Differential Risk for Emotion Processing Difficulties by Gender and Age in Major Depressive Disorder

Background: Differences in emotion processing during Major Depressive Disorder (MDD) have not been well explored as a potential explanation for age and gender disparities in rates of depression and depressive symptoms. Early studies by our group demonstrated that those with MDD underperform in emotion processing of faces, although recently we showed a selective decrement in young women with MDD. We now extend this study of gender differences in facial emotion processing during MDD to the full age spectrum. We assessed emotion processing performance using posed facial emotional expressions in those with early (age < 36) and late (age > 35) MDD as well as in women and men to determine if there was differential impact of MDD in these four groups. We hypothesized that knowledge about gender, age, and emotion processing performance differences might increase understanding of risk for and expression of MDD in women and in those with later onset MDD. Methods: Participants included 161 young adults (123 women, 38 men) and 150 adults (100 women, 50 men) diagnosed with MDD, as well as 97 young adult (60 women, 37 men) and 35 adult (24 women, 11 men) healthy controls. A conservative age classification ≤ age 35 was used to separate young adult and adult control and MDD groups in order to be to be confident that potential causes of late onset MDD (e.g., cardiovascular) were less likely to be present in the young adult MDD groups. Results: There was an interaction between age, gender, and MDD status for response time, with slower response times in young MDD patients compared to their age-matched control groups. This effect of slower response time was not detected in the comparisons Sara L. Wright and Scott A. Langenecker 2 between adults with and without MDD. Young adult and adult women and adult men with MDD made significantly more errors than did their same-age, same-gender control counterparts (ps < .05), whereas young men with MDD performed similarly to same-age control men (p > .26). Further, although adult women and men with MDD performed more poorly in facial perception relative to same age control cohorts, older men with late onset MDD performed worse than older men with early onset MDD, in contrast to no difference between performance of women with late and early onset MDD. Conclusions: These findings suggest that young men with MDD may have a different neurobiological etiology of depression compared to young women. In contrast, older men and all women with MDD appear to have similar difficulties with emotion processing, suggesting comparable neurobiological mechanisms of illness. Notably, older men with late onset MDD appear to have a greater burden of emotion processing deficit compared to other depressed groups.