Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men

Evaluation of male-specific psychoeducation for major depressive disorder compared to cognitive behavioral therapy psychoeducation: A randomized controlled investigation in mentally distressed men

Background: Research suggests that male-specific psychotherapy approaches for major depressive disorder (MDD) that consider traditional masculinity ideologies (TMI) may achieve improved treatment efficacy and reduced therapy dropout. However, studies examining male-specific psychotherapy for MDD or specific therapy aspects remain lacking. Methods: An anonymous online study on men's mental health examined 152 self-reporting mentally distressed cisgender men (Mage = 25.5 ± 9.1) from German-speaking countries of Europe. After completing baseline assessments (T1) of state self-esteem, state shame, positive/negative affect, depressive symptoms, and TMI, men were randomly assigned to read either a male-specific (MSP) or a cognitive behavioral therapy-oriented (CBT) psychoeducation text for MDD. Immediately afterwards, participants rated its usefulness and completed follow-up assessments (T2). Results: Men in the MSP condition showed a stronger decrease in shame and negative affect as compared to men in the CBT-psychoeducation condition. Furthermore, in the MSP condition, prototypical depression symptoms tended to increase as compared to the CBT-psychoeducation, whereas male-typical externalizing depression symptoms tended to decrease. Conclusion: MSP for MDD may help depressed men feel less ashamed about their MDD and experience less negative affect about their condition than CBT-psychoeducation. Furthermore, MSP for MDD may elicit a shift from male-typical externalizing depression symptoms to prototypical depression symptoms.

Exploring the Role of Discrepancy Stress and Muscle Dysmorphia in the Association Between Gender Role Discrepancy and Masculine Depression in Israeli Men

Guided by the dynamic model of masculinity and men's psychopathology, the current study aimed to explore the mediating role of masculine discrepancy stress and each of the muscle dysmorphia dimensions (drive for size, appearance intolerance, and functional impairments) in the association between masculine gender role discrepancy and masculine depression. For the present study, 936 Israeli men completed a structured self-report questionnaire. Masculine discrepancy stress and some of the muscle dysmorphia dimensions were found to partially mediate the association between masculine gender role discrepancy and masculine depression. The findings demonstrate how the internalization of social gender expectations and men's gender role discrepancy is reflected in the gap between perception of self and the typical man, which is eventually related to mental health outcomes. In turn, men attempt to mitigate the stress through what they perceive as masculine, reflecting muscle dysmorphia: drive for size, appearance intolerance, and functional impairments, which in turn predict masculine depression. Therefore, mental and physical health professionals are advised to be aware of these mechanisms, in order to recognize the negative mental health outcomes arising from traditional societal gender role expectations and provide specific solutions for them.

Assessing age invariance of the Male Depression Risk Scale-22 in younger and older adult males

OBJECTIVES

Women are twice as likely to be diagnosed with major depressive disorder as men. Yet suicide rates are four times higher in men than women, increasing to six times when comparing older men to older women. Investigators have begun researching if depression presents differently in individuals who adhere to masculine norms, leading to the conceptualization of masculine depression. Despite validity evidence for the Male Depression Risk Scale-22 (MDRS-22) in mixed-age samples, few studies have investigated the possibility of age-related differences in masculine depression. The present study aimed to test for age invariance of the MDRS-22.

METHOD

Age invariance for the MDRS-22 was tested via a multi-group confirmatory factor analysis with groups of younger (18-64 years) and older (65+ years) males (N = 469).

RESULTS

Age invariance for the MDRS-22 was not established, ΔX2 = 451.47, Δdf = 16, p < 0.001.

CONCLUSION

Results of the study indicate that masculine depression may present differently between younger and older men. To fully understand the construct of masculine depression, it is important to investigate how symptoms may present in individuals of all ages. Overall, the study highlights the importance of investigating how masculine depression may present differently in older men.

Adherence to Masculinity Norms and Depression Symptoms Among Israeli Men: The Moderating Role of Psychological Flexibility

Being a man has been recognized as a salient risk factor for suicide. Adopting uncompromised masculine perceptions (i.e., conforming to the masculine gender role norms) may restrict emotional expressiveness in men, which, in turn, may contribute to depression and somatization symptoms. We examined the moderating role of psychological flexibility and alexithymia in the relationship of masculinity with depression and somatization symptoms. A sample of 119 men completed measures of masculinity, alexithymia (difficulty identifying and delivering subjective feelings), psychological flexibility, depression, and somatization symptoms in a cross-sectional design study. Psychological flexibility levels moderated the relationship between masculinity and depression symptoms: Masculinity contributed as positively associated with depression symptoms when psychological flexibility was low, but no such association was found at moderate or high levels of psychological flexibility. As a cognitive factor promoting adaptive emotional regulation, psychological flexibility might reduce depression symptoms among inflexible masculine men. Clinical implications relate to diagnosing at-risk subgroups and their treatment.

TaKeTiNa Music Therapy for Outpatient Treatment of Depression: Study Protocol for a Randomized Clinical Trial

BACKGROUND/OBJECTIVES

Depression is a prevalent and debilitating illness that significantly affects psychological and physical well-being. Apart from conventional therapies such as psychotherapy and medication, individuals with depression often lack opportunities for activities that are generally perceived as enjoyable, such as music, meditation, and arts, which have demonstrated therapeutic effectiveness. TaKeTiNa music therapy has been employed as a therapeutic intervention for more than two decades. However, there is a notable absence of well-designed clinical trials investigating its antidepressant effects, a gap we aim to address in our current study. Furthermore, shifts in the progression of depression may manifest both psychologically, by influencing emotional states, and physiologically, by leading to alterations in lipid and sphingolipid metabolism, cortisol levels, and immune system function. Our study seeks to analyze the impact of TaKeTiNa music therapy on both levels.

METHODS

This is a prospective monocentric randomized waitlist-controlled clinical trial. It investigates the influence of TaKeTiNa music therapy on patients with major depression in an outpatient setting. Therefore, interested persons are randomly assigned to two groups, an intervention group or a control group, after completing a screening procedure. The intervention group starts with an eight-week TaKeTiNa music therapy intervention. The waiting group receives the same therapy program after completing the follow-up period. Blood and saliva sampling as well as responses to questionnaires are obtained at specific time points.

DISCUSSION

Our study investigates the effects of TaKeTiNa music therapy, a non-pharmacological antidepressant treatment option, on depressive symptoms. We also address functional and causal immunological changes; hormonal changes, such as changes in cortisol levels; and metabolic changes, such as changes in serum lipids and sphingolipids, during the course of depression. We expect that this study will provide evidence to expand the range of treatment options available for depression.

