Better Outcomes For Men
Australian males are diverse in age, social and economic circumstances, culture, language, and levels of education. Beliefs about themselves and others influence health behaviours, health outcomes, exposure to risk factors, and access to healthcare. Major depression is twice as prevalent in women than in men and severe depression is known to significantly increase risk of suicide. Despite depression being identified more frequently in women, men have worse health outcomes overall, an increasing life expectancy gap, are more likely to have disrupted personal relationships, substance use disorders, experience social isolation, and they are 3 to 4 times more likely to die by suicide. All before considering any intersecting complexities of ethnicity, disability, sexuality, lower educational attainment, and socioeconomical disadvantage, associated with poorer outcomes.
If we are to work well with men experiencing depression, we first have to be better at detecting it.
The validity of sex specific presentations seems to come into question often and debate in this arena can become politically charged. Neglecting sex based research though can obscure phenomenology and maintain the status quo by adhering to current approaches. These current approaches to diagnosis emphasise persistent sadness, loss of interest or pleasure in previously enjoyed activity, as well as changes in affect, cognition, and overall function. Most recent research into depression amongst males demonstrates an externalising set of symptoms divergent from our current understanding of depression with many men expressing depression through emotion suppression, anger and aggression, substance use, somatic complaints, and an increase in risk taking behaviours. The stereotype of men not asking for help is gradually being written out of the research as a false assumption; indeed, they do seek help, they just do it differently and report symptoms we are only just starting to give the right amount of attention to.
The experiences of depression in men contradict many elements of masculine socialisation and frequently may lead to the labelling of masculinity as ‘toxic’; a particularly accepted narrative within mainstream media. In the research space though, we see the truth of this is much more complex, with many of the same masculine norms shown to be protective in health engagement. The evidence suggests then that to encourage men at the first point of contact, we should be aiming to leverage these norms, not label and dismiss them as simply maladaptive risk factors.
General Practitioners as primary care are best placed to understand, recognise, and leverage masculine beliefs to attain better outcomes for men and are instrumental in change. In my own research of both urban and rural, under review, 90% of all male respondents had seen their GP within the prior 12 months. Where men recognise their own experience as depression, they may hold beliefs that label their experience as a fight, a weakness, or by emphasising a personal failing.
Leveraging masculine norms in this case may reframe help-seeking as courageous, honourable, or the harder choice requiring greater strength.
How can we work together to help men?
Be curious and aware of our own biases that shape responses to men’s help seeking.
Mirror and reflect their language, avoid clinical or diagnostic reframing.
Manage expectations and invite reflection on help-seeking beliefs and internalised stereotypes.
Acknowledge the difficulty of overcoming stereotypes and socialisation that often shape men’s beliefs.
Acknowledge beliefs about relinquishing control and accepting vulnerability as the greater difficulty requiring courage and strength.
Promote treatment seeking as a strength based, action-oriented process.