Do the diagnostic criteria determine the sex ratio in depression?

The 1-year prevalence rates and sex ratio of dysphoric mood, brief (BDE, less than 2 weeks) and extensive (EDE, greater than or equal to 2 weeks) depressive episodes and major depression (RDC, DSM-III) from an epidemiologic study are presented. Factors influencing the sex ratio are analyzed: subjective suffering from EDE, social and work impairment were found to an equal degree in both genders. Factors favoring female preponderance: women report more symptoms, men most probably forget symptoms, frequency and length of less recent depressions more readily, women see a physician or proceed to self-medication much more often. Consequently, the identical minimum symptom number for both genders is questioned and occupational impairment suggested as an alternative case-defining criterion.