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Gender Differences in Depression among Undergraduates from Seventeen Islamic Countries

في الأحد يناير 27, 2013 9:54 pm
Bader M. Alansari
Kuwait University, Kuwait
This study investigated gender differences in depression among volunteer undergraduates
(N = 8,538) recruited from 17 Islamic countries. The Beck Depression Inventory II (Beck,
Steer, & Brown, 1996), was used in its Arabic form for all groups except the Pakistan group,
which used the English version. Results indicated that there are significant gender differences
in 9 of the Islamic countries in which females tended to be higher in depression namely,
Iraq, Syria, Egypt, Pakistan, Algeria, Oman, Qatar, Morocco, and Kuwait. However, males
scored significantly higher than females in Saudi Arabia, while there are no significant gender
differences in depression in Lebanon, Tunisia, Palestine, U.A. Emirates, Yemen, Jordan, and
Sudan. The salient gender differences were interpreted in the light of a socialization process;
especially sex-typing and gender roles.
Keywords: depression, BDI-II, gender, Arab country, Islamic country, cross-cultural research,
undergraduates.
Depression is perhaps the oldest recorded psychiatric disorder. It is most
probable that adults only were referred to with this disorder, notwithstanding the
fact that sadness, unhappiness, or dysphoric mood can occur at any age.
SOCIAL BEHAVIOR AND PERSONALITY, 2006, 34(6), 729-738
© Society for Personality Research (Inc.)
729
Professor Bader M. Alansari, Department of Psychology, Faculty of Social Sciences, University of
Kuwait, Kuwait.
This study was supported by Kuwait University, Research Administration through Research Grant
# (ORP001).
The authors expresses his thanks to the large number of colleagues, vice rectors and participants from
the Islamic countries for their able cooperation and help.
Appreciation is due to reviewers including: Wade Mackey, PhD, 7103 Oakwood Glen Blvd, Apt 19,
Spring, TX 77379, USA, Email: waddmac@aol.com
Please address correspondence and reprint requests to: Professor Bader Alansari, Department of
Psychology, Faculty of Social Sciences, University of Kuwait, P.O. Box 68168, Kaifan. Code No.
71962, Kuwait. Phone: 4846843-4146; Fax: 00965-4830157; Email: baderansari@yahoo.com;
Web: http://www.baderansari.info/:
730 GENDER AND DEPRESSION IN ISLAMIC COUNTRIES
Each year, approximately 18.8 million Americans suffer from some form of
depression, roughly 7% of the U.S population. A depressive disorder is an illness
that involves the body, mood, and thoughts. It affects the way a person eats and
sleeps, the way one feels about oneself, and the way one thinks about things. A
depressive disorder is not the same as a passing blue mood, not is it a sign of
personal weakness or a condition that can be willed or wished away. People with
a depressive illness cannot merely “pull themselves together” and get better.
Without treatment, symptoms can last for weeks, months, or years. However,
appropriate treatment, can help most people who suffer from depression.
(http://infoscouts.com/health/depression.htm 9/10/2004)
Clinical depression affects twice as many women as men, both in the USA
and in many societies around the world. It is estimated that one out of every
seven women will suffer from depression in their lifetime. Additionally, women
experience higher rates of seasonal affective disorder and dysthymia (chronic
depression), while the rates of bipolar disorder (manic depression) are similar in
men and women; however, women have higher rates of the depressed phase of
manic depression and rapid-cycling bipolar disorder.
(http:// web.nami.org/helpline/women.html 9/10/2004)
Depression is often considered a “female disease,” since it is reported to affect 4
times as many women as it does men. Yet male depression may be more rampant
than we realize. Many men try to hide their condition, thinking it unmanly to act
moody, and it works: National studies suggest that doctors miss the diagnosis
in men a full 70% of the time. But male depression also stays hidden because
men tend to express depression differently from the way in which women do,
as was explained at the recent annual meeting of the American Psychological
Association.
