Longitudinal sex differences of externalising and internalising depression symptom trajectories: Implications for assessment of depression in men from an online study

Int J Soc Psychiatry. 2015 May;61(3):236-40. doi: 10.1177/0020764014540149. Epub 2014 Jun 29.


Background: Clinical reports indicate that men tend to engage in a range of externalising behaviours in response to negative emotional states. Such externalising behaviours have been theorised to reflect a male sub-type of depression that is inconsistent with current diagnostic criteria, resulting in impeded detection and treatment rates of depressed men.

Aims: In addressing previous study design limitations, this article presents self-report longitudinal data for the multidimensional Male Depression Risk Scale (MDRS-22) against ratings of diagnostic criteria for major depressive disorder as assessed by the Patient Health Questionnaire-Depression Module (PHQ-9). Longitudinal psychometric properties of the MDRS-22 are reported and symptom trajectories described.

Method: A sample of 233 adults (males = 125; 54%) completed measures of externalising and prototypic depression symptoms at Time 1, and again at Time 2 (15 weeks later). Psychometric properties were examined and within-subjects analyses undertaken.

Results: The MDRS-22 demonstrated stable internal consistency and test-retest correlations equivalent to those observed for the PHQ-9. Both prototypic and externalising depression symptoms increased with experiences of recent negative life events. Marked gender differences were observed. Males experiencing ≥ 2 stressful negative life events reported significantly higher MDRS-22 scores at both Time 1 and Time 2 relative to comparable females.

Conclusion: Findings contribute to the validity of the MDRS-22 as a measure of externalising depression symptoms. Results suggest that while both males and females experience externalising depression symptoms, these symptoms may be particularly elevated for men following experiences of negative life events. Findings suggest that externalising symptoms may be a special feature of depression for men. Given the problematic nature of such externalising symptoms (e.g. excessive substance use, aggression, risk-taking), their clinical assessment appears warranted.

Keywords: Depression; externalising symptoms; men; psychometric; sex differences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aggression
  • Depression / psychology*
  • Depressive Disorder, Major / diagnosis*
  • Emotions
  • Female
  • Humans
  • Internet
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Risk-Taking
  • Self Report
  • Sex Factors*
  • Social Media
  • Young Adult