Kramer · Psychological medicine 2008 · cross-sectional observational study · n=2992

The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes.

Cited 190 times in the scientific literature.

Level 4 - case-series / case-control

Cross-sectional structural equation modeling in a registry-based cohort

PubMed 17892625 · doi:10.1017/S0033291707001572 · record verified 2026-08-26

What was done

Researchers examined the latent structure and factorial invariance of 11 psychopathological syndromes in 2,992 middle-aged adults (mean age 52.66 ± 5.82 years; 37% men) from the community-based Minnesota Twin Registry. Syndromes were assessed using 10 scales of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and an adult antisocial behavior scale. Confirmatory factorial invariance models were evaluated using an internalizing-externalizing framework.

What was found

A strong gender invariance model showed the best fit, demonstrating that gender differences in the means of individual syndromes were accounted for by gender differences in latent internalizing and externalizing factors. Women had higher mean levels of internalizing (d = 0.23) and lower mean levels of externalizing (d = -0.52) than men.

Why it matters

The findings show that gender disparities across common psychiatric disorders largely reflect broader liability dimensions rather than syndrome-specific mechanisms, suggesting etiologic research should target latent factor levels.

Limits

The study relies on a cross-sectional self-report screening questionnaire rather than structured clinical diagnostic interviews. The sample is restricted to middle-aged participants from a single state twin registry with an unbalanced sex ratio (37% men).

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