The Journal of Psychology
ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20
Sex Differences in Mental Health Linda J. Webb & Richard Allen To cite this article: Linda J. Webb & Richard Allen (1979) Sex Differences in Mental Health, The Journal of Psychology, 101:1, 89-96, DOI: 10.1080/00223980.1979.9915057 To link to this article: http://dx.doi.org/10.1080/00223980.1979.9915057
Published online: 02 Jul 2010.
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Date: 13 November 2015, At: 20:34
Published as a separate and in The Journal of Psychology, 1979, 101, 89-96.
SEX DIFFERENCES I N MENTAL HEALTH* Texas Research Institutr of Mental Sciences
Downloaded by [Deakin University Library] at 20:34 13 November 2015
LINDAJ. WEBB A N D RICHARDALLEN
SUMMARY The purpose of this study was to investigate the relationship between sex and mental illness. A sample of male and female adult psychiatric outpatients (n = 44) completed the Denver Community Mental Health Questionnaire (DCMHQ), the Taylor Manifest Anxiety Scale, an abbreviated version of the Minnesota Multiphasic Personality Inventory (the Mini-Mult), and the Social Readjustment Rating Scale. Differences in life event experiences, as well as differences on measures of anxiety, depression, psychological distress, and social functioning, were explored and identified by means of Pearson product-moment correlations. The strongest correlations were found between sex and four of the subscales of the DCMHQ: women tended to be less productive and evidenced more psychological distress than men; men had more legal difficulties and were more likely to use soft drugs. A modest correlation was found on the Taylor Manifest Anxiety Scale, with women showing higher scores. A.
INTRODUCTION
The study of the epidemiology of mental illness is concerned with the relationship between various sociological variables and psychiatric disorder. Research in this area has essentially established that there is an inverse relationship between social class and mental illness, although the cause of this relationship is still debated (4, 7 ) . The relationship between mental illness and other sociological variables, however, is not so clear-cut. In particular, the relationship between sexual status and mental illness has generated considerable interest as well as controversy. While a number of studies have been conducted, there is little consensus among the researchers as to the results or the interpretation of the results. In general, most epidemiological surveys indicate that women report -
*
Received in the Editorial Office on October 2 7 , 1978, and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press.
89
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higher numbers of symptoms than men ,3, 6, 10, III There is, however, variation in the findings when reviewed by diagnostic category. Dohrenwend and Dohrenwend (5) found in a review of over 80 epidemiological studies no consistent sex differences in the rates of functional psychoses in general or for schizophrenia in particular. Rates for manic-depressive psychoses were generally found to be higher for women. Rates of neuroses were found to be consistently higher for women, with rates for personality disorder consistently higher for men. The interpretations of the results of the epidemiological surveys are generally explained in terms of a true difference between men and women or an artifact of response bias. The most frequent interpretation is that women are more emotionally disturbed than men. Phillips and Segal (l.3), however, argue that differences found are due to the fact that women are more likely to report certain behaviors and feelings than men because it is more socially acceptable for them to express their difficulties. Mazer (12) also concludes that women are more aware of distress and are more likely to respond positively on questionnaires used in many total prevalence studies. On the other hand, on the basis of their response bias research, Clancy and Gove (2) argue that women do in fact have more emotional problems than men. This discrepancy in the literature on the relationship between sexual status and psychiatric disorder is complicated by problems of both methodology and conceptualization. There has been a tendency among researchers to want to resolve unequivocally the false question of whether men or women are more prone to "mental illness." Undifferentiated, unidimensional concepts of psychiatric disorder have been employed; and the postulation of theory has often been based on insufficient evidence. In addition, the research on sex differences has primarily been limited to untreated populations. Those studies that do investigate sex differences in treated populations generally focus on differences in the utilization rates of mental health services. There has been little research and consequently little understanding of the differences in presenting problems, prior life event experiences, and symptomatology for male and female patients. The purpose of this paper is to report on a study investigating the sex differences on a variety of psychological measures in a population seeking psychiatric treatment at an outpatient mental health facility in Houston, Texas. Differences in prior life event experiences are explored as well as differences on measures of anxiety. depression, and psychological distress. Measures of social functioning are also compared.
LINDA J, WEBB AND RICHARD ALLEN
B.
Downloaded by [Deakin University Library] at 20:34 13 November 2015
1.