Research shows that women usually internalize distress, while men externalize
it. Depressed women are more likely to talk about their problem and reach out
for help; depressed men often have less tolerance for internal pain and turn to
some action or substance for relief. Male depression is not as obvious, as men
use defenses to run from it. This is a “covert depression”. It has three major
symptoms. First, men attempt to escape pain by overusing alcohol or drugs,
working excessively or seeking extramarital affairs. They go into isolation,
withdrawing from loved ones. They may lash out, becoming irritable or violent.
The causes of depression differ in men and women as well. While depressed
women often feel disempowered, depressed men always feel disempowered;
depressed men feel disconnected – from their needs and from others. This begins
in childhood, as society teaches boys early on to pull away from their mothers,
their emotions and their vulnerabilities.
(http://www.keepmedia.com/pubs/psychologyToday/2000/01/01/
8070/?extID=10047&... 9/10/2004)
GENDER AND DEPRESSION IN ISLAMIC COUNTRIES 731
Although men and women exhibit similar symptoms of depression, women
report more atypical symptoms including anxiety, somatization (the physical
expression of mental processes such as aches and pains with no physiological
cause), increases in weight and appetite, oversleeping, and expressed anger and
hostility.
(http://web.nami.org/helpline/women.htm 1 9/10/2004)
In the field of gender differences in depression, in Islamic countries, a number
of studies have been conducted using Arabic students, and significant gender
differences were observed in these studies, in that females are significantly more
likely than males to suffer from depression, using the BDI-I. For example, in
Kuwait, Abdel-Khalek (1991), Abdel-Khalek and Alansari (1995), Abdullateef
(1997), Alansari (1997 a,b,c, 1998, 2003), Al-Mashaan (1995), Al-Naser (2000).
In Egypt, research has been conducted by Ali (1998), Al-Nayal (1991), Ghareeb
(2000), Mursi (1997), Shukeer (1995), in Syria by Radwan (2001, 2003), in
Algeria by Muameria (2000), and in Saudi Arabia by Ibrahim and Ibrahim
(1997).
The Beck Depression Inventory second edition (BDI-II) (Beck, Steer, &
Brown, 1996) is a 21–item self-report instrument intended to assess the existence
and severity of symptoms of depression as listed in the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV: 1994). This new revised edition replaces the BDI and the BDIIA,
and includes items intended to index symptoms of severe depression which
would require hospitalization. Items have been changed to indicate increases
or decreases in sleep and appetite, items labeled body image, work difficulty,
weight loss, and somatic preoccupation have been replaced with items labeled
agitation, concentration difficulty and loss of energy, and many statements have
been reworded resulting in a substantial revision of the original BDI and BDI-IA.
When presented with the BDI-II, a patient is asked to consider each statement
as it relates to the way s/he has felt for the past two weeks, to more accurately
correspond to the DSM-IV criteria. The BDI-II, which was originally developed
in English, has comparable forms and results of several studies in Arabic
(Alansari, 2003; Al-Musawi, 2001; Ghareeb, 2000); Spanish (Gahr, Camy, &
Pepperdine, 2002); and in Japanese (Kojima et al., 2002).
The aim in this investigation was to explore sex-related differences in
depression by using the BDI-II, with undergraduates recruited from 17 Islamic
countries.
Method
Participants
The BDI-II was mailed to either university rectors or colleagues in the
selected countries included in the present study. The final sample included
732 GENDER AND DEPRESSION IN ISLAMIC COUNTRIES
8,538 respondents distributed among the 17 countries: Saudi Arabia, Malek
Sued University; Qatar, Qatar University; Syria, Damascus University; Egypt,
Alexandria University, Mansura University and Al-Aswan University; Algeria,
Institute of Psychology and Educational Sciences; Oman, Sultan Qaboos
University; Iraq, University of Baghdad and Mussels University; Yemen,
University of Adan; Lebanon, Lebanese American University; Palestine, University
of Gaza Strip; Kuwait, Kuwait University; Morocco, Minas University; Jordan,
Al-Isra Private University and Yormouk University, Irbid; Sudan, University
of Sudan for Science and Technology; UAE, United Arab Emirates University;
Tunisia, The Higher Institute of Humanistic Sciences; Pakistan, Iqraa University.
