ArticlePDF AvailableLiterature Review

Critical Issues in Men’s Mental Health

  • Vancouver Psych Safety Consulting Inc.


This narrative review highlights key issues in men’s mental health and identifies approaches to research, policy and practice that respond to men’s styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to service provision designed to improve men’s accessing of care, with an emphasis on Canadian programs. The main conclusion is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional. There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are made to address men’s mental health through: healthcare policy that facilitates access; research on tailoring interventions to men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is sensitive to the expression of mental health problems in men and that responds in a relevant manner.
In Review Series
Critical Issues in Men’s Mental Health
Dan Bilsker, PhD
, Andrea S. Fogarty, PhD
and Matthew A. Wakefield, MA
This narrative review highlights key issues in men’s mental health and identifies approaches to research, policy and practice
that respond to men’s styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in
Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male
depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the
risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways
in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the
underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to
service provision designed to improve men’s accessing of care, with an emphasis on Canadian programs. The main conclusion
is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional.
There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are
made to address men’s mental health through: healthcare policy that facilitates access; research on tailoring interventions to
men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is
sensitive to the expression of mental health problems in men and that responds in a relevant manner.
Enjeux importants de la sante
´mentale des hommes Cet examen narratif pre
´sente les principaux enjeux de la sante
´mentale des
hommes et e
`re les approches de la recherche, des politiques et de la pratique qui re
´pondent aux styles d’adaptation des
hommes. Les enjeux discute
´s sont : 1. l’incidence e
´edefac¸on inquie
´tante du suicide masculin (80 % des de
`s par suicide au
Canada, avec une pointe dans le groupe d’a
ˆge de mi-cinquantaine) accompagne
´e d’une faible sensibilisation du public; 2. la nature
´routante de la de
´pression masculine,qui se manifeste sous des formes mal reconnues par les approches diagnostiques actuelles
et qui est donc mal traite
´e; 3. l’usage risque
´de l’alcool par les hommes, encore une fois re
´pandu de fac¸on inquie
´tante, qui a detre
lourdes re
´percussions sur la sante
´mentale et physique; 4. les fac¸ons caracte
´ristiques des hommes de composer avec la souffrance
psychologique, les aptitudes d’adaptation a
ˆtre et les lacunes a
`aborder; 5. la sous-utilisation par les hommes des services
de sante
´mentale et l’implication pour les re
´sultats cliniques; et 6. les approches typiquement masculines de la prestation de
services conc¸ue pour ame
´liorer l’acce
`s aux soins pour les hommes, en mettant l’accent sur les programmes canadiens. La
principale conclusion est qu’une forte proportion d’hommes dans la socie
´occidentale ont acquis des strate
´gies d’adaptation qui
sont souvent dysfonctionnelles. Il y a un besoin pour les hommes d’apprendre plus d’approches d’adaptation, bien avant
d’atteindre le point d’une crise. Des recommandations qui abordent la sante
´mentale des hommes se trouvent dans : les poli-
tiques de sante
´qui facilitent l’acce
`s; la recherche sur la personnalisation des interventions pour les hommes; les initiatives dans la
population pour renforcer la capacite
´des hommes de s’adapter a
`la de
´tresse psychologique; et la pratique clinique qui est sensible
`l’expression des proble
`mes de sante
´mentale chez les hommes et qui y re
´pond de fac¸on pertinente.
Barriers to treatment, Common mental disorders, Depressive disorders, emental health, Gender, Healthcare utilization
Department of Psychiatry, Faculty of Medicine, University of British Columbia, British Columbia, Canada
Black Dog Institute, University of New South Wales, Sydney, Australia
Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
Corresponding Author:
Dan Bilsker, PhD, Department of Psychiatry, Faculty of Medicine, University of British Columbia, British Columbia, Canada.
The Canadian Journal of Psychiatry /
La Revue Canadienne de Psychiatrie
ªThe Author(s) 2018
Reprints and permission:
DOI: 10.1177/0706743718766052 |
Psychiatric Association
ssociation des psychiatres
du Canada
There is increasing public awareness of the importance of a
gendered perspective on the mental health of Canadian men.
This perspective considers effective intervention
approaches, barriers to accessing appropriate care and psy-
chological coping issues. It has been observed that men’s
mental health issues have been ‘hidden in plain sight’. For
example, even though it is well known that most suicide
deaths are males, there has historically been a lack of atten-
tion to this dramatic gender disparity, whether in health
research, policy, or care delivery. The research literature
on men’s mental health, policy addressing this area, and
psychological care specifically targeting men are all in early
stages of development.
The aim of this review is to highlight some of the key
issues in men’s mental health. The time is right to implement
new approaches to research, policy and practice that respond
to men’s styles of coping, vulnerability and psychological
suffering. We are past the point where mere calls to action
will suffice.
Critical Issues
Male Suicide
Suicide in men has been described by a leading researcher as
a ‘silent epidemic’.
It is ‘silent’ because there is low public
awareness regarding the magnitude of this problem, with
surprisingly little research and few preventive efforts specif-
ically targeting male suicide. Furthermore, men are reluctant
to seek help for suicidality. It is ‘epidemic’ because of the
high incidence and because it is a major contributor to men’s
mortality: between the ages of 15 and 44 y, suicide is among
the top 3 sources of men’s mortality.
Across all countries
reporting these data (except China and India), the male sui-
cide rate that is 3- to 7.5-times that of women.
In Canada,
the male suicide rate is about 3 times that of women.
Figure 1 charts the age- and gender-specific incidence of
suicide in Canada, based on data from 2000 to 2011. The
chart shows 2 patterns:
The male suicide rate increases fairly steadily with
age, peaking in the late 40s, then falling significantly
and rising again in the 80s.
Male rates of suicide are greater than female rates at
all ages and substantially greater across most of the
The peak in suicide rate among Canadian men in their 40s
and 50s is surprising in light of past data showing a peak of
suicide in younger age groups.
However, a change in this
suicide pattern seems to be underway. It is apparent that our
knowledge of men’s suicide is lagging behind changes in the
age-specific incidence of this cause of death.
Until we
understand the underlying reasons for this relative increase
in men’s suicide rates in middle age, including potential
cohort effects, we will not be able to implement effective
preventive action.
To address male suicide, it will be important to understand
how suicidality manifests in men and how it can be detected
at an early stage. A recent review found that signs indicative
of increased suicidal risk in men include ‘desperation and
frustration in the face of unsolvable problems, helplessness,
worthlessness, statements of suicidal intent’.
However, the
reviewers highlight the uncertainty regarding the sensitivity
and specificity of these signs in identifying men’s suicidal
risk and call for prospective research to identify signs of
imminent risk of suicidal ideation, attempt, or death in men.
A recent longitudinal study of 13,884 men found that one
aspect of Western role norms of masculinity may contribute
to men’s suicide ideation, in that men who strongly identified
as ‘self-reliant’ had 34%greater odds of reporting thoughts of
However, suicidal thinking alone is not a sufficient
predictor of an imminent attempt.