91
METHOD Setting
The Texas Research Institute of Mental Sciences, a component of the Texas Depaxtment of Mental Health and Mental Retardation, was established by the State Legislature in 1960. The Institute is committed to a mission of service, research, and training. The service branch of the Institute is comprised of both inpatient and outpatient divisions. Three clinics in the outpatient division-Symptom Relief, Personality, and Marriage and Family-are the setting for the current research. The clients in these three clinics are typically noncrisis and nonpsychotic, aged 18 to 60. The Symptom Relief Clinic provides brief, short-term therapy for clients who are seeking treatment for single, identifiable symptoms. Frequent approaches to the treatment of these patients include behavior modification, desensitization, assertive training, and biofeedback. The average length of therapy is approximately three months. The Marriage and Family Clinic provides services to individuals and couples. The primary focus of treatment is on the family as a unit although individual and group therapy are available when indicated. The Personality Clinic is available for persons who in general present with chara.cterologica1 disorders. Traditional psychoanalytical long-term therapy is the approach to treatment, and the recommended term of therapy is one year. 2 . Subjects The Ss for the study were 17 male and 27 female admissions to three adult outpatient clinics. A demographic profile reveals that as a group, the Ss tended to be young, single “Anglos” in the lower-middle or middlemiddle socioeconomic classes. The mean age for men was 30, while that for women was 32. Eighty-two percent of the male Ss and 85 percent of the females were “Anglo.” All of the males and 96 percent of the females had a high school diploma. Thirty-five percent of the males had at least a Bachelor’s degree, while 26 percent of the females had one. Two-thirds of the males and 45 percent of the females had incomes greater than $600 per month. Seventy percent of the males and 67 percent of the females were unmarried. 3.
Procedure
Clients in this study were sampled from the intake schedules of the three clinics duiing a four month time period. During the intake session, the
Downloaded by [Deakin University Library] at 20:34 13 November 2015
02
JOLTRNAL OF PSYCHOLOGY
client was asked by the therapist to participate in the research project. If the client agreed. an appointment was scheduled with the project interviewer. I n the interview, four questionnaires were completed by the client: the Taylor Manifest Anxiety Scale, the Denver Community Mental Health Questionnaire ( D C M H Q ) , the Social Readjustment Rating Scale (SRRS), and a n abbreviated version of the Minnesota Multiphasic Personality Inventory (MMPI). T w o of the instruments, the SRRS and the Taylor Anxiety Scale, were self-administered, T h e remaining two were administered by the project iiiterviewer. 4.
h l l ’ i l S14 Y P S
The SO-iteni Taylor Manifest Anxiety Scale was constructed by Taylor from items in the M M P I and is widely used as a measure of distress. T h e Denver Cornmunit>- Mental Health Questionnaire ( D C M H Q ) was designed by Ciarlo and Keihnian ( 1 ) in an effort to measure the effective level of personal and social functioning of a n individual. T h e D C M H Q was not designed to provide symptom-specific or problem-specific information. It was designed, rather. as a means of providing a measure of the benefits of a community mental health center to individuals, families, and communities. ‘4s a consequence. personal and social functioning in the community is emphasized, while symptomatology , self-esteem, sexual functioning, and personality dynamics are either played down or omitted entirely. T h e Minnesota Multiphasic Personality Inventory (MMPI) has been widely used but is handicapped in administration by its length. I t consists of more than 500 items and can require several hours to complete. In response, Kincannon (9) has introduced the Mini-Mult, a n abbreviated form of the MMPI The Mini-Mult retains the scales of the M M P I but reduces the number of items to 7 1 . A prediction of the standard raw scales of the MMPI is made from the Mini-Mult raw scales by the use of a conversion table. Kincannon and others have shown the Mini-Mult to be a useful substitute for the long version of the M M P I without unreasonable loss of reliability. Dealing with life pattern change as the stressful component of life events, Holmes a n d Rahe (8) developed the Social Readjustment Rating Scale (SRRS) which consists of 43 life events which have been given a magnitude weight reflecting the adjustment in life pattern associated with the occurrence of each event. By summing the adjustment scores of all events a n individual has experienced in a defined period of time, a measure of the amount of stress the individual has encountered is derived. (14)
LINDA J . WEBB A N D RICHARD ALLEN
Downloaded by [Deakin University Library] at 20:34 13 November 2015
5.
