MEN'S MENTAL HEALTH
Bethany Shouk examines current research on men’s mental health and explores what directions future research should take.
Currently, Mental Health Awareness Month is in full swing - providing everyone with the opportunity to improve our understanding of mental health-related issues, reduce stigma, and perhaps to take more care of our own mental wellbeing. The global pandemic has forced us to take a closer look at mental health, with the prevalence of mental illnesses showing a sharp increase from 18.9% in 2018-19 to 27.3% of UK the population in April 2020.(1) With more people than ever facing difficulties with mental health, improving mental health education, access and attitudes is more important now than ever. Additionally, it’s commonly known that more women than men struggle with mental health issues; one in five women and one in eight men are diagnosed with a common mental illness such as anxiety and depression (2), implying women are more susceptible to developing psychopathologies. However, these statistics can only get us so far in understanding the true landscape of mental health.
From the diagnostic rates, more women than men appear to be struggling. However, a number of statistics paint a more complex picture of the state of men’s mental health. Men are three times more likely to commit suicide compared to women, although both sexes are equally likely to attempt. (3) Looking at the discrepancy between men’s diagnoses and suicide statistics implies the rates of common mental health disorders, especially depression, are underestimated. The statistics seem limited and only able to capture individuals who seek treatment.
The discontinuity between male suicide rate and male prevalence of mental health issues gives us insight into how seeking help for psychological therapies may be particularly hard for men. They’re less likely to access psychological therapies: only 36% of NHS referrals for talking therapies are from men.(4) In addition to the professional help-seeking discrepancy, men are also less likely to disclose a mental health problem to friends and family compared to women. (5) With fewer men than women seeking support professionally and in their personal lives, ‘missed cases’ and suicide appears to be more common among men.
In the face of this bleak picture, the reasons behind men’s greater resistance to reach out has received much research attention in recent years. A Priory commissioned survey on 1,000 men revealed several reasons men don’t talk about their mental health. The most common of these was that they’d learnt to deal with it (40%), followed by not wanting to be a burden on anyone (36%), being too embarrassed (29%) and feeling there was a negative attitude towards opening up about their problems (20%). Additionally, 22% of the people surveyed reported they’d feel uncomfortable speaking to a professional about their mental well-being (6). Looking at these figures, men seem to not seek support, despite the majority of the sample reporting that their mental health problems negatively impacted their work, parenting abilities and relationships. A common theme appears to be shame experienced around their mental health struggles such as not wanting to burden others or feelings of embarrassment, although similar feelings are also found in women.
Further work on why men underutilize mental health services in the UK was investigated with an online sample of men who completed various questionnaires assessing multiple suspected reasons.(7) Traditional masculine ideology has been linked with reluctance to seek help, such as men expressing attitudes that they ‘should’ be reluctant to seek help.(8) Another factor addressed in this study was alexithymia - the inability to identify and describe emotions in the self and others. Lastly, the study also looked at fear of intimacy. Men who scored highly on all three of these factors reported more negative attitudes towards seeking professional psychological help with alexithymia fully mediating the effect of fear of intimacy. More educated men were also more likely to report more positive attitudes towards help-seeking, which may be explained by having access to more education surrounding mental health.
The current research suggests traditional Western standards of masculinity, such as being stoic and strong, act as a barrier in help-seeking for mental health related issues. For men, feeling ‘weak’ due to struggling with their mental health may be more embarrassing or taboo than for women, leading to underdiagnosis and undertreatment. Another contributing element may be alexithymia, referring to troubles in understanding oneself emotionally. A lack of emotional literacy may be directly linked to reduced help-seeking, with more men than women being unable to describe or understand their emotional experiences which may act as another barrier to confiding in a professional or a close other.