An intriguing qualitative
study examined factors that interrupt suicide attempts in men,
finding that ‘suicidal ideation may be reduced through pro-
vision of practical help to manage crises, and helping men to
focus on obligations and their role within families’.
in a survey of men who had previously made a suicide
attempt, 67%reported ‘thinking about the consequences for
family’ helped prevent future attempts.
Follow-up analyses highlight some tensions between sui-
cidal men and their support systems that interfere with effec-
tive suicide prevention.
For example, it is difficult to
identify which changes in behaviour signify imminent risk
of an attempt v. normal fluctuations in mood; or difficulty in
monitoring signs of risk while still affording at-risk men
privacy and autonomy. Though recent work suggests that
men are more likely than women to develop an ‘acquired
Figure 1. Average Age-Specific Suicide Rates Ages 10þfrom 2000
to 2011. (Reproduced with permission from Jones W, Goldner EM,
Butler A, McEwan K. Informing the future: mental health indicators
for Canada technical report. Mental Health Commission of Canada
RFP No. MHCC-DATA-2013-2014-02; 2015. Page 314.)
2The Canadian Journal of Psychiatry
capability’ for suicide through greater insensitivity to pain
and reduced fear of death,
there is still considerable debate
over the role of biology
v. social factors (e.g., men tend to
have a higher occupational exposure to pain-habituating
Male Depression
Epidemiological research shows that the incidence of uni-
polar depression in men is half that for women.
Three main
explanations have been proffered. First, men are simply less
likely to experience depression, for unclear reasons. Second,
men are reluctant to acknowledge depressive symptoms due
to aspects of male socialization.
Third, men experience
depression in a specific way, with different symptoms, such
that the standard operational criteria for depression (which
typically emphasise internalizing symptoms such as sadness
and worry) are not valid in a male population.
This latter
explanation is built upon the concept of ‘male depressive
syndrome’, where externalizing symptoms (e.g., anger, alco-
hol misuse, risk-taking) are considered indicative of men’s
depression yet not diagnostically recognised as such.
recent systematic review compared the patterns of symptoms
in men and women diagnosed with unipolar depression, find-
ing relatively minor differences. They found that effect sizes
for these symptoms were small except for risk taking and
poor impulse control, indicating that differences between
genders on most symptoms may have only minor clinical
relevance for the assessment and treatment of depression.
However, if men’s depression is qualitatively different,
many men will not be ‘diagnosed’ as depressed and thus will
be absent from the literature. There is some evidence that
men describe depression using language (e.g. ‘stressed’,
‘angry, ‘tired’) that does not concord with existing clinical
criteria, or endorse different warning signs of depression
(e.g., being ‘irritable’, ‘on auto-pilot’, and ‘more aggressive
towards others’).
It is notable that the concept of a male-
version depression raises the question of depression’s onto-
logical status—we lose the epistemic shelter of operational
definition (as in the DSM, where depression is that which
meets the criteria) and must seek a theoretical definition of
depression encompassing different presentations.
Men and Substance Use
Alcohol has the greatest impact upon men’s mental health
across all substance use. The overuse of alcohol to cope with
psychological distress, resulting in significant mental health
impact and dependence, is common in men. Men are 2- to
3-times more likely than women to have a serious alcohol
use problem.
In a 2012 study of mental health and
substance use disorders in Canada, it was found that ‘males
had higher rates of substance use disorders in the past 12
months ...6.4%of males and 2.5%of females reported
symptoms consistent with substance use disorder’.
Alcohol use is a risk factor for a number of serious dis-
orders and sources of mortality.
As one might expect from
their relatively high rate of use, men suffer disproportionately
from the health impacts of alcohol: data from 2004 show the
rate of global deaths attributable to alcohol use as almost 6-
times higher for men (6.3%) than for women (1.1%).
It is
worth noting that alcohol dependence is a strong contributor
to suicidality, suggesting a partial explanation for the associ-
ation between male gender and suicide mortality.
Regarding the mitigation of alcohol-related risk in men, a
systematic review of long-term outcome in alcohol depen-
dence found that men show strikingly worse outcomes than
do women.
Yet, another review found that effort in the
primary care setting to reduce levels of problem drinking
is equally efficacious for men and women.
An intriguing development is the potential role of canna-
bis as a substitute for alcohol in individuals who have been
using alcohol in a risky manner.
Notably, in US states that
have legalised medical cannabis, decreases in deaths due to
motor vehicle accidents and suicide have been observed; it
has been suggested that these decreases may be related to
substitution of alcohol by cannabis in young men.
is a need for research in this area.
Opioid misuse (especially fentanyl) has come into sharp
focus due to the staggering number of associated overdose
deaths. Despite intense public concern, only recently has
attention been drawn to the preponderance of men in these
deaths: for example, a review of fentanyl overdose deaths in
British Columbia between 2012 and 2017 found that 82%
involved men.
Although there has been some research on
gender differences in opioid use,
little is known about
the reasons for this substantial disparity in overdose deaths.
We speculate that the same social influences and coping
strategies leading men to overuse alcohol foster other forms
of substance misuse as well.
How Men Cope with Psychological Distress
Recent research has studied the ways in which men cope
with psychological suffering. Recent reviews have attributed
the use of negative coping styles to the tendency of some
men to adhere rigidly to certain stereotyped features of mas-
culinity: misuse of alcohol and drugs to numb distress; con-
cealing and ignoring negative emotions; engaging in risky
behaviours; or valuing self-reliance and autonomy over pro-
fessional care.
Such approaches can increase the risk of
suicide, if used in conjunction with social isolation and with-
drawal from relationships.
Some men report attempts to redefine notions of mascu-
line coping; for example, where help-seeking allows for the
maintenance of traditional roles such as providing for the
A research group in Australia has been examining
positive coping strategies used by men: far from relying only
on negative coping strategies, many men reported enacting
various prevention and management strategies for mood
Interestingly, these positive strategies fell
La Revue Canadienne de Psychiatrie 3
along a continuum – some men were more comfortable with
‘typically masculine’ approaches (e.g. problem solving,
achievements, structured plans, goal-setting) while others
were open to using less ‘masculine’ strategies (e.g. accep-
tance of vulnerability, talking openly about problems, seek-
ing help). Crucially, some men described only becoming
open to such strategies after significant periods of distress.
Men’s Use of Mental Health Care
A considerable body of research has identified a notably
lower utilization of mental health care by men.
One might
assume that this usage pattern reflects a lower rate of com-
mon mental health conditions such as depression, but the
available research data tends to point rather to men’s reluc-
tance to access mental health care; i.e., a pervasive disincli-
nation to seek help in dealing with psychological distress,
whether help from the health system, family members, or
Indeed, men are often unwilling to express or
acknowledge psychological suffering.
