1
|
Alcalde E, Rouquette A, Wiernik E, Rigal L. How do men and women differ in their depressive symptomatology? A gendered network analysis of depressive symptoms in a French population-based cohort. J Affect Disord 2024; 353:1-10. [PMID: 38395202 DOI: 10.1016/j.jad.2024.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The experience of depressive manifestations and the presentation of symptoms in clinical settings may differ in men and women. Despite the extensive literature, it remains unclear how depressive manifestations interact at symptom levels in men and women. First, we aimed to describe and compare depressive networks by sex. Second, we examined symptom connections to Clinical depression and Functional Limitations as a proxy of self-recognition of a depressive episode. METHODS We estimated networks from the 20 CES-D items in men and women from a large population-based French cohort. We computed centrality measures and ran comparisons. Then, we re-estimated two networks in men and women separately, adding, on the one hand, Clinical Depression and, on the other hand, Limitations due to a depressive episode. RESULTS Over 200,000 participants were included in this study. Women were twice as likely to have a previous diagnosis of depression. Sex-ratio was less pronounced (1,7:1) for Limitations due to depression. Centrality measures revealed similar symptom patterns. However, network structures differed between men and women. We found some symptom connections to Clinical depression and Limitations to be non-invariant according to sex. LIMITATIONS Cross-sectional data does not capture the direction of the connections between symptoms and an eventual diagnosis. We lacked data about the diagnosis's context and could not account for other factors influencing depressive symptomatology. CONCLUSIONS Network structures differed, suggesting gender-specific mechanisms in activating symptoms and depressive states. Addressing central symptoms evoking depressed moods with tailored interventions may serve to tackle depressive states in men and women.
Collapse
Affiliation(s)
- Eugenia Alcalde
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; IRIS, INSERM U997, Aubervilliers, France.
| | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; Public Health and Epidemiology Department, AP-HP Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Emmanuel Wiernik
- Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, UMS 011 Population-based Cohorts Unit, Paris, France
| | - Laurent Rigal
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; Public Health and Epidemiology Department, AP-HP Paris-Saclay University, Le Kremlin-Bicêtre, France
| |
Collapse
|
2
|
Tsindos G, Scurrah K, Benakovic R, Reynolds KA, King K. Exploring the Association Between Help-Seeking Intentions and Suicidal Ideation in Australian Adult Men. CRISIS 2024; 45:234-241. [PMID: 38441130 DOI: 10.1027/0227-5910/a000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background: Men account for three-quarters of suicide deaths in Australia. Self-reliant masculine norms may act as barriers to men's help-seeking and contribute to suicidal ideation. Men who seek help may be less likely to experience suicidal ideation. Aim: We evaluated the association between help-seeking intentions and suicidal ideation in Australian adult men using data from Wave 2 of the Australian Longitudinal Study on Male Health (Ten to Men). Method: Using scores on the General Help-Seeking Questionnaire, we explored the association between informal help-seeking intentions (e.g., friend, family), formal help-seeking intentions (e.g., psychologist), overall help-seeking intentions (all sources), and new-onset suicidal ideation. We conducted logistic regression analyses using a sample of 7,828 men aged 18-60 years. Results: Increased overall help-seeking intentions and informal help-seeking intentions were significantly associated with lower odds of new-onset suicidal ideation, whereas formal help-seeking intentions were not significantly associated. Limitations: The cross-sectional design limits inferences about causality. Conclusion: Men who have greater informal help-seeking intentions may be less likely to experience a new onset of suicidal ideation; however, more longitudinal research is needed.
Collapse
Affiliation(s)
- Georgia Tsindos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Katrina Scurrah
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
- Data and Lifecourse Studies, Australian Institute of Family Studies, Melbourne, VIC, Australia
| | - Ruben Benakovic
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Kate A Reynolds
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Kylie King
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Victorson D, Mishra KK, Sauer J, Langford G, Maletich C, Horowitz B, Sauer C, Sejpal SV, Kalapurakal J. Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241249140. [PMID: 38694593 PMCID: PMC11062214 DOI: 10.1177/27536130241249140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024]
Abstract
Background The most common and debilitating side effects of radiation therapy (RT) for prostate cancer (PC) are fatigue, sleep disturbance, anxiety, and depression. Previous research has reported palliative benefits from certain self-management approaches, such as mindfulness meditation. Objective To develop, pre-test, and evaluate the feasibility, acceptability and initial benefit of brief, audio-based mindfulness delivered during daily RT for PC compared to a relaxing music control. Methods Following intervention development, participants were randomized to either brief guided mindfulness audio recordings or a relaxing music control during daily RT. A pre-testing phase was first conducted to determine optimal program start time, length, and content most associated with retention. A final program (n = 26) was delivered daily, starting on day one of week 2 of RT and lasting 4 consecutive weeks. Feasibility was defined as ≥70% on enrollment rate, retention, and audio program adherence. Acceptability was measured with a 12-item post-study survey. A secondary focus compared between group changes on patient reported outcomes of fatigue, anxiety, depression, sleep disturbance, and related outcomes at baseline and follow up assessments. Descriptive statistics and general linear models were used. Results Overall, 76% (n = 38) of approached men enrolled. Pre-testing retention rates were <70% while the final program's retention rate was 89%. The majority of acceptability criteria were met in both conditions, with relatively higher ratings in the mindfulness arm. Compared to music controls, mindfulness participants demonstrated significantly less uncertainty intolerance at 4-weeks (P = .046, d = .95); and significantly lower fatigue scores (P = .049, d = 1.3) and lower sleep disturbance scores (P = .035, d = 1.1) at the 3 months follow up. Conclusion The final intervention met feasibility and acceptability criteria. Pre-testing refinements played a key role for optimal program delivery and retention. Audio-based mindfulness delivered during RT for PC hold potential to help decrease RT-related physical and emotional side effects.
Collapse
Affiliation(s)
- David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Joseph Sauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- University of Illinois-Chicago Medical School, Chicago, IL, USA
| | - Grace Langford
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carly Maletich
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruriah Horowitz
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina Sauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - John Kalapurakal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
4
|
Davenport C, Swami V. "What Can I Do to Not Have This Life"? A Qualitative Study of Paternal Postnatal Depression Experiences among Fathers in the United Kingdom. Issues Ment Health Nurs 2023; 44:1188-1199. [PMID: 37819864 DOI: 10.1080/01612840.2023.2262574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Understandings of paternal postnatal depression (PND) in fathers from the United Kingdom (UK) have received limited attention, particularly in view of changing dynamics of contemporary parenthood. To rectify this, eight UK fathers with PND took part in one-to-one interviews, with Interpretative Phenomenological Analysis used to understand their lived experiences. Our findings demonstrate that UK fathers with PND experienced extremely distressing emotions, including anger and misery, after their babies are born. Their working practices were highly relevant to their fatherhood, with working considered a key responsibility and a source of stress, but also a "legitimate" escape from the home. Fathers' relationships with their partners were experienced as less intimate and conflicted. Fathers often hid their feelings to protect their partners, but also reported their partners as being aware of their challenging and difficult emotions. Healthcare providers should be professionally curious about fathers' mental health and consider the assistance of mothers in identifying cases of paternal PND.
Collapse
Affiliation(s)
| | - Viren Swami
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| |
Collapse
|
5
|
Lilly KJ, Howard C, Zubielevitch E, Sibley CG. Thinking twice: examining gender differences in repetitive negative thinking across the adult lifespan. Front Psychol 2023; 14:1239112. [PMID: 38022916 PMCID: PMC10663279 DOI: 10.3389/fpsyg.2023.1239112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background A wealth of literature shows that women report greater levels of repetitive negative thinking, particularly rumination, than men in adolescence and adulthood. However, little research has examined how these gender differences develop or change across the entire adult lifespan. Methods The present study addresses these oversights using a nationwide longitudinal probability sample of adults over 12 annual assessment points (N = 64,901; Mage = 42.50, range 18-81; 62.9% women) and a single-item measure of global repetitive negative thinking. Critically, we use multigroup cohort-sequential latent growth modeling to determine whether changes in this construct over time are due to (a) normative aging, (b) generational differences associated with the historical period one was born and raised in, or (c) a combination of these processes. Results Our results reveal that rumination peaks in young adulthood for both women and men but declines steadily thereafter, reaching its lowest levels at the end of the adult lifespan. That said, some gender and cohort differences emerged, with young women-particularly young cohorts-reporting higher levels of rumination than their male counterparts and older birth cohorts. Discussion Our study suggests that gender differences in rumination may be most prevalent among young birth cohorts, though future research is needed to elucidate the mechanisms underlying these processes.