Australian men's help-seeking intentions for anxiety symptoms: The impact of masculine norm conformity and gender role conflict

Research highlights a discrepancy between the number of men experiencing mental illness and those seeking professional help, particularly for anxiety. Conformity to masculine norms (CMN) and gender role conflict (GRC) have been recognised as barriers to men's mental health help-seeking, but few studies have examined these relationships for anxiety. This study aimed to examine the relationship between anxiety severity and help-seeking intentions in Australian men, and the additional impact of CMN and GRC. A total of 610 Australians aged 18-89 years (M = 46.02, SD = 17.14) participated in an online survey, which included demographic information and four standardised questionnaires measuring anxiety, help-seeking intentions, CMN, and GRC. CMN but not GRC was found to fully mediate the relationship between anxiety severity and anxiety-related help-seeking intentions. The results have theoretical implications for the study of masculinity and clinical implications for therapeutic approaches for men with anxiety symptoms.

Does risk-taking or alcohol misuse mediate the association between anger and suicidal ideation in male depression?

Anger is among the core symptoms in male-specific inventories of depression and has consistently been linked with suicidal ideation. In this study, we assessed whether this link may be mediated via other prominent symptoms of depression in men, namely risk-taking and alcohol misuse. We used self-reported data from 322 men responding to a 3-wave survey over 6 months. Regression with mediation analysis was employed to test whether anger at baseline predicted suicidal ideation six months later through the mediating effects of risk-taking or alcohol misuse at 3 months. We found a statistically significant indirect effect (indicating a mediation effect) of anger at baseline on suicidality at 6-months follow-up through risk taking at 3-months follow-up (effect = 0.007, SE = 0.003, 99% Confidence interval = 0.0002 to 0.0161). Anger at baseline was not significantly associated with alcohol misuse at 3-months follow-up (β = .062, t = 0.919, p = .358), thus nullifying alcohol misuse as a possible mediator between anger and suicidal ideation. In conclusion, the results of this study suggest that risk-taking, but not alcohol misuse, may be a mediator between anger and suicidal ideation in the context of male depression. If these results are replicated, assessing anger and risk-taking may inform monitoring of suicidality. Also, anger and risk-taking may be promising targets for treatment aimed at reducing the risk of suicide.

Masculine depression and its problem behaviors: use alcohol and drugs, work hard, and avoid psychiatry!

The gender role influences vulnerability to mental illness. Substance use, even critical in scale, is perceived as masculine, just like hard (over-)work, while not seeking help. With the ongoing separation between gender and sex, masculine norms become more relevant also to females' mental health. The male depression concept highlights the role of male symptoms in affective disorders. However, the empirical evidence is still limited. Here, we use the denomination 'masculine depression' to open the category for female patients and tested substance use patterns, health services' utilization, and working hours as predictors in a case-control study of 163 depressed in-patients (44% women; masculine vs. non-masculine depression according to a median split of the Male Depression Rating Scale-22) and 176 controls (51% women). We assessed higher depression severity in patients with masculine (vs. non-masculine) depression. Masculine depression (vs. non-masculine depression and vs. no depression) was predicted by more frequent and critical use of alcohol (including binge drinking), tobacco, and illicit drugs, and by longer working times. Moreover, fewer health services contacts due to mental complaints during the previous year were associated with masculine (vs. non-masculine) depression. Alarmingly, even critical substance misuse was not significantly associated with more frequent health services contacts; however, the higher the depression severity, the more contacts the patients reported. Here, we provide evidence that patients with masculine depression are highly burdened and undertreated, which applies equally to female and male patients. This study identified promising targets to establish specialized care offers.

Associations between unintended fatherhood and paternal mental health problems: A systematic review and meta-analysis

BACKGROUND

Unintended pregnancies are linked to adverse parental mental health, yet little attention has been given to this relationship in fathers specifically. We aimed to meta-analyse associations between unintended pregnancies and mental health problems in fathers with children aged ≤36 months.

METHODS

We conducted keyword searches of Medline, CINAHL, Academic Search Complete, PsycInfo and Embase to February 2, 2022, and hand searched included reference lists.

RESULTS

Of 2826 records identified, 23 studies (N = 8085 fathers), reporting 29 effects, were eligible for meta-analysis. Included studies assessed depression, anxiety, stress, parenting stress, post-traumatic stress disorder (PTSD), alcohol misuse and psychological distress. Pooled estimates, from random effects meta-analyses, for all mental health outcomes (k = 29; OR = 2.28) and depression only (k = 19; OR = 2.36), showed that the odds of reporting mental health difficulties were >2-fold higher in men reporting unintended births compared with those reporting intended births. However, there was no evidence of association with anxiety (k = 2) or stress (k = 2). Overall, mental health problems were greater in low-income countries. No differences were found across parity, timepoint of mental health assessment, or instruments used to measure mental health symptoms.

LIMITATIONS

Analyses were limited by the use of retrospective assessment of pregnancy intention, and heterogeneity of measures used. Further, assessment of fathers' mental health was restricted to the first year postpartum. This review was limited to English language studies.

CONCLUSIONS

Unintended pregnancies present an identifiable risk for postpartum mental health problems in fathers.

Examining the predictive potential of depressed mood and alcohol misuse on risky driving

AIMS

Male driving while impaired (DWI) offenders are at heightened risk for engaging in risky driving. Males in a depressed mood are also more prone to alcohol misuse, which may further contribute to risky driving. This manuscript investigates the predictive potential of combined depressed mood and alcohol misuse on risky driving outcomes 3 and 9 years after baseline in male DWI offenders.

METHODS

At baseline, participants completed questionnaires assessing depressed mood (Major Depression scale of the Millon Clinical Multiaxial Inventory-III), alcohol misuse (Alcohol Use Disorders Identification Test), and sensation-seeking (Sensation Seeking Scale-V). Risky driving data (Analyse des comportements routiers; ACR3) were collected at follow-up 3 years after baseline. Driving offence data were obtained for 9 years after baseline.

RESULTS

There were 129 participants. As 50.4% of the sample were missing ACR3 scores, multiple imputation was conducted. In the final regression model, R2 = 0.34, F(7,121) = 8.76, P < 0.001, alcohol misuse significantly predicted ACR3, B = 0.56, t = 1.96, P = 0.05. Depressed mood, however, did not significantly predict ACR3 and sensation-seeking was not a significant moderator. Although the regression model predicting risky driving offences at Year 9 was significant R2 = 0.37, F(10,108) = 6.41, P < 0.001, neither depressed mood nor alcohol misuse was a significant predictor.

CONCLUSIONS

These findings identify alcohol misuse as a predictor of risky driving 3 years after baseline among male DWI offenders. This enhances our prediction of risky driving, extending beyond the widely researched acute impacts of alcohol by exploring chronic patterns.