93
Data Analysis
The dependent variable of this study was the categorical one, sex. Self-assignment by the client was used to form the two categories, male and female. With the sex variable treated as a simple dichotomy, a Pearson product-moment correlation was computed on sex and each of the independent variables. With use of the results of the Pearson Y , a set of variables was selected which showed the strongest correlations with sex. A discriminant function analysis was then computed to determine the differences between the two sex groups simultaneously on the chosen variables. These included (a) five scales from Ciarlo’s DCMHQ-psychological distress, productivity, legal difficulties, public system dependency, and soft drug use; (6) three scales from the Mini-Mult-L scale, hypochondriasis, and personality disorder; and (c) the Taylor Manifest Anxiety Scale.
C.
RESULTS .
The independent variables included in this study vary greatly in their capacity to distinguish between the sexes. The strongest correlations were found on four of the scales from the DCMHQ. In order of their significance the correlations were as follows: productivity (r = . 4 2 , p = .Ol); soft drug use (Y = .4.0,p = .01); legal difficulties (r = .36, p = .02); and psychological distress (r = .32, p = .04). The directions of the differences were that women tended to be less productive and evidenced more psychological distress as measured by the DCMHQ. The men had more legal difficulties and a greater frequency of soft drug use. Correlations at the p 5 .10 level included the L (“Lie”) scale of the MMPI (r = - .30, p = .05);the DCMHQ public systems dependency scale (Y = - . 2 5 , p = .lo); the hypochondriasis scale of the MMPI (r = .25, p = .lo); and the personality disorder scale of MMPI (r = - . 2 5 , p = .lo). The directions of the differences were that women scored higher on the hypochondriasis and public systems dependency scales, while men had higher scores on the L and personality disorder scales of the MMPI. Other correlations in the range of .19 to .23, with less significance, included the Taylor Anxiety Scale (r = .23, p = .13); the K scale of the MMPI (Y = - . 2 1, p = .18); the psychasthenia scale of the MMPI (Y = . 2 1, p = .17); the hard drug use scale of the DCMHQ (r = . 2 0 , p = .17); and the interpersonal isolation-family scale of the DCMHQ (Y = .19, p = .22). Inappreciable correlations were found on the DCMHQ scales for interper-
Downloaded by [Deakin University Library] at 20:34 13 November 2015
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sonal isolation from friends, interpersonal aggression with friends, and substance abuse. The scales F. hysteria, paranoia, schizophrenia, hypomania, and depression of the MMPI also showed inconsequential correlations. Essentially no correlation was found between sex and the Social Readjustment Rating Scale. A discriminant function analysis of the difference between the sex groups as related to the selected dependent variables is presented in Table 1. As can be seen by the analysis of variance, there are well defined differences between the two sex groups. The level of significance [ F ( 9 , 34) = 3.77; p < .002 1 indicates a strong pattern of differences for these two groups.
D. DISCUSSION The results indicate that there was a significant difference on a number of variables between men and women seeking psychiatric outpatient treatment. In general, the noncrisis, nonpsychotic women seeking treatment tended to report higher levels of anxiety and greater psychological distress. Women also reported more public systems dependency and less productivity as measured by the DCMHQ. In contrast, the nonpsychotic, noncrisis men seeking treatment reported more legal difficulties and a more frequent use of both hard and soft drugs. In addition, analysis of the differences between men and women on the various scales on the abbreviated version of the MMPI revealed significant correlations. Women tended to score higher on the hypochondriasis scale. Men, on the other hand, scored higher on the L and personality disorder scales. These findings are in accord with a number of previous studies. The greater degrees of anxiety and psychoTABLE 1 SUMMARY OF DISCRIMINANT FUNCTION ANALYSIS OF SEX DIFFERENCES
P
Function weight
Variable
r
Taylor Manifest Anxiety Srale Denver Community Mental Health Questionnaire (DCMHQ) Psychological distress Productivity Legal difficulties Public system dependency Soft drug use Mini-Mult MMPI L scale Hypochondriasis Personality disorder Multiple r
.24
. 13
.32
.04
,001
- .12
- .02 1
.40
.01 .02 10 .01
- .30
.os
.25 -.25
.I0
,091 .018
.36 -.25
71
10 ,002
,004
. 133 ,003 ,010
,035
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95