Collapse
Affiliation(s)
- Kieren J. Lilly
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Chloe Howard
- School of Psychology, University of Auckland, Auckland, New Zealand
| | | | - Chris G. Sibley
- School of Psychology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
Black O, Lane TJ, Flatau-Harrison H, Canuto K, Smith JA. Exploring Health Literacy and Psychological Resilience as Moderators of Symptoms of Mental Illness Among Australian Men. Am J Mens Health 2023; 17:15579883231211054. [PMID: 37963873 PMCID: PMC10647959 DOI: 10.1177/15579883231211054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Although highly related, mental illness may not fully determine perceived well-being, a distinction captured by dual-continuum models. Separating mental illness and well-being into related but separate constructs prompted investigation into potential buffers to reduce the impact of mental illness on perceived well-being. This study explored two such buffers in health literacy and psychological resilience among Australian men. Using the Ten to Men Australian Longitudinal Study on Male Health, this secondary data analysis of n = 8,408 men between 18 and 60 years of age assessed the moderating effect of three components of health literacy (feeling supported by health care providers, ability to find health information, and active engagement with health care providers) and psychological resilience on the relationship between mental illness and well-being. Mental illness symptoms were negatively associated with well-being, whereas psychological resilience, active engagement with health care, and health care provider support (β res = .65, β eng = .28, and β sup = .25) had positive significant relationships with the outcome (all p ≤ .001). Ability to find health information (p = .25) and psychological resilience (p = .43) were not significantly associated with well-being. Of the four interactions tested, health literacy relating to health care worker support was the only significant moderator between mental illness and well-being (β sup = .03). This study identified that meaningful support and understanding from health care providers for Australian men aged between 18 and 60 years may somewhat ameliorate the impact of mental illness on well-being. Further related investigation may reveal specific interventions that improve perceptions of support among men.
Collapse
Affiliation(s)
- Oliver Black
- Flinders University, Casuarina, Northern Territory, Australia
| | | | | | - Kootsy Canuto
- Flinders University, Casuarina, Northern Territory, Australia
| | - James A. Smith
- Flinders University, Casuarina, Northern Territory, Australia
| |
Collapse
|
7
|
Boerma M, Beel N, Jeffries C, Ruse J. Review: Recommendations for male-friendly counselling with adolescent males: A qualitative systematic literature review. Child Adolesc Ment Health 2023; 28:536-549. [PMID: 36604844 DOI: 10.1111/camh.12633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There are growing calls to tailor counselling practices for adolescent males, a population reluctant to engage in psychological treatment despite concerning rates of mental illness. The objective of this systematic review (PROSPERO: CRD4202125547) was to collate and synthesise recommendations for individual counselling with adolescent males (12-18 years). METHOD The databases Psychology and Behavioural Science Collection, PsycArticles, PsycINFO, Academic Search Complete, EBSCO eBook Collection, Wiley Science Collection, Taylor and Francis Collection and ProQuest One Academic were searched for articles published between 1995 and November 2021. The quality of evidence was assessed using the JBI critical appraisal checklists, and thematic analysis was employed to synthesise findings across the literature. RESULTS A total of 1625 texts were identified, of which 16 met the inclusion criteria. Generated themes included (a) therapist knowledge of masculinity, gender socialisation, and male-relational styles; (b) necessity of therapists to address masculinity in the therapeutic space; and (c) customising engagement and treatment practices to appeal to adolescent males. CONCLUSIONS The themes highlighted the unique developmental, and sociocultural considerations practitioners should be aware of when working with young men. Through a multicultural counselling competency framework, masculinity and adolescent male identity are expressions of diverse sociocultural identities that psychological assessment and intervention should ideally be tailored to suit. The findings of the review suggest that empirical research focusing on the experiences of adolescent males receiving psychological treatment is sparse. Further research is needed to inform the development of practicable, gender-sensitive adaptions to counselling practice for young men.
Collapse
Affiliation(s)
- Micah Boerma
- School of Psychology & Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - Nathan Beel
- School of Psychology & Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
- Applied Psychology, Counselling, Australian College of Applied Professions, Brisbane, Australia
| | - Carla Jeffries
- School of Psychology & Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - Jesse Ruse
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
8
|
Turrini M. "There Are Many of Us": Online Testimonies From "Pill Victims" as a New Form of Health Activism. QUALITATIVE HEALTH RESEARCH 2023; 33:567-577. [PMID: 37014711 DOI: 10.1177/10497323231163741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The French pill scare is usually presented as a "media debate" triggered by the case of Marion Larat, a young woman who suffered a stroke attributed to the pill she was taking. This article intends to focus on a practice that preceded, accompanied, and followed this health scare: the publication of online testimonies of thrombotic reactions posted on the website of the French Association of Victims of Pulmonary Embolism and Stroke Associated with Hormonal Contraception (Avep). Through a discourse analysis, we intend to analyze these online public self-reports as an activist practice aimed at criticizing the dominant medical discourse on contraception. Four discursive frames emerged: unpreparedness of women and doctors, denial of blame and search for the cause, breaking the silence and building solidarity, and collective action. The first two frames concern the process women put in place to obtain the right to speak about and criticize a medical practice. The right to speak is achieved through a concise narrative style focusing on facts, bodily manifestations, and risk factors. The second pair refers to the formation of pill victims as subjects with an ambivalent status and ephemeral agency. The testimonies build what we call "lone solidarity", that is, the creation of a social bond and action around a common experience of witnessing medical injustice that develops without any exchange between members. This proves to be inclusive and viral, but at the same time fiercely anti-representational with respect to political struggles or social identification.
Collapse
Affiliation(s)
- Mauro Turrini
- Institute of Public Goods and Policies (IPP), Spanish National Research Council (CSIC), Madrid, Spain
| |
Collapse
|
9
|
Cotter CA, O’Neill MK, Stevens MN, Sanders PG, Henninger J. Counseling With Male Clients: The Case for Relational Resilience Approach. Am J Mens Health 2023; 17:15579883231179328. [PMID: 37334899 PMCID: PMC10286188 DOI: 10.1177/15579883231179328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023] Open
Abstract
Although there is no lack of research on masculinity and help-seeking behavior, men continue to seek counseling less often than women. It is crucial we find effective therapeutic approaches to connect and meet men where they are, acknowledging the positive aspects of their masculinity while addressing their needs in the counseling setting. In this conceptual research article, we propose a new approach for counselors to utilize with men seeking counseling, the Relational Resilience Approach, which applies tenets of Relational-Cultural Theory, Positive Psychology, and Shame Resilience Theory.