An Evaluation of the Boys Do Cry Suicide Prevention Media Campaign on Twitter: Mixed Methods Approach

BACKGROUND

In most countries, men are more likely to die by suicide than women. Adherence to dominant masculine norms, such as being self-reliant, is linked to suicide in men in Western cultures. We created a suicide prevention media campaign, "Boys Do Cry," designed to challenge the "self-reliance" norm and encourage help-seeking in men. A music video was at the core of the campaign, which was an adapted version of the "Boys Don't Cry" song from "The Cure." There is evidence that suicide prevention media campaigns can encourage help-seeking for mental health difficulties.

OBJECTIVE

We aimed to explore the reach, engagement, and themes of discussion prompted by the Boys Do Cry campaign on Twitter.

METHODS

We used Twitter analytics data to investigate the reach and engagement of the Boys Do Cry campaign, including analyzing the characteristics of tweets posted by the campaign's hosts. Throughout the campaign and immediately after, we also used Twitter data derived from the Twitter Application Programming Interface to analyze the tweeting patterns of users related to the campaign. In addition, we qualitatively analyzed the content of Boys Do Cry-related tweets during the campaign period.

RESULTS

During the campaign, Twitter users saw the tweets posted by the hosts of the campaign a total of 140,650 times and engaged with its content a total of 4477 times. The 10 highest-performing tweets by the campaign hosts involved either a video or an image. Among the 10 highest-performing tweets, the first was one that included the campaign's core video; the second was a screenshot of the tweet posted by Robert Smith, the lead singer of The Cure, sharing the Boys Do Cry campaign's video and tagging the campaign's hosts. In addition, the pattern of Twitter activity for the campaign-related tweets was considerably higher during the campaign than in the immediate postcampaign period, with half of the activity occurring during the first week of the campaign when Robert Smith promoted the campaign. Some of the key topics of discussions prompted by the Boys Do Cry campaign on Twitter involved users supporting the campaign; referencing the original song, band, or lead singer; reiterating the campaign's messages; and having emotional responses to the campaign.

CONCLUSIONS

This study demonstrates that a brief media campaign such as Boys Do Cry can achieve good reach and engagement and can prompt discussions on Twitter about masculinity and suicide. Such discussions may lead to greater awareness about the importance of seeking help and providing support to those with mental health difficulties. However, this study suggests that longer, more intensive campaigns may be needed in order to amplify and sustain these results.

"Hey Amir, How Are You REALLY Doing?": Participant Perspectives of a Peer-Based Suicide Prevention Campaign for Men

Suicide is a major public health concern and leading cause of death among men in Canada. This study reports the feasibility and acceptability of Buddy Up, a peer-based suicide prevention campaign for men. A mixed-methods approach was used to analyze respondent survey questionnaires (n = 48) and individual participant interviews (n = 19) collected from campaign users. Survey respondents reported that they enjoyed their involvement in the campaign (92%), were more confident to talk with men about mental health and suicide (95%), and would recommend Buddy Up to others (95%). Qualitative interviews were thematically analyzed to develop three inductively derived themes: (a) Engaging men with relatable masculine content and design: "Buddy Up really spoke to them in their language," highlighting the importance of understanding and working with gendered practices and motivations to legitimize and motivate involvement in suicide prevention; (b) Leveraging campaign participation to initiate conversations and promote mental health: "It gives men language and license to start asking questions," revealing ways in which participants utilized Buddy Up to negotiate and norm checking-in to promote men's mental health; and (c) Driving new masculine cultures: "We start every meeting with a mental health moment," identifying how participants fostered healthy milieus for disclosing mental health challenges with teamwork and preventive action under the banner of Buddy Up. The study findings support the feasibility of Buddy Up and highlight the acceptability of peer-based approaches to mental health promotion. The findings can also empirically guide future efforts for systematically building men's peer-based suicide prevention programs.

Depressive symptoms and social support among Australian men: A 7-year longitudinal study

BACKGROUND

Mental health disorders are ranked globally as the single largest contributor to non-fatal ill-health. Social support can be a means of reducing and managing depression. However, depression can also impact on a person's level of social support.

OBJECTIVE

As men typically have fewer sources of social support than females, this study investigated the bi-directional associations between depressive symptoms and perceived levels of social support among Australian males, aged 18-63.

METHODS

Three waves of panel data from Ten to Men: The Australian Longitudinal Study on Male Health collected over 7 years (2013-2020) were used. A random intercept cross-lagged panel analysis with 5112 participants was undertaken. Mediating effects and indirect and total effects for lagged and cross-lagged pathways were also examined.

RESULTS

Over time, greater social support was found to be associated with lower depression levels, and simultaneously greater levels of depression was found to be associated with lower levels of social support. Standardised cross-lagged effects between waves were mostly similar (β = 0.10). However, mediation analyses identified that only the total effect size of the association for depression at wave 1 predicting social support at wave 3 (β = -0.29) was significant. Mediated effects of social support at wave 1 predicting depression at wave 3 were not significant.

LIMITATIONS

These include the number of years between each wave, and data were collected during the COVID pandemic.

CONCLUSION

The study provides robust longitudinal evidence supporting the notion that social support and depression are both a cause and consequence of the other. However, the long-term effects of depression reducing social support were longer lasting than the effects of social support reducing depression.

Young men and anxiety: Resisting, reckoning and responding

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study

BACKGROUND

Masculinity norms play a crucial role in men's help-seeking behaviors, service-use, and coping strategies for depression. While previous studies provided evidence for the association between gender role orientations, work related attitudes, stigmatization of men with depression and depressive symptoms, it remains unclear to what extent gender role orientations change over time and whether psychiatric and psychotherapeutic treatment have an impact on these transformations. Additionally, the role of partners in supporting depressed men and the impact of dyadic coping on these processes have not been explored. The aim of this study is to investigate how masculinity orientations and work-related attitudes change over time in men treated for depression, and to examine the role of their partners and dyadic coping in these transformation processes.

METHODS

TRANSMODE is a prospective longitudinal mixed-methods study investigating the transformation of masculinity orientations and work-related attitudes in men treated for depression between the ages of 18 and 65 from different settings in Germany. The study will recruit 350 men from various settings for quantitative analysis. By applying a latent transition analysis, the primary outcome are changes in masculine orientations and work-related attitudes over time, measured at four times (t0, t1, t2, t3) with intervals of 6 months. Qualitative interview with a subsample of depressed men selected using latent profile analysis, will be conducted between t0 and t1 (a1) with a follow-up of 12 months (a2). In addition, qualitative interviews with the partners of depressed men will be conducted between t2 and t3 (p1). Qualitative data will be analysed using qualitative structured content analysis.