A recent review
found that the degree of individual adherence to masculine
role norms negatively impacts help-seeking, such that treat-
ment is delayed until internal resources are depleted or a
crisis-point reached.
Barriers to help-seeking, such as a
need for control, self-reliance or tendency to minimize symp-
toms, are more likely in the context of long-standing depres-
sion in men.
A recent meta-analysis reported a stronger link
between conforming to masculine norms and reduced help-
seeking than with mental health outcomes per se.
ingly, Canadian research found that men were unlikely to
disclose distress to their doctors, regardless of measures of
masculinity or symptom severity.
Taken together, the research implies a knock-on effect
where men do not perceive the need for care, immediate
support systems do not identify male-specific warning signs,
diagnostic criteria do not detect men with mental health prob-
lems, and men delay treatment until problems are too severe
to ignore. Efforts have been made to address this poor ‘acces-
sing of care’ (v. ‘access to care’) and there are indicators of
For example, in Australia, the proportion of men
with mental health problems who used appropriate services
has increased from 32%in 2006–2007, to 40%in 2011–
However, there is substantial room for improvement.
Male-Specific Mental Health Services
A recently released policy review, ‘Keeping It Real’, empha-
sizes the importance of implementing novel programs that
reach out to men, and designing care approaches that
enhance coping.
Promising examples of online interven-
tions to enhance psychological coping include the Mood-
Gym program; however, such online interventions show
lower uptake and adherence in men.
A review noted
a ‘high drop-out rate amongst males in particular and certain
programmes such as MoodGym appear insufficiently enga-
ging to adult men’.
Nonetheless, we would argue that
given existing challenges to men’s timely accessing of
appropriate care, development of e-health interventions is
still a promising avenue, particularly where such programs
are designed with men’s input.
Male-specific programs include:
The Australian ‘Well@Work’ program, which aims
to improve workplace mental health in male-
dominated workforces (e.g., police, fire, and emer-
gency services);
An ambitious mental health prevention and promo-
tion program targeting adolescent boys via
community-based sports clubs, funded by the Move-
mber Foundation;
A Canadian adaptation of the Australian Men’s Shed
program, which focuses on the mental health of older
HeadsUpGuys, a website where men can access psy-
choeducation regarding depressive symptoms among
men, practical tips for preventing and dealing with
depression, how to access professional services, and
videos of men who have overcome depression;
BroMatters, which provides psychoeducation about
stress, depression, and alcohol use, along with self-
help in the form of CBT, mindfulness relaxation pro-
grams and strategies for workplace stress.
DUDES Club, a ground-breaking program primarily
targeting the health and well-being of indigenous men
in Vancouver, BC’s Downtown Eastside—a group of
men facing high risk of addiction, poverty, and home-
The goal of DUDES Club is to promote
health literacy and build a sense of ‘brotherhood’. It
integrates traditional indigenous medicine and teach-
ings and provides access to healthcare professionals
who facilitate interactive ‘health discussions’.
Although several of these programs have received forma-
tive evaluation, it must be emphasised that none has been
proven effective by controlled research trials. They are pro-
mising but unproven.
The central conclusion we derive from the literature on
men’s mental health is this: a high proportion of men in
Western society have acquired psychological coping strate-
gies that are often dysfunctional and leave them vulnerable
to a number of negative physical or psychological outcomes.
This acquisition is not necessarily inherent to being male, but
rather a product of various degrees of socialization to West-
ern role norms. The problematic coping strategies include:
Failing to obtain appropriate support from friends,
family, or healthcare providers;
Overusing alcohol to lessen emotional suffering
4The Canadian Journal of Psychiatry
Denying suffering, ‘sucking it up’
Isolation, or reducing social connectedness in times of
Each of these coping strategies will, in situations, be
appropriate and adaptive; for example, indifference to suf-
fering in emergency situations where certain tasks must be
accomplished. Likewise, brief periods of isolation can
relieve stress. However, using these strategies excessively
or rigidly leaves men vulnerable to a wide range of negative
consequences and less able to access the health buffering
effects of diverse social support networks.
There is a need
for men to learn adaptive coping approaches long before
they reach a crisis point.
Healthcare policy should mandate that Health Services to
men be delivered in a way that is appropriate and accep-
table to those men in need. Male-focused programs appear
to hold considerable potential for improving our manage-
ment of men’s mental health. However, such programs
have thus far reached only a small proportion of the male
population, and it is unclear how scalable they are to the
male population vulnerable to mental health conditions and
psychological suffering.
Further, though many countries have mental health stra-
tegies that acknowledge gender differences, very few articu-
late strategies aimed at men. Future policy development
should identify men as a vulnerable population and articulate
specific strategies to address the known factors that increase
mental health risk among men. A useful resource for policy
development is the Keeping It Real report, which focuses on
policy development aimed at young men’s mental health.
The Canadian research agenda should make men’s mental
health a priority, including outcome research to determine
how existing treatment methods could be tailored to a male
population and how men can be encouraged to increase
appropriate use of mental health services.
suicide-prevention research, which has focused on teens and
young adults, should prioritize middle-aged men, as they are
the most vulnerable group.
Population Health Intervention
Population-level initiatives should be implemented to
enhance the capacity of Canadian men to cope with psycho-
logical distress and thus help prevent the negative conse-
quences of poorly managed suffering. Such an initiative
would be based on evidence about positive coping strategies,
tailored knowledge translation, and social marketing. One
approach would involve community education and
prevention campaigns that engage with traditional notions
of masculinity and seek to reframe men’s vulnerability to
mental health problems, men’s typical responses to such vul-
nerability, and the act of help-seeking as brave and a ‘mascu-
line’ thing to do.
Another would involve novel delivery of
treatment and skills development to larger population groups,
whether through new technology or diverse settings. Contin-
ued development and evaluation of online interventions
designed to engage men is a promising approach.
Clinical Practice
This review points to several important aspects of clinical
work with male patients. First, men are more prone to anger
and interpersonal aggression, a coping pattern with substan-
tial negative impact on quality of life and relationships.
There is a need for enhanced clinical focus on identifying
and modifying anger coping skills in men. Second, identify-
ing high-risk use of alcohol is a key issue in the clinical care
of men. High-risk use is, of course, far more common than
diagnosable alcohol dependence (which requires intensive
treatment). Controlled drinking or supported self-care inter-
ventions are appropriate for most men overusing alco-
Third, the clinician must be sensitive to suicidality
in men, even where the patient dismisses his own emotional
suffering and presents relationship or occupational crises in a
calm and ‘rational’ manner.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
1. BBC NEWS, UK. The silent epidemic of male suicide. 2008
February 4. London (UK): BBC News; [Cited 2017 July 31]
2. British Columbia Vital Statistics Agency, Ministry of Health
Planning. Selected Vital Statistics and Health Status Indicators:
Annual Report 2002. Victoria (BC): Author; 2002.