logical distress reported by women are congruent with epidemiological surveys of untreated populations (3, 10, 13). The reporting of more legal difficulties by men in the study is congruent with the finding of Mazer (12) that men are more likely to come to the attention of legal agencies. Also, the higher scores by men on the personality disorder scale of the MMPI is in support of Dohrenwend and Dohrenwend’s (5) review of over 80 epidemiological studies, as well as NIMH statistics on admissions to state and county mental hospitals. The motit important difference noted between the current findings and those of previous investigations ( 5 ) is that the present study found no significant difference between men and women on the MMPI depression and hypomania scales. Several explanations for this finding are possible. There may in fact not be a real difference in the level of depression in a nonpsycho tic population seeking outpatient psychiatric services; the population may be unique; the MMPI may not be a valid measure of depression; or in terms of the results of the L scale, a response bias may account for the lack of differences. The higher score for men on the L scale indicates that men are more likely to falsify their responses to the question on the MMPI than are women. I n essence, men are more likely to deny symptomatology. These results are in contrast to Clancy and Gove’s (2) study which found no significant response bias differences between men and women. The difference in falsification for men and women may also account for differences found on other psychological and psychosociological variables in this study and generates questions for further research with larger sample sizes. It is important to note that while there were no reported differences between men and women in the life events experienced in the 12 months prior to entering treatment or overall stress scores on the SRRS, the psychologi~:al and psychosociological responses of women and men to these life events reflect significant differences. These differences highlight the absurdity of attempting to answer the question, “Who are crazier, men or women?” The differences found do, however, ,indicate a need for differentiating between men and women who seek psychiatric treatment. Their symptomatological and sociological responses are alike in some respects and different in others. These differences have implications for psychiatric treatment as well as efforts aimed at prevention. In the past, treatment programs have been designed primarily on the basis of diagnostic classifications. Of course, individualized treatment plans have been encouraged. However, there has been little effort to date to begin to examine
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systematically how men and women might respond differently to life event experiences and thus how their treatment needs might be different.
REFERENCES CIARLO,J . , & REIHMAN,J. The Denver Community Mental Health Questionnaire: Development of a multi-dimensional program evaluation isstrument. Report of the Mental Health Systems Evaluation Project of the Northwest Denver Mental Health Center and the University of Denver, Denver, Colorado, 1974. 2. CLANCY, K., & COVE,W. Sex differences in mental illness: An analysis of response bias in self reports. Amer. 1.Sociol., 1974, 80, 205-216. 3. DAVIS,J. A. Stipends and Spouses. Chicago: Univ. Chicago Press, 1962. 4. DOHRENWEND, B. P., & DOHRENWEND, B. S. Social Status and Psychological Disorder. New York: Wiley, 1969. 5. . Sex differences and psychiatric disorders. d m u . J. Sociol., 1976, 81, 1447-
Downloaded by [Deakin University Library] at 20:34 13 November 2015
1.
1454.
CURIN,C., VEROFF,J . , & FELD,S. Americans View Their Mental Health. New York: Basic Books, 1960. HOLLINGSHEAD, A. B., & REDLICH,F. C. Social Class and Mental Illness: A CommuI . nity Study. New York: Wiley, 1958. 8. HOLMES,T. H., & W E , R. H. The social readjustment rating scale. J. Psychosomat. Res., 1967. 11, 213-18. 9. KINCANNON,J . Prediction of the standard MMPI scale score from 71 items, the Mini-Mult. J. Consult. G Clin. P s y h o l . , 1968, 32, 319-325. T. S., & MICHAEL,S. T. Life Stresses and Mental Health. London, Eng.: 10. LANGNER, Free Press of Clencoe, 1963. 11. LEIGHTON,D. C., c1 al. The Character of Danger. New York Basic Books, 1963. 12. MAZER,M. People in predicament: A study in psychiatric and psychosocial epidemiol6.
ogy. Sol-. Psychiat., 1974, 9, 85-90.
B. E. Sex status and psychiatric symptoms. A m w . Sorzolog. PHILLIPS,D. L., & SSGAL, R e v . . 1969, 34, 58-72. J. .4. A personality scale of manifest anxiety. J . JDn. ci So(.. P.syc.hol., 1953, 14. TAYLOR, 48. 285-290. 13.