DISCUSSION

A comprehensive understanding of the transformation processes of masculinity orientations over time including the impact of psychiatric/psychotherapeutic treatment and the role of partners can lead to the development of gender-sensitive depression treatment tailored to the unique needs of men with depression. Thus, the study can promote more effective and successful treatment outcomes and further contribute to reducing the stigma surrounding mental health issues among men and encourage them for mental health service use.

TRIAL REGISTRATION

This study is registered in the German Clinical Trail Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (Date of registration 06 February 2023).

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone

Background

Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT).

Aim

This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist.

Methods

The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36.

Expected results

Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT.

Discussion

This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT05435222.

New directions in male-tailored psychotherapy for depression

Purpose of review

Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men's presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men's help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders.

Recent findings

A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James' Place program, a male-tailored community-based service, improved suicidal men's overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners' capacity to engage and support men in therapy.

Summary

Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.

Prenatal paternal depression, anxiety, and somatic symptom burden in different risk samples: an explorative study

PURPOSE

Growing evidence implies that transition to parenthood triggers symptoms of mental burden not only in women but likewise in men, especially in high-risk pregnancies. This is the first study that examined and compared the prevalence rates of depression, anxiety, and somatic symptom burden of expectant fathers who face different risk situations during pregnancy.

METHODS

Prevalence rates of paternal depression (Edinburgh postnatal depression scale), anxiety (generalized anxiety disorder seven), and somatic symptom burden (somatic symptom scale eight) were examined in two risk samples and one control group in the third trimester of their partners' pregnancy: risk sample I (n = 41) consist of expectant fathers whose partners were prenatally hospitalized due to medical complications; risk sample II (n = 52) are fathers whose partners were prenatally mentally distressed; and control group (n = 70) are those non-risk pregnancies.

RESULTS

On a purely descriptive level, the data display a trend of higher symptom burden of depression, anxiety, and somatic symptoms in the two risk samples, indicating that expectant fathers, whose pregnant partners were hospitalized or suffered prenatal depression, were more prenatally distressed. Exploratory testing of group differences revealed an almost three times higher prevalence rate of anxiety in fathers whose partner was hospitalized (12.2%) compared to those non-risks (4.3%).

CONCLUSION

Results underline the need for screening implementations for paternal prenatal psychological distress, as well as specific prevention and treatment programs, especially for fathers in risk situations, such as their pregnant partners' prenatal hospitalization. The study was registered with the German clinical trials register (DRKS00020131) on 2019/12/09.

Suicidal ideation in men during COVID-19: an examination of protective factors

BACKGROUND

Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour.

METHODS

A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis.

RESULTS

Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans.

CONCLUSIONS

Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

Sex and gender role differences on stress, depression, and anxiety symptoms in response to the COVID-19 pandemic over time

Introduction

Stress, depression, and anxiety symptoms have been reported during the pandemic, with important inter-individual differences. Past cross-sectional studies have found that sex and gender roles may contribute to the modulation of one's vulnerability to develop such symptoms. This longitudinal study aimed to examine the interaction of sex and psychological gender roles on stress, depression, and anxiety symptoms in adults during the COVID-19 pandemic.

Methods

Following the confinement measures in March 2020 in Montreal, stress, depression, and anxiety symptoms were assessed every 3 months (from June 2020 to March 2021) with the Depression, Anxiety and Stress Scale among 103 females and 50 males. Femininity and masculinity scores were assessed with the Bem Sex Role Inventory before the pandemic and were added as predictors along with time, sex, and the interactions between these variables using linear mixed models.

Results

We observed similar levels of depressive symptoms between males and females, but higher levels of stress and anxious symptoms in females. No effects of sex and gender roles on depressive symptoms were found. For stress and anxiety, an interaction between time, femininity, and sex was found. At the beginning of the pandemic, females with high femininity had more stress symptoms than males with high femininity, whereas females with low femininity had more anxiety symptoms 1 year after the confinement measures compared to males with low femininity.

Discussion

These findings suggest that sex differences and psychological gender roles contribute to heterogeneous patterns of stress and anxiety symptoms over time in response to the COVID-19 pandemic.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

A rapid review to determine the suicide risk and risk factors of men who are survivors of sexual assault

This rapid review assessed the suicide risk and risk factors of men who are survivors of sexual assault. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles in English published between 2010 and 2022. We rated the quality of the evidence based on the National Health and Medical Research Council Levels of Evidence. One systematic review and 16 papers featuring primary studies were included relating to suicide rates and risk. Findings suggest men who have been sexually assaulted (as a child or adult) are at increased risk of suicidal thoughts, attempts and behaviours compared with men who have not been sexually assaulted. Factors such as frequency of abuse and other concurrent forms of childhood abuse may further increase the risk of suicidal thoughts and behaviours. This evidence base was rated as good. The strength of this evidence supports a need for targeted suicide prevention in this high risk group.

The Relationship Between Workplace Burnout and Male Depression Symptom Assessed by the Korean Version of the Gotland Male Depression Scale

Screening for depression in males is important because their symptoms differ from those of females, ranging from indications of aggression to attempts at suicide. Men and women differ in their responses to job stress. There are no tools that have been verified, developed, or translated for screening male depression in Korea. Our team translated the Gotland Male Depression Scale (GMDS) into Korean. The Korean version of GMDS (K-GMDS) and Maslach Burnout Inventory-General Survey (MBI-GS) were administered to 277 office workers in one public institution. Gender differences in each scale score were measured along with the correlation between the K-GMDS and the MBI-GS. There was no significant difference in the K-GMDS score between males and females, whereas females scored significantly higher on the MBI-GS (p < .001). The correlation between the K-GMDS total score and the MBI total score (male: r = .702, p < .001, female: r = .375, p < .001) and MBI subscale scores were higher in males than females. Gender moderated the relationship between total K-GMDS and total MBI scores (p < .001). The Korean version of the GMDS is suitable for screening male depression symptoms in the workplace. The results of the K-GMDS demonstrated a strong correlation between depressive symptoms and work-related burnout among men. This study can be used as a basis for studying male depression symptoms in Korea, which has not been studied extensively. This will prove beneficial for work environments.

Male-Type Depression Mediates the Relationship between Avoidant Coping and Suicidal Ideation in Men

Despite known links between men's avoidant coping behaviours (e.g., distraction, denial, substance use) and suicide risk, little research has explored the mechanisms underpinning this relationship. This study sought to examine whether male-type depression symptoms (e.g., anger, aggression, emotion suppression), assessed by the Male Depression Risk Scale, mediate the association between avoidant coping and suicide/self-harm ideation in men. Data were drawn from an online survey of a community sample of 606 Australian men (M age = 50.11 years; SD = 15.00), conducted during the COVID-19 pandemic. Mediation analyses were applied to examine the effect of male-type depression on the association between avoidant coping and suicidal/self-harm ideation, controlling for age, resilience and the experience of two psychosocial stressors during the COVID-19 pandemic (financial stress and government restrictions). Avoidant coping was associated with suicidal/self-harm ideation, r = 0.45, p < 0.001. Results supported a mediating role of male-type depression symptoms in this relationship, R²= 0.29, P_M = 0.36, p < 0.001, underscoring the importance of screening for male-type depression symptoms to better identify men at risk of suicidal/self-harm ideation. Results also suggest a need to support men to develop effective coping strategies, particularly in the context of common psychosocial stressors experienced during the COVID-19 pandemic and beyond.