3. Nock MK, Borges G, Bromet EJ, et al. Suicide and suicidal
behavior. Epidemiol Rev. 2008;30:133-154.
4. Jones W. Background Epidemiological Review of Selected
Conditions. Burnaby (BC): Centre for Applied Research in
Mental Health and Addiction; 2010.
5. Shah A. The relationship between suicide rates and age: an
analysis of multinational data from the World Health Organi-
zation. Int Psychogeriatr. 2007;19(6):1141-1152.
6. Bertolote JM, Fleischmann A. A global perspective in the epi-
demiology of suicide. Suicidologi. 2002;7(2):6-8.
7. Hu G, Wilcox HC, Wissow L, et al. Midlife suicide: an increas-
ing problem in US Whites, 1999-2005. Am J Prev Med. 2008;
La Revue Canadienne de Psychiatrie 5
8. Hunt T, Wilson CJ, Caputi P, et al. Signs of current suicidality
in men: a systematic review. PLoS One. 2017 [Cited 2017 July
9. Pirkis J, Spittal MJ, Keogh L, et al. Masculinity and suicidal
thinking. Soc Psychiatry Psychiatr Epidemiol. 2017;52(3):
10. Van Orden KA, Witte TK, Cukrowicz KC, et al. The interper-
sonal theory of suicide. Psychol Rev. 2010;117(2):575-600.
11. Player MJ, Proudfoot J, Fogarty A, et al. What interrupts sui-
cide attempts in men: a qualitative study. PLoS One. 2015;
12. Shand FL, Proudfoot J, Player MJ, et al. What might interrupt
men’s suicide? Results from an online survey of men. BMJ
Open. 2015;5(10).
13. Fogarty AS, Spurrier M, Player MJ, et al. Tensions in perspec-
tives on suicide prevention between men who have attempted
suicide and their support networks: Secondary analysis of qua-
litative data. Health Expect. Forthcoming 2017;21(1):261-269.
14. Witte TK, Gordon KH, Smith PN, et al. Stoicism and sensation
seeking: male vulnerabilities for the acquired capability for
suicide. J Res Pers. 2012;46(4):384-392.
15. Deshpande G, Baxi M, Witte T, et al. A neural basis for the
acquired capability for suicide. Front Psychiatry. 2016;7:125.
16. Bryan CJ, Cukrowicz KC, West CL, et al. Combat experience
and the acquired capability for suicide. J Clin Psychol. 2010;
17. Kessler RC, McGonagle KA, Swartz M, et al. Sex and depres-
sion in the National Comorbidity Survey I: lifetime prevalence,
chronicity and recurrence. J Affect Disord. 1993;29(2):85-96.
18. Aneshensel CS, Estrada AL, Hansell MJ, et al. Social psycho-
logical aspects of reporting behavior: lifetime depressive epi-
sode reports. J Health Soc Behav. 1987;28(3):232-246.
19. Rutz W, von Knorring L, Pihlgren H, et al. Prevention of male
suicides: lessons from Gotland study. Lancet. 1995;
20. Mo¨ ller-Leimkuu
¨hler AM. The gender gap in suicide and pre-
mature death or: why are men so vulnerable? Eur Arch Psy-
chiatry Clin Neurosci. 2003;253:1-8.
21. Addis ME. Gender and depression in men. Clin Psychol Sci Pr.
22. Rice SM, Aucote HM, Parker AG, et al. Men’s perceived bar-
riers to help seeking for depression: longitudinal findings rela-
tive to symptom onset and duration. J Health Psychol. 2015;
23. Cavanagh A, Wilson CJ, Kavanagh DJ, et al. Differences in the
expression of symptoms in men versus women with depres-
sion: a systematic review and meta-analysis. Harv Rev Psy-
chiatry. 2017;25(1):29-38, 29.
24. Wilsnack RW, Wilsnack SC, Kristjanson AF, et al. Gender and
alcohol consumption: patterns from the multinational GENA-
CIS project. Addiction. 2009;104(9):1487-1500.
25. National Institute on Alcohol Abuse and Alcoholism. Eighth
Special Report to the US Congress on Alcohol and Health.
Washington (DC): Department of Health and Human Ser-
vices; 1993.
26. Kessler RC, Crum RM, Warner LA, et al. Lifetime and 12-
month prevalence of DSM III-R psychiatric disorders in the
United States: Results from the National Comorbidity Survey.
Arch Gen Psychiatry. 1994;51:8-19.
27. Eaton WW, Kramer M, Anthony JC, et al. The incidence of
specific DIS/DSM-III mental disorders: data from the NIMH
Epidemiologic Catchment Area Program. Acta Psychiatrica
Scandinavica. 1989;79:163-178.
28. CDC - Fact Sheets - Alcohol Use and Health - Alcohol. Atlanta
(GA): Centers for Disease Control and Prevention; 2016 July
25 [Cited 2017 July 31].
29. Rehm J, Mathers CF, Popova S, et al. Global burden of disease
and injury and economic cost attributable to alcohol use and
alcohol-use disorders. Lancet. 2009;373(9682):2223-2233.
30. Moreira CA, Marinho M, Oliveira J, et al. Suicide attempts and
alcohol use disorder. Eur Psychiatry. 2015;30:521.
31. Bravo F, Gual A, Lligon
˜a A, et al. Gender differences in the
long-term outcome of alcohol dependence treatments: an anal-
ysis of twenty-year prospective follow up. Drug Alcohol Rev.
32. Ballesteros J, Gonza´lez-Pinto A, Querejeta I, et al. Brief inter-
ventions for hazardous drinkers delivered in primary care are
equally effective in men and women. Addiction. 2004;99(1):
33. Lucas P, Walsh Z, Crosby K, et al. Substituting cannabis for
prescription drugs, alcohol and other substances among medi-
cal cannabis patients: the impact of contextual factors. Drug
Alcohol Rev. 2016;35(3):326-333.
34. Anderson DM, Hansen B, Rees DI. Medical marijuana laws,
traffic fatalities, and alcohol consumption. J Law Econ. 2013;
35. Anderson DM, Rees DI. The legalization of recreational mar-
ijuana: how likely is the worst-case scenario? J Policy Anal
Manage. 2014;33(1):221-232.
36. British Columbia Coroners Service. Fentanyl-Detected Illicit
Drug Overdose Deaths: January 1, 2012 to April 30, 2017.
Burnaby (BC): Ministry of Public Safety and Solicitor General,
Office of the Chief Coroner; 2017.
37. Back SE, Payne RL, Simpson AN, et al. Gender and prescrip-
tion opioids: findings from the national survey on drug use and
health. Addict Behav. 2010;35(11):1001-1007.
38. Jamison RN, Butler SF, Edwards RR, et al. Gender differences
in risk factors for aberrant prescription opioid use. J Pain. 2010;
39. Whittle EL, Fogarty AS, Tugendrajch S, et al. Men, depression,
and coping: are we on the right path? Psychol Men Masc. 2015;
40. Spendelow JS. Men’s self-reported coping strategies for
depression: a systematic review of qualitative studies. Psychol
Men Masc. 2015;16(4):439-447.
