A review of the 257 meta-analyses of the differences between females and males in prevalence and risk, protective factors, and treatment outcomes for mental disorder.

backgroundDespite decades of research, there are still unanswered questions about whether sex-specific treatment or prevention programs are required.

methodAn overview of reviews that is, an exploratory domain analysis comprising three umbrella reviews, using PRISMA guidelines, of meta-analyses reporting differences between males and females in the (1) prevalence and risk factors for mental disorders, (2) protective factors, and (3) treatment outcomes were conducted. To assist integration across umbrella reviews, sub-themes relevant to the domain were generated based on the findings of the searches. An extensive and transparent synthesis of the types of evidence, the comparative magnitude of effects, and representation is provided.

resultsWe searched PubMed, Cochrane Library, and APA PsycINFO from inception to July 2021 and located 257 meta-analyses of 11,038 studies with 619,013,307 participants, reporting results for females and males, of which 205 reported prevalence and risk factors, 29 reported preventative and protective factors, and 23 reported on treatment outcomes. The first umbrella review has three main domains of (1) physical and behavioural conditions, (2) diagnosis and antecedents, and (3) suicide and antecedents, and these domains were further categorised into six (e.g., diabetes.), 14 (e.g., Anxiety), and six (e.g., Suicide) sub-themes respectively. The second umbrella review was categorised into five domains (e.g., coping), and the third umbrella review examined treatment outcomes. The risk of bias was assessed using publication bias reported by authors in selected articles, controlling for study design (e.g., clinical trial versus correlations) and effects (e.g., direct versus indirect). Across the three umbrella reviews, 43.9% of the estimates were greater in females, 28.5% in males, and 27.6% found no differences. The differences were small in 90% of the studies (Effect Size between 0 and 0.5). This review confirmed that the prevalence of internalising disorders was greater in females, and externalising disorders were more common in males. Suicide deaths were higher in males, but suicide attempts and ideation were higher in females; females with mental disorders had more heart disease but similar rates of diabetes and obesity. Sexual and physical abuse are strongly associated with a mental disorder in both females and males. Economic adversity and substance use were associated with the poor mental health of males. Rigorous physical activity was of greater benefit to males. In contrast, coping techniques and social supports were more beneficial for females, and females and males obtained similar benefits from treatment for most conditions.

conclusionA key finding was that most forms of treatment were similarly beneficial for males and females, although the study revealed significant gaps in research on treatment effects. However, the available evidence did not support the need for sex-specific treatment programs or services.