Extending the Male Depression Risk Scale for use with older men: the effect of age on factor structure and associations with psychological distress and history of depression

OBJECTIVES

The Male Depression Risk Scale (MDRS-22) is a self-report scale that assesses externalising and male-typical depression symptoms with promising psychometric properties reported in young-to-middle aged men. However, studies are yet to consider the psychometric properties of the MDRS-22 in older men. This study examined the psychometric properties of the MDRS-22 in both younger and older males and its relationship to prototypic depression symptoms and self-reported depression history.

METHOD

A community sample of younger (n = 510; 18-64 years) and older (n = 439; 65-93 years) males completed the original 82 MDRS items from which the MDRS-22 was derived, the Patient Health Questionnaire (PHQ-9), and provided information regarding previous depression diagnoses. Exploratory and confirmatory factor analyses were used to examine factor structure. Generalised linear models examined the relationship between externalised and male-typical symptoms with prototypic depression symptoms in younger and older men.

RESULTS

Model fit indices demonstrated that the MDRS-22 performs well in older males. Results also revealed that the MDRS-22 is associated with prototypic depression symptoms and a previous depression diagnosis in both age groups.

CONCLUSION

Results support the psychometric validity of the MDRS-22 as a measure of externalising and male-typical depression symptoms in older men. Use of scales such as the MDRS-22 may help to improve the detection of depression in men across the lifespan and may also identify factors that put men at risk of poor physical and mental health outcomes.

Bioimpedance Body Measures and Serum Lipid Levels in Masculine Depression

Background

Major depressive disorder (MDD) is a main reason for suicide, and serum lipids are involved in both affective disorders and related suicidal behavior. Moreover, masculine depression has been suggested as a subtype of depression with an increased risk for suicide. Here, we studied the relationship between body measures, serum lipids, suicidal thoughts, and masculine depression.

Methods

Depressed patients (44% women) were divided by a sex-separated median-split into a group of 81 "patients with masculine depression" (mean age ± standard error: 36.4 ± 1.6 years) and a group of 82 "patients with non-masculine depression" (age 45.7 ± 1.6 years) according to the Male Depression Risk Scale. We compared body measures, serum lipid levels, and past suicidal ideation between these groups and explored differences between these groups and 176 healthy controls (51% women; age 37.2 ± 1.0 years).

Results

Patients with masculine depression did not significantly differ from patients with non-masculine depression in any of the body measures, lipid markers, or suicidal thoughts. Compared to healthy controls, both patient groups showed significantly higher body fat (B[masculine depression] = 0.041 and B[non-masculine depression] = 0.050), lower high-density lipoprotein (HDL) cholesterol (B = -0.045 and -0.044), and a higher risk for suicidal thoughts (B = 3.927 and 2.663) than healthy controls. Suicidal thoughts were significantly associated with lower low-density lipoprotein (LDL)/HDL ratios (B = -0.455) in patients with depression and with higher LDL cholesterol levels (B = 0.020) in healthy controls subjects.

Limitation

Correlational study design and focus on in-patients.

Conclusion

In the studied cohort, masculine depression was not significantly associated with the analyzed parameters of body measures, serum lipids, or suicidal thoughts in in-patients with depression.

The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review

Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.

"Appreciate the Little Things": A Qualitative Survey of Men's Coping Strategies and Mental Health Impacts During the COVID-19 Pandemic

The COVID-19 pandemic has presented a suite of circumstances that will simultaneously affect mental health and mobilize coping strategies in response. Building on a lack of research specifically exploring men's mental health impacts during the COVID-19 pandemic, this study presents the results of a qualitative survey exploring men's self-reported aspects of the pandemic giving rise to mental health challenges, alongside their diverse coping strategies applied during this time. The sample comprised 555 men from North America (age M = 38.8 years; SD = 13.5 years), who participated via an online survey with two open-ended qualitative questions assessing, respectively, the aspects of the pandemic affecting their mental health, and the strategies used to manage these challenges. Free-text responses were coded using inductive content analysis. Results pertaining to the mental health impacts of COVID-19 were categorized into two overarching themes: far-reaching ramifications of COVID-19 encompassing consequences for lifestyle, work, and functioning, alongside novel anxieties related to health risks and daily uncertainty. In addition, coping strategies reported were categorized into two broad themes: efforts to avoid, dull or distract oneself from distress, alongside adapting and doing things differently, which encompassed largely approach-oriented efforts to flexibly ameliorate distress. Results signal the far-reaching impacts of COVID-19, alongside profound flexibility and diverse enactments of resilience among men in adapting to unprecedented challenges. Findings have implications for mental health promotion that should aim to leverage men's adaptive coping to encourage opportunities for social connectedness in response to the mental health impacts of the various psychosocial challenges of the COVID-19 pandemic.

Brief assessment of male depression in clinical care: Validation of the Male Depression Risk Scale short form in a cross-sectional study of Australian men

OBJECTIVES

To develop and validate a short form of the Male Depression Risk Scale (MDRS-22) for use in primary care, examining associations with prototypic depression symptoms, psychological distress and suicidality.

DESIGN

Cross-sectional study with 8-month follow-up.

SETTING

Community-based.

PARTICIPANTS

A community sample of younger (n=510; 18-64 years) and older (n=439; 65-93 years) men residing in Australia (M age=58.09 years, SD=17.77) participated in the study. A subset of respondents (n=159 younger men; n=169 older men) provided follow-up data approximately eight months later.

PRIMARY AND SECONDARY OUTCOME MEASURES

Quantitative data were obtained through a survey comprising a range of validated measures, including the MDRS-22, the Patient Health Questionnaire (PHQ-9) and the Kessler Psychological Distress Scale (K10). The MDRS-22 was refined using exploratory and confirmatory factor analysis in line with best practice guidelines. Analysis of variance and generalised linear models were conducted to explore relationships between variables.

RESULTS

The short-form MDRS consisted of seven items (MDRS-7) and captured all of the domains in the original tool. Participants with mixed symptoms (PHQ-9 ≥ 10 and MDRS-7 > 5) had significantly higher risk of mental illness (K10 ≥ 25) and current suicidality (PHQ-9 item 9 ≥ 1) than those with exclusively prototypic symptoms (PHQ-9 ≥ 10 and MDRS-7 ≤ 5). Furthermore, the MDRS-7 was shown to be effective at predicting elevated symptoms of depression at follow-up, after controlling for previous depression diagnosis.

