Open Access
Feature Article

Recognition and management of depression in men

Open Access
Feature Article

Recognition and management of depression in men

ZAC E. SEIDLER, SIMON M. RICE

Figures

© anthony mujica viera/ stock.adobe.com model used for illustrative purposes only
© anthony mujica viera/ stock.adobe.com model used for illustrative purposes only
Dr Seidler is a Clinical Psychologist and Research Fellow at Orygen in the Centre for Youth Mental Health, University of Melbourne; and Director of Mental Health Training at Movember. Associate Professor Rice is a Clinical Psychologist and Principal Research Fellow at Orygen in the Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic.

Abstract

Although men have apparently lower rates of depression than women, their high rates of suicide, substance misuse and physical violence point to an undercurrent of distress. GPs can help their male patients with depression by recognising externalising symptoms  such as anger, substance misuse and risk-taking, leveraging men's strengths, broadening their mental health literacy and building a collaborative therapeutic relationship.

Key Points

  • Although prevalence rates indicate men are less likely than women to experience depression, the difficulty of reaching, recognising and retaining men with depression in treatment may explain much of this difference.
  • Given men may experience and express depression through externalising symptoms (e.g. anger, substance use, risk-taking), detecting, discussing and normalising these manifestations of distress may be useful.
  • Building collaborative, trusting and transparent doctor-patient relationships may help men to understand and communicate their mental health difficulties.
  • Clarifying and demystifying mental health treatment pathways and men’s expectations may further catalyse recovery from depression.

Depression is the most common mental disorder and a leading cause of disability worldwide.1 In Australia, major depressive disorder is reported to affect about one in eight men across their lifetimes, compared with about one in six women.2 Although these statistics suggest men have greater resilience against depression than women, the vast majority of suicide deaths in Australia are in men (76%), and men have high rates of substance misuse and physical violence.3,4 This suggests an undercurrent of distress requiring intervention in men. 

In the common narrative, the discrepancy between men’s reported depression rates and negative outcomes is due to men not seeking help. However, no single factor appears responsible; rather, a complex interplay of factors related to men’s help-seeking pathways is implicated.5 Importantly, many of these factors are ripe for targeted intervention by GPs. 

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This article discusses barriers to care for men with depression and how to overcome them. It presents resources and tips to help GPs identify and manage male patients with depression, including improving their mental health literacy and building a collaborative therapeutic relationship with men with depression or suicidality. 

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Men's help-seeking 

If we are to intervene effectively in men’s depression, we must first be able to detect it. Even when men manage to overcome barriers to care, there is often a lengthy delay in their help-seeking.6 Some adopt a ‘wait and see’ approach and reach out only when their symptoms are severe, risk is high and crisis intervention becomes necessary.7 The ramifications of undetected and untreated depression among men are long term. Increasing hopelessness and withdrawal negatively impact on work productivity and attendance, social functioning and family wellbeing.8

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