By combining traditional and alternative symptoms of depression, a new study found that roughly one-third of men and women show symptoms of depression.

When it comes to experiencing depression, men and women may not be that far off, according to a new study that also looked at non-traditional symptoms which better identify men with the disorder.

Researchers from the University of Michigan found that about one-third of men and women displayed signs of depression when assessed using not only traditional symptoms, but also alternative ones such as anger or aggression, sleep problems, and substance abuse.

“Paying attention to a couple of these other symptoms allowed men who didn’t really meet the threshold of symptoms to be considered,” Lisa Martin, the study’s lead author from the University of Michigan in Dearborn, tells Reuters Health.

In their paper, the authors state that around 16 percent of Americans—more than 32 million—meet the criteria for depression. According to the Centers for Disease Control and Prevention, women are more likely to be diagnosed with depression. This is true for all age groups.

Men and Women Display Depression Differently

Other studies, however, have found that men are less likely to display symptoms of depression openly. In addition, depression in men may show up differently than in women, often appearing as anger, self-destructive behavior, or irritability.

In the new study, published in JAMA Psychiatry, researchers re-evaluated data from a nationally representative mental health survey of 3,310 women and 2,382 men.

When they used a method—or scale—designed to evaluate symptoms of depression in men, 26 percent of men met the criteria, compared to 22 percent of women.

In this case, men were also more likely than women to report having experienced anger or aggression, substance abuse, or risk-taking behavior. Women tended to report other symptoms of depression such as stress, irritability, sleep problems, and loss of interest in work, relationships, and hobbies.

Traditional and Alternative Symptoms Give Better Picture of Depression

However, when the scale used to assess men was combined with more traditional symptoms, virtually the same number of men and women showed signs of depression—31 percent of men and 33 percent of women.

As before, depression in men showed up differently than in women. However, feeling “depressed” was the top symptom for both men and women. Other leading symptoms for both sexes included anger or aggression, stress, irritability, and anxiety or uneasiness.

The researchers mention that one of the reasons for undertaking the study was to highlight that the current criteria may be biased toward detecting depression in women, leaving many men undiagnosed.

“Right now we’re in an interesting place where clinicians and some research say we really need to pay attention to (alternative depression symptoms),” says Martin.

The study shows that men may express depression in ways that women don’t, possibly due to men being expected to behave differently than in society.

In the future, the combined scale used in the study could help doctors more easily identify men who would benefit from treatment for depression. This, however, is only the first step in getting men the help they need.

“It doesn’t do us a lot of good to know more men get depression more than we thought if we can’t get them through the door to get help,” says Martin. “How we advertise for support groups and how we do outreach to people needs to change.”

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References: Martin LA, Neighbors HW, & Griffith DM (2013). The Experience of Symptoms of Depression in Men vs Women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry PMID: 23986338

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Originally published on The Health Journal