Depression among Swedish 70-year-olds - Sex differences from a gender perspective

Depression is one of the leading causes of global burden of disease. Due to increased life expectancy, late-life depression is an escalating public health issue. The prevalence is reported to be almost twice as high among women compared to men. Little is known about the role of gender expression (femininity, masculinity, or androgyny) in relation to depression epidemiology, and whether the prevalence of late-life depression may change over time. The overarching aim of this thesis was to study prevalence, time trends, and subjective experiences of depression among older adults, with specific focus towards potential differences by sex and gender expression. All samples were derived from the population-based Gothenburg H70 Birth Cohort Studies. Paper 1 describes the examination of 70-year-olds (born 1944) in 2014-16. As all papers are based on this examination, Paper 1 generates an overall understanding of the data framework. Paper 2 tests the validity and reliability of the Positive-Negative Sex-Role Inventory (PN-SRI), a measure of gender expression. The findings suggest that PN-SRI is applicable in a Swedish research setting among older adults due to a satisfactory level of internal consistency and face validity. Paper 3 gives an overview of the prevalence of depression between the 1970s and the 2010s, placing it in a Swedish historical context. We found that depression decreased among women across the study period. Paper 4 generates an opportunity to deeper understand the experiences of depression by enabling the participants to share their lived experiences in focus group discussions. The participants expressed unmet needs of communication, as well as a lack of trust regarding healthcare for depression. They also desired more knowledge about available treatments, potential side effects, and how to avoid recurrence. Paper 5 examines sex and gender expression in relation to depression. Irrespective of biological sex, femininity was associated with a greater burden of depressive symptoms. The inverse was observed for androgyny and masculinity. Perspectives of gender have an important place within mental health research, which is highlighted in this thesis. We found a decreasing time trend in the prevalence of late-life depression among women. The sex ratio in depression is complex, partly linked to gender-related factors such as gender expression. Older adults have expressed limited trust towards healthcare providers in seeking medical help for depression. Also, they have expressed a need for more communication and health knowledge about depression