Collapse
Affiliation(s)
- Carol A. Cotter
- Department of Counselor Education, Adams State University, Alamosa, CO, USA
| | - Melissa K. O’Neill
- Department of Counselor Education, Adams State University, Alamosa, CO, USA
| | | | - Penny G. Sanders
- Department of Counselor Education, Adams State University, Alamosa, CO, USA
| | - Janessa Henninger
- Department of Counselor Education, Adams State University, Alamosa, CO, USA
| |
Collapse
|
10
|
Williams ED, Lateef H, Gale A, Boyd D, Albrecht J, Paladino J, Koschmann E. Barriers to School-Based Mental Health Resource Utilization Among Black Adolescent Males. CLINICAL SOCIAL WORK JOURNAL 2023; 51:1-16. [PMID: 37360754 PMCID: PMC10148625 DOI: 10.1007/s10615-023-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/28/2023]
Abstract
Black adolescent males use available mental health services at a disproportionately lower rate compared to males of other racial groups. This study examines barriers to school-based mental health resource (SBMHR) use among Black adolescent males, as a means of addressing reduced usage of available mental health resources and to improve these resources to better support their mental health needs. Secondary data for 165 Black adolescent males were used from a mental health needs assessment of two high schools in southeast Michigan. Logistic regression was employed to examine the predictive power of psychosocial (self-reliance, stigma, trust, and negative previous experience) and access barriers (no transportation, lack of time, lack of insurance, and parental restrictions) on SBMHR use, as well as the relationship between depression and SBMHR use. No access barriers were found to be significantly associated with SBMHR use. However, self-reliance and stigma were statistically significant predictors of SBMHR use. Participants who identified self-reliance in addressing their mental health symptoms were 77% less likely to use available mental health resources in their school. However, participants who reported stigma as a barrier to using SBMHR were nearly four times more likely to use available mental health resources; this suggests potential protective factors in schools that can be built into mental health resources to support Black adolescent males' use of SBMHRs. This study serves as an early step in exploring how SBMHRs can better serve the needs of Black adolescent males. It also speaks to potential protective factors that schools provide for Black adolescent males who have stigmatized views of mental health and mental health services. Future studies would benefit from a nationally representative sample allowing for more generalizable results regarding barriers and facilitators to Black adolescent males' use of school-based mental health resources.
Collapse
Affiliation(s)
- Ed-Dee Williams
- School of Social Work, University of Michigan, 1080 South University Avenue, Office 3765, Ann Arbor, MI 48109-1106 USA
| | - Husain Lateef
- Washington University in St. Louis School of Social Work, St. Louis, MO USA
| | - Adrian Gale
- Rutgers University School of Social Work, New Brunswick, NJ USA
| | - Donte Boyd
- The Ohio State University School of Social Work, Columbus, OH USA
| | - Jeffrey Albrecht
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105 USA
| | - Jill Paladino
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105 USA
| | | |
Collapse
|
11
|
Haider K, Humer E, Weber M, Pieh C, Ghorab T, Dale R, Dinhof C, Gächter A, Probst T, Jesser A. An Assessment of Austrian School Students' Mental Health and Their Wish for Support: A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4749. [PMID: 36981657 PMCID: PMC10049003 DOI: 10.3390/ijerph20064749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students' mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) assessing wishes for support regarding mental well-being and mental health indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were "professional help" and "someone to talk to". The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people's mental health problems and that this need is even more urgent for students.
Collapse
Affiliation(s)
- Katja Haider
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Elke Humer
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Magdalena Weber
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
- Department of Organizational Psychology, Private University of Schloss Seeburg, 5201 Seekirchen am Wallersee, Austria
| | - Christoph Pieh
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Tiam Ghorab
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Rachel Dale
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Carina Dinhof
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Afsaneh Gächter
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Thomas Probst
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| | - Andrea Jesser
- Department of Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, 3500 Krems, Austria
| |
Collapse
|
12
|
Chen C, Yip HT, Leong KH, Yao WC, Hung CL, Su CH, Kuo CF, Tsai SY. Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan. J Transl Med 2023; 21:98. [PMID: 36755267 PMCID: PMC9907887 DOI: 10.1186/s12967-023-03886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE An increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan. METHODS An analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls. RESULTS Compared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04-1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59-2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09-1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women. CONCLUSION This population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.
Collapse
Affiliation(s)
- Chi Chen
- grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hei-Tung Yip
- grid.411508.90000 0004 0572 9415Management Office for Health Data, China Medical University Hospital, Taichung, 404 Taiwan
| | - Kam-Hang Leong
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Wei-Cheng Yao
- grid.415675.40000 0004 0572 8359Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chung-Lieh Hung
- grid.452449.a0000 0004 1762 5613Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Huang Su
- grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Chien-Feng Kuo
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, 25245 Taiwan ,grid.413593.90000 0004 0573 007XDivision of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, 252, Taiwan. .,Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104, Taiwan. .,Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan. .,Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| |
Collapse
|
13
|
Boydell KM, Nicolopoulos A, Macdonald D, Habak S, Christensen H. Understanding Protective Factors for Men at Risk of Suicide Using the CHIME Framework: The Primacy of Relational Connectedness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2259. [PMID: 36767634 PMCID: PMC9914937 DOI: 10.3390/ijerph20032259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Suicide is a global problem, ranking among the leading causes of death in many countries across the world. Most people who die by suicide are "under the radar", having never seen a mental health professional or been diagnosed with a mental illness. This article describes the protective factors for men experiencing suicidal thoughts, plans, and/or attempts who are "under the radar". Using in-depth qualitative interviews, we aimed to understand stakeholder perspectives on the protective factors that influence men's wellbeing. The pervasiveness of relational connectedness in men's narratives was identified as a central protective factor. Other key protective factors included meaningful activity, empowerment, and hope. These results have the potential to facilitate the development of focused community initiatives. More generally, the current research offers an example of a qualitative inquiry into men's wellbeing that focuses on strengths and positive factors in their lives and may provide a guide for future community-based suicide prevention research.
Collapse
Affiliation(s)
- Katherine M. Boydell
- Black Dog Institute, Sydney 2034, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2034, Australia
- Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Alexandra Nicolopoulos
- Black Dog Institute, Sydney 2034, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2034, Australia
| | - Diane Macdonald
- Black Dog Institute, Sydney 2034, Australia
- Faculty of Medicine, University of New South Wales, Sydney 2034, Australia
| | | | - Helen Christensen
- Faculty of Medicine, University of New South Wales, Sydney 2034, Australia
| |
Collapse
|
14
|
Pebole MM, Greco CE, Gobin RL, Phillips BN, Strauser DR. Impact of childhood maltreatment on psychosomatic outcomes among men and women with disabilities. Disabil Rehabil 2022; 44:7491-7499. [PMID: 34762011 DOI: 10.1080/09638288.2021.1998666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This project examined the impact of childhood maltreatment types on psychosomatic outcomes among adults with a range of self-reported disabilities. MATERIALS AND METHODS Participants (n = 643) were recruited using Amazon Mechanical Turk and Cloud Research. Single-item questions assessed sociodemographic information. The Childhood Trauma Questionnaire measured childhood maltreatment types (emotional, physical, and sexual abuse, and emotional and physical neglect) and the RAND-36 Item Health Survey evaluated physical functioning, pain, and energy/fatigue. Logistic regressions determined associations between childhood trauma and psychosomatic outcomes; stratified models compared men and women. RESULTS Multivariate-adjusted models indicated physical abuse was positively associated with poor physical functioning (OR: 2.03; 95%CI: 1.35-3.06) with this relationship being stronger for men (OR: 3.25; 95%CI: 1.42-7.43) than women (OR: 1.91; 95%CI: 1.17-3.13). Adjusted models showed that physical neglect was protective against fatigue (OR: 0.58; 95% CI: 0.36-0.94), while emotional neglect increased the risk of fatigue (OR: 1.74; 95%CI: 1.02-2.95). Lastly, physical abuse was positively associated with pain (OR: 1.53; 95%CI: 1.01-2.33). This relationship was stronger in men (OR: 4.99; 95%CI: 1.91-12.99). CONCLUSIONS Results improve our understanding of risk factors for poor physical health outcomes and can guide the development of trauma-sensitive rehabilitation services.Implications for RehabilitationIndividuals with disabilities who report childhood maltreatment may experience poor psychosomatic outcomes in adulthood.Consequences of experiencing childhood maltreatment may manifest differently between men and women over the course of the lifespan.It is essential to integrate trauma-informed principles into treatment plans for individuals with poor psychosomatic health.Rehabilitation professionals should screen for abuse and refer individuals to the appropriate mental and physical health services.
