Depression in Women and in Men: Differences on Behavioral Avoidance and on Behavioral Activation

Depression is a well-known disorder characterized by e.g. sadness, loss of interest and pleasure, feelings of guilt or worthlessness. Depression is also characterized by a decrease of the level of engagement in activities also conceptualized as behavioral avoidance. Indeed, depressed patients less and less engage themselves in pleasurable activities (e.g. they spend more and more time in their bed, see their friends more rarely). Reciprocally, this decrease of the level of engagement in activities reinforces and maintains depressive symptoms. This relationship between depression and a low level of engagement in activities is well-established in the scientific literature but no study has, until now, discussed the reasons of this decrease of engagement in activities. According to theoretical models of depression (Beck, 2008; Lewinsohn, 1985; Watkins, 2009), five sets of psychological processes (PP) are involved in depressive symptomatology: negative repetitive thoughts, maladaptive emotion regulation strategies, low environmental rewards, negative self-image and inhibition. We hypothesize that these PP could be considered as explaining factors of the behavioral avoidance. Furthermore, we hypothesize that other PP could be considered as explaining factors of the behavioral activation (adaptive emotion regulation strategies, high environmental rewards, positive self-image, approach and high self-clarity). Then, our aim is to assess the links between behavioral avoidance as well as activation and the PP mentioned above. In order to reach this objective, we developed a model of these links based on the psychological model of mental ill-health of Kinderman (2005, 2013). According to this model, biological, social and circumstantial factors lead to mental disorders through their conjoint effects on psychological processes. Furthermore, because depression is different in women and in men, we assessed the adequacy of our model according to the sex.
Clinical and community adults completed an online survey assessing the psychological processes mentioned above, avoidance and activation. Since several questionnaires were used to assess each PP, factorial scores were computed for each one.
Preliminary analyses (confirmatory factor analyses) were realized with a sample of 393 women and 139 men. The results revealed differences between men and women. For women, on the one hand, low levels of environmental rewards, maladaptive emotion regulation strategies and negative repetitive thoughts are linked to behavioral avoidance, and on the other hand, high levels of environmental rewards and positive self-image are linked to behavioral activation. For men, on the one hand, negative self-image, maladaptive emotion regulation strategies and low environmental rewards are linked to behavioral avoidance, and, on the other hand, high levels of environmental rewards and positive self-image are linked to behavioral activation.
The final results will be presented during the convention, as data-collection is on-going and will end in May 2015. Clinical implications of these results will also be discussed such as the relevance of working on the levels of environmental rewards.