Findings contribute to the validity of the MDRS-22 as a measure of externalising depression symptoms. Results suggest that while both males and females experience externalising depression symptoms, these symptoms may be particularly elevated for men following experiences of negative life events. Findings suggest that externalising symptoms may be a special feature of depression for men. Given the problematic nature of such externalising symptoms (e.g. excessive substance use, aggression, risk-taking), their clinical assessment appears warranted.

The aim of this study was to gain more empirical ideas for the concept of patient satisfaction and its usefulness as an instrument for quality assurance by analyzing the relationship between inpatient experiences and inpatient satisfaction with psychiatric services. Data were obtained from 91 inpatients of the Psychiatric Hospital of the Ludwig-Maximilians-University in Munich (85% of all patients who had been in hospital at least 3 weeks and who could be asked) by questionnaires on a fixed day. Patients had been asked about their overall satisfaction as well as their experiences with special aspects of the services.Overall satisfaction was high, but there was a remarkable amount of adverse experience with components concerning patient information and time with a psychiatrist offered to the patients. The results give evidence that communication and empathy of the medical staff are key indicators of patient satisfaction and dissatisfaction. Furthermore, results suggest that global satisfaction scores should not be used as an instrument of quality assurance.

ZusammenfassungFrauen erkranken etwa 2-bis 3-mal so häufig an einer Depression wie Männer. Als Ursachen dafür müssen methodische, biologische, psychosoziale und sozioökonomische Faktoren angenommen werden. Die soziale Geschlechterrolle ist dabei ein entscheidender Faktor. Eine Überdiagnos-tizierung der Depression bei Frauen wird durch die bisherigen Forschungsergebnisse nicht belegt, vielmehr muss die hohe Depressionsrate auf belastungsreiche Lebenslagen von Frauen, einer spezifisch weiblichen Vulnerabilität für soziale Stressoren und einer ebenfalls spezifisch weiblichen emotionsbezogenen Stressverarbeitung zurückgeführt werden. Bei Männern dagegen kann die geringere Depressionsrate am ehesten mit einer Unterdiagnostizierung erklärt werden. Gründe dafür sind mangelnde Hilfesuche, männerspezifische Stressverarbeitung und eine einseitige Depressionsdiagnostik. Die bisherigen Befunde zur Depression bestätigen, wie wichtig eine geschlechtersensible Perspektive in Forschung und Praxis ist, insbesondere bei Erkrankungen, die als geschlechtstypisch gelten. AbstractMajor depression is two to three times as common in women as in men. Explanations for this difference include methodological, biological, psychosocial, and socioeconomic factors. Gender roles are most important in this context. Previous findings suggest that depression in women is not mainly due to overdiagnosing but to stressful life situations, a specific vulnerability to social stressors, and an emotion-focused stress response. In men, depression can more likely be explained by underdiagnosing resulting from men's insufficiency in seeking help; men's externalizing of the stress response, thus masking typical depressive symptoms; and a gender bias in diagnosing. A gender-sensitive approach in research and clinical practice is necessary for improving assessment and treatment of men and women, especially with regard to diseases that are held to be gender-specific.

Our data do not support the convergence hypothesis related to gender-role orientation, but support the traditional feminine self-concept as an unspecific risk factor for vulnerability. The question whether an undifferentiated self-concept could be a specific risk factor for alcoholism is discussed.

The concept of male depression basically assumes that the well-known depressive symptoms in males are compensated for or masked by external behavioral patterns, which are atypical for depression and therefore not included in conventional depression inventories. In a community sample of young males (n=1,004) the general well-being and risk of male depression were investigated using the WHO-5 Well-Being Scale and the Gotland Scale for Male Depression. The main questions focused on the analysis of symptoms dependent on the risk of male depression. Hypotheses were related to depressive symptoms being masked by distress symptoms, to the dimensionality of the Gotland Scale, to different symptom clusters and to the contribution of isolated symptoms to the risk of depression. The results demonstrated a reduced well-being and a risk of male depression in 22% of the respondents. The data gave no evidence to support the hypothesis that depressive symptoms are masked by distress symptoms or for latent depression and stress components. However, a "depression cluster" and a "distress cluster" could be differentiated by cluster analyses giving indications of the clinical relevance of the male distress symptoms for the development of depression. The more severe these are, the higher is the risk of male depression. Finally, the results are discussed in the face of the limitations of the study, the previous evidence and open questions.