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Depression and Gender Differences 285Surge in Depression and Emergence of GenderDifferences in AdolescenceAdolescence, a transitional developmental period between childhood and adulthood,is characterized by more biological, psychological, and social role changesthan any other stage of life except infancy (Holmbeck & Kendall, 2002). Developmentalepidemiology has revealed two dramatic clinical phenomena of depressionassociated with adolescence that provide the point of departure for this chapter.First, whereas the rate of depression is low among children, there is a surge ofdepression during adolescence, with first episodes frequently occurring during thisdevelopmental period (Burke, Burke, Regier, & Rae, 1990). Prospective, longitudinalstudies over the past decade (Hankin et al., 1998; Weissman et al., 1997) haveshown that the rates of depression begin to increase dramatically in midadolescence,around age 13–14, and reach strikingly high levels by late adolescence, or age 18.Moreover, recent longitudinal studies have confirmed the continuity of depressionfrom adolescence into adulthood (Lewinsohn, Rohde, Klein, & Seeley, 1999; Weissmanet al. 1999), with formerly depressed adolescents showing very extensive impairmentin young adulthood (Lewinsohn et al., 2003).The second fact motivating this chapter is the robust finding of a gender differencein depression among adults. Twice as many adult women are depressed asadult men (Nolen-Hoeksema, 1990; Weissman & Klerman, 1977). Corroboratingcross-sectional results (Nolen-Hoeksema & Girgus, 1994) with our prospectivestudy, we (Hankin et al., 1998) found that the female preponderance in depressionhad clearly emerged by age 13–14. This gender gap in rates of depressionwidened dramatically between ages 14 and 18. By age 18, the sample exhibitedthe 2:1 ratio of greater female depression seen among adults. However, age maymask important developmental transitions (Rutter, 1989) that could more accuratelypinpoint when the gender difference in depression emerges. In fact, pubertaldevelopment predicted the emergence of the gender difference better than agealone, as girls showed increased rates of depressive disorders after Tanner stageIII (Angold, Costello, & Worthman, 1998).Recent findings from two cross-sectional studies (Hayward, Gotlib, Schradley,& Litt, 1999; Siegel et al., 1998, 1999) suggest that ethnicity also must be consideredin understanding the relation between puberty and the emergence of the femalepreponderance in depression. Specifically, gender differences in depressionfollowing puberty either do not occur or are weaker in African American and Latinoadolescents. Two limitations of these studies, however, are that they were crosssectionaland assessed only depressive symptoms but not depressive episodes.Thus, it is not known whether ethnicity similarly would moderate the relationshipbetween pubertal status and the emergence of gender differences in depressionin longitudinal studies of onsets of depressive disorders.