N= (630) (200); (772); [(215) and (300) and (220)] (306); (236); [(641) and (85)]
(648); (248); (568); (510); (692); [(423) and (499)]; (258); (150); (262) and
(476), respectively.
The ages of the participants ranged between 18 and 25. The questionnaires
were distributed with the understanding that all completed questionnaires would
be returned within three months from the date of their issue. The Arabic version
of the scale was administered in small group sessions to volunteer undergraduates
enrolled in the 16 Islamic universities and the original English version of the
BDI-II was administrated to volunteer undergraduates enrolled in Pakistan.
The Scale
The BDI-II is a 21-item inventory that assesses the severity of depressive
symptomatology. Each item is rated on a scale ranging from 0 (normal) to 3
(most severe) with summary scores ranging between 0 and 63. The BDI-II has
been found to display high internal consistency (α =.93 among college students
(Beck, Steer, & Brown, 1996). Ghareeb, (2000) translated the BDI-II into Arabic
and provided proper validity and reliability evidence for Egyptian samples; Al-
Musawi (2001) translated the BDI-II into Arabic and provided proper validity
and reliability evidence for Bahraini undergraduates.
Item-remainder correlations ranged from .21 to .63. Reliabilities ranged from
.88 to .92 (alpha) and between .79 and .75 (test-retest) denoting good internal
consistency and stability. Criterion-related validity of the scale ranged between
61 and 87 (3 criteria), while the loadings of the scale on a general factor of
Depression yielded .93 and .95 in 2-factor analyses, demonstrating the scale’s
criterion-related and factorial validity. Divergent and discriminant validities
of the scale were also demonstrated (Al-Musawi, 2001; Ghareeb, 2000). The
alpha coefficients in the 17 samples in the present study ranged from .82 to .93,
denoting good internal consistency of the Arabic form of the BDI-II adapted by
Ghareeb (2000).
GENDER AND DEPRESSION IN ISLAMIC COUNTRIES 733
Procedure
The study primarily concerned examining the internal consistency of an
Arabic adaptation of the Beck Depression Inventory II in 17 Islamic countries,
so as to determine the reliability of the scale among undergraduate students at
universities in these countries. The BDI-II was mailed to the university presidents
of the all selected countries included in the study, and the sample included
8,538 respondents distributed among the 17 Islamic countries as listed under
“Participants”. The BDI-II was administered to students in their classes, and the
test administration took about 10 minutes.
Results
Table 1 sets out the descriptive statistics of the BDI-II scales. Inspection of
this table shows that the mean BDI-II score is higher among female college
students than the mean score of their male counterparts in Iraq, Syria, Egypt,
Pakistan, Algeria, Oman, Qatar, Morocco, and Kuwait, However, males scored
significantly higher than females in Saudi Arabia.
Table 1
Mean (Ms) and Standard Deviation (SDs) of the BDI-II in 17 Islamic Countries
No. Country Male Female F Value t Value p Level
N M SD N M SD
1. Iraq 363 15.4 9.37 363 20.2 10.68 41.3 6.43 .001
2. Syria 386 21.6 10.3 386 27.4 8.43 34.2 6.22 .001
3. Saudi Arabia 315 18.1 11.4 315 14.2 10.1 20.7 4.55 .001
4. Egypt 467 16.8 9.09 467 19.7 9.12 16.5 4.07 .001
5. Algeria 153 14.2 8.20 153 17.5 8.76 11.5 3.39 .001
6. Oman 118 14.3 9.33 118 18.3 .963 10.9 3.30 .001
7. Morocco 346 14.0 9.17 346 16.0 10.1 07.7 2.77 .01
8. Kuwait 255 13.0 9.73 255 15.0 9.17 05.7 2.38 .02
9. Qatar 100 12.3 8.24 100 15.1 9.05 05.4 2.32 .05
10. Pakistan 238 21.1 13.3 238 23.8 14.0 04.6 2.15 .05
11. Lebanon 124 14.1 8.32 124 15.8 7.87 02.6 1.62 .11
12. Tunisia 131 17.8 9.65 131 19.9 8.81 03.4 1.85 .07
13. Palestine 284 17.7 10.0 284 18.6 9.51 01.2 1.11 .27
14. U.A. Emirates 75 19.3 13.0 75 17.8 11.2 00.6 0.74 .46
15. Yemen 324 15.8 9.20 324 16.3 10.5 00.4 0.64 .52
16. Jordan 461 17.3 10.5 461 17.7 9.91 00.2 0.49 .62
17. Sudan 129 14.6 9.62 129 15.2 10.2 00.2 0.43 .67
734 GENDER AND DEPRESSION IN ISLAMIC COUNTRIES
Table 2
ANOVA for Culture and Gender Effects of Depression
Source Sum of Squares Degree of Freedom Mean Square F p-Value
Factor Culture A 54021.60 17 2843.24 4.99 .000
Factor Culture B 1308.75 1 1308.75 9.374 .003
Culture + Gender 10831.46 17 570.08 5.662 .000
On the other hand, there were no significant gender differences among
participants from Lebanon, Tunisia, Palestine, U.A. Emirates, Yemen, Jordan
and Sudan. Table 2 shows that there is interaction between gender and culture
with depression.