41. Roy P, Tremblay G, Robertson S. Help-seeking among male
farmers: connecting masculinities and mental health. Sociolo-
gia Ruralis. 2014;54(4):460-476.
42. Proudfoot J, Fogarty AS, McTigue I, et al. Positive strategies
men regularly use to prevent and manage depression:
6The Canadian Journal of Psychiatry
a national survey of Australian men. BMC Public Health.
43. Kessler RC, Brown RL, Broman CL. Sex differences in psy-
chiatric help-seeking: evidence from four large-scale surveys.
J Health Soc Behav. 1981;22(1):49-64.
44. Moller-Leimkuhler AM. Barriers to help seeking by men: a
review of socio-cultural and clinical literature with particular
reference to depression. J Affect Disord. 2002;71(1–3):1-9.
45. Doherty DT, Kartalova-O’Doherty Y. Gender and self-
reported mental health problems: predictors of help seeking
from a general practitioner. Br J Health Psychol. 2010;15(1):
46. Good GE, Mintz LB. Gender role conflict and depression in
college men: evidence for compounded risk. J Couns Dev.
47. Seidler ZE, Dawes AJ, Rice SM, et al. The role of masculinity
in men’s help-seeking for depression: a systematic review. Clin
Psychol Rev. 2016;49:106-118.
48. Rice SM, Fallon BJ, Aucote HM, et al. Development and pre-
liminary validation of the male depression risk scale: furthering
the assessment of depression in men. J Affect Disord. 2013;
49. Wong YJ, Ho MR, Wang SY, et al. Meta-analyses of the rela-
tionship between conformity to masculine norms and mental
health-related outcomes. J Couns Psychol. 2017;64(1):80-93.
50. Wide J, Mok H, McKenna M, et al. Effect of gender socializa-
tion on the presentation of depression among men: a pilot
study. Can Fam Physician. 2011;57(2):e74-e78.
51. Whiteford HA, Buckingham WJ, Harris MG, et al. Estimating
treatment rates for mental disorders in Australia. Aust Health
Rev. 2014;38(1):80-85.
52. Harris MG, Diminic S, Reavley N, et al. Males’ mental health
disadvantage: an estimation of gender-specific changes in ser-
vice utilisation for mental and substance use disorders in Aus-
tralia. Aust N Z J Psychiatry. 2015;49(9):821-832.
53. Baker D, Rice S. Keeping It Real: Reimagining Mental Health
Care for All Young Men. Melbourne (AUS): Orygen, The
National Centre of Excellence in Youth Mental Health; 2017.
54. Twomey C, O’Reilly G, Byrne M, et al. A randomized con-
trolled trial of the computerized CBT programme, MoodGYM,
for public mental health service users waiting for interventions.
Br J Clin Psychol. 2014;53:433-450.
55. Robertson S, White A, Gough B, et al. Promoting Mental
Health and Wellbeing with Men and Boys: What Works?
Leeds (UK): Centre for Men’s Health, Leeds Beckett Univer-
sity; 2014.
56. Fogarty AS, Proudfoot J, Whittle EL, et al. Preliminary evalua-
tion of a brief web and mobile phone intervention for men with
depression: men’s positive coping strategies and associated
depression, resilience, and work and social functioning. JMIR
Ment Health. 2017;4(3):e33.
57. Deady M, Peters D, Lang H, et al. Designing smartphone men-
tal health applications for emergency service workers. Occup
Med (Lond). 2017;67(6):425-428.
58. Movember Australia. Report Cards. Melbourne (AUS): Move-
mber Foundation; c2017 [Cited 2017 July 31]. https://au.move
59. Men’s Sheds Canada. Winnipeg (MB): Canadian Men’s Sheds
Association; [Cited 2017 September 18].
60. Nurmi MA, MacKenzie CS, Roger K, et al. Older men’s per-
ceptions of the need for and access to male-focused community
programmes such as Men’s Sheds. Ageing Soc. 2016 [Cited
2017 September 18]. doi:10.1017/S0144686X16001331.
61. HeadUpGuys | Manage & Prevent Depression in Men. Van-
couver (BC): HeadsUpGuys; [Cited 2017 July 31]. https://head
62. Wang J, Patten SB, Lam RW, et al. The effects of an e-mental
health program and job coaching on the risk of major depres-
sion and productivity in Canadian male workers: protocol for a
randomized controlled trial. JMIR Res Protoc. 2016;5(4):e218.
63. Gross PA, Efimoff I, Lyana P, et al. The DUDES Club: a
brotherhood for men’s health. Can Fam Phys. 2016;62:
64. Smith DT, Mouzon DM, Elliott M. Reviewing the assumptions
about men’s mental health. Am J Mens Health. 2016 [Cited
2017 July 31]. doi: 10.1177/1557988316630953.
65. Va¨rnik A, Ko
˜lves K, van der Feltz-Cornelis CM, et al. Suicide
methods in Europe: a gender-specific analysis of countries
participating in the “European Alliance Against Depression”.
J Epidemiol Community Health. 2008;62(6):545.
66. Man Therapy uses a caricature “Dr. Brian Ironwood” to talk
about men’s problems, with some evidence of impact. Media
Releases. Hawthorn (AUS): Beyond Blue Ltd; c2016 [Cited
2017 July 31].
67. Ettner SL, Xu H, Duru OK, et al. The effect of an educational
intervention on alcohol consumption, at-risk drinking, and
health care utilization in older adults: The Project SHARE
study. J Stud Alcohol Drugs. 2014;75(3):447-457.
68. Babor TF, Higgins-Biddle JC. Brief Intervention for Hazar-
dous and Harmful Drinking: A Manual for Use in Primary
Care. Geneva (CH): World Health Organization; 2001.
La Revue Canadienne de Psychiatrie 7
... Exploring the male perspective on mental health helps identify the effective mental health intervention, issues and barriers, and their coping mechanisms. Bilsker et al. [2] noted that men's mental health is "hidden in plain sight" because they were less likely to express their feelings and emotions for unclear reasons. Baker [3] added that men are reluctant to accept their mental health issues and have their way of expressing their feelings. ...
... Furthermore, psychological expression is uncommon for men [11], and this is associated with the adherence of men to their masculine role, which prevents them from seeking mental health and expressing their feelings [2]. Men tend to control and strive to suppress their feelings and emotions, negatively affecting their mental health [12]. ...
... Breland et al. [13] further showed that men are doubtful to share their emotions and feelings even if they show manifestations of mental problems. The social contract of males is one of the reasons why identifying their mental health status is difficult [2]. This idea accounts for the high prevalence of male mental health issues, with nearly 8,000,000 committing suicides, wherein males have a higher prevalence than females [14]. ...