Collapse
Affiliation(s)
- Michelle M Pebole
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Chelsea E Greco
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Brian N Phillips
- Department of Special Education and Rehabilitation Counseling, Utah State University, Logan, UT, USA
| | - David R Strauser
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| |
Collapse
|
15
|
Smyth N, Buckman JEJ, Naqvi SA, Aguirre E, Cardoso A, Pilling S, Saunders R. Understanding differences in mental health service use by men: an intersectional analysis of routine data. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2065-2077. [PMID: 35318495 PMCID: PMC9477949 DOI: 10.1007/s00127-022-02256-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Rates of help-seeking for common mental health problems are lower for men, but less is known about patterns of engagement once they are in contact with services. Previous research has been limited in its ability to understand the intersection between service user characteristics and engagement. This study compared analytic approaches to investigate intersectional associations between sociodemographic and socioeconomic indicators and use of psychological treatment services by men. METHOD Data from 9,904 male service users attending two psychological treatment services in London were analysed. The association between ethnicity, sexual orientation, religious affiliation and employment status of service users and service use outcomes was explored using multinomial logistic regression and latent class analysis (LCA). RESULTS Being from a minoritised ethnic background, of Muslim faith, being unemployed, and living in the most deprived neighbourhoods were associated with greater risk of not commencing or completing treatment. Seven classes were identified in LCA, with men predominately differentiated by self-reported ethnicity and religion. Compared with the 'White British, non-religious' class, the 'Asian Muslim' class and the 'minoritised ethnic, non-religious' class were at higher risk of disengagement, whilst the 'Asian, other religion' class were at higher risk of being referred elsewhere rather than completing initiated treatment. CONCLUSIONS There were significant inequalities in engagement by men associated with ethnicity, religion and socioeconomic status. Compared with the regression models, further nuance was apparent in LCA regarding the intersection of gender, religion and ethnicity. Identifying groups at greater risk of discontinuation of treatment could inform more personalised pathways through care.
Collapse
Affiliation(s)
- Natasha Smyth
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK.
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Syed A Naqvi
- North East London NHS Foundation Trust, London, UK
| | | | - Ana Cardoso
- North East London NHS Foundation Trust, London, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
| |
Collapse
|
16
|
Trail K, Wilson MJ, Rice SM, Hunt T, Pirkis J, Seidler ZE. "I Called When I Was at My Lowest": Australian Men's Experiences of Crisis Helplines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159143. [PMID: 35897513 PMCID: PMC9332851 DOI: 10.3390/ijerph19159143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 01/09/2023]
Abstract
Background: Helplines are an accessible form of support for people struggling with difficulties in their lives and are key services in suicide prevention and intervention. Men’s experiences of telephone helplines are not well understood, despite high male suicide rates. Methods: We conducted an online cross-sectional survey with N = 684 Australian men (aged 17–83 years, M = 50.13) using open- and closed-ended questions about their experiences of helplines during the COVID-19 pandemic. Descriptive statistics were analysed to investigate differences between men using and not using helplines. Qualitative responses were analysed using thematic analysis. Results: Within the sample, 100 men (14.6%) had used a helpline service. Men using helplines were more likely to be unemployed and in younger age brackets than those not using helplines. They were also more likely to report experiencing stressors related to COVID-19, including financial stress and job loss, perceived impact on mental health and relationship breakdown. Qualitative analysis indicated varied experiences of helplines, with men shedding light on how their interaction with a counsellor, the structure of services and their expectations of the service impacted their experience. Conclusions: Further in-depth qualitative enquiry in this space is required, with the objective of understanding how helpline services may seek to better engage with male callers.
Collapse
Affiliation(s)
- Katherine Trail
- Orygen, Parkville, VIC 3052, Australia; (M.J.W.); (S.M.R.); (Z.E.S.)
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC 3010, Australia
- Correspondence:
| | - Michael J. Wilson
- Orygen, Parkville, VIC 3052, Australia; (M.J.W.); (S.M.R.); (Z.E.S.)
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Simon M. Rice
- Orygen, Parkville, VIC 3052, Australia; (M.J.W.); (S.M.R.); (Z.E.S.)
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Tara Hunt
- Lifeline Research Foundation, Lifeline Australia, Sydney, NSW 2000, Australia;
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Zac E. Seidler
- Orygen, Parkville, VIC 3052, Australia; (M.J.W.); (S.M.R.); (Z.E.S.)
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| |
Collapse
|
17
|
'You're on the waiting list': An interpretive phenomenological analysis of young adults' experiences of waiting lists within mental health services in the UK. PLoS One 2022; 17:e0265542. [PMID: 35303040 PMCID: PMC8932552 DOI: 10.1371/journal.pone.0265542] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Waiting lists in mental health services are currently considered too long. Lengthy waits of up to 18 weeks are commonly reported in the UK. Waiting lists have long been associated with a variety of negative psychological responses, however there is little understanding behind young adults’ personal experiences of such delays within mental health services. The current study aimed to explore young adults’ experiences of waiting lists in mental healthcare in the UK. Seven young adults were interviewed in the current study (aged 19–22). Interpretive phenomenological analysis was utilised to explore participant accounts. Three super-ordinate themes were generated: Reliance on Alternative Methods of Support; Inability to Function Sufficiently; and Emergence of Negative Beliefs, Emotions and Thoughts. Participants primarily reported a variety of negative psychological and behavioural consequences associated with waiting lists in mental health services, as well as exacerbated existing physical and psychological health issues. In accordance with the limited number of previous studies, waiting lists are considered by patients to be barriers to mental health support and intervention. Future direction is advised.
Collapse
|
18
|
Simpson NJ, Oliffe JL, Rice SM, Kealy D, Seidler ZE, Ogrodniczuk JS. Social Disconnection and Psychological Distress in Canadian Men During the COVID-19 Pandemic. Am J Mens Health 2022; 16:15579883221078145. [PMID: 35172641 PMCID: PMC8859659 DOI: 10.1177/15579883221078145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic has significantly challenged many men’s mental health. Efforts to control the spread of the virus have led to increasing social disconnection, fueling concerns about its long-term effects on men’s mental health, and more specifically their experience of psychological distress. Social disconnection, psychological distress, and the relationship between them have yet to be formally explored in a Canadian male sample during the COVID-19 pandemic. The present study examined whether reduced social connection among men was associated with increased anxiety and depressive symptoms (psychological distress) and whether this association was moderated by living alone. The sample consisted of 434 help-seeking Canadian men who completed standardized measures. Analyses controlled for the potentially confounding effects of age and fear of COVID-19. Findings revealed that less social connection was associated with increased psychological distress. This association was not moderated by living alone, nor was living alone directly associated with psychological distress. Younger age and fear of COVID-19 were each independently associated with psychological distress. Socially disconnected men were more likely to experience anxiety and depressive symptoms, suggesting the need for interventions focussed on men’s social connectedness, social support, and belongingness to help reduce some COVID-19-induced mental health risks.
Collapse
Affiliation(s)
- Nick J. Simpson
- School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Nursing, The University of Melbourne, Victoria, Australia
| | - Simon M. Rice
- Orygen, Parkville, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zac E. Seidler
- Orygen, Parkville, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Victoria, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- John S. Ogrodniczuk, Department of Psychiatry, University of British Columbia, #420-5950 University Boulevard, Vancouver, British Columbia, Canada V6T 1Z3.
| |
Collapse
|
19
|
Sharp P, Bottorff JL, Rice S, Oliffe JL, Schulenkorf N, Impellizzeri F, Caperchione CM. "People say men don't talk, well that's bullshit": A focus group study exploring challenges and opportunities for men's mental health promotion. PLoS One 2022; 17:e0261997. [PMID: 35061764 PMCID: PMC8782463 DOI: 10.1371/journal.pone.0261997] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/15/2021] [Indexed: 01/26/2023] Open
Abstract
Men’s mental health promotion presents unique challenges including gender-related barriers and stigmas, which demand novel approaches to prevention, treatment, and management. The aim of this study was to explore men’s perceptions of mental health and preferences for mental health promotion. Seven focus groups (N = 59) were conducted in Sydney, Australia, including 5 groups of men (M = 50.65, SD = 13.75 years) and 2 groups of stakeholders who had frontline experience working with men (e.g., men’s groups, health clubs, mental health advocates). Data were analysed using thematic analysis and interpreted using a gender relations approach to explore connections between gender roles, relations and identities, and men’s mental health. Three overarching themes were identified; (1) Roles, identities, and the conceptualisation and concealment of mental health challenges, revealing challenges to mental health promotion related to perceptions of men’s restrictive emotionality and emotional awareness as well as difficulties with conceptualising the internalised experiences of mental health, (2) Constraining social contexts of stigma and gender relations, identifying how social context and the policing of gender roles often obscured opportunities for discussing mental health and help-seeking behaviour, (3) Anchoring mental health promotion to acceptable lifestyle practices, highlighting potential remedies included leveraging men’s social practices related to reciprocity, normalising mental health promotion relative to other behaviours, and embedding mental health promotion within acceptable masculine practices. Discussed are directions for men’s community-based mental health promotion and opportunities for how masculinities may be negotiated and expanded to embody mental health promoting values.
