A salutogenetic perspective on how men cope with major depression in daily life, with the help of professional and lay support

Fear of depression recurrence among individuals with remitted depression: a qualitative interview study

BACKGROUND

Major Depressive Disorder (MDD) is a prevalent psychiatric condition and the largest contributor to disability worldwide. MDD is highly recurrent, yet little is known about the mechanisms that occur following a Major Depressive Episode (MDE) and underlie recurrence. We explored the concept of fear of depression recurrence (FoDR) and its impact on daily functioning among individuals in remission from MDD.

METHODS

30 participants (83% female; 37% White; Mage = 27.7, SD = 8.96) underwent semi-structured qualitative interviews. The interviews explored participants' experiences of FoDR including the frequency, severity, content, triggers, and impact of fears and associated coping strategies. We used content analysis to analyze the transcriptions.

RESULTS

Most participants (73%) reported having FoDR, with varying frequency, severity, and duration of fears. The triggers and content of participants' fears often mirrored the symptoms (e.g., low mood, anhedonia) and consequences (e.g., job loss, social withdrawal) endured during past MDEs. Some participants reported a minimal impact of FoDR on daily functioning, whereas others reported a positive (e.g., personal growth) or negative (e.g., increased anxiety) influence.

LIMITATIONS

Our sample size did not allow for explorations of differences in FoDR across unique MDD subtypes or sociocultural factors.

CONCLUSIONS

The concept of FoDR may present a window into understanding the unique cognitive and behavioural changes that occur following MDD remission and underlie depression recurrence. Future research should aim to identify underlying individual differences and characteristics of the disorder that may influence the presence and impact of FoDR. Finally, a FoDR measure should be developed so that associations between FoDR and recurrence risk, depressive symptoms, and other indices of functioning can be determined.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

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.

Masculinity and Help-Seeking Among Men With Depression: A Qualitative Study

Background: Many studies indicate that men are more reluctant to seek help for mental health problems than women. Traditional ideas of masculinity are often seen as a cause of this phenomenon. However, little is known about the diversity of experiences during the processes of help-seeking and service use among men with depression who have already utilized mental health services. This study aims to explore men's experiences and attitudes toward depression, help-seeking, and service use in order to develop gender-sensitive services. Methods: Narrative-biographical interviews were conducted with men treated for depression (n = 12). Interview topics included individual experience with depression, help-seeking behavior, and mental health service use. Transcripts were analyzed using qualitative content analysis. Results: Before seeking treatment, men's help-seeking behavior was negatively affected by internalized masculine norms. However, findings indicate a change of attitudes toward depression after mental health service use. Men with depression emphasized a salutogenic perspective toward mental health problems and critically reflected on masculine norms. The positive function of men-only groups were described as key for successful service use. Conclusions: Men with depression reported experiences toward help-seeking and service use on four different levels: (i) attitudes toward depression, (ii) perception of societal views on depression, (iii) experiences within the family context and (iv) experiences with mental health services. Interventions to reduce the stigma of being "unmanly" and to improve men's capacity to cope with being unable to work should be developed. Peer-led men-only groups may increase participants' self-esteem and assist in disclosing weaknesses. In the context of GPs' mediating role, training for health professionals concerning the impact of masculine norms on mental health is recommended.

Men's use of positive strategies for preventing and managing depression: A qualitative investigation

BACKGROUND

One in eight men experience depression and men account for 75% of suicides. Previous research has focused on men's reluctance to seek help and use of unhelpful coping strategies.

METHOD

Thematic analysis was used on transcripts from 21 focus groups and 24 in-depth interviews focused on positive strategies men use to prevent and manage depression.

RESULTS

In total, 168 men were recruited and the majority (63%) reported no current depression. Four major themes were identified, where men: (1) used a broad variety of positive strategies and made clear distinctions between prevention and management, (2) used strategies that were "typically masculine", as well as challenged expectations of manliness, (3) felt powerless in the face of suicide, and (4) had accumulated wisdom they felt was beneficial for others. Men specifically advised others to talk about problems. Prevention relied upon regular routines for "balance", while management relied upon "having a plan".

LIMITATIONS

The majority of the men were aged over 55 years and highly educated. Younger men or those without tertiary education may favour different strategies.

CONCLUSIONS

In contrast to using only unhelpful strategies, the men used a broad range of positive strategies and adapted their use depending on mood, symptom or problem severity. Use of positive strategies was sophisticated, nuanced, and often underlined by a guiding philosophy. Rather than simply reacting to problems, men actively engaged in preventing the development of depressed moods, and made conscious choices about when or how to take action. Clinical and public health implications are discussed.

Positive strategies men regularly use to prevent and manage depression: a national survey of Australian men

BACKGROUND

Men are at greater risk than women of dying by suicide. One in eight will experience depression--a leading contributor to suicide--in their lifetime and men often delay seeking treatment. Previous research has focused on men's use of unhelpful coping strategies, with little emphasis on men's productive responses. The present study examines the positive strategies men use to prevent and manage depression.