Full-text available
Background Every person has a persona (or mask) which is the façade that every person shows to the world. Thus, males use façade to reveal or conceal their true feelings and emotions. Also, the male uses mental health façade to protect themselves from prejudice and judgment. Thus, the study aimed to explore the experiences of male Saudi nursing students of mental health. Method Husserl’s descriptive phenomenology was used as a guiding lens to explore. Eleven participants were involved in the study by using the referral sampling technique. An unstructured interview was performed to gather information from the participants. The seven steps of the descriptive Colaizzi process were followed to investigate and examine the obtained data. The credibility, dependability, confirmability, transferability, and reflexivity criteria were observed to ensure the rigor of the study. Results The findings have two major themes. The first theme is the unadulterated smile that describes optimism in the family and mutual guarantee. The second theme is the orchestrated smile, which describes avoiding diverting burdens, social responsibility, protection of self, and reputation. Conclusions The findings document that the mental health façade of male Saudi nursing students is associated with the expectation of family optimism, mutual guarantee, the expectation of society, and self-protection.
... From the papers included in the research, we observed that, while a particular confluence was noted in the authors' findings regarding the higher prevalence of conditions such as substance abuse and disorders related to men's impulsivity, there are questions regarding the lower prevalence of common mental disorders 11,13 . Affleck et al. 13 highlight the discrepancy between the prevalence of depression in men -which is significantly lower than in women -and the incidence of suicide -substantially higher in this populationas a possible indication of the underdiagnosis of depressive disorder and this is because, as pointed out by the authors, most cases of suicide are associated with depression. ...
... The authors argue that men seem to engage in alcohol abuse, exaggerated risk-taking, and violence due to a phenomenon described in psychoanalysis as "acting-out". This reaction is potentially harmful and seems to contribute to mental distress not being recognized by health professionals 11 . Thus, this review shows that the discrepancy between suicide and depression data in men, the possible limitations in recognizing psychological distress, and role-playing behaviors seem to lead to what some authors have pointed out as the "silent crisis" of mental health of men 13 . ...
Full-text available
Resumo Os problemas de saúde mental têm grande relevância sanitária internacional. De natureza multifatorial, tais condições de saúde, aqui consideradas como sofrimentos, são influenciadas, inclusive, por elementos sociais, como a construção da masculinidade, em que pese as críticas e lutas cada vez mais evidentes contra o machismo. Diante deste cenário, este artigo aborda o sofrimento mental masculino e seu cuidado, a partir de uma revisão da literatura, tendo como base a BVS e considerando o período de 2010 a 2020. Foram selecionados 22 artigos. Os resultados do estudo foram organizados em torno das categorias: Características/ Particularidades do sofrimento mental de homens; Acesso/Modo de procura por ajuda de homens em sofrimento e Abordagem/Cuidado de homens em sofrimento mental. Conclui-se haver necessidade de mais visibilidade para a relação entre masculinidade e sofrimento mental e suas especificidades no âmbito do cuidado, considerando a existência de uma aparente crise silenciosa, o direito dos homens (enquanto pessoas) ao cuidado bem como a possível contribuição, ainda que indireta e modesta, da abordagem do sofrimento dos homens para a luta contra o machismo.
... For example, an individual may use humour or seek practical help from others while relying on minimisation or substances to rigidly avoid stress-induced aversive thoughts and emotions. Moreover, some avoidant strategies may be endorsed as traditional masculine-conforming ways of coping with stress and distress (55). For example, qualitative researchers found men's disclosures of depressed feelings (including irritability) may be minimised or dismissed by some mental health professionals who perceive men's alcohol use and efforts to cope independently as expressions of traditional masculinity and lower openness to treatment (56). ...
Full-text available
Individuals cope with stress using multiple strategies, yet studies of coping profiles are rare. We draw data from a longitudinal study of Australian men ( n = 272; 30–37 years), assessed before (T1) and during (T2) a nation-wide COVID-19 lockdown. We aimed to: (1) identify men's multi-strategy coping profiles before and during the pandemic; (2) assess cross-sectional (T1-T1, T2-T2) and prospective (T1-T2) associations between profiles and symptoms of psychological distress (stress, anxiety, depression, and anger); and (3) examine relationships between coping profiles and appraisals of pandemic-related stressors and options for coping. In latent profile analyses of 14 coping strategies, three profiles emerged that were largely consistent across T1 and T2: (1) Relaxed Copers (low use of all strategies), (2) Approach Copers, and (3) Dual Copers (high avoidant and moderate-high approach-oriented strategies). Compared to Relaxed and Approach Copers, men who were Dual Copers had elevated psychological distress cross-sectionally before (T1) and during (T2) the pandemic, but not prospectively. Post hoc analyses suggested this was because many men changed coping profiles in the context of the pandemic. Men with stable (T1-T2) or new (T2 only) Dual Coping profiles experienced greater psychological distress and more negative appraisals of pandemic stressors and options for coping. In sum, at the sample level, the composition of men's coping profiles and associations with mental health risk were relatively stable over time and contexts; however, many men appeared to respond to pandemic conditions by changing coping profile groups, with mostly positive mental health outcomes. Of concern were men who adopted more avoidant strategies (e.g., denial, self-distraction, disengagement, substance use, and self-blame) under pandemic conditions. These Dual Coper men also engaged in commonly observable approach-oriented behaviours (e.g., planning, active coping, humour, seeking practical social support) that may mask their vulnerability to mental health risk. Our findings highlight the clinical importance of enquiring about escalating or frequent avoidant coping even in the presence of more active and interactive approach-oriented behaviours.
Male suicide continues to be a significant issue worldwide for which there are a myriad of social risk factors. Amongst these, distressed and/or disrupted (i.e., separation, divorce) intimate partner relationships are known to heighten men's mental illness and suicide risk. The current qualitative study offers novel insights to the connections between masculinity and mental illness in and after men's intimate partner relationships. Drawing from in-depth interviews with 47 Canadian and Australian men, three themes were inductively derived: 1) The trouble inside, 2) Breaking up and breaking down, and 3) Finding help. The ‘trouble inside’ results revealed relationship transitions wherein challenges to couple dynamics flowed from diverse life course events (conflict, illness, bereavement, co-parenting). Partnership transgressions (most often infidelity) also featured to heighten men's mental illness vulnerabilities and threaten the feasibility of the relationship. ‘Breaking up and breaking down’ chronicled participants' anxiety, depression and suicidality in the aftermath of their relationship ending. Herein, substance use and other maladaptive behaviours were used by men to blunt feelings and/or self-medicate mental illness. These strategies were ineffectual for moving on from blaming partners or grieving the loss of support and social connectedness provided by ex-partners. ‘Finding help’ included men's eventual self-help, uptake of informal assistance from friends and family, formal professional care services, and the use of facilitated male peer group resources. Norming the use of these diverse help resources were men's alignments to strength-based asset-building masculine ideals, wherein their help-seeking was bridged to, and reflective of their (albeit latent) self-reliance and commitment to better managing their mental health and future relationships. Highlighting the gendered dimensions of mental illness in men's intimate partner relationships, the current study also thoughtfully considers content and contexts for the delivery of tailored upstream suicide prevention programs focussed on men building better relationships.
