Distress Concealment and Depression Symptoms in a National Sample of Canadian Men: Feeling Understood and Loneliness as Sequential Mediators

Loneliness corresponds with neural representations and language use that deviate from shared cultural perceptions

The word zeitgeist refers to common perceptions shared in a given culture. Meanwhile, a defining feature of loneliness is feeling that one's views are not shared with others. Does loneliness correspond with deviating from the zeitgeist? Across two independent brain imaging datasets, lonely participants' neural representations of well-known celebrities strayed from group-consensus neural representations in the medial prefrontal cortex-a region that encodes and retrieves social knowledge (Studies 1 A/1B: N = 40 each). Because communication fosters social connection by creating shared reality, we next asked whether lonelier participants' communication about well-known celebrities also deviates from the zeitgeist. Indeed, when a strong group consensus exists, lonelier individuals use idiosyncratic language to describe well-known celebrities (Study 2: N = 923). Collectively, results support lonely individuals' feeling that their views are not shared. This suggests loneliness may not only reflect impoverished relationships with specific individuals, but also feelings of disconnection from prevalently shared views of contemporary culture.

Psychic Pain Among Men: Factor Structure, Psychosocial Correlates, and Mediation of Social Connectedness and Suicidal Ideation

ABSTRACT

The Psychic Pain Scale (PPS) measures a form of mental pain involving overwhelming negative affect and loss of self-control. Understanding psychic pain among men is needed to advance efforts for preventing male suicide. The present study examined the factor structure and psychosocial correlates of the PPS among 621 online help-seeking men. Confirmatory factor analysis indicated a higher-order factor comprising affect deluge and loss of control factors. Psychic pain evinced significant associations with general psychological distress, r = 0.64; perceived social support, r = -0.43; social connectedness, r = -0.55; and suicidal ideation, r = 0.65 (all p 's < 0.001)-the latter three remained significant after controlling for general distress. Psychic pain also mediated the association between social disconnection and suicidal ideation (standardized indirect effect = -0.14 [-0.21, -0.09]), after controlling for social support and distress. Findings support the PPS as a promising measure for investigating psychic pain among men and indicate psychic pain as a link between social disconnection and suicidal ideation.

Suicidal ideation among men during COVID-19: Examining the roles of loneliness, thwarted belongingness, and personality impairment

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self-functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self-report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self-functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self-functioning. The findings are important to consider within the COVID-19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI.

Connecting and Healing: The Role of Existential Isolation in Mediating the Impact of the Therapeutic Relationship on Canadian Men's Mental Health Outcomes

The therapeutic relationship has emerged as one of the most important components of successful treatment outcomes, regardless of the specific form of therapy. Research has now turned its attention to better understanding how the therapeutic relationship contributes to patient improvement. Extant literature contends that a strong therapeutic relationship may help reduce a patient's sense of existential isolation (i.e., a sense of not feeling understood by others). Research indicates that existential isolation might be especially problematic for men, potentially increasing their risk for suicidality. This study investigated the association between strength of the therapeutic relationship and psychological distress and suicidality among men who received psychotherapy, and whether existential isolation mediated this association. A total of 204 Canadian men who had previously attended psychotherapy participated in a cross-sectional survey, completing measures of the quality of their most recent therapeutic relationship, existential isolation, depression and anxiety symptoms, and suicidality. Regression with mediation analysis was conducted. Two models were tested; one with depression/anxiety symptoms as the dependent variable and the other with suicidality as the dependent variable. Both mediation models emerged as significant, indicating an indirect effect for quality of the therapeutic relationship on symptoms of anxiety/depression and suicidality through existential isolation. The findings suggest that a positive therapeutic relationship can contribute to men feeling less isolated in their experiences in life (i.e., less existentially isolated), thereby helping mitigate psychological distress and suicidality.

Conditional Process Modeling of the Relationship Among Self-Reliance, Loneliness, and Depressive Symptoms, and the Moderating Effect of Feeling Understood

ABSTRACT

Self-reliance features as one of the notable male norms espoused by traditional masculine socialization. Strict adherence to a self-reliant attitude has been found to confer risk for depression and suicidality among men. Yet, little research has investigated the factors that may contribute to self-reliance having a negative impact for men. Using data from a large sample of Canadian men (N = 530), the present study examined the association between self-reliance and depression, while also assessing the roles of loneliness and not feeling understood as contributing factors in this process. Findings indicated that the moderated mediation model was significant, pointing to loneliness as a significant mediator in the association between self-reliance and depression. Furthermore, the findings revealed that not feeling understood moderated the relationship between self-reliance and loneliness, indicating that this association applies mainly to those men who do not feel understood by at least one important person in their life.