METHOD

A national online survey investigated Australian men's use of positive strategies, including 26 strategies specifically nominated by men in a previous qualitative study. Data were collected regarding frequency of use or openness to using untried strategies, depression risk, depression symptoms, demographic factors, and other strategies suggested by men. Multivariate regression analyses explored relationships between regular use of strategies and other variables.

RESULTS

In total, 465 men aged between 18 and 74 years participated. The mean number of strategies used was 16.8 (SD 4.1) for preventing depression and 15.1 (SD 5.1) for management. The top five prevention strategies used regularly were eating healthily (54.2 %), keeping busy (50.1 %), exercising (44.9 %), humour (41.1 %) and helping others (35.7 %). The top five strategies used for management were taking time out (35.7 %), rewarding myself (35.1 %), keeping busy (35.1 %), exercising (33.3 %) and spending time with a pet (32.7 %). With untried strategies, a majority (58 %) were open to maintaining a relationship with a mentor, and nearly half were open to using meditation, mindfulness or gratitude exercises, seeing a health professional, or setting goals. In multivariate analyses, lower depression risk as measured by the Male Depression Risk Scale was associated with regular use of self-care, achievement-based and cognitive strategies, while lower scores on the Patient Health Questionnaire-9 was associated with regular use of cognitive strategies.

CONCLUSIONS

The results demonstrate that the men in the study currently use, and are open to using, a broad range of practical, social, emotional, cognitive and problem-solving strategies to maintain their mental health. This is significant for men in the community who may not be in contact with professional health services and would benefit from health messages promoting positive strategies as effective tools in the prevention and management of depression.

Being stuck in a vice: The process of coping with severe depression in late life

Articles describing older persons’ experiences of coping with severe depression are, to our knowledge, lacking. This article is methodologically grounded in phenomenological hermeneutics, inspired by Paul Ricoeur, and applies a descriptive design with in-depth interviews for producing the data. We included 18 older persons, 13 women and 5 men, with a mean age of 77.9 years, depressed to a severe or moderate degree, 1–2 weeks after admission to a hospital for treatment of depression. We found the metaphor “being in a vice” to capture the essence of meaning from the participants’ stories, and can be understood as being stuck in an immensely painful existence entirely dominated by depression in late life. This is the first article where coping in older men and women experiencing the most severe phase of depression is explored.

Cognitive-behavioral treatment of depression in men: tailoring treatment and directions for future research

Depression is a significant public health issue and many researchers have suggested that modifications to conventional cognitive-behavioral therapy (CBT) are required to address infrequent help-seeking in men and counter negative effects of traditional masculinity on therapeutic engagement. This narrative review summarizes recommended alterations to CBT in the areas of therapeutic setting, process, and content. Key themes from this literature include a focus on behavioural interventions, and harmful cognitions that orginate from the traditional male gender stereotype. This literature is marked by limited empirical support for many of the recommended treatment modifications, and several options for future research are outlined.

Experiences of major depression: individuals' perspectives on the ability to understand and handle the illness

In all social groups, major depression is an increasingly serious problem in modern society. Important aspects of a person's capacity for recovery are the person's own understanding of the illness and the ability to use this understanding to manage the illness. The aim of this study is to describe how individuals with major depression understand their illness and use their understanding to handle it. Twenty participants treated in community care for major depression as determined by the Diagnostic and Statistical Manual of Mental Disorders were interviewed between February and June, 2008. Content analysis of the interviews revealed three major themes: (1) awakening insight, (2) strategies for understanding and managing, and (3) making use of understanding, each with additional subthemes. Individual understandings of the illness varied and led to differences in the ways participants were able to handle their depression. In clinical care it is essential to support an individual's understanding of depression and his or her use of that understanding to handle the illness.

The meaning of major depression in family life: the viewpoint of the ill parent

AIM AND OBJECTIVE

The aim was to elucidate the meaning of major depression in family life from the viewpoint of an ill parent. Background. Major depression according to Diagnostic and Statistical Manual of Mental Disorders is common and may appear repeatedly over several years, and affects family life. Depression in parents has a negative impact on family function and children's health; however, studies regarding the deeper understanding of major depression in family life are lacking.

DESIGN

A qualitative explorative study using narrative interviews with eight parents who were identified with major depression.

METHODS

A phenomenological-hermeneutic method of interpretation was used for analysing interview texts and included naïve understanding, a structural analysis where text was divided into meaning units, which were condensed and abstracted, and finally a comprehensive understanding.

RESULT

Two themes were extracted: 'to be afflicted in an almost unmanageable situation' with sub-themes 'feeling hopelessly bad', 'being worthless', 'being unsatisfied' and the theme 'to reconcile oneself to the situation' with sub-themes 'being active', 'being satisfied' and 'maintaining parenthood'.

CONCLUSION

Comprehensive understanding revealed the parents' simultaneous suffering and dignity in family life; suffering with serious lack of well-being and health, destroyed self-confidence and unhappiness, and dignity with strength, confidence and joy in children. The movement between suffering and dignity complicated family life. Dignity was threatened by the awareness that suffering in major depression was recurrent. Dignity had to be repeatedly restored for self and the family, and family dignity has to be restored before others outside the family circle.