Collapse
Affiliation(s)
- Paul Sharp
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Joan L. Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Simon Rice
- Orygen, Parkville, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Nico Schulenkorf
- Business School, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Franco Impellizzeri
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Cristina M. Caperchione
- School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
McKenzie SK, Oliffe JL, Black A, Collings S. Men's Experiences of Mental Illness Stigma Across the Lifespan: A Scoping Review. Am J Mens Health 2022; 16:15579883221074789. [PMID: 35125015 PMCID: PMC8832600 DOI: 10.1177/15579883221074789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The stigma of men's mental illness has been described as having wide-reaching and profound consequences beyond the condition[s] itself. Stigma negatively impacts men's mental health help-seeking and the use of services amid impeding disclosures, diminishing social connection and amplifying economic hardship. Although men often face barriers to discussing their struggles with, and help-seeking for mental illness challenges, research focused on men's lived experiences of mental illness stigma is, at best, emergent. This scoping review explores men's mental illness related stigmas synthesizing and discussing the findings drawn from 21 published qualitative articles over the last 10 years. Four thematic findings were derived: (a) the weight of societal stigma, (b) stigma in male-dominated environments, (c) inequity driven stigmas, and (d) de-stigmatizing strategies. Despite evidence that stigma is a common experience for men experiencing diverse mental illness challenges, the field remains underdeveloped. Based on the scoping review findings, research gaps and opportunities for advancing the field are discussed.
Collapse
Affiliation(s)
- Sarah K McKenzie
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, University of Melbourne, Victoria, Australia
| | - Alice Black
- Suicide and Mental Health Research Group, Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Sunny Collings
- School of Health, Te Herenga Waka-Victoria University of Wellington, New Zealand
| |
Collapse
|
21
|
Høegmark S, Andersen TE, Grahn P, Roessler KK. The Wildman Programme – Experiences from a first implementation of a nature-based intervention designed for men with stress and chronic illnesses. Complement Ther Clin Pract 2022; 46:101535. [DOI: 10.1016/j.ctcp.2022.101535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/09/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
|
22
|
Aguayo F. NARRATIVES ON DEPRESSION, MASCULINITY AND WORK. A STUDY WITH LIFE STORIES OF CHILEAN MEN. PSICOLOGIA & SOCIEDADE 2022. [DOI: 10.1590/1807-0310/2022v34251463en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract: Each year in Chile, one in ten men have demonstrated signs or symptoms of depression. (MINSAL, 2018; Center for Conflict and Social Cohesion Studies, 2018). However, both in the country and in the rest of Latin America, there are few studies that address male depression from its qualitative and narrative aspects. The aim of this study was to analyze reports of depression in men and their references to concepts of hegemonic masculinity. A qualitative study was carried out with interviews with five Chilean men who experienced a depressive process. With a life story methodology, the depressive processes in each biography were explored. The results show that men report depression and malaise from a crisis or main drama, and according to aspects that challenge the values of hegemonic masculinity.
Collapse
|
23
|
Aguayo F. NARRATIVAS SOBRE DEPRESIÓN, MASCULINIDAD Y TRABAJO. UN ESTUDIO CON RELATOS BIOGRÁFICOS DE HOMBRES CHILENOS. PSICOLOGIA & SOCIEDADE 2022. [DOI: 10.1590/1807-0310/2022v34251463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumen: En Chile, uno de cada diez hombres presenta indicios o síntomas de depresión cada año. (MINSAL, 2018; Centro de Estudios de Conflicto y Cohesión Social, 2018). Sin embargo, tanto en el país como en el resto de Latinoamerica, son escasos los estudios que aborden la depresión masculina desde sus aspectos cualitativos y narrativos. El objetivo de este estudio fue analizar los relatos de depresión en hombres y sus referencias a los valores de la masculinidad hegemónica. Se realizó un estudio cualitativo con entrevistas a cinco hombres chilenos que habían pasado por un proceso depresivo. Con una metodología de relato de vida, se exploraron los procesos depresivos en su biografía. Los resultados muestran que los hombres narran la depresión y su malestar a partir de una crisis o drama principal y según aspectos que desafían los valores de la masculinidad hegemónica.
Collapse
|
24
|
Ogrodniczuk JS, Beharry J, Oliffe JL. An Evaluation of 5-Year Web Analytics for HeadsUpGuys: A Men's Depression E-Mental Health Resource. Am J Mens Health 2021; 15:15579883211063322. [PMID: 34861812 PMCID: PMC8646842 DOI: 10.1177/15579883211063322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua Beharry
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Vickery A. Men's Help-Seeking for Distress: Navigating Varied Pathways and Practices. FRONTIERS IN SOCIOLOGY 2021; 6:724843. [PMID: 34901258 PMCID: PMC8661038 DOI: 10.3389/fsoc.2021.724843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
There is a widely accepted dominant narrative surrounding men's mental health help-seeking, that men are less likely to pursue formal mental health support on account of hegemonic masculine ideals that limit emotional expression and vulnerability. Across the literature, little attention has been given to the varied ways in which men can and will seek out help when experiencing mental health troubles. This paper reports findings from a qualitative study of men's experiences of distress, specifically focused on their help-seeking and everyday coping and management of distress. Between 2016 and 2017, 38 individual interviews were carried out in South Wales, United Kingdom, with men of a range of ages (21-74 years of age) and social backgrounds. Analysis identifies nuanced help-seeking practices and pathways, emphasizing ways in which men can and will engage with mental health support. Some men struggled with articulating personal issues in mental health terms, and some portrayed ambivalence to help-seeking, yet at the same time reconstructed help-seeking to positively align with masculine values. The paper further highlights the significant influence of familial and friendship networks in the help-seeking process as well as the value of therapy for men experiencing mental health difficulties, challenging the idea that masculinity inhibits the disclosure of emotional problems. Awareness of the diversity of ways in which men can actively engage with their mental health is needed so that mental health support interventions and practitioners can best reach out to men experiencing distress and provide gender-sensitive support suitable to a range of different men.
Collapse
|
26
|
Olsson S, Burström B, Hensing G, Löve J. Poorer mental well-being and prior unmet need for mental healthcare: a longitudinal population-based study on men in Sweden. ACTA ACUST UNITED AC 2021; 79:189. [PMID: 34732262 PMCID: PMC8564598 DOI: 10.1186/s13690-021-00706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022]
Abstract
Background Depression and anxiety disorder contribute to a significant part of the disease burden among men, yet many men refrain from seeking care or receive insufficient care when they do seek it. This is plausibly associated with poorer mental well-being, but there is a lack of population-based research. This study investigated 1) if men who had refrained from seeking mental healthcare at any time in life had poorer mental well-being than those who sought care, 2) if those who had sought care but perceived it as insufficient had poorer mental well-being than those who had perceived care as sufficient, and 3) if these differences persisted after 1 year. Methods This longitudinal study used questionnaire data from a population-based sample of 1240 men, aged 19–64 years, in Sweden. Having refrained from seeking mental healthcare, or perceiving the care as insufficient, at any time in life, was assessed in a questionnaire, 2008. Current mental well-being was assessed in 2008 and 2009 using mean scores on the WHO (Ten) Well-being Index. Lower scores indicate poorer mental well-being. Group differences were calculated using t-tests and multivariable linear regression analysis. Results Of the men who had perceived a need for mental healthcare, 37% had refrained from seeking such care. They had lower mental well-being scores in 2008, compared to those who sought care. Of those seeking care, 29% had perceived it as insufficient. They had lower mental well-being scores in 2008, compared to those who perceived the care as sufficient, but this was not statistically significant when controlling for potential confounders. There were no differences in mental well-being scores based on care-seeking or perceived care-sufficiency in 2009. Conclusions This population-based study indicates that men who have previously refrained from seeking mental healthcare, or perceived the care as insufficient, have poorer mental well-being. However, the lack of differences at the one-year follow-up contradicts these results. The results highlight the need for larger longitudinal studies, measuring care-seeking within a more specified time frame. This should be combined with efforts to increase men’s mental healthcare-seeking and to provide mental healthcare that is perceived as sufficient. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00706-0.
