Gender differences in depressive symptoms among older adults: a cross national comparison. The CLESA project.

Objectives To assess country-specific gender differences in depressive symptoms and to explore if exposures and vulnerabilities vary by gender among older men and women from four European countries and Israel. Methods Data on 4,449 subjects between 75 and 84 years old were derived from CLESA ("Cross-national determinants of quality of life and health services for the elderly". A ratio score of depressive symptoms derived form the CESD and GDS scales was regressed on education, marital status, living arrangements, comorbidity and disability and all interactions of these factors with gender and country. Results The prevalence of depressive symptoms is higher in women than in men in every country, except Sweden. Women are more likely to be exposed to socio-structural risks, and have poorer health and more disability than men in most of the countries. However, women are not more vulnerable to these risk factors. Conclusions Findings indicate that the female excess in depressive symptoms remains after taking into account the higher prevalence of socio-structural and health-related risk factors and that older women are not more vulnerable than older men to these known risk factors, suggesting the existence of additional pathways linked to gender and/or biological sex.