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Depression: Helping men to get help

Dr Vanessa Cooper

Dr Vanessa Cooper

Dr Alicia Hughes

Dr Alicia Hughes

Depression: Helping men to get help

Rates of diagnosed depression and the findings of surveys suggest that women are at least twice as likely to suffer from depression than men.1,2 In contrast, rates of suicide and substance abuse disorder are consistently much higher in men.3 It may therefore be that the true prevalence of depression in men is masked by the underreporting of depressive symptoms, gender differences in the presentation of depression and lower rates of diagnosis of depression by clinicians.4

 

How does depression differ in men

In many cultures, boys are socialized not to express feelings such as sadness and fear, so men may be more likely to respond to mental pain by externalizing symptoms such as substance misuse, risk-taking and poor impulse control or experience emotions through physical (somatic) symptoms such as headaches.5,6 These symptoms and behaviours may be seen as “depressive equivalents,” meaning that they mask underlying sadness, loneliness and alienation.3 Studies have found that men who conform to the traditional masculinity norms (for instance, independence, physical toughness, minimal emotional expression) are more likely to have a more externalising, somatic pattern of depression than with less traditional gender norms.6

 

Are men less likely to seek professional help for depression?

Men may be less likely than women to seek help when they experience difficulties with their mental health.8 In a recent study of 530 men with moderate to severe depression, only 8.5% were currently engaged with professional mental health support.9 Tailored approaches to screening, promotion of help-seeking and treatment of depression in men may therefore be needed.5

Young men are the least likely to seek help, yet the need in this age group may be greatest, since the onset of mental illness often begins in early adulthood. Untreated mental health problems can have short- and longer- term consequences including poorer education and employment opportunities, drug and alcohol problems and antisocial behaviour.7

 

How can we support men to seek help for depression?

In order to understand some of the barriers to receiving mental health support faced by men, we conducted a rapid review of the literature (Figure 1). We categorised these barriers in terms of the COM-B model.

Most of the barriers we identified could be addressed by targeted interventions. We’ve included examples of intervention components to address each group of barriers.

Interventions to promote help seeking for mental health should be user-driven, informed by the views and experiences of the target group and leverage everyday technology practices.

Barriers
Potential interventional components
Capability
  • Low mental health literacy12
  • Does not recognise symptoms of depression 11
  • Difficulty identifying or communicating emotions11
  • Not knowing where to go to get professional help11
  • Psychoeducational material designed to improve mental health knowledge, help men to identify and communicate their emotions and to recognise symptoms of depression
  • Integrate mental health into formal education to increase mental health literacy and normalize professional help seeking11
Motivation
  • Negative attitudes towards professional help seeking11,14
  • Concerns about confidentiality15
  • Fear of being incompetent,feeling that you should be able to cope or be able to solve problems independently9,11,16
  • Concern about dependency11
  • Embarrassment, fear and shame around asking for help13,17
  • Avoidance, minimization, ignoring and escaping 19
  • Education about the possible benefits of seeking mental health support and treatment
  • Address concerns about seeking help, for example about confidentiality and dependence
  • Employ reliable and relevant public figures with lived experience to reinforce the message that seeking help is a strong coping response and overcome the belief that seeking help is weak
  • Problem solving to identify barriers that prevent them seeking help and identify ways to overcome these
Physical opportunity
  • Inadequate provision of services 15
  • Increase the availability, accessibility and variety of services
  • To appeal to younger men, advertising could be included on gaming websites, through social media, between sports matches or shows11
Social opportunity
  • Inadequate provision of services 15
  • Stigma20
  • Ridicule and rejection from peers13
  • Masculine ideals of self-reliance and denial of emotions11
  • Address the misconception that strength is shown through denial of emotions
  • Emphasise the value of positive ‘masculine’ qualities such as self-reliance and responsibility, in gaining support for emotional difficulties10
  • Redefine mental health as ‘mental fitness’ – so that seeking help feels more like a positive step towards self-improvement rather than dealing with a problem11

 

Additional resources and programs to support men’s mental health

https://www.mentalhealth.org.uk/our-work/campaigns/mens-mental-health-month/our-work-mens-mental-health

https://happiful.com/young-men-increasingly-reaching-out-mental-health-support/

https://www.nimh.nih.gov/health/topics/men-and-mental-health/

https://www.acu.ac.uk/the-acu-review/a-silent-crisis/-

 

