Depression: It’s different for men

CrossCurrents

Walter never admitted he was mentally ill, even after being hospitalized seven times in four years. He had a steady job at the General Motors plant in Oshawa, Ontario. He was happily married, with a son. But in the late 1990s, Walter began showing serious signs of mental instability. “He didn’t want to talk,” recalls his wife, Christine. He always said, ‘I’m fine.’” Walter blamed physical ailments and job-related stress for repeated hospital visits. But clearly, Walter wasn’t fine on the day in November 2002 when he walked into the path of an oncoming train, ending his life at age 49.

Walter’s story reflects a perplexing reality: While depression is more common in women than men, men die by suicide at four times the rate of women, according to Health Canada. It’s a tragic paradox: Depression, after all, is one of the strongest risk factors for suicide, says Dr. John Ogrodniczuk, an assistant psychiatry professor at the University of British Columbia.

The relationship between men’s low rate of reported depression and high suicide rates raises questions about men’s beliefs, their mental health “literacy” and behaviours and how they experience depression. Ogrodniczuk and John Oliffe, an assistant professor in the Department of Nursing, are examining these issues. The goal of the research, the first of its kind in Canada, is to “better understand how men experience and express depression in order to improve our detection of depression among men,” says Ogrodniczuk.

The researchers have recently completed a small pilot study and plan to soon launch a province-wide study. Gender stereotypes and narrow medical definitions might partly explain the paradox. Men are conditioned to be robust, uncomplaining and strong. Acknowledging any kind of perceived weakness, like depression, may be difficult.

The few studies of male depression that exist suggest that male depression may go undiagnosed because it may look different. “Researchers and clinicians are questioning whether the traditional signs of depression like crying and sadness accurately represent men’s experience” says Ogrodniczuk. “Depression in men may be masked by behaviours like overworking, irritability, substance abuse and promiscuity.”

A study on “hidden depression” in men, published in a 2005 issue of the Australian and New Zealand Journal of Psychiatry, found that depressed men were more likely than women to engage in risk-taking and antisocial behaviour such as fighting, multiple random sexual encounters, gambling, drunk-driving and substance abuse. The very nature of therapy itself, particularly its reputation as a confessional, “touchy-feely” process, might make men reluctant to seek help. “Stereotypical male traits such as difficulties with identifying and speaking about emotions, admitting vulnerabilities and being comfortable with emotional intimacy can complicate the therapeutic process,” says Ogrodniczuk. Making therapy “male-friendly” might be a good way to get more men into counselling, says Dr. Chris Kilmartin, a psychology professor at the University of Mary Washington in Fredericksburg, Virginia.

Instead of focusing on self-confession and feelings, therapists should encourage male clients to tell stories and anecdotes. “Men are good at story-telling,” says Kilmartin. “You get them to tell stories, then you highlight emotional themes in those stories.” Kilmartin also advises patience, understanding and recognition of “how difficult it is for men to ask for help and engage in the therapeutic process.” Ogrodniczuk and Oliffe hope findings from their research will lead to gender appropriate treatment approaches that may include workshops, coaching, mentoring or online chat rooms and support.

But before therapy can begin, men must acknowledge they need help, as Walter’s wife, Christine, knows too well. For Walter, “depression seemed extremely personal,” she says. However, with new insights gleaned from research into men’s depression, perhaps the personal will become public, raising awareness and breaking down barriers to help and support.

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