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.

For GPs, setting expectations so that your male patient enters treatment prepared is key. Never overestimate men’s knowledge of the mental health system, which is foreign and uncomfortable for many. The basics to cover include:

  • cost (e.g. how the Medicare rebate works)
  • duration (e.g. psychological treatment can vary significantly in length depending on the presenting problem and severity)
  • the mechanics of therapy and treatment options (e.g. the difference between cognitive behavioural therapy [CBT] and acceptance and commitment therapy [ACT])
  • questions they can and should ask their therapist (e.g. how will I know if I am making progress?).

Follow up 

Finding opportunities to check in with patients early in the treatment process, and reassuring them of their options if the chosen therapist does not meet their expectations, may help prevent negative outcomes. If a male patient navigates all the barriers to seeing their GP, from initially disclosing their distress to gaining a referral and attending a session with a therapist, this effort and openness for change should be leveraged for therapeutic advantage. 

The importance of the GP-patient relationship

GPs are often termed ‘gatekeepers’ when it comes to men’s mental health: the initial and often instrumental point of contact where men might disclose their concerns for the first time. A recent study of over 2000 help-seeking men showed that about half found a mental health practitioner (e.g. a psychologist) through their GP.27 The stereotype that men do not seek help is gradually being disproven, with recent research highlighting that almost half of men studied who were experiencing severe depressive symptoms saw their GP five or more times in the past year, with over 90% of all men in the study seeing their GP once in the year.28

Advertisement

Connecting with suicidal men

There is a unique opportunity for GPs to connect with, understand and effectively transition men who seek help into the broader mental health system. Nonetheless, pressure remains for GPs to act as a ‘one stop shop’ for mental health care, even though this often exceeds the time and resources available. Worryingly, but not unexpectedly, studies have shown that GPs are often the last help-seeking service that people visit before suicide.29 A possible explanation is the finding that men do not volunteer suicidal thoughts to GPs if not directly asked, again reinforcing the need for an open, honest and trusting relationship.30 

We encourage GPs to practice having frank conversations with patients about potential suicidal thoughts and also to avoid assuming that help-seeking men will offer up the full extent of their distress voluntarily. In addition, although distress remains the leading risk factor for suicidality in women, common situational stressors are uniquely important to suicidality in men, including relationship breakdown, financial insecurity and job loss. These events often interact with a male patient’s identity, self-worth and purpose, and may trigger suicidality even in those with no history of mental health difficulties. 

Advertisement

Tips for working alongside a male patient with suicidality are shown in Box 4. Having a conversation about suicidal thoughts or behaviours with your male patients may be helped by a robust doctor-patient relationship. A shared understanding and openness have specific importance in the context of men’s mental health, given the possible challenges surrounding mistrust. Research suggests that the more a man feels that their GP cares for and understands them, the more motivated they will be to pursue treatment for depression, whether pharmacotherapy or talk therapy.31