Texas Research Iustitute of Mental Sciences 1300 Mouvsund Avenue Houston, Texas 77030
ISSN: 0022-3980 (Print) 1940-1019 (Online) Journal homepage: http://www.tandfonline.com/loi/vjrl20
Sex Differences in Mental Health Linda J. Webb & Richard Allen To cite this article: Linda J. Webb & Richard Allen (1979) Sex Differences in Mental Health, The Journal of Psychology, 101:1, 89-96, DOI: 10.1080/00223980.1979.9915057 To link to this article: http://dx.doi.org/10.1080/00223980.1979.9915057
Published online: 02 Jul 2010.
Submit your article to this journal
Article views: 8
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=vjrl20 Download by: [Deakin University Library]
Date: 13 November 2015, At: 20:34
Published as a separate and in The Journal of Psychology, 1979, 101, 89-96.
SEX DIFFERENCES I N MENTAL HEALTH* Texas Research Institutr of Mental Sciences
Downloaded by [Deakin University Library] at 20:34 13 November 2015
LINDAJ. WEBB A N D RICHARDALLEN
SUMMARY The purpose of this study was to investigate the relationship between sex and mental illness. A sample of male and female adult psychiatric outpatients (n = 44) completed the Denver Community Mental Health Questionnaire (DCMHQ), the Taylor Manifest Anxiety Scale, an abbreviated version of the Minnesota Multiphasic Personality Inventory (the Mini-Mult), and the Social Readjustment Rating Scale. Differences in life event experiences, as well as differences on measures of anxiety, depression, psychological distress, and social functioning, were explored and identified by means of Pearson product-moment correlations. The strongest correlations were found between sex and four of the subscales of the DCMHQ: women tended to be less productive and evidenced more psychological distress than men; men had more legal difficulties and were more likely to use soft drugs. A modest correlation was found on the Taylor Manifest Anxiety Scale, with women showing higher scores. A.
INTRODUCTION
The study of the epidemiology of mental illness is concerned with the relationship between various sociological variables and psychiatric disorder. Research in this area has essentially established that there is an inverse relationship between social class and mental illness, although the cause of this relationship is still debated (4, 7 ) . The relationship between mental illness and other sociological variables, however, is not so clear-cut. In particular, the relationship between sexual status and mental illness has generated considerable interest as well as controversy. While a number of studies have been conducted, there is little consensus among the researchers as to the results or the interpretation of the results. In general, most epidemiological surveys indicate that women report -
*
Received in the Editorial Office on October 2 7 , 1978, and published immediately at Provincetown, Massachusetts. Copyright by The Journal Press.
89
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JOURNAL OF PSYCHOLU(;Y
higher numbers of symptoms than men ,3, 6, 10, III There is, however, variation in the findings when reviewed by diagnostic category. Dohrenwend and Dohrenwend (5) found in a review of over 80 epidemiological studies no consistent sex differences in the rates of functional psychoses in general or for schizophrenia in particular. Rates for manic-depressive psychoses were generally found to be higher for women. Rates of neuroses were found to be consistently higher for women, with rates for personality disorder consistently higher for men. The interpretations of the results of the epidemiological surveys are generally explained in terms of a true difference between men and women or an artifact of response bias. The most frequent interpretation is that women are more emotionally disturbed than men. Phillips and Segal (l.3), however, argue that differences found are due to the fact that women are more likely to report certain behaviors and feelings than men because it is more socially acceptable for them to express their difficulties. Mazer (12) also concludes that women are more aware of distress and are more likely to respond positively on questionnaires used in many total prevalence studies. On the other hand, on the basis of their response bias research, Clancy and Gove (2) argue that women do in fact have more emotional problems than men. This discrepancy in the literature on the relationship between sexual status and psychiatric disorder is complicated by problems of both methodology and conceptualization. There has been a tendency among researchers to want to resolve unequivocally the false question of whether men or women are more prone to "mental illness." Undifferentiated, unidimensional concepts of psychiatric disorder have been employed; and the postulation of theory has often been based on insufficient evidence. In addition, the research on sex differences has primarily been limited to untreated populations. Those studies that do investigate sex differences in treated populations generally focus on differences in the utilization rates of mental health services. There has been little research and consequently little understanding of the differences in presenting problems, prior life event experiences, and symptomatology for male and female patients. The purpose of this paper is to report on a study investigating the sex differences on a variety of psychological measures in a population seeking psychiatric treatment at an outpatient mental health facility in Houston, Texas. Differences in prior life event experiences are explored as well as differences on measures of anxiety. depression, and psychological distress. Measures of social functioning are also compared.