CONCLUSIONS

Findings provide preliminary evidence of the potential utility of the MDRS-7 as a screening tool for externalised and male-type symptoms associated with major depression in men. Field trials of the MDRS-7 in primary care settings may facilitate identification of men at risk of suicide and psychological distress who do not meet cut-off scores for existing measures of major depression symptoms.

Examining the Role of Traditional Masculinity and Depression in Men's Risk for Contracting COVID-19

In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men's health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.

Mechanisms of an eHealth program targeting depression in men with overweight or obesity: A randomised trial

BACKGROUND

The SHED-IT: Recharge study demonstrated that a gender-tailored eHealth program could improve the depressive symptoms of men with overweight or obesity and low mood. This study examined whether changes in key behaviours and cognitions acted as significant mediators of this treatment effect.

METHODS

The study was a randomised controlled trial (RCT) including 125 men with overweight or obesity (mean (SD) weight 103.8 (15.8) kg), and current depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 5; mean (SD) 9.2 (4.1) units). Assessments were held at baseline, 3 months (post-intervention), and 6 months (follow-up). Depressive symptoms were assessed using the validated PHQ-9 and Masculine Depressive Risk Scale (MDRS-22). Behavioural and cognitive mediators were assessed with validated measures. Intention-to-treat mediation analyses were conducted using the PROCESS macro in SPSS.

RESULTS

Single mediation analyses demonstrated that the intervention effect on both PHQ-9 and MDRS-22 scores was significantly mediated by changes in MVPA, energy-dense nutrient-poor foods, cognitive flexibility, and behavioural activation. In addition, changes in sleep quality mediated improvements in MDRS-22 scores. No mediation effects were observed for light physical activity, sedentary behaviour, fruit and vegetable intake, risky alcohol consumption or mindfulness.

LIMITATIONS

The study was a secondary analysis with power to detect moderate-to-large mediation effects only.

CONCLUSION

To prevent or treat depression in men with overweight or obesity, early evidence suggests MVPA, sleep quality, energy-dense nutrient-poor food intake, cognitive flexibility, and behavioural activation are important intervention targets.

Protocol for a cluster randomized control trial of the impact of the Breaking the Man Code workshops on adolescent boys' intentions to seek help

BACKGROUND

Males in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men's wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in the Breaking the Man Code workshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop.

METHODS

A stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group.

DISCUSSION

The Breaking the Man Code workshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need for Tomorrow Man to introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12620001134910 ). Registered on 30 October 2020.

J. Young's Early Maladaptive Schemas and Symptoms of Male Depression

Aim: There are more non-specific, hence harder to diagnose, symptoms in the picture of male depression. These symptoms are strongly linked to social norms and roles traditionally assigned to men. The aim of this study was to assess the interrelationship of early maladaptive schemas that affect the formation of self-image as a man with indicators of male depression. Materials and methods: The Gender-Sensitive Depression Screening (GSDS-26) by A.M. Möller-Leimkühler and the Early Maladaptive Schema Questionnaire by J. Young (YSQ-S3-PL) were used. A group of 75 men (aged 18 to 50) were qualified to take part in the research. Results: The total score of the GSDS-26 scale and individual indicators of male depression are strongly positively correlated with the severity of all five domains of the YSQ-S3-PL questionnaire. The highest correlation coefficient value was obtained in the following areas: "Disconnection and rejection" (0.741), "Other-directedness" (0.711), and "Overvigilance and inhibition" (0.711). In case of the GSDS-26 total score and the following indicators-Elevated stress, Aggressiveness, Emotional control, Risky behavior, and Classic symptoms of depression-positive statistically significant associations were confirmed with each of the 18 schemas from the YSQ-S3-PL questionnaire. Multiple regression results revealed that the following domains were significant for symptoms typical of male depression: "Disconnection and rejection" and "Impaired autonomy and performance". The "Impaired limits" area was found to be statistically significant only for symptoms of classic depression. Conclusions: (1) The GSDS-26 scale scores show positive associations with each domain of the YSQ-S3-PL questionnaire. (2) The following areas seem to be more important for atypical depressive symptoms in men: "Disconnection and rejection" and "Impaired autonomy and performance", while for classic depression: "Impaired limits" was more important. (3) In therapeutic work with male depressive symptoms, it is useful to focus on dominant maladaptive schemas alongside beliefs about stereotypical male roles.

[Gender-Sensitive Depression Screening (GSDS) - Further Validation of a New Self-Rating Instrument]

OBJECTIVE

To check the validity of the preliminary results with the Gender-Sensitive Depression Screening (GSDS) in two German samples of non-psychiatric outpatients.

METHODS

The psychometric validation of the GSDS-33 was performed in a sample of non-psychiatric outpatients of different clinics belonging to the Ludwig-Maximilians-University of Munich (n = 958) and in a male non-psychiatric sample of the Men's Health Center in Berlin (n = 237).

RESULTS

Findings of the first validation study of the GSDS (Möller-Leimkühler, Mühleck 2020) were largely confirmed. The data also confirmed the factors 'aggressiveness' and 'emotional control' as important components of an increasing depression risk. Compared to a standard screening the GSDS again identified more risk cases among men in the two samples (8 % and 18 %).

CONCLUSIONS

The GSDS-25 is a multidimensional, valid and reliable scale for better identifying men with a risk of depression.

Men's anxiety: A systematic review

AIM

Anxiety disorders are amongst the most commonly diagnosed mental illnesses amongst men; however male-specific anxiety research is lacking. This review explores men's anxiety symptoms and disorders including help-seeking, coping and the role of masculinity.

METHOD

Four electronic database searches identified 8,333 citations, with 25 studies meeting inclusion criteria. Nineteen studies employed quantitative methods, five studies reported qualitative research, and one utilised mixed methods.

RESULTS

Unique profiles of anxiety, including psychosomatic symptoms, were identified and persisted over extended periods of time. Men commonly reported self-reliance over formal help-seeking, and typically managed anxiety symptoms through problem-based coping. Masculinity was related to anxiety in complex ways; adherence to norms of toughness could be protective against anxiety onset, while adherence to emotional restrictiveness and heterosexual presentation norms were positively associated with anxiety. The experience of, and help-seeking for anxiety transgressed many men's adherence to masculinity norms resulting in significant social and self-stigmas.

LIMITATIONS

The anxiety measurement scales utilised were inconsistent across included studies and there was limited scope of research into panic disorders, phobias and agoraphobia.