Discussion
The main objective of the current series of investigations was adequately
fulfilled. The female groups had higher mean depression scores in 9 countries
than their male counterparts (Iraq, Syria, Egypt, Pakistan, Algeria, Oman,
Qatar, Morocco, and Kuwait). Therefore, it is safe to conclude that differences
overshadow similarities. This finding is consistent with previous results (Abdel-
Khalek, 1991; Abdel-Khalek & Alansari, 1995; Abdullatiff, 1997; Alansari,
1997 a,b,c, 1998, 2003; Ali, 1998; Al-Mishaan, 1995; Al-Naser, 2000; Al-Nayal,
1991; Ghareeb, 2000; Ibrahim & Ibrahim, 1997; Muameria, 2000; Murssi, 1997;
Radwan, 2001, 2003; Shukeer, 1995).
The preponderance of depression amongst females has been a consistent
finding, whether in children, adolescents, undergraduates, adults, the aged,
depression disorder patients, or in community surveys.
Other factors in Islamic and Eastern countries are that there are fewer job
opportunities for women workers than for men, and a woman has less opportunity
to express herself, her way of living a life, and to defend herself – and society
holds her in lower regard. All these factors could lead to more anxiety, instability,
fear and worries, but the way chosen by females to overcome these may lead
them to hide those factors in order not to adversely affect personal attraction,
That way, the depression symptoms are not obvious in them.
Blumenthal & Endicott (1996) had an explanation for the gender gap in
susceptibility to depression which, they said, lies in a combination of biological,
genetic, psychological, and social factors.
From the Biological Point of View
Some women experience behavior and mood changes premenstrually. As
many as 10%–15% experience a clinical depression during pregnancy or after
the birth of a baby. There also appears to be an increase in depression during
GENDER AND DEPRESSION IN ISLAMIC COUNTRIES 735
the perimenopausal period, but after menopause this does not appear to be the
case.
Additionally, differences in thyroid function between men and women may
contribute to the gender difference in the prevalence of mood disorders. Another
biological factor that may contribute to gender differences in depression can be
linked to circadian rhythm patterns, the complex system that regulates sleep and
activity over each 24-hour period. Depressed women report more hypersomnia
(excessive sleeping) than do men. Gender differences in the activity of neurotransmitters,
including serotonin and the effects of estrongen on their function,
may also be linked to the gender disparity in rates of depression.
From the Genetic Factors Point of View
Some forms of depression run in families. There is a 25% chance of depression
in the first-degree relatives (mother, father, siblings) of people with depression,
and greater prevalence of the illness in first-degree and second-degree female
relatives. But depression also occurs in people who have no family history of
the disease.
From the Psychosocial Factors Point of View
Sometimes the stress of multiple work and family responsibilities, sexual and
physical abuse, sexual discrimination, lack of social supports, traumatic life
experiences, and poverty result in depression. Women also appear to be more
willing than men to admit to feelings of depression and report past episodes of
depression to physicians, perhaps also contributing to the gender difference in
depression rates. Women with low self-esteem, pessimistic views, and tendencies
towards stress are prone to clinical depression.