LINDA J, WEBB AND RICHARD ALLEN
B.
Downloaded by [Deakin University Library] at 20:34 13 November 2015
1.
91
METHOD Setting
The Texas Research Institute of Mental Sciences, a component of the Texas Depaxtment of Mental Health and Mental Retardation, was established by the State Legislature in 1960. The Institute is committed to a mission of service, research, and training. The service branch of the Institute is comprised of both inpatient and outpatient divisions. Three clinics in the outpatient division-Symptom Relief, Personality, and Marriage and Family-are the setting for the current research. The clients in these three clinics are typically noncrisis and nonpsychotic, aged 18 to 60. The Symptom Relief Clinic provides brief, short-term therapy for clients who are seeking treatment for single, identifiable symptoms. Frequent approaches to the treatment of these patients include behavior modification, desensitization, assertive training, and biofeedback. The average length of therapy is approximately three months. The Marriage and Family Clinic provides services to individuals and couples. The primary focus of treatment is on the family as a unit although individual and group therapy are available when indicated. The Personality Clinic is available for persons who in general present with chara.cterologica1 disorders. Traditional psychoanalytical long-term therapy is the approach to treatment, and the recommended term of therapy is one year. 2 . Subjects The Ss for the study were 17 male and 27 female admissions to three adult outpatient clinics. A demographic profile reveals that as a group, the Ss tended to be young, single “Anglos” in the lower-middle or middlemiddle socioeconomic classes. The mean age for men was 30, while that for women was 32. Eighty-two percent of the male Ss and 85 percent of the females were “Anglo.” All of the males and 96 percent of the females had a high school diploma. Thirty-five percent of the males had at least a Bachelor’s degree, while 26 percent of the females had one. Two-thirds of the males and 45 percent of the females had incomes greater than $600 per month. Seventy percent of the males and 67 percent of the females were unmarried. 3.
Procedure
Clients in this study were sampled from the intake schedules of the three clinics duiing a four month time period. During the intake session, the
Downloaded by [Deakin University Library] at 20:34 13 November 2015
02
JOLTRNAL OF PSYCHOLOGY
client was asked by the therapist to participate in the research project. If the client agreed. an appointment was scheduled with the project interviewer. I n the interview, four questionnaires were completed by the client: the Taylor Manifest Anxiety Scale, the Denver Community Mental Health Questionnaire ( D C M H Q ) , the Social Readjustment Rating Scale (SRRS), and a n abbreviated version of the Minnesota Multiphasic Personality Inventory (MMPI). T w o of the instruments, the SRRS and the Taylor Anxiety Scale, were self-administered, T h e remaining two were administered by the project iiiterviewer. 4.
h l l ’ i l S14 Y P S
The SO-iteni Taylor Manifest Anxiety Scale was constructed by Taylor from items in the M M P I and is widely used as a measure of distress. T h e Denver Cornmunit>- Mental Health Questionnaire ( D C M H Q ) was designed by Ciarlo and Keihnian ( 1 ) in an effort to measure the effective level of personal and social functioning of a n individual. T h e D C M H Q was not designed to provide symptom-specific or problem-specific information. It was designed, rather. as a means of providing a measure of the benefits of a community mental health center to individuals, families, and communities. ‘4s a consequence. personal and social functioning in the community is emphasized, while symptomatology , self-esteem, sexual functioning, and personality dynamics are either played down or omitted entirely. T h e Minnesota Multiphasic Personality Inventory (MMPI) has been widely used but is handicapped in administration by its length. I t consists of more than 500 items and can require several hours to complete. In response, Kincannon (9) has introduced the Mini-Mult, a n abbreviated form of the MMPI The Mini-Mult retains the scales of the M M P I but reduces the number of items to 7 1 . A prediction of the standard raw scales of the MMPI is made from the Mini-Mult raw scales by the use of a conversion table. Kincannon and others have shown the Mini-Mult to be a useful substitute for the long version of the M M P I without unreasonable loss of reliability. Dealing with life pattern change as the stressful component of life events, Holmes a n d Rahe (8) developed the Social Readjustment Rating Scale (SRRS) which consists of 43 life events which have been given a magnitude weight reflecting the adjustment in life pattern associated with the occurrence of each event. By summing the adjustment scores of all events a n individual has experienced in a defined period of time, a measure of the amount of stress the individual has encountered is derived. (14)
LINDA J . WEBB A N D RICHARD ALLEN
Downloaded by [Deakin University Library] at 20:34 13 November 2015
5.