CONCLUSION

Findings demonstrate the enduring nature of anxiety for men and a potential under-reporting of symptoms, especially amongst younger men. To better tailor clinical care and public health resources to the needs of men with anxiety disorders, targeted research examining men's lived experiences of (and coping strategies for) anxiety is essential.

The psychometric characteristics of the Kessler Psychological Distress Scale (K6) in help-seeking youth: What do you miss when using it as an outcome measure?

This is the first study to describe psychometric properties of the Kessler Psychological Distress Scale (K6) in a large cohort of help-seeking young people presenting to primary mental health care services. The aim was to determine whether the K6 was appropriate for monitoring outcomes in such settings. 1067 young people were recruited from Australian headspace services. We examined dimensionality of the K6, measurement invariance, and how the K6 correlated with the the Patient Health Questionnaire-9 (PHQ-9)and the Generalised Anxiety Disorder-7 Scale (GAD-7). Standardised Response Mean (SRM) and Cohen's d effect size (ES) were used to examine 3-month stability of the K6. The best-fitting model was a two-factor model: (i) nervous and restlessness; and (ii) hopeless, worthless, depressed and effort. Measurement non-invariance was observed for sex and age groups. K6 strongly correlated with the PHQ-9 and GAD-7. The K6 was less sensitive to change compared to these other two measures. There was some support for the K6 being a screener for young people presenting to primary care; however, there issues arise with its use as an outcome measure. These issues include measurement non-invariance, concern about the dimensionality and focus of items, and its sensitivity to change.

Angst und Depression bei Typ-1-Diabetes – Erste Ergebnisse des Screenings auf psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen im Rahmen des COACH-Konsortiums

Die interdisziplinäre Forschungskooperation COACH-Konsortium (Chronic Conditions in Adolescents – Implementation and Evaluation of Patient-centered Collaborative Healthcare) untersucht die psychosoziale Situation von Jugendlichen und jungen Erwachsenen mit chronischen körperlichen Erkrankungen. Zur Untersuchung der psychischen Komorbidität wurden bisher 1.023 Patienten mit Diabetes mellitus Typ 1 im Alter von 12–21 Jahren bei Routinevorstellungen in der Klinik bzw. Ambulanz mittels der Screening-Fragebogen Patient Health Questionnaire (PHQ-9) und Generalized Anxiety Disorder Scale-7 (GAD-7) zu Angst- und Depressionssymptomen befragt. 29,8 % der Jugendlichen und jungen Erwachsenen zeigten ein auffälliges Screening-Ergebnis. Dabei wurden 17,8 % der Fragebogen zu Angstsymptomen und 25,6 % der Fragebogen zu Depressionssymptomen auffällig mit Gesamtscore-Werten ≥ 7 in GAD-7 bzw. PHQ-9 beantwortet. Patienten mit erhöhten Depressions- und Angstwerten wiesen im Mittel einen deutlich höheren medianen HbA1c-Wert als Zeichen einer schlechteren Stoffwechseleinstellung auf (8,33 [8,09; 8,56]) als Patienten mit unauffälligem Screening (7,58 [7,48; 7,68]; p < 0,0001). Angesichts der hohen Prävalenz auffälliger Depressions- und Angstwerte und der Assoziation mit höheren HbA1c-Werten sollte bei allen Jugendlichen mit Diabetes mellitus Typ 1 regelmäßig das Vorliegen psychischer Belastungen abgeklärt werden. Dies könnte eine frühzeitige Diagnose einer psychischen Komorbidität und Intervention ermöglichen. Auf der Basis der Studien im COACH-Projekt können nun evidenzbasierte Empfehlungen für die interdisziplinäre Gesundheitsversorgung von Jugendlichen mit chronischen körperlichen Erkrankungen erstellt werden, die die psychischen Komorbiditäten systematisch berücksichtigen.

Reflective functioning and men's mental health: Associations with resilience and personal growth initiative

Mentalizing, or reflective functioning, refers to the capacity to reflect on one's own and others' mental states in terms of desires, intentions, and feelings. Reflective functioning in men's mental health is poorly understood, particularly in reference to men's resilience and motivation for personal growth. Using a cross-sectional design, the present study investigated impaired reflective functioning in relation to resilience and personal growth initiative among men with mental health concerns. An online sample of 1065 men self-reporting mental health concerns completed measures of reflective functioning, psychological distress, resilience, and personal growth initiative. Logistic regression examined reflective functioning in relation to likely serious mental illness, including interaction with age. Subsequent regression analyses controlled for distress severity in examining associations with resilience and personal growth initiative, and in examining the potential mediating role of reflective functioning. Impaired reflective functioning was significantly associated with serious psychological distress irrespective of age and, after controlling for distress severity, with resilience and personal growth initiative. Moreover, impaired reflective functioning was a significant mediator of the relationship between resilience and personal growth initiative. Findings provide preliminary support for reflective functioning as salient to men's resilience and agency for personal change, indicating a potentially important target in men's mental health work.

Men's Shame and Anger: Examining the Roles of Alexithymia and Psychological Distress

The psychological mechanisms connecting shame and anger among men remain underexplored. This study aimed to understand the potential roles of psychological distress and alexithymia in this pathway, both in the form of difficulty identifying and describing one's feelings. Self-report measures were completed by 1,000 men (age mean = 49.6 years; range = 19-86 years). Conditional process analysis investigated a moderated mediation effect to determine whether men's distress mediated the relationship between shame and anger, and whether this effect differed according to severity and type of alexithymia. Findings indicated moderated mediation, with psychological distress a significant mediator in the association between shame and anger. Furthermore, difficulties describing feelings (but not identifying feelings) moderated the relationship between shame and psychological distress. Men's shame can be expressed via anger when experiencing psychological distress, and the inability to express one's feelings exacerbates this pathway. Clinical and public health avenues to reduce the impact of alexithymia are discussed.Supplemental data for this article is available online at https://doi.org/10.1080/00223980.2021.1977598 .

Gender-Specific Differences in Depressive Behavior Among Forensic Psychiatric Patients

Background

Women are almost twice as likely to develop depression than men, but men commit suicide more often. One explanation for this paradox is that current depression inventories do not fully capture typical male symptoms of depression. Several studies showed that most depression symptoms in men are masked by externalizing behaviors, such as aggressiveness, addiction, and risky behavior. Here, we explored the differences in depression symptoms between men and women in a forensic psychiatric sample.

Methods

We screened 182 forensic psychiatric patients and selected a matched sample (21 women and 21 men). External symptoms of depression were assessed with the Gender-Sensitive Depression Screening (GSDS) and internal symptoms with the Beck Depression Inventory Revision.

Results

Although externalizing behaviors were similar in both groups, we found a significant relationship between external and internal depression symptoms only in men. In addition, male forensic patients with a history of suicide had higher scores in the GSDS, whereas female patients with a history of suicide had higher scores in the Beck Depression Inventory Revision.