RELEVANCE TO CLINICAL PRACTICE

A deeper understanding of the meaning of major depression in family life is helpful and for healthcare professionals to prevent individual and family suffering by assisting and preserving dignity.

Persons living with bipolar disorder--their view of the illness and the future

The aim of this study is to describe the meaning of living with bipolar disorder (BD) based on individuals' views of the illness and their future. Interviews were conducted with 18 participants who resided in Sweden and had been diagnosed with bipolar disorder. Qualitative content analysis was employed. The findings revealed that daily life of those with BD was characterized by insecurity and challenges of accepting, understanding, and managing the illness. Increased hope of being able to influence the condition and receiving support to achieve a stable structure in life facilitates the management of daily life. Further research is needed on the next of kins' experiences of living with persons with BD.

Major depression in a family: what happens and how to manage - a case study

Major depression challenges the ways of living for both individuals and families. The aim of this study was to describe what happens and how to manage major depression in a family. The case in this paper is a family with a mother who is suffering major depression and her son and daughter. Narrative interviews and qualitative content analysis were conducted. The findings revealed six themes: "a stealthy intruder," "moving slowly to helplessness," "saving the situation," "protecting oneself and others," "conveying things that are beyond words," and the "dispersal of shadows." These themes elucidated the family members' varying views of depression and the unique ways they managed the situation.

A qualitative exploration of depression in emerging adulthood: disorder, development, and social context

OBJECTIVE

One in four emerging adults will experience a depressive episode between the ages of 18-25. We examined the lived experience of emerging adults with a focus on their treatment seeking, development and the social context of their illness.

METHOD

In-depth interviews were conducted with 15 participants with major or minor depression. Interviews were recorded, transcribed verbatim and analyzed using established qualitative methods.

RESULTS

Emerging adults reported dynamic and complex interactions within and between thematic areas including identification as an individual with depression, interactions with the healthcare system, relationships with friends and family, and role transitions from childhood to adulthood. Depressed mood, concerns about self-identifying one's self as being depressed, the complexity of seeking care often without insurance or financial support, alienation from peers and family, and a sense of failure to achieve expected developmental milestones appeared to interact and exacerbate functional impairment.

CONCLUSIONS

Further research is needed to better understand and intervene upon pathways that lead to poor outcomes such as delayed milestones among emerging adults with depression. Health care providers should be conscious of the unique vulnerabilities posed by depressive disorders in this age group.

The recovery process in major depression: an analysis employing Meleis' transition framework for deeper understanding as a foundation for nursing interventions

The number of persons with mental illness is increasing globally; despite this fact, nursing research on research-based interventions to prevent or minimize illness and increase quality of life is sparse. The purpose of this secondary analysis of men and women recovering from major depression (N = 25) was to gain a deeper understanding of the concept of transition in the recovery process associated with major depression as well as to develop and suggest nursing interventions that support the recovery process. The transition framework was useful, as it was describing the transition process as fluid, going back and forth, which was confirmed by the respondents' statements. Transition planning is a feasible way of supporting both the recovery process and health promotion, thus laying the foundations for a good quality of life.

Nurses' tending instinct as a conduit for men's access to mental health counseling

No article has been found melding the phenomenon of nurses' tending instinct and men's mental health counseling access. This theoretical article presents nurses' tending instinct as a viable rationale to support men in utilizing mental health counseling services. Nurses can be the conduit that assists men in accessing mental health counseling when the need arises. An amalgamation of related topics, including nurses' tending instinct, men's illness/injury/disease profile, psychological medicine, and counselor skills, were forged together to unify this innovative theoretical consideration. Implications for nursing practice also were explored.

Sense of coherence and social support in relation to recovery in first-episode patients with major depression: a one-year prospective study

Major depression is a common illness, with a lifetime prevalence rate of 10-13% for men and 21-24% for women. The experience of having a serious illness such as major depression affects the individual's quality of life and requires significant adaptation in order to cope. The aim of this study was to explore sense of coherence and social support in patients treated for a first episode of major depression in a 1-year follow up. The study design was prospective and longitudinal. A total of 24 patients, aged 18 years or over, with a first episode of major depression were included. Semi-structured interviews and self-assessment questionnaires were used at baseline as well as in a 1-year follow up in order to measure the level of severity of the depression, social support, and sense of coherence. The result showed that 71% of the patients had recovered at follow up. The sense of coherence scores were low at baseline, although the patients who recovered increased their sense of coherence scores significantly. Another factor of importance for recovery was a significant increase in social support. Social support is an important cornerstone in the restoration of a person's sense of coherence. It can be used in interventions that include the patient's family or close social network in combination with support to assist the patient to view his/her situation as comprehensible, manageable, and meaningful, thereby promoting or improving health. Mental health nurses are in a key position to identify patients' strengths and weaknesses so that the support and interventions provided can be tailored to meet the needs of each patient.

Depressive mood after a cardiac event: gender inequality and participation in rehabilitation programme

BACKGROUND

Depressive mood after a cardiac event is common with serious consequences for the patient.

AIMS

To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood.

METHODS

166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation.

RESULTS

At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs.

CONCLUSION

Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men.