An Evaluation of 5-Year Web Analytics for HeadsUpGuys: A Men's Depression E-Mental Health Resource

The present study reports an evaluation of web analytics, over a 5-year period, for HeadsUpGuys.org, an eHealth resource for men with depression. Google Analytics, Search Console, and Tag Manager were used to monitor user activity over the course of the website's first 5 years (June 15, 2015-June 15, 2020). Through this period, HeadsUpGuys had a total of 1,665,356 unique users, amounting to 1,948,481 sessions and 3,328,258 page views. Organic traffic accounted for the highest proportion (53.44%; n = 1,041,277) of website sessions. Four of the top 10 Google search queries that brought users to the website related to suicidality. Three countries (United States, United Kingdom, Canada) accounted for almost three-quarters (71.10%; n = 1,385,485) of the site's traffic. Nearly three-quarters (73.35%; n = 1,429,285) of sessions occurred on a mobile device. The goal conversion rate for the Self Check was 60.27%. The average time on page was 2 min 53 s, with a bounce rate of 65.92%, and an exit rate of 57.20%. The goal conversion rate for the Stress Test was 52.89%. The average time on page was 4 min 8 s, with a bounce rate of 72.40% and an exit rate of 48.88%. The conversion rate for the final goal was 11.53%, indicating that approximately one in 10 visitors to the site had a session of at least 3 min. The findings illustrate the potential of eHealth resources to support men's mental health and provide a real-world benchmark to help advance the men's eHealth field.

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 .

Distress disclosure and psychological Distress among men: the role of feeling understood and loneliness

We examined whether men’s distress disclosure would be indirectly associated with psychological distress through feeling understood by others and loneliness as serial or parallel mediators. We conducted path analyses (N = 1827 adult men; mean 37.53 years, SD = 14.14) to test the mediators while controlling for race/ethnicity. Post-hoc multi-group analysis was conducted to examine differences across White and Asian men. The serial mediation model fit the data better than the parallel mediation model. Controlling for race/ethnicity, a significant partial indirect association was found between greater distress disclosure and lower psychological distress through greater feelings of being understood and lower feelings of loneliness. Post-hoc multi-group analysis suggested that the hypothesized paths fit equivalently across White and Asian men, and the direct effect was not significant for Asian men. Our hypothesized serial model also fit the data significantly better than alternative models with distress and the mediators predicting disclosure. Distress disclosure may be a socially conducive strategy for men to feel understood and socially connected, a process that may be associated with lower psychological distress.

Reduced Emotional Awareness and Distress Concealment: A Pathway to Loneliness for Young Men Seeking Mental Health Care

Background: Loneliness, the painful affective state that reflects perceived deficits in social relationships, is a significant health issue requiring further understanding. Individual differences in awareness and disclosure of emotional concerns may contribute to loneliness, and may do so diversely according to gender and age. The present study examined a hypothesized mediation pathway from emotional awareness abilities to loneliness through distress concealment, with moderation by gender and age, in a sample of adults attending outpatient mental health services. Methods: In a cross-sectional study design, 244 patients attending Canadian community mental health clinics completed study assessments at the commencement of care. Conditional process modeling examined interactions between gender and age and both emotional awareness and distress concealment in mediation models predicting loneliness. Results: A significant three-way interaction between gender, age, and distress concealment was observed, along with significant conditional moderated mediation. The indirect effect of emotional awareness on loneliness through the mediating effect of distress concealment was significant for young- and mid-adulthood men, but not for women or older men. Limitations: The study was limited by exclusive use of self-report assessment, and cross-sectional design precluding representation of causal sequencing over time. Conclusion: Findings suggest the pathway to loneliness from reduced emotional awareness through distress concealment to be particularly salient for younger men. Thus, intervention targeting restricted awareness and disclosure of emotional concerns should be considered in helping young men to address the pain of loneliness.