A more detailed look into the reasons why men deter from seeking assistance found that normalization around help-seeking for mental health problems was key for men to share their experiences with their peers.(9) The role of a significant other encouraging help-seeking was also identified as a significant enabler of more help-seeking behaviours. Sharing mental health concerns as a group norm is needed for men to openly discuss mental health problems - implying men critically need to feel at ease with disclosing issues before discussing them. The study also examined the role of high-profile sportsmen, thought to epitomize the masculine ideal, and their public admission of mental health help-seeking. This also had a positive impact on men’s attitudes and help-seeking behaviour. This may have neutralized their feelings of shame, guilt and embarrassment around mental health by promoting the normalization of mental health issues and breaking down the barriers between men and seeking treatment. Male celebrities are role models for men and may therefore be especially effective in reforming men’s perceptions of masculinity in relation to help-seeking, that illness and treatment doesn’t take away their masculine identities.
Promoting men to seek help and improve their mental wellbeing requires interventions which specifically target men as a demographic and appeals to their specific set of barriers towards treatment. In this sense, finding ‘what works’ for men will be key in men getting the help they deserve. Settings that promote safe male spaces which act to promote trust, reduce stigma and normalize men’s engagement in interventions have been found to ‘work’ in improving attitudes and disclosing for men. (10) In addition to this, using ‘male-sensitive’ language in line with traditional ideals of male identity such as ‘struggling with’ or ‘battling against’ rather than ‘feeling sad or depressed’ facilitated men’s engagement, positive expressions of emotions and provided a basis for open communication.
Some key facets of promoting men’s mental health awareness and utilization of services from the research appear to consist of appealing to the male identity, such as high-profile sportsmen’s public candour with their own mental health help-seeking and use of male-sensitive language. This highlights the importance of creating a mental health message which resonates specifically with men. More work using male-specific language to improve their mental health could be accomplished by framing the mental health journey from illness to health with words such as ‘strong’, ‘brave’ or ‘resilient’, more consistent with a masculine identity but potentially also helpful for the general population. Furthermore, the same strategy of group-specific targeting of mental health education and awareness campaigns has potential for fruitful interventions in the future if applied to other groups such as gay men or women who face specific barriers and concerns with regards to mental health. All in all, inroads into understanding men’s mental health have provided men with more tools to maintain their own mental well-being and have chipped away at the shame men especially experience when it comes to mental illness.
Although the current research on men’s mental health have been fruitful in generating new ways to tackle men’s mental ill-health, there are important caveats. Currently, the prevalence for depression among gay men is three times the general population risk, with 21% of gay and bisexual men reported being depressed within the last 12 months (11). Research has also suggested that there may be systematic biases against men specifically in the diagnosis of depression. Men’s symptomology of depression involves more drug/alcohol misuse, risk taking and poor impulse control more so than depressed women, which is not reflected in current diagnostic tools. (13) This may contribute to men be underdiagnosed compared to women – revision of the diagnostic criteria may help capture at-risk people.
To conclude, men’s mental health appears to be receiving the attention it rightly deserves and fascinating insights have been discovered as to why the barrier between men and mental health help exists. Future research should aim to look at gay men, a particularly at-risk group, and apply the same group-specific research and campaigns to help these communities.
Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., . . . Abel, K. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet. Psychiatry, 7(10), 883-892.
C. Deverill and M. King (2009), ‘Common mental disorders’, in Adult Psychiatric Morbidity Survey
Sullivan, L., Camic, P., & Brown, J. (2015). Masculinity, alexithymia, and fear of intimacy as predictors of UK men's attitudes towards seeking professional psychological help. British Journal of Health Psychology, 20(1), 194-211.
Harding, C., & Fox, C. (2015). It’s Not About “Freudian Couches and Personality Changing Drugs”: An Investigation Into Men’s Mental Health Help-Seeking Enablers. American Journal of Men's Health, 9(6), 451-463.
Robertson, S., Gough, B., Hanna, E., Raine, G., Robinson, M., Seims, A., & White, A. (2018). Successful mental health promotion with men: The evidence from ‘tacit knowledge’. Health Promotion International, 33(2), 334-344.
Lee, C., Oliffe, J., Kelly, M., & Ferlatte, O. (2017). Depression and Suicidality in Gay Men: Implications for Health Care Providers. American Journal of Men's Health, 11(4), 910-919.
Cavanagh, Anna, Wilson, Coralie J., Kavanagh, David J., & Caputi, Peter. (2017). Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis. Harvard Review Of Psychiatry, 25(1), Harvard review of psychiatry. Volume 25:Issue 1 (2017).