93
Data Analysis
The dependent variable of this study was the categorical one, sex. Self-assignment by the client was used to form the two categories, male and female. With the sex variable treated as a simple dichotomy, a Pearson product-moment correlation was computed on sex and each of the independent variables. With use of the results of the Pearson Y , a set of variables was selected which showed the strongest correlations with sex. A discriminant function analysis was then computed to determine the differences between the two sex groups simultaneously on the chosen variables. These included (a) five scales from Ciarlo’s DCMHQ-psychological distress, productivity, legal difficulties, public system dependency, and soft drug use; (6) three scales from the Mini-Mult-L scale, hypochondriasis, and personality disorder; and (c) the Taylor Manifest Anxiety Scale.
C.
RESULTS .
The independent variables included in this study vary greatly in their capacity to distinguish between the sexes. The strongest correlations were found on four of the scales from the DCMHQ. In order of their significance the correlations were as follows: productivity (r = . 4 2 , p = .Ol); soft drug use (Y = .4.0,p = .01); legal difficulties (r = .36, p = .02); and psychological distress (r = .32, p = .04). The directions of the differences were that women tended to be less productive and evidenced more psychological distress as measured by the DCMHQ. The men had more legal difficulties and a greater frequency of soft drug use. Correlations at the p 5 .10 level included the L (“Lie”) scale of the MMPI (r = - .30, p = .05);the DCMHQ public systems dependency scale (Y = - . 2 5 , p = .lo); the hypochondriasis scale of the MMPI (r = .25, p = .lo); and the personality disorder scale of MMPI (r = - . 2 5 , p = .lo). The directions of the differences were that women scored higher on the hypochondriasis and public systems dependency scales, while men had higher scores on the L and personality disorder scales of the MMPI. Other correlations in the range of .19 to .23, with less significance, included the Taylor Anxiety Scale (r = .23, p = .13); the K scale of the MMPI (Y = - . 2 1, p = .18); the psychasthenia scale of the MMPI (Y = . 2 1, p = .17); the hard drug use scale of the DCMHQ (r = . 2 0 , p = .17); and the interpersonal isolation-family scale of the DCMHQ (Y = .19, p = .22). Inappreciable correlations were found on the DCMHQ scales for interper-
Downloaded by [Deakin University Library] at 20:34 13 November 2015
93
JOURNAL OF PSYCHOLOGY
sonal isolation from friends, interpersonal aggression with friends, and substance abuse. The scales F. hysteria, paranoia, schizophrenia, hypomania, and depression of the MMPI also showed inconsequential correlations. Essentially no correlation was found between sex and the Social Readjustment Rating Scale. A discriminant function analysis of the difference between the sex groups as related to the selected dependent variables is presented in Table 1. As can be seen by the analysis of variance, there are well defined differences between the two sex groups. The level of significance [ F ( 9 , 34) = 3.77; p < .002 1 indicates a strong pattern of differences for these two groups.