Prospective Validation of an Electronic Health Record-Based, Real-Time Suicide Risk Model

IMPORTANCE

Numerous prognostic models of suicide risk have been published, but few have been implemented outside of integrated managed care systems.

OBJECTIVE

To evaluate performance of a suicide attempt risk prediction model implemented in a vendor-supplied electronic health record to predict subsequent (1) suicidal ideation and (2) suicide attempt.

DESIGN, SETTING, AND PARTICIPANTS

This observational cohort study evaluated implementation of a suicide attempt prediction model in live clinical systems without alerting. The cohort comprised patients seen for any reason in adult inpatient, emergency department, and ambulatory surgery settings at an academic medical center in the mid-South from June 2019 to April 2020.

MAIN OUTCOMES AND MEASURES

Primary measures assessed external, prospective, and concurrent validity. Manual medical record validation of coded suicide attempts confirmed incident behaviors with intent to die. Subgroup analyses were performed based on demographic characteristics, relevant clinical context/setting, and presence or absence of universal screening. Performance was evaluated using discrimination (number needed to screen, C statistics, positive/negative predictive values) and calibration (Spiegelhalter z statistic). Recalibration was performed with logistic calibration.

RESULTS

The system generated 115 905 predictions for 77 973 patients (42 490 [54%] men, 35 404 [45%] women, 60 586 [78%] White, 12 620 [16%] Black). Numbers needed to screen in highest risk quantiles were 23 and 271 for suicidal ideation and attempt, respectively. Performance was maintained across demographic subgroups. Numbers needed to screen for suicide attempt by sex were 256 for men and 323 for women; and by race: 373, 176, and 407 for White, Black, and non-White/non-Black patients, respectively. Model C statistics were, across the health system: 0.836 (95% CI, 0.836-0.837); adult hospital: 0.77 (95% CI, 0.77-0.772); emergency department: 0.778 (95% CI, 0.777-0.778); psychiatry inpatient settings: 0.634 (95% CI, 0.633-0.636). Predictions were initially miscalibrated (Spiegelhalter z = -3.1; P = .001) with improvement after recalibration (Spiegelhalter z = 1.1; P = .26).

CONCLUSIONS AND RELEVANCE

In this study, this real-time predictive model of suicide attempt risk showed reasonable numbers needed to screen in nonpsychiatric specialty settings in a large clinical system. Assuming that research-valid models will translate without performing this type of analysis risks inaccuracy in clinical practice, misclassification of risk, wasted effort, and missed opportunity to correct and prevent such problems. The next step is careful pairing with low-cost, low-harm preventive strategies in a pragmatic trial of effectiveness in preventing future suicidality.

Psychosocial impact of the COVID-19 pandemic: a cross-sectional study of online help-seeking Canadian men

Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. The present study investigated psychosocial impacts of the COVID-19 pandemic on a help-seeking sample of Canadian men, focusing on diverse aspects of their psychosocial well-being.Methods: A cross-sectional, open survey study design was used. Canadian adult men who were visiting an eHealth depression resource (HeadsUpGuys.org) were recruited to complete an online survey. Descriptive statistics, including means and standard deviations for continuous variables and frequency and percentages for categorical variables, were used to summarize survey responses. Regression analysis was utilized to identify factors associated with various mental health indicators (anxiety, depression, fear of COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 were used to assess the mental health indicators.Results: A total of 434 men completed the study. Most respondents (79.3%; N = 344) indicated that their mental health was negatively affected by COVID-19, and two-thirds (65.5%; N = 284) conveyed that government-imposed physical distancing measures had negatively affected their mental health. Half the sample (51.2%; N = 222) reported at least moderate financial stress due to COVID-19. Nearly a third of respondents (31.1%; N = 135) reported that their current living situation has had a considerable or severe negative impact on their mental health since COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a negative impact on their relationship with their intimate partner. Nearly a third of respondents who were in a relationship (30.9%; N = 77) reported that they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) toward their intimate partner during COVID-19, and more than a quarter (27.3%; N = 68) reported being abused by their intimate partner (also primarily verbal abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents indicated experiencing suicidal ideation.Conclusion: These findings can help inform providers of health services to Canadian men, as well as policies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.