Collapse
Affiliation(s)
- Sara Olsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
| |
Collapse
|
27
|
Hahm KS, Chase AS, Dwyer B, Anthony BW. Indoor Human Localization and Gait Analysis using Machine Learning for In-home Health Monitoring. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6859-6862. [PMID: 34892682 DOI: 10.1109/embc46164.2021.9630761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Homes equipped with ambient sensors can measure physiological signals correlated with the resident's health without requiring a wearable device. Gait characteristics may reveal physical imbalances or recognize changes in cognitive health. In this paper, we use the physical interactions with floor to both localize the resident and monitor their gait. Accelerometers are placed at the corners of the room for sensing. Gradient boosting regression was used to perform localization with an accuracy of 82%, reasonably accounting for inhomogeneity in the floor with just 3 sensors. A method using step time variance is proposed to detect gait imbalances; results on induced limps are presented.
Collapse
|
28
|
Horikoshi N, Maeda M, Harigane M, Iwasa H, Murakami M, Momoi M, Goto S, Yasumura S. Vulnerability of Evacuees Having No One to Consult after the Fukushima Nuclear Disaster: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910075. [PMID: 34639377 PMCID: PMC8508194 DOI: 10.3390/ijerph181910075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
After the accident at the Fukushima nuclear power plant in 2011, caused by the Great East Japan Earthquake, some evacuees had no one to consult despite many local care providers offering assistance. This study identified the characteristics of individuals who did not receive consultations and the relevant determinants, and proposed the available measures to address this issue. Altogether, 32,699 participants aged 16 years or older and residing in the disaster area at Fukushima were surveyed. Those with no one to consult showed a significantly higher prevalence of psychological distress (16.2%, p < 0.001) and drinking problems (21.5%, p < 0.001). Multivariate analysis revealed that these behaviors were associated with the middle age group (i.e., 40–64 years old) (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.16–1.46), men (OR = 2.46; 95% CI, 2.27–2.66), bad financial circumstances (OR = 2.11; 95% CI, 1.96–2.27), and living alone (OR = 1.53; 95% CI, 1.39–1.68). This research verifies that people with such characteristics were more likely to be isolated and vulnerable to psychiatric problems, such as depression. We suggest that it is integral for local care providers to recognize those who have no one to consult and provide targeted support.
Collapse
Affiliation(s)
- Naoko Horikoshi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Correspondence: ; Tel.: +81-24-581-5365
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Mayumi Harigane
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hajime Iwasa
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michio Murakami
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Maho Momoi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Saori Goto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (M.M.); (M.H.); (H.I.); (M.M.); (M.M.); (S.G.); (S.Y.)
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| |
Collapse
|
29
|
Tveit OG, Ruud T, Hanssen-Bauer K, Haavet OR, Hussain A. An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway. BMC Health Serv Res 2021; 21:960. [PMID: 34517868 PMCID: PMC8436443 DOI: 10.1186/s12913-021-06982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers. METHODS In this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency. RESULTS We found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers. CONCLUSIONS Men were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.
Collapse
Affiliation(s)
- Ole Gunnar Tveit
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ole Rikard Haavet
- Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ajmal Hussain
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
30
|
Saini P, Chopra J, Hanlon CA, Boland JE. A Case Series Study of Help-Seeking among Younger and Older Men in Suicidal Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147319. [PMID: 34299773 PMCID: PMC8307966 DOI: 10.3390/ijerph18147319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to compare help-seeking among younger and older men who attended a therapeutic centre for men in a suicidal crisis. In this case series study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD = 3.4). Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM), and engagement with the therapy. For the CORE-OM, there was a clinically significant reduction in mean scores between assessment and discharge (p < 0.001) for both younger and older men. At initial assessment, younger men were less affected by entrapment (46% vs. 62%; p = 0.02), defeat (33% vs. 52%; p = 0.01), not engaging in new goals (38% vs. 47%; p = 0.02), and positive attitudes towards suicide (14% vs. 18%; p = 0.001) than older men. At discharge assessment, older men were significantly more likely to have an absence of positive future thinking (15% vs. 8%; p = 0.03), have less social support (45% vs. 33%; p = 0.02), and feelings of entrapment (17% vs. 14%; p = 0.02) than younger men. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service.
Collapse
Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
- Correspondence: ; Tel.: +44-151-231-8121
| | - Jennifer Chopra
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
| | - Claire A. Hanlon
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK; (J.C.); (C.A.H.)
| | | |
Collapse
|
31
|
Liddle SK, Vella SA, Deane FP. Attitudes about mental illness and help seeking among adolescent males. Psychiatry Res 2021; 301:113965. [PMID: 34023672 DOI: 10.1016/j.psychres.2021.113965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Adolescent males are at particularly high risk of mental health problems and suicide. However, many in need are left undetected and untreated, and rates of help-seeking are low. To help explain this unmet need, the current study aimed to utilise Exploratory Factor Analysis to validate a measure of help-seeking attitudes using 16 items of the Mental Health Literacy Scale. Convergent validity was assessed through correlations of the factors with other measures capturing aspects of mental health literacy and psychological distress. Male adolescent sport participants (N=361) aged between 12 and 18 years participated in the study. The results revealed a distinct four-factor structure: social distance, stigmatising attitudes, confidence accessing information about mental health, and negative help-seeking attitudes. Each factor had satisfactory levels of internal consistency. The patterns of relationships suggest that the four factors may differentiate between important influencers of mental health help-seeking. The measure is brief and is likely to have high utility in measuring attitudes about mental illness and help-seeking among adolescent males. This may have implications for understanding the processes that could influence or improve help-seeking amongst this vulnerable group.
Collapse
Affiliation(s)
- Sarah K Liddle
- School of Psychology, University of Wollongong, NSW Australia 2522.
| | - Stewart A Vella
- School of Psychology, University of Wollongong, NSW Australia 2522
| | - Frank P Deane
- School of Psychology, University of Wollongong, NSW Australia 2522
| |
Collapse
|
32
|
Gough B, Robertson S, Luck H. Engendered Expressions of Anxiety: Men's Emotional Communications With Women and Other Men. FRONTIERS IN SOCIOLOGY 2021; 6:697356. [PMID: 34268351 PMCID: PMC8275859 DOI: 10.3389/fsoc.2021.697356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
While the contemporary therapeutic discourse inveigles us to talk about our personal problems, a countervailing neo-liberal healthist discourse, aligning with conventional masculinity norms, presumes that we will manage any issues independently. This discursive tension can be difficult to navigate, especially for men confronted with still powerful traditional expectations around masculinity (e.g., self-reliance; personal control; restricted emotionality). Although qualitative research has examined how men negotiate masculinities with respect to depression, to date there has been scant attention focused on men experiencing anxiety. This article reports on an interview study with men, some with anxiety diagnoses and some without (N = 17). Thematic analysis highlights that participants can and do talk about their anxieties, most readily with significant women in their lives (e.g., partners; mothers)-although this is not always straightforward. Talking to other men was more fraught, and while participants were wary of sharing problems with male friends, or signaled issues indirectly, they also highlighted situations where they would open up e.g., workspaces where they felt safe; with best friends. Those who had gone through a therapeutic process over many years tended to me more comfortable talking to others, male or female, about their mental health-and were also keen to other support to others where they could. Our analysis suggests that despite stereotypical notions of silent, self-contained men, there are many contexts where men may feel comfortable sharing their stories of pain and suffering. This chimes with wider cultural changes and the reported experiences of some mental health initiatives.
