Research report Gender differences in clinical characteristics in a naturalistic sample of depressive outpatients: The Leiden Routine Outcome Monitoring Study Martijn S. van Noorden ⁎, Erik J. Giltay, Margien E. den Hollander-Gijsman, Nic J.A. van der Wee, Tineke van Veen, Frans G. Zitman Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands article info abstract Article history: Received 28 September 2009 Received in revised form 3 December 2009 Accepted 3 December 2009 Available online 6 January 2010 Background: No previous large scale studies have assessed gender differences in naturalistic samples of major depressive disorder (MDD) outpatients. We therefore determined gender differences in comorbidity, symptom patterns and subjective health status in these outpatients in a mental healthcare setting. Methods: Of 3798 consecutive adult patients (age range: 18–65), 1131 (65.1% women) fulfilled DSM-IV criteria of current MDD on the Mini-International Neuropsychiatric Interview (MINI- Plus). Patients were routinely assessed with Routine Outcome Monitoring (ROM), including the Montgomery–Äsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI) and Short Form-36 (SF-36). Results: No gender differences were found in disease severity using the clinician-rated MADRS. However, women showed a significant higher depression severity measured with the self-report BDI-II. Also, psychopathological symptoms self-reported with the BSI were higher, and reported health status on the SF-36 was lower in women. In men with MDD, social phobia, attention deficit hyperactivity disorder, and alcohol and drug misconduct were more common comorbid disorders, while in women with MDD posttraumatic stress disorder and bulimia nervosa were more common, as well as atypical features of depression. Limitations: The use of retrospective reports of lifetime psychopathology might have led to recall bias. 20% of subjects were excluded from ROM due to language problems or logistical reasons. Conclusions: Although women self-reported higher depression severity, more severe general psychopathological symptoms and lower health status, no differences in disease severity were found on interviewer ratings. These findings could have implications for clinical decision making and treatment. © 2009 Elsevier B.V. All rights reserved. Keywords: Major depressive disorder Outpatients Sex Gender Comorbidity Health status 1. Introduction Although differences in course and symptom patterns between male and female depressive patients are not reflected in classification systems, there is evidence that important gender differences exist that point to underlying differences in the pathophysiology of depression (Smith et al., 2008). Gender differences in the prevalence of major depressive disorder (MDD) have extensively been reported based on both population-based (Angst et al., 2002; Kessler et al., 2005; Kuehner, 2003) and clinical trial samples (Fava et al., 1996; Kornstein et al., 2000; Marcus et al., 2005, 2008). Consistently, lifetime prevalence ratios are 2:1 for women as compared to men, whereas a ratio of 1.7:1 for point prevalence rates is reported (Angst et al., 2002; Kessler et al., 2003; Kuehner, 2003; Nolen-Hoeksema, 1987). The cause of the female preponder- ance of MDD remains to be elucidated (Kendler, 2001; Journal of Affective Disorders 125 (2010) 116–123 ⁎ Corresponding author. Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 26 5263785; fax: +31 26 5248156. E-mail address: m.s.van_noorden@lumc.nl (M.S. van Noorden). 0165-0327/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2009.12.007 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad