The role of masculinity
The experience of depression fundamentally contradicts many core elements of ‘traditional’ masculinity.7,9 Some men view and interpret depressive symptoms as signs of personal weakness and failure, and as in direct opposition to socialised attitudes that men should remain stoic, invulnerable and emotionally restricted.10 As a result, the act of seeking help for depression presents internal conflicts for many men, where admitting to their experience of psychological distress is akin to relinquishing control, self-reliance and independence.11 By contrast, refusal, avoidance or denial of the need for treatment is often aligned with a perceived strength of masculine character.7
Leveraging men’s strengths
The reframing of mental health help-seeking as a courageous and honourable act is often needed to improve men’s willingness to access services.12-14 Men themselves often describe the act of redefining strength by figuratively ‘fighting’ their depression and drawing on a sense of personal responsibility to reshape their help-seeking narrative.7,15,16 As such, the masculine traits that in one context can be harmful to men can be used to their advantage through tailored intervention.12,17 Some support groups that ‘go to where men are’, building on male-oriented activities and language, are listed in Box 1.
Mental health literacy
If we want to help men accept that depression is an issue worthy of intervention, it is essential to build up their ability to understand, recognise and communicate their mental health problems, known as mental health literacy.18 Men are reliably found to have poorer overall health literacy than women, with a lack of practice and feelings of fear or mistrust, stigma and shame all potentially playing a role.19,20 This manifests in some men presenting with nonspecific symptoms and brief, indirect descriptions of their internalised experience.
Importantly, gender differences in mental health literacy are not due to an emotional deficiency in men. Rather, mental health literacy requires time and effort to cultivate in a safe and trusted space.21,22 Global movements such as Movember aim to bring mental health conversations into men’s lives and show how and why having these conversations with friends and family can be life-saving.23
Some strategies to encourage your male patients to think differently about their mental health are shown in Box 2. Resources to suggest to your male patients to improve their mental health literacy and understanding and communicating about their mental health are listed in Box 3.
As more men present to their GP seeking mental health advice or specialist referral for ongoing treatment, there is potential that they will not be fully engaged by care from a mental health practitioner. Our recent study of 1907 Australian men who sought mental health help found that 45% dropped out of treatment prematurely without communicating with their clinician, and 27% of these men accessed therapy once and did not return.24 Importantly, therapy dropout typically occurs after the first or second session of psychological treatment. An unsatisfying experience can have detrimental ramifications for future disclosure of distress, as the patient may lose trust in the health system and see this outcome as confirming their own prognostic pessimism or ingrained doubt in help-seeking.25,26