev Public Health 34:119–138CrossRefPubMedPubMedCentralGoogle Scholar
  21. Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Ustün TB, Wang PS (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psychiatr Soc 18:23–33CrossRefGoogle Scholar
  22. Kim JH, Cho MJ, Hong JP, Bae JN, Cho SJ, Hahm BJ, Lee DW, Park JI, Lee JY, Jeon HJ, Chang SM (2015) Gender differences in depressive symptom profile: results from nationwide general population surveys in Korea. J Korean Med Sci 30:1659–1666CrossRefPubMedPubMedCentralGoogle Scholar
  23. Kish L (1985) Survey sampling. Wiley, New YorkGoogle Scholar
  24. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613CrossRefPubMedPubMedCentralGoogle Scholar
  25. Kroenke K, Spitzer RL, Williams JBW (2002) The PHQ-15: validity of a new measure for evaluating somatic symptom severity. Psychosom Med 64:258–266CrossRefPubMedGoogle Scholar
  26. Marcus SM, Young EA, Kerber KB, Kornstein S, Farabaugh AH, Mitchell J, Wisniewski SR, Balasubramani GK, Trivedi MH, Rush AJ (2005) Gender differences in depression: findings from the STAR*D study. J Affect Disord 87:141–150CrossRefPubMedGoogle Scholar
  27. Moskvina V, Farmer A, Jones IR, Brewster S, Ferrero F, Gill M, Jones LA, Maier W, Mors O, Owen MJ, Perry J, Preisig M, Rietschel M, McGuffin P, Craddock N, Korszun A (2008) Sex differences in symptom patterns of recurrent major depression in siblings. Depress Anxiety 25:527–534CrossRefPubMedGoogle Scholar
  28. National Bureau of Statistics (2014) Lagos Household Survey. Central Office of Statistics (COS) - Lagos State GovernmentGoogle Scholar
  29. Ogunsemi OO, Oluwole FA, Abasiubong F, Erinfolami AR, Amoran OE, Ariba AJ (2010) Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria. Ment Illn 2:e10CrossRefPubMedPubMedCentralGoogle Scholar
  30. Oloruntoba-Oju T (2007) Body images, beauty culture and language in the Nigeria, African context. Understanding Human Sexuality, 2007 SeriesGoogle Scholar
  31. Parker G, Fletcher K, Paterson A, Anderson J, Hong M (2014) Gender differences in depression severity and symptoms across depressive subtypes. J Affect Disord 167:351–357CrossRefPubMedGoogle Scholar
  32. Patel V, Minas H, Cohen A, Prince MJ (Eds) (2013) Global mental health: principles and practice. Oxford University PressGoogle Scholar
  33. Patten SB, Williams JV, Lavorato DH, Wang JL, Bulloch AG, Sajobi T (2016) The association between major depression prevalence and sex becomes weaker with age. Soc Psychiatry Psychiatr Epidemiol 51:203–210CrossRefPubMedGoogle Scholar
  34. Piccinelli M, Wilkinson G (2000) Gender differences in depression. Critical review. Br J Psychiatry 177:486–492CrossRefPubMedGoogle Scholar
  35. Romans SE, Tyas J, Cohen MM, Silverstone T (2007) Gender differences in the symptoms of major depressive disorder. J Nerv Ment Dis 195:905–911CrossRefPubMedGoogle Scholar
  36. Schuch JJ, Roest AM, Nolen WA, Penninx BW, de Jonge P (2014) Gender differences in major depressive disorder: results from the Netherlands study of depression and anxiety. J Affect Disord 156:156–163CrossRefPubMedGoogle Scholar
  37. Sheehan D, Lecruiber Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33PubMedGoogle Scholar
  38. Silverstein B, Edwards T, Gamma A, Ajdacic-Gross V, Rossler W, Angst J (2013) The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Soc Psychiatry Psychiatr Epidemiol 48:257–263CrossRefPubMedGoogle Scholar
  39. Smith DJ, Kyle S, Forty L, Cooper C, Walters J, Russell E, Caesar S, Farmer A, McGuffin P, Jones I, Jones L, Craddock N (2008) Differences in depressive symptom profile between males and females. J Affect Disord 108:279–284CrossRefPubMedGoogle Scholar
  40. Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097CrossRefPubMedGoogle Scholar
  41. Townsend C, Takishima-Lacasa JY, Latner JD, Grandinetti A, Keawe'aimoku Kaholokula J (2014) Ethnic and gender differences in ideal body size and related attitudes among Asians, Native Hawaiians, and Whites. Hawaii J Med Public Health 73:236–243PubMedPubMedCentralGoogle Scholar
  42. Ustün TB (2000) Cross national epidemiology of depression and gender. J Gend Specif Med 3:54–58PubMedGoogle Scholar
  43. Ustun TB, Ayuso-Mateos J, Chatterji S, Mathers C, Murray C (2004) Global burden of depressive disorders in the year 2000. Br J Psychiatry 184:386–392CrossRefPubMedGoogle Scholar
  44. Üstün TB, Kostanjsek N, Chatterji S, Rehm J (2010) Measuring health and disability: manual for WHO disability assessment schedule (WHODAS 2.0). WHO; GenevaGoogle Scholar
  45. World Health Organization (2001) The World Health Report 2001. Mental health: new understanding, new hopeGoogle Scholar
  46. World Health Organization (2008) The global burden of disease 2004. Switzerland, GenevaGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Abiodun O. Adewuya
    • 1
    • 2
  • Olurotimi A. Coker
    • 1
  • Olayinka Atilola
    • 1
  • Bolanle A. Ola
    • 1
  • Mathew P. Zachariah
    • 1
  • Tomilola Adewumi
    • 2
  • Olufemi Olugbile
    • 3
  • Adedolapo Fasawe
    • 4
  • Olajide Idris
    • 4
  1. 1.Department of Behavioural MedicineLagos State University College of MedicineIkejaNigeria
  2. 2.Centre for Mental Health Research & InitiativeIkejaNigeria
  3. 3.Synthesiz ConsultsIkejaNigeria
  4. 4.Lagos State Ministry of HealthIkejaNigeria

Personalised recommendations