According to the National Institute of Mental Health (NIMH), about six million American men suffer from depression
every year. Yet psychologists know that men are far less likely than women to seek help not only for all mental-health problems, but depression in particular.
According to the NIMH public-information campaign, "Real Men. Real Depression." which began in 2003, men may be unlikely to admit to depressive symptoms and seek help.
Researchers and clinicians are beginning to think that the traditional signs of depression
(sadness, worthlessness, excessive guilt) may not represent many men's experience of a depressive period. Although research is just beginning to support the idea of a "male-based depression," it is possible that men may instead express their depression in terms of increases in fatigue, irritability and anger (sometimes abusive in nature), loss of interest in work or hobbies and sleep disturbances. It has also been shown that men use more drugs and alcohol, perhaps to self-medicate, which can mask the signs of depression, making it harder to detect and treat effectively.
Psychologists also are investigating whether men who are depressed try to hide it with overwork; others expose themselves to harm via risky behavior. Untreated depression can result in personal, family and financial problems, even suicide. According to NIMH, four times as many men as women die by suicide in the U.S., which may result from a higher prevalence of untreated depression. Yet eight out of 10 cases of depression respond to treatment.
Psychologist Aaron Rochlen, PhD, of the University of Texas, says that research shows that the men who need mental health services most are the least interested in getting help. He has begun research into alternative methods of marketing and providing counseling to more counseling-resistant populations. In addition, Rochlen and his colleagues have been documenting how the traditional male role—which restricts emotional expression and encourages a pre-occupation with success, power and competition—is associated with negative physical and psychological consequences, such as depression, anxiety and relationship problems.
APA President Ronald Levant, EdD, Dean of Buchtel College of Arts and Sciences at the University of Akron, coined the term "normative male alexithymia" to describe men's greater problems with expressing their emotions, a possible contributor to depression and barrier to treatment.
According to NIMH, doctors may also overlook the signs of depression in older men. It can be especially hard to single out depression when men have other problems such as heart disease, stroke or cancer, which can cause depressive symptoms, or whose medications may have depressive side effects. Yet it is critical to identify depression among the elderly because they, especially older white males, have the highest rates of suicide. Researchers are trying to help physicians to detect and treat depression in older adults, who respond well to treatment medication, psychotherapy, or a combination of both.
What the Research Means
New insight into the nature and scope of depression in men is prompting psychologists and other health professionals to further differentiate research and treatment. Clinicians are increasingly aware that they must be sensitive to depression danger signs for men that are different than those for women. Psychologists and other mental health providers are also giving special attention to men's mental health issues given men's greater resistance to even seeking treatment, their greater discomfort with emotional expression and their higher risk of abusive anger, substance abuse, risky behavior and suicide.
How We Use the Research
By learning how depression and help-seeking are different in men, psychologists are able to communicate their findings to physicians, family members, friends and employers, to help them better spot the signs of depression and steer men to effective treatment. For example, the NIMH "Real Men. Real Depression." campaign draws upon the latest research, providing up-to-date information, using bold art and direct language, and featuring the real stories of men who have been successfully treated for depression. In 2005, the campaign added new materials to reach Spanish-speaking and Native American men.
Clinicians are similarly making changes to connect with and accommodate men. For example, John Robertson, PhD, of Lawrence, Kansas, the past president of the APA's Society for the Psychological Study of Men and Masculinity, has given his office wood paneling, leather chairs and sports-themed art. He uses male-friendly terms such as meetings or consultations rather than sessions, and strategies and goals rather than treatments. Mark Kiselica, PhD, a counseling psychologist with The College of New Jersey, will take a walk with a new client, throw a ball around or grab a bite to eat—all to help men, more comfortable with shared activities than sitting and talking about feelings, open up.
Sources & Further Reading
Addis, M.E. and Mahalik, J.R. 2003. Men, Masculinity, and the Contexts of Help Seeking. American Psychologist, 58(1), p5. Washington, DC: American Psychological Association.
Bruce, M.L. and Pearson, J.L. 1999. Designing an intervention to prevent suicide: PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Dialogues in Clinical Neuroscience, 1(2): 100-12.
Cochran S.V., Rabinowitz, F.E. 2000. Men and depression: clinical and empirical perspectives. San Diego: Academic Press.
Cochran, S.V. & Rabinowitz, F.E. 2003. Gender-sensitive recommendation for assessment and treatment of men. Professional Psychology: Research and Practice, 34, 132-140. Washington, DC: American Psychological Association.
Horne, A. & Kiselica, M.S. (1999) Handbook of counseling boys and adolescent males: A practitioner's guide. Thousand Oaks, Calif.: Sage. Includes a chapter on counseling depressed boys, as well as male-friendly approaches to working with boys.
Mahalik, J. R. and Rochlen, A. B. (in review). Men's likely coping responses to clinical depression: What are they and do masculinity norms predict them? Being reviewed by Psychology of Men and Masculinity. Washington, DC: American Psychological Association.
National Institute of Mental Health. Real Men. Real Depression. Web site retrieved June 15, 2005: http://menanddepression.nimh.nih.gov. Washington, DC: National Institute of Mental Health.
Pollack W. 1998. Mourning, melancholia, and masculinity: recognizing and treating depression in men. In: Pollack. W., Levant, R., eds. New Psychotherapy for Men. New York: Wiley.
Rabinowitz, F. E. and Cochran, S. V. 2002. Recommendations for clinicians concerning psychotherapy with men. Clinician's Research Digest, 20, Suppl. 26, June. Washington, DC: American Psychological Association.
Rochlen, A. B., McKelley, R., and Pituch, K. (in press). A preliminary examination of the Real Men. Real Depression campaign. Being reviewed by Psychology of Men and Masculinity. Washington, DC: American Psychological Association.
Rochlen, A. B., Whilde, M. R., & Hoyer, W. D. (in press). Real Men. Real Depression: Overview, theoretical implications, and research considerations. Psychology of Men and Masculinity. Washington, DC:
American Psychological Association.
American Psychological Association, July 14, 2005