Studies also indicate that sexual and physical abuse are major risk factors for
depression. Women are twice as likely as men to have experienced sexual abuse.
Abuse by males tends to be high in the Islamic country of Saudi Arabia, which
can be explained on the basis of its low rate of employment opportunities, and
associated economic problems for adolescents. The inability to have sex because
they cannot marry is another stressor, besides financial problems which drives
the young men of Saudi Arabia to abuse of women – and to depression (UNDP,
2002, 2003).
On the other hand, there is no significant difference in Tunisia, Palestine,
U.A. Emirates, Yemen, Jordan and Sudan, because they have better social and
economic situations, and either a lack of employment opportunities for both
genders, or equal chances of working for both males and females.
In countries where there is no significant difference in the economic and social
status of either gender, this is due to the absence of job opportunities or equal
chances of jobs for both genders and similarities due to their young age, less
experience, and less maturity in both males and females in this age period.
736 GENDER AND DEPRESSION IN ISLAMIC COUNTRIES
Different theories have been proposed to elucidate the development of sex
role behavior. Foremost among them are the social learning theory (modeling
and imitation), cognitive developmental theory, and the gender schema theory
(Jacklin, 1989). In the same vein, environmental stress has been reported as
relevant to the development and exacerbation of depression (Barlow, 1988),
as well as conflict-affected family environments (Silverman & Nelles, 1988),
impaired social functioning (Benjamin, Costello, & Warren, 1990), low selfesteem
(Messer & Beidel, 1994), emotional reliance findings indicate that
emotional reliance is significantly related to depression and that women report
greater reliance than men. Moreover, the positive association betwen emotional
reliance and depression is greater for women (Bornstein, 1991 & Johnson,
1990), social desirability (social desirability bias is one of the key factors
identified as affecting self-reported accuracy. Women reported greater social
desirability than men.) (Hagborg, 1991), somatic health complaints (Last, 1991),
and pain behavior (Sullivan, Tripp, & Santor, 2000). Shear, Feske, and Greeno
(2000) focused on four areas of gender differences, that is, gender roles, genderrole
stress, social relationships, and gender differences in exposure to social
adversity.
As far as the Arab countries are concerned, Arab researchers hypothesized the
impact of both child-rearing practices and orthodox Arab traditions. Al-Subaie
and Alhamad (2000) maintained that “there is a growing conflict between the
traditional female role of getting married and bearing children and the new
endeavors of gaining education and working outside the home” (p. 207).
Following a similar pattern, Fakhr-El-Islam (2000) stated that “tradition
maintains a hierarchical order in the family in which dominance of male over
female and older over younger is observed. A son is given more freedom,
authority, and responsibility than a daughter. The preference of Arabs for male
children is surpassed by only a few cultures, for example, the Chinese, who have
a saying: ‘it is better to raise geese than daughters’, and who also share the belief
that a woman determines the sex of her babies. The traditionally disadvantaged
status of Arab women emphasizes submission and dependency as important
feminine attributes in the upbringing of girls” (p. 123).
By the same token, Seeman (1997), based on the examination of the female
hormones, concluded that “the estrogens are neuroprotective with respect
to neuronal degeneration, growth, and susceptibility to toxins. The cyclic
fluctuations of estrogens and progesterone enhance the response to stress, which
confers susceptibility to depression” (p. 1641).
From the present researcher’s point of view, the Depression score of any given
person is the end product of both biological and psychosocial factors and their
interaction. Furthermore, the response styles, especially social desirability and
the tendency to hyperbole have an impact on depression scores.
GENDER AND DEPRESSION IN ISLAMIC COUNTRIES 737
It is worth noting that there are specific limitations on this current series of
studies. Foremost among them is the sample. Notwithstanding the large sample
size (N=8538) recruited from a large number of Arab and Islamic countries, the
sample was limited by the economic status, equality of job opportunities and
social status of both genders.
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http://infoscouts.com/ health/ depression.htm 9/10/2004
http:// web.nami.org/helpline/women.html 9/10/2004
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9/10/2004
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