Discussion

The finding that the GSDS detected depression symptoms in men indicates that this instrument might be useful for developing assessments to prevent suicide in forensic practice.

Male depression syndrome is characterized by pronounced Cluster B personality traits

BACKGROUND

Male depression syndrome (Male-DS) refers to alternative depression symptoms related to the male sex, such as externalizing behaviors, emotional suppression, substance misuse, and risk-seeking. Although these symptoms contribute to gender bias in the diagnosis of depression, Male-DS can be found in both sexes. In this cross-sectional study, we analyzed associations between Male-DS and clinical personality accentuations.

METHODS

We compared clinical personality accentuations between 78 depressed patients with high Male-DS scores (46% women; mean age ± standard error of the mean: 36.5 ± 1.6 years) and 76 depressed patients with low Male-DS scores (43% women; age 44.8 ± 1.7 years). We also explored differences between the two patient groups and 176 healthy controls (51% women; age 37.2 ± 1.0 years).

RESULTS

Depressed patients with high Male-DS scores showed stronger borderline (partial η² 0.121), impulsive (0.112), and antisocial (0.078) personality accentuations than those with low Male-DS scores after Bonferroni adjustment and controlling for sex, depression severity, and age. Relative to healthy controls, patients with high Male-DS values scored higher in all personality dimensions except for the narcissistic dimension. Patients with low Male-DS values scored higher in all Cluster A and C dimensions and the impulsive and borderline dimensions, but their scores were lower in the narcissistic dimension.

LIMITATIONS

Cross-sectional design and focus on in-patients.

CONCLUSIONS

We found pronounced Cluster B personality in patients with high Male-DS scores versus patients with low scores. Further prospective research is needed to verify that Cluster B personality traits represent a pre-morbid risk factor for Male-DS.

Can lifestyle interventions improve Canadian men's mental health? Outcomes from the HAT TRICK programme

Engaging men in mental health promotion can be difficult because of reticence about help-seeking, especially for gender neutral programmes. Developments in men's health research has pointed to the success of gender-sensitized programmes to increase men's engagement in healthy lifestyle interventions targeting physical activity and healthy eating; however, less is known about the impact of these interventions on men's mental health. This study explored changes to men's depression risk and health-related quality of life at post-intervention (12 weeks) and 9-month follow-up, after participating in HAT TRICK, a gender-sensitized lifestyle intervention for overweight men. Participants completed validated self-report measures of mental health at baseline, post-intervention (12 weeks) and 9-month follow-up. Men's scores on the Male Depression Risk Scale (MDRS) and the SF-12 questionnaire, including physical health (PH12) and mental health (MH12) composite scores, were analyzed using mixed linear models to assess linear trends. At baseline, men (N = 62) had a mean age of 50.98 (SD = 10.09) years and BMI of 35.87 (SD = 5.51) kg/m2. Results show that both the MDRS and the MH12 showed improvements in participants' mental health, with significant linear trends (p = 0.003; p = 0.003) qualified with significant quadratic trends over time (p = 0.02; p = 0.03). There were no significant changes in the PH12 over time. Gender-sensitized programmes for overweight men, such as HAT TRICK, are a promising approach to positively influence components of men's mental health, with the potential for sustained improvements over the long term.

Gender effects on outcomes of psychosomatic rehabilitation are reduced

OBJECTIVE

The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men.

METHODS

We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic.

RESULTS

Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden.

CONCLUSION

Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods.

The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

Australian men's initial pathways into mental health services

ISSUE ADDRESSED

Many men are challenged by barriers to mental health help-seeking and engagement. For men who do access care, their pathways to engaging services can offer important insights to what might constitute gender-specific care.

METHODS

Data were drawn from an online cross-sectional survey of N = 2009 Australian men (aged 16-85; M = 43.5) reflecting on their initial pathways to mental health services, including their reasons for help-seeking, how they first located a therapist and the source of any initial recommendation for engaging with services. Respondents were recruited with targeted advertisements via Movember's Facebook page.

RESULTS

A relatively even age distribution was observed, with most respondents residing in metropolitan areas (60.4%), a majority employed full time (47.7%), and 25.7% identifying as gay or bisexual. Participants tended to be self-motivated to seek help, with referrals by general practitioners to specialist mental health services. The most common underpinning precipitant for seeking help was anxiety, particularly for younger men, whereas older men tended to have sought help more commonly for familial, relationship or work-related factors. Older men were also more likely to report self-motivated help-seeking, whereas younger men more commonly sought help on the recommendation of a family member.

CONCLUSIONS

There are varied pathways for men's initial mental health help-seeking journeys that require an ongoing examination to ensure health promotion efforts are appropriately tailored and responding to men's needs.

SO WHAT

As more men access mental health services, having a nuanced understanding of their likely pathways to care can inform the help-seeking efforts of other men as well as guide improved services and systems to reduce barriers.

Cohort profile: the Men and Parenting Pathways (MAPP) Study: a longitudinal Australian cohort study of men's mental health and well-being at the normative age for first-time fatherhood

PURPOSE

The Men and Parenting Pathways (MAPP) Study is a prospective investigation of men's mental health and well-being across the normative age for transitioning to fatherhood. This includes trajectories and outcomes for men who do and do not become fathers across five annual waves of the study.

PARTICIPANTS

Australian resident, English-speaking men aged 28-32 years at baseline were eligible. Recruitment was over a 2-year period (2015-2017) via social and traditional media and through engagement with study partners. Eight hundred and eighteen eligible men consented to participate. Of these, 664 men completed the first online survey of whom 608 consented to ongoing participation. Of the ongoing sample, 83% have participated in at least two of the first three annual online surveys.

FINDINGS TO DATE

Three waves of data collection are complete. The first longitudinal analysis of MAPP data, published in 2020, identified five profiles that characterise men's patterns of depressive symptom severity and presentations of anger. Profiles indicating pronounced anger and depressive symptoms were associated with fathers' lack of perceived social support, and problems with coparenting and bonding with infants. In a second study, MAPP data were combined with three other Australian cohorts in a meta-analysis of associations between fathers' self-reported sleep problems up to 3 years postpartum and symptoms of depression, anxiety and stress. Adjusted meta-analytic associations between paternal sleep and mental health risk ranged from 0.25 to 0.37.

FUTURE PLANS

MAPP is an ongoing cohort study. Waves 4 and 5 data will be ready for analyses at the end of 2021. Future investigations will include crossed-lagged and trajectory analyses that assess inter-relatedness and changing social networks, mental health, work and family life. A nested study of COVID-19 pandemic-related mental health and coping will add two further waves of data collection in a subsample of MAPP participants.