Collapse
|
33
|
Lashewicz B, Mitchell J, Boettcher N, Jones E, Wang J. You better be as stressed as I am: Working men's mental health amidst workplace expectations for busyness. Work 2021; 66:645-656. [PMID: 32651345 DOI: 10.3233/wor-203207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In western societies, busy lifestyles that include long hours spent in paid employment are highly regarded. Given the ongoing primacy of men's roles as employees and providers, researchers need to understand men's mental health in terms of men's relationships to paid employment and expectations for "busyness". OBJECTIVE This study is an examination of if and how working men ascribe to workplace expectations for "busyness" and what mental health impacts these expectations can entail. METHODS We present a secondary analysis of narrative data drawn from three focus groups and 23 individual interviews with working men (n = 37) about work-related mental health. RESULTS We found two themes of workplace expectations for busyness: 1) immediate manifestations and 2) background manifestations. Immediate manifestations are intensity and volume of work while background manifestations include a) unspoken messages and b) mixed messages. We found a third theme of 3) impacts of expectations for busyness and this includes a) busyness pride/costs of being "unbusy" and b) trade-offs in self-care. CONCLUSIONS Obvious and subtle workplace expectations for busyness are abundant and may obstruct attending to one's mental health as well as contribute to a frame of reference where not being busy precipitates feelings of anxiety and depression.
Collapse
Affiliation(s)
- Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Mitchell
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicholas Boettcher
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Erin Jones
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - JianLi Wang
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
34
|
River J, Flood M. Masculinities, emotions and men's suicide. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:910-927. [PMID: 33751613 DOI: 10.1111/1467-9566.13257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 05/12/2023]
Abstract
Men account for approximately 75% of the one million annual suicide deaths worldwide. Emerging research indicates a link between suicide and men's active pursuit of hegemonic masculinity via emotional restriction. However, little is known of the continuum of suicidal men's emotional practice, and particularly how men mobilise emotions to actively pursue or resist hegemonic masculine ideals. This theorised life-history study aimed to explore the emotional lives of 18 Australian men who had attempted suicide. Findings indicate that men in this study experienced a range of emotions. However, during childhood, they learned that expressing emotions such as sadness reduced masculine standing, whereas expressing emotions such as anger through acts of violence could enhance masculine status. Although the gendering of emotions offered participants multiple avenues of action to pursue or contest masculine ideals, they remained vulnerable to suicide. For some men, it became impossible to conceal escalating feelings of distress. For other men, displays of anger and violence resulted in job loss, relationship breakdown or criminal conviction. Many participants indicated that suicide presented a means of ending painful emotions. Paradoxically, suicide could also become an alternative means of demonstrating masculinity, whereby the body became both the vehicle and object of violence.
Collapse
Affiliation(s)
- Jo River
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michael Flood
- Faculty of Law, School of Justice, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
35
|
Oliffe JL, Kelly MT, Montaner GG, Links PS, Kealy D, Ogrodniczuk JS. Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:433-445. [PMID: 33719600 PMCID: PMC8107953 DOI: 10.1177/07067437211000631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?. METHOD A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. RESULTS Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities (n = 29); (2) age-specific (n = 30); and (3) occupation (n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men's suboptimal connections to existing mental health care services were also highlighted. CONCLUSION While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men's mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.
Collapse
Affiliation(s)
- John L Oliffe
- 70439School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Mary T Kelly
- 70439School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Paul S Links
- 153002Department of Psychiatry and Behavioural Neurosciences at McMaster University, Hamilton, ON, Canada
| | - David Kealy
- 175098Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John S Ogrodniczuk
- 175098Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
36
|
Drioli-Phillips PG, Le Couteur A, Oxlad M, Feo R, Scholz B. 'I know you shouldn't compare to other people, but I can't do anything most people can': Age, family and occupation categorisations in men's reasoning about their anxiety in an online discussion forum. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:678-696. [PMID: 33899253 DOI: 10.1111/1467-9566.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 05/24/2023]
Abstract
Despite its prevalence, men's anxiety is arguably under-researched and poorly understood. The present study explores the reasoning provided by male posters to an online discussion forum about the source of their anxiety. Posts were collected from an Australian anxiety online discussion forum. This study utilises discursive psychology, informed by principles of membership categorisation analysis, to describe how age, occupation and family-related identities can be invoked within common sense reasoning about the source of male anxiety. References to various identity categories were routinely employed by male forum posters in their representations of themselves, in order to describe the source of their anxiety in terms of a contrast between how they are, and how they should be. In examining accounts of anxiety and responses to those accounts, we can trace cultural knowledge about issues regarding men, masculinity and anxiety that those accounts make relevant. Findings illustrate how men's descriptions of the source of their anxiety should be understood as culturally bound and related to expectations and obligations associated with their social context and category memberships. By enhancing understandings of how men describe the source of their anxiety, this study offers insight into improving the identification and engagement of men experiencing anxiety in health services.
Collapse
Affiliation(s)
- Phoebe G Drioli-Phillips
- Faculty of Health and Medical Sciences, School of Psychology, University of Adelaide, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Freemasons Foundation Centre for Men's Health, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Amanda Le Couteur
- Faculty of Health and Medical Sciences, School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Melissa Oxlad
- Faculty of Health and Medical Sciences, School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
37
|
Sileo KM, Kershaw TS. Dimensions of Masculine Norms, Depression, and Mental Health Service Utilization: Results From a Prospective Cohort Study Among Emerging Adult Men in the United States. Am J Mens Health 2021; 14:1557988320906980. [PMID: 32079448 PMCID: PMC7036518 DOI: 10.1177/1557988320906980] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to examine the role of multidimensional masculine
norms (“status,” “toughness,” “anti-femininity”) on depression and mental health
service utilization among emerging adult men in the Northeast United States.
This study examines substance use and hostility as secondary outcomes and
depression status as an effect moderator on the relationship between masculine
norms and mental health service utilization. This study used data from a
prospective cohort study that followed 18- to 25-year-old heterosexual men over
6 months. At baseline and 6 months, approximately 29% and 25% of the sample met
the criteria for depression. The results of multivariate linear and logistic
regression models found that greater endorsement of masculine status was
associated with less depressive symptoms at baseline and 6 months, masculine
toughness was associated with more substance use at baseline, and masculine
anti-femininity was associated with greater hostility at baseline and 6 months.
The multivariate Poisson model found that greater endorsement of status was
associated with greater mental health service utilization in the prior year,
especially for men not meeting the criteria for depression. In contrast, greater
endorsement of anti-femininity and toughness norms was associated with less
mental health service utilization; for men endorsing toughness norms, this
effect was greater for those who were depressed. This study sheds light on the
harmful and protective effects of masculine norms on depression, related mental
health outcomes, and mental health service utilization, with implications for
gender-tailored approaches to engage and retain young men in mental health
services.
Collapse
Affiliation(s)
- Katelyn M Sileo
- The University of Texas at San Antonio, TX, USA.,The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Trace S Kershaw
- The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
38
|
Oberoi D, Martopullo C, Bultz BD, Carlson LE. The effectiveness of a men-only supportive expressive group therapy intervention for psychosocial health outcomes in gastrointestinal cancer patients: a 6-month longitudinal study. Health Qual Life Outcomes 2021; 19:47. [PMID: 33546718 PMCID: PMC7866473 DOI: 10.1186/s12955-021-01687-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An increasing number of gastrointestinal cancer (GI) patients suffer from side effects of cancer treatment that can affect their mood states and quality of life. Despite its demonstrated effectiveness in female cancer patients, Supportive Expressive Group Therapy (SEGT) has not been tested in male cancer patients. The current study sought to examine the longitudinal effects of a professionally-led, men-only SEGT on mood states, coping, and quality of life (QoL) in male GI cancer patients. METHODS A sample of male GI cancer patients (n = 31), at different stages of cancer treatment, was recruited from an ongoing, men-only biweekly GI cancer SEGT. Data were collected at baseline (before or near the beginning of group attendance) and at three months and six months follow-up. All study outcomes were patient-reported and included socio-demographic data as well as validated questionnaires: Profile of Mood States (POMS) for mood states, Functional Assessment of Cancer Therapy-General (FACT-G) for QoL, and Ways of Coping-Cancer Version (WOC) for coping. Linear mixed models were used to examine the change in outcomes over time. Effect sizes were estimated using Cohen's d. RESULTS The Anxiety (p = .04; d = 0.70), Depression (p = .03; d = 0.93) and Anger (p = .04; d = 1.28) subscales of the POMS decreased between baseline and six months. Participants also reported improvements in coping through Distancing (distancing oneself from negative thoughts, being more accepting of the situation, and looking for positives) of the WOC (p = .04; d = 0.4) between baseline and six months. There was no change in any of the FACT subscales (QoL) over time. CONCLUSIONS This is the first study to investigate the effects of a SEGT intervention in male cancer patients. Participation in the intervention was associated with improved mood states and coping in male GI cancer patients; however, there was no change in measures of QoL.