Less than 50% of people with a mental illness use formal mental health services, with service-utilization rates significantly lower in men compared with women, even when controlling for the presence of mental disorder. This underutilization has typically been attributed to harmful masculine norms that lead to a dysfunctional silence and stubbornness among men with mental health issues. However, this monocausal explanation ignores several pertinent factors related to men’s underutilization of mental health services. First, there is a high degree of external stigma in workplaces, the family, and elsewhere that can deter men from using formal mental health services. Second, evidence suggests that the formal mental care system can be unwelcoming and unengaging for men and typically suffers from male gender blindness, with few formal services devoted specifically to men’s mental health. Third, research indicates that there are various modalities of healing, with men often preferring more informal action-based approaches, but these are not readily available in the formal mental healthcare system, which typically proceeds on a “one-size-fits-all” approach. All this has contributed to the growing popularity of informal action-based interventions such as men’s sheds, which are a promising and innovative practice that incorporates many essential elements of a male-friendly approach.
Men experience elevated rates of various mental health issues including suicide, substance use disorder and attention-deficit hyperactivity disorder, as well as lower rates of mental health service utilization. Moreover, men and boys are experiencing increasing difficulties in sectors such as education and employment, with increased risk of low educational attainment and failure to launch. Such difficulties are sometimes narrowly explained with reference to a singular concept – masculinity – without exercising any peripheral vision to examine social context and population-level factors. This narrow approach has tended to unduly dominate the conversation about men’s mental health, and can also verge on victim blaming the affected men. This chapter argues for change, namely, the adoption of a novel public-health inspired approach to men’s mental health, with a focus on distal and proximal social determinants. Such change would involve moving beyond a narrow one-dimensional focus on the concept of masculinity, and would instead focus on population-level factors that negatively affect men’s mental health including: (i) harmful stereotypes of men; (ii) the gender empathy gap; and (iii) male gender blindness. These three concepts are described and illuminated with reference to various examples, including male victims of intimate partner violence, and recent discussions about gender and COVID-19.
Purpose The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. Materials and Methods A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. Results Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. Conclusions Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.
Health technology is changing the way consumers engage with health professionals and their own well-being. Although digital solutions often focus on supplementing physical care, some have potential as an alternative to offline engagements. This research considers how such phygital experiences can promote well-being and social connectedness. Specifically, we explore how online mental health apps help men to engage in well-being discourses, conversations that they would feel unable to have or uneasy about having without the anonymity of the online setting. However, unlike other phygital products, this app can hinder ongoing offline therapy and even deter some men from seeking professional medical help. Data are drawn from an online peer-support forum and interviews with men struggling with mental illness and mental health advocates. The manuscript concludes by recognising the imperative for research furthering understanding of consumption practices associated with poor mental health and marketing practices that promote mental well-being.
Background: The COVID-19 pandemic has brought about enormous impacts on people's lives. Insights garnered through deductive efforts to understand and document these impacts are needed in order to optimise ongoing responses to the pandemic and inform disaster preparedness efforts for the future. Objective: This study sought to examine the psychosocial impacts of COVID-19 with a sample of Australian adults. Methods: Data analysed were derived from a larger cross-sectional survey of Australian adults that was collected during the month of May 2020. Participants (n=3483) were asked in which ways COVID-19 had most greatly impacted them. Qualitative were analysed using descriptive analyses and Natural Language Processing to determinant participant sentiment towards COVID-19 impacts and compared against the Theoretical Domains Framework to determine the most-frequently impacted life domains. Finally, a multinomial regression analysis, stratified by participant sex, was conducted to identify psychological and demographic socialisations with sentiment towards COVID-19. Results: In total, 3483 participants completed the cross-sectional survey, the majority of whom were female (80.2%, n = 2793). Participants' impact stories were most commonly categorised as neutral (44.3%), followed by negative (32.6%), and positive (23.1). The most frequently-impacted life domains included Behavioural regulation, Environmental context and resources, Social influences, and Emotions, suggesting that the COVID-19 pandemic was impacting these areas of participants' lives the most. Finally, the regression results suggested that for females, lower satisfaction with life as well as higher financial stress was associated with increased likelihood of negative, rather than positive, sentiment (p=<0.05), however, the proportion of variance in sentiment explained was very small (<5%). Conclusions: Participant sentiment towards COVID-19 varied. High rates of neutral and negative sentiment were identified. Positive sentiment was identified but it was not as common. Impacts to different areas of people's lives were identified with a major emphasis on behavioural regulation and related domains such as social influences, environmental context and resources, and emotions. The impacts of COVID-19 are not only health-related but also extend to people's psychosocial wellbeing, behaviours, and relationships with others. Clinicaltrial:
Full-text available
Objectives To examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men. Design Prospective cohort study. Setting Community-based. Participants Men aged 35–80 years at recruitment (2002–2005), randomly selected from the northern and western suburbs of Adelaide, Australia, without depression at baseline, who attended follow-up visits (2007–2010) (n=1464). Primary and secondary outcome measures Depression symptoms were categorised into high burden (total score of ≥13 for the Beck Depression Inventory (BDI) or ≥10 for the Centre for Epidemiologic Studies Depression Scale (CES-D) or low burden (<13 for the BDI or <10 for the CES-D). Diagnosed depression was determined by patient-reported physician diagnosis. Frequent general practitioner (GP) visits were those occurring 5+ times over the preceding year. Use of national medical and prescription services (Medicare Benefit Schedule and Pharmaceutical Benefit Scheme; MBS and PBS) was assessed through data linkage. Results Frequent attendance and depression diagnosis was more common in men with a high than low burden of depression symptoms (45.9% vs 29.3%–18.7% vs 1.9%, p<0.001). Depression diagnoses were also more common in frequent GP attenders compared with low-average attenders (5.1% vs 2.2%, p<0.001). Among men with high burden of symptoms, there was no age-adjusted or multi-adjusted difference for likelihood of depression diagnosis between non-regular and frequent GP attenders. Annualised MBS and PBS expenditure was highest for men with undiagnosed depression. Conclusions Men with a high burden of depression symptoms have commensurate use of health services when compared with those with a low burden, but only half report a physician diagnosis of depression. Undiagnosed depression led to a higher usage of medical and prescription services.
Full-text available
To date, 16 states have passed medical marijuana laws, yet very little is known about their effects. Using state-level data, we examine the relationship between medical marijuana laws and a variety of outcomes. Legalization of medical marijuana is associated with increased use of marijuana among adults, but not among minors. In addition, legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption. Our estimates provide strong evidence that marijuana and alcohol are substitutes.