 

References
  1. Emslie C, Ridge D, Zeibland S, Hunt K. Men’s accounts of depression: Reconstructing or resisting hegemonic masculinity? Social Sciences and Medicine. 2006;62:2246–2257.
  2. National Institute of Mental Health. Major depression. Retrieved June 2021, from https://www.nimh.nih.gov/ health/statistics/major-depression.shtml
  3. Affleck, W., Carmichael, V., Whitley, R. Men’s Mental Health: Social Determinants and Implications for Services. Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 2018, Vol. 63(9) 581-589
  4. Mahalik, J.R., Dagirmanjian, F.R. Working-Class Men’s Constructions of Help-Seeking When Feeling Depressed or Sad. American Journal of Men’s Health. 2019, 1-13.
  5. Oliffe, J., Rossnagel, E., Seidler, Z.E., Kealy, D., Ogrodniczuk, J.S., Rice, S.M. Men’s depression and suicide. Curr Psychiatry Rep. 2019; Spe 14; 21 (10):103
  6. Magovcevic M, Addis ME. The masculine depression scale: Development and psychometric evaluation. Psychology of Men and Masculinity. 2008;9:117–132.
  7. Burns J. & Birrell E. Enhancing early engagement with mental health services by young people. Psychology Research and Behavior Management 2014:7 303–312
  8. Sagar-Ourighli, I., Godfrey, E., Bridge, L. Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking.  American Journal of Men’s Health (2019): 1–18.
  9. Rice, S.M., Oliffe, J.L., Kealy, D., Seidler, Z.E., Ogrodniczuk, J.S. Men’s help-seeking for depression: attitudinal and structural barriers in symptomatic men. J. Prim Care Community Health, 2020,11:2150132720921686
  10. Fogarty, A. S., Proudfoot, J., Whittle, E. L., Player, M. J., Christensen, H., Hadzi-Pavlovic, D., & Wilhelm, K. (2015). Men’s use of positive strategies for preventing and managing depression: A qualitative investigation. Journal of Affective Disorders, 188, 179–187.
  11. Lynch, L., Long, M. Young men, help seeking and mental health services: exploring barriers and solutions. American Journal of Men’s Health, 2018, Vol 12 (1); 138-149
  12. Mackenzie, C. S., Gekoski, W. L., & Knox, V. J. Age, gender, and the underutilization of mental health services: The influence of help-seeking attitudes. Aging & Mental Health, 2006, 10, 574-582
  13. Rickwood, D., Deane, F. P., & Wilson, C. J. When and how do young people seek professional help for mental health problems? Medical Journal of Australia, 2007, 187, S35- S39
  14. Rothì, D. M., & Leavey, G. (2006). Mental health help-seeking and young people: A review. Pastoral Care in Education, 24(3), 4-13
  15. Chan, M. E. Antecedents of instrumental interpersonal help-seeking: An integrative review. Applied Psychology, 2013, 62, 571-596
  16. Rughani, J., Deane, F. P., & Wilson, C. J. (2011). Rural adolescents’ help-seeking intentions for emotional problems: The influence of perceived benefits and stoicism. Australian Journal of Rural Health, 19, 64-69.
  17. Vogel, D. L., Wade, N. G., Wester, S. R., Larson, L., & Hackler, A. H. (2007). Seeking help from a mental health professional: The influence of one’s social network. Journal of Clinical Psychology, 63, 233-245.
  18. Cleary, A. (2012). Suicidal action, emotional expression, and the performance of masculinities. Social Science & Medicine, 74, 498-505
  19. Clement, S., Schauman, O., Graham, T., Maggioni, F., EvansLacko, S., Bezborodovs, N., . . . Thornicroft, G. (2015). What is the impact of mental-health related stigma on help seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 11-27.
  20. Booth, M. L., Bernard, D., Quine, S., Kang, M. S., Usherwood, T., Alperstein, G., & Bennett, D. L. (2004). Access to health care among Australian adolescents: Young people’s perspectives and their sociodemographic distribution. Journal of Adolescent Health, 34, 97-103

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