D. DISCUSSION The results indicate that there was a significant difference on a number of variables between men and women seeking psychiatric outpatient treatment. In general, the noncrisis, nonpsychotic women seeking treatment tended to report higher levels of anxiety and greater psychological distress. Women also reported more public systems dependency and less productivity as measured by the DCMHQ. In contrast, the nonpsychotic, noncrisis men seeking treatment reported more legal difficulties and a more frequent use of both hard and soft drugs. In addition, analysis of the differences between men and women on the various scales on the abbreviated version of the MMPI revealed significant correlations. Women tended to score higher on the hypochondriasis scale. Men, on the other hand, scored higher on the L and personality disorder scales. These findings are in accord with a number of previous studies. The greater degrees of anxiety and psychoTABLE 1 SUMMARY OF DISCRIMINANT FUNCTION ANALYSIS OF SEX DIFFERENCES
P
Function weight
Variable
r
Taylor Manifest Anxiety Srale Denver Community Mental Health Questionnaire (DCMHQ) Psychological distress Productivity Legal difficulties Public system dependency Soft drug use Mini-Mult MMPI L scale Hypochondriasis Personality disorder Multiple r
.24
. 13
.32
.04
,001
- .12
- .02 1
.40
.01 .02 10 .01
- .30
.os
.25 -.25
.I0
,091 .018
.36 -.25
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LINDA J. WEBB AND RICHARD ALLEN
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logical distress reported by women are congruent with epidemiological surveys of untreated populations (3, 10, 13). The reporting of more legal difficulties by men in the study is congruent with the finding of Mazer (12) that men are more likely to come to the attention of legal agencies. Also, the higher scores by men on the personality disorder scale of the MMPI is in support of Dohrenwend and Dohrenwend’s (5) review of over 80 epidemiological studies, as well as NIMH statistics on admissions to state and county mental hospitals. The motit important difference noted between the current findings and those of previous investigations ( 5 ) is that the present study found no significant difference between men and women on the MMPI depression and hypomania scales. Several explanations for this finding are possible. There may in fact not be a real difference in the level of depression in a nonpsycho tic population seeking outpatient psychiatric services; the population may be unique; the MMPI may not be a valid measure of depression; or in terms of the results of the L scale, a response bias may account for the lack of differences. The higher score for men on the L scale indicates that men are more likely to falsify their responses to the question on the MMPI than are women. I n essence, men are more likely to deny symptomatology. These results are in contrast to Clancy and Gove’s (2) study which found no significant response bias differences between men and women. The difference in falsification for men and women may also account for differences found on other psychological and psychosociological variables in this study and generates questions for further research with larger sample sizes. It is important to note that while there were no reported differences between men and women in the life events experienced in the 12 months prior to entering treatment or overall stress scores on the SRRS, the psychologi~:al and psychosociological responses of women and men to these life events reflect significant differences. These differences highlight the absurdity of attempting to answer the question, “Who are crazier, men or women?” The differences found do, however, ,indicate a need for differentiating between men and women who seek psychiatric treatment. Their symptomatological and sociological responses are alike in some respects and different in others. These differences have implications for psychiatric treatment as well as efforts aimed at prevention. In the past, treatment programs have been designed primarily on the basis of diagnostic classifications. Of course, individualized treatment plans have been encouraged. However, there has been little effort to date to begin to examine
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systematically how men and women might respond differently to life event experiences and thus how their treatment needs might be different.
REFERENCES CIARLO,J . , & REIHMAN,J. The Denver Community Mental Health Questionnaire: Development of a multi-dimensional program evaluation isstrument. Report of the Mental Health Systems Evaluation Project of the Northwest Denver Mental Health Center and the University of Denver, Denver, Colorado, 1974. 2. CLANCY, K., & COVE,W. Sex differences in mental illness: An analysis of response bias in self reports. Amer. 1.Sociol., 1974, 80, 205-216. 3. DAVIS,J. A. Stipends and Spouses. Chicago: Univ. Chicago Press, 1962. 4. DOHRENWEND, B. P., & DOHRENWEND, B. S. Social Status and Psychological Disorder. New York: Wiley, 1969. 5. . Sex differences and psychiatric disorders. d m u . J. Sociol., 1976, 81, 1447-
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CURIN,C., VEROFF,J . , & FELD,S. Americans View Their Mental Health. New York: Basic Books, 1960. HOLLINGSHEAD, A. B., & REDLICH,F. C. Social Class and Mental Illness: A CommuI . nity Study. New York: Wiley, 1958. 8. HOLMES,T. H., & W E , R. H. The social readjustment rating scale. J. Psychosomat. Res., 1967. 11, 213-18. 9. KINCANNON,J . Prediction of the standard MMPI scale score from 71 items, the Mini-Mult. J. Consult. G Clin. P s y h o l . , 1968, 32, 319-325. T. S., & MICHAEL,S. T. Life Stresses and Mental Health. London, Eng.: 10. LANGNER, Free Press of Clencoe, 1963. 11. LEIGHTON,D. C., c1 al. The Character of Danger. New York Basic Books, 1963. 12. MAZER,M. People in predicament: A study in psychiatric and psychosocial epidemiol6.
ogy. Sol-. Psychiat., 1974, 9, 85-90.
B. E. Sex status and psychiatric symptoms. A m w . Sorzolog. PHILLIPS,D. L., & SSGAL, R e v . . 1969, 34, 58-72. J. .4. A personality scale of manifest anxiety. J . JDn. ci So(.. P.syc.hol., 1953, 14. TAYLOR, 48. 285-290. 13.
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