Full-text available
Background: Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men. Objective: To explore the views of at-risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved. Design: Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation. Setting and participants: A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved. Results: Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services. Conclusion: Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.
Full-text available
Background: Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men's mental health needs are required. Objective: This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. Methods: A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. Results: A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. Conclusions: This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.
Full-text available
Suicide signs have been identified by expert consensus and are relied on by service providers, community helpers’ and family members to identify suicidal men. Whether signs that are reported in suicide literature accurately describe male presentations of suicidality is unclear. A systematic review of the literature was conducted to identify male-specific signs of current suicidality and identify gaps in the literature for future research. Searches through Medline, CINAHL, PsychInfo and the Behavioral Sciences Collection, guided by the PRISMA-P statement, identified 12 studies that met the study eligibility criteria. Although the results generally reflected suicide signs identified by expert consensus, there is little research that has examined male-specific signs of the current suicidal state. This review highlights the need for scientific research to clarify male presentation of suicidality. Implications for future research to improve the prompt identification of suicidal men are discussed.
Full-text available
Although participating in community social programming is associated with positive physical and mental health outcomes for older adults, older men participate less often than women. Men's Sheds is a community programme used primarily by older men that originated in Australia and is well established there. The goal of the current study was to explore men's perceptions of the need for Men's Sheds and issues concerning access to them in Canada, a country with a small but growing Men's Sheds movement. We conducted focus groups with 64 men aged 55 years and older, including Men's Sheds members and men from the community who were unfamiliar with this programme, and analysed the data using the framework analytic approach. The data revealed two primary themes concerning: (a) the need for male-focused community programmes, including the sub-themes reducing isolation, forming friendships and engaging in continued learning; and (b) access to programmes, including the sub-themes points of contact, sustaining attendance and barriers. Findings suggest that in order to reduce the likelihood of isolation and increase opportunities for social engagement, exposure to the concept of male-focused programming should begin before retirement age. In addition, such programmes should be mindful of how they are branded and marketed in order to create spaces that are welcoming to new and diverse members. Copyright © Cambridge University Press 2016 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Full-text available
PurposeMales feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area. Methods We used baseline data from 13,884 men (aged 18–55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables. ResultsAfter controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity—self-reliance—stood out as a risk factor for suicidal thinking (AOR 1.34; 95% CI 1.26–1.43). Conclusions It suggests that one particular element of dominant masculinity—being self-reliant—may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence.
Full-text available
Despite theoretical postulations that individuals' conformity to masculine norms is differentially related to mental health-related outcomes depending on a variety of contexts, there has not been any systematic synthesis of the empirical research on this topic. Therefore, the authors of this study conducted meta-analyses of the relationships between conformity to masculine norms (as measured by the Conformity to Masculine Norms Inventory-94 and other versions of this scale) and mental health-related outcomes using 78 samples and 19,453 participants. Conformity to masculine norms was modestly and unfavorably associated with mental health as well as moderately and unfavorably related to psychological help seeking. The authors also identified several moderation effects. Conformity to masculine norms was more strongly correlated with negative social functioning than with psychological indicators of negative mental health. Conformity to the specific masculine norms of self-reliance, power over women, and playboy were unfavorably, robustly, and consistently related to mental health-related outcomes, whereas conformity to the masculine norm of primacy of work was not significantly related to any mental health-related outcome. These findings highlight the need for researchers to disaggregate the generic construct of conformity to masculine norms and to focus instead on specific dimensions of masculine norms and their differential associations with other outcomes. (PsycINFO Database Record
Full-text available
Background Major depression (MDE) is prevalent in men and affects men’s health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to seek help for emotion and stress-related issues. Therefore, innovative solutions tailored for men are needed. With rapid development of the Internet and information technologies, one promising solution that has drawn considerable attentions is electronic mental (e-mental) health programs and services. Objective The objective of our study is to evaluate the effectiveness of the e-mental health program BroHealth on reducing the risk of having MDE and improving productivity and return to investment. Methods The target population is Canadian working men who are at high risk of having MDE (N=1200). Participants will be recruited using the method of random digit dialing across the country and workplace advertisement. Eligible participants will be randomly allocated into the following groups: (1) a control group, (2) a group receiving BroHealth only, and (3) a group receiving BroHealth and telephone-based job coaching service. The groups will be assessed at 6 and 12 months after randomization. The primary outcome is the risk proportion of MDE over 12 months, which will be assessed by the World Health Organization's (WHO’s) Composite International Diagnostic Interview-Short Form for Major Depression. Intention-to-treat principle will be used in the analysis. The 12-month proportions of MDE in the groups will be estimated and compared. Logistic regression modeling will be used to examine the effect of the intervention on the outcome, controlling for the effects of baseline confounders. Results It is anticipated that the randomized controlled trial (RCT) will be completed by 2018. This study has been approved by the Conjoint Health Research Ethics Review Board of the University of Calgary. The trial is funded by a team grant from the Movember Foundation, a global charity for men’s health. BroHealth was developed at the Digital Emergency Medicine, University of British Columbia, and the usability testing has been completed. Conclusions BroHealth was developed based on men’s needs. We hypothesized that BroHealth will be an effective, acceptable, and sustainable product for early prevention of MDE in workplaces. ClinicalTrial NCT02777112; (Archived by WebCite at
Background: Emergency service workers are often exposed to trauma and have increased risk of a range of mental health (MH) conditions. Smartphone applications have the potential to provide this group with effective psychological interventions; however, little is known about the acceptability and preferences regarding such initiatives. Aims: To describe the preferences and opinions of emergency service workers regarding the use of smartphone MH applications and to examine the impact of age on these preferences. Methods: Participants were recruited from four metropolitan Fire and Rescue NSW stations and responded to questionnaire items covering three key domains: current smartphone use, potential future use and preferences for design and content as well as therapeutic techniques. Results: Overall, approximately half the sample (n = 106) claimed they would be interested in trying a tailored emergency-worker MH smartphone application. There were few differences between age groups on preferences. The majority of respondents claimed they would use an app for mental well-being daily and preferred terms such as 'well-being' and 'mental fitness' for referring to MH. Confidentiality, along with a focus on stress, sleep, exercise and resiliency were all considered key features. Behavioural therapeutic techniques were regarded most favourably, compared with other therapies. Conclusions: Emergency workers were interested in utilizing smartphone applications focused on MH, but expressed clear preferences regarding language used in promotion, features required and therapeutic techniques preferred.
Objective: While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression. Methods: PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender. Results: The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges’s g = 0.26 [95% confidence interval (CI), 0.11–0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47–0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = −0.20 [95% CI, −0.33 to −0.08]), appetite disturbance/weight change (g = −0.20 [95% CI, −0.28 to −0.11]), and sleep disturbance (g = −0.11 [95% CI, −0.19 to −0.03]). Conclusions: Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.