Collapse
Affiliation(s)
- Devesh Oberoi
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,Cancer Control AB, Tom Baker Cancer Centre Holy Cross Site, 2202 2nd St. SW, Calgary, AB, T2S 3C1, Canada
| | - Celestina Martopullo
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,Cancer Control AB, Tom Baker Cancer Centre Holy Cross Site, 2202 2nd St. SW, Calgary, AB, T2S 3C1, Canada
| | - Barry D Bultz
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.,Cancer Control AB, Tom Baker Cancer Centre Holy Cross Site, 2202 2nd St. SW, Calgary, AB, T2S 3C1, Canada
| | - Linda E Carlson
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada. .,Cancer Control AB, Tom Baker Cancer Centre Holy Cross Site, 2202 2nd St. SW, Calgary, AB, T2S 3C1, Canada.
| |
Collapse
|
39
|
Hassouneh D, Fornero K. "You have to fight to legitimize your existence all the time": The social context of depression in men with physical disabilities. Arch Psychiatr Nurs 2021; 35:80-87. [PMID: 33593519 PMCID: PMC7890048 DOI: 10.1016/j.apnu.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
Little is known about the common experience of depression in men with physical disabilities. To help address this gap, we present findings from a qualitative study situated in the social determinants of health (SDH). Findings describe the detrimental effects of marginalization, economic precarity, restrictive masculine norms, stigma, and the need to resist ableist messages on men's health and well-being. It is our intention to raise awareness of the impact of the SDH on depression in men with physical disabilities and encourage clinicians and policy makers to address the social domain as they seek to improve mental health in this population.
Collapse
Affiliation(s)
- Dena Hassouneh
- Oregon Health & Science University, Portland, OR, United States of America.
| | - Kiki Fornero
- Oregon Health & Science University, Portland, OR, United States of America
| |
Collapse
|
40
|
Seidler ZE, Wilson MJ, Oliffe JL, Kealy D, Toogood N, Ogrodniczuk JS, Rice SM. "Eventually, I Admitted, 'I Cannot Do This Alone'": Exploring Experiences of Suicidality and Help-Seeking Drivers Among Australian Men. FRONTIERS IN SOCIOLOGY 2021; 6:727069. [PMID: 34660775 PMCID: PMC8517224 DOI: 10.3389/fsoc.2021.727069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/14/2021] [Indexed: 05/08/2023]
Abstract
While research has explored the intersection between masculinities and men's experiences of suicidality, comparatively little attention has been paid to the stories surrounding suicidal men's decision to seek help. The ways in which men experiencing suicidal thoughts and behaviors embody masculinities alongside their enlistment of mental health services remains largely unknown. The present study explored 262 Australian men's stories surrounding the impetus for help-seeking for suicidal thoughts and behaviors. The sample comprised men ranging in age from 17 to 74 years (M = 40.99; SD = 15.92 years), with most participants residing in a metropolitan area (55.3%), employed full time (43.1%), non-indigenous (95.4%) and heterosexual (73.7%). Participants elaborated on their reasons for help-seeking via an open-text qualitative survey, delivered as part of a larger study exploring help-seeking experiences of Australian men. Thematic analysis of responses generated four themes highlighting the diversity of experience across men, with some highlighting impacts of emasculating early trauma(s) on their suicidality, while others reflected an impulsiveness tied to situational stressors that fractured their masculine identity (e.g., relationship breakdown; job loss). Many men had epiphanies as they reached the limits of their self-reliance and came to terms with their need for help. As their suicidality was witnessed by-and began to impact-those around them, the sight of their previously masked pain by others often facilitated their help-seeking journey. The present findings underscore the complex and multifactorial role of masculinities in men's suicidality and their paths to help-seeking. Important inroads for future public mental health promotion efforts are discussed, in terms of leveraging self-reliant and caring masculinities in helping men to develop healthy coping in the context of suicidality.
Collapse
Affiliation(s)
- Zac E. Seidler
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Movember, Melbourne, VIC, Australia
- *Correspondence: Zac E. Seidler,
| | - Michael J. Wilson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Nicholas Toogood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Simon M. Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
41
|
Shi P, Yang A, Zhao Q, Chen Z, Ren X, Dai Q. A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males. Front Psychiatry 2021; 12:589687. [PMID: 34759845 PMCID: PMC8572815 DOI: 10.3389/fpsyt.2021.589687] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis "Gender differences in self-reporting symptom of depression," suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.
Collapse
Affiliation(s)
- Peixia Shi
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Aigang Yang
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Qing Zhao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhaohua Chen
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Xiaomei Ren
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| | - Qin Dai
- Department of Nursing Psychology, Army Medical University, Chongqing, China
| |
Collapse
|
42
|
Jacques MC. Le dévoilement de soi dans la recherche d’aide et le suivi dans les services de santé mentale et psychiatrie. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073552ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Le dévoilement de soi des patients est essentiel au travail des professionnels de la santé, et ceci est encore plus critique en santé mentale où la parole du patient est le reflet du contenu de la psyché. Le dévoilement de soi concerne alors des symptômes invisibles qui sont associés à des problèmes de santé où la discrimination et la stigmatisation sont encore très présentes. Cet article explore les enjeux éthiques de ce phénomène encore très peu étudié. Le dévoilement en tant que processus décisionnel, interpersonnel, dynamique et complexe sera défini et approfondi à l’aide d’exemples tirés de la recherche. Par la suite, la vulnérabilité de la personne qui se dévoile sera abordée, suivie des enjeux liés aux normes de pratique professionnelle associées au dévoilement des patients et à leur responsabilité avers celui-ci. Ces éléments mettent en lumière de nombreuses questions éthiques et nous amènent, en dernier lieu, à une amorce de proposition pour positionner les professionnels impliqués.
Collapse
Affiliation(s)
- Marie-Claude Jacques
- École des sciences infirmières, Université de Sherbrooke, Longueuil, Québec, Canada
| |
Collapse
|
43
|
Seidler ZE, Rice SM, Oliffe JL, Fogarty AS, Dhillon HM. Men In and Out of Treatment for Depression: Strategies for Improved Engagement. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12331] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Simon M. Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne,
| | | | | | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence‐Based Decision‐Making, The University of Sydney,
| |
Collapse
|
44
|
Utter K, Waineo E, Bell CM, Quaal HL, Levine DL. Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study. JMIR Ment Health 2020; 7:e19171. [PMID: 33107831 PMCID: PMC7655468 DOI: 10.2196/19171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/31/2020] [Accepted: 09/12/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations. OBJECTIVE We aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications. METHODS Three investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram's search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator's data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag. RESULTS All three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X2=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X2=1.533, P=.22; X2=1.241, P=.27; X2=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X2 values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair. CONCLUSIONS Women are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma.
Collapse
Affiliation(s)
- Kierstin Utter
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Eva Waineo
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Capricia M Bell
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Harrison L Quaal
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Diane L Levine
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| |
Collapse
|
45
|
de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217797. [PMID: 33114464 PMCID: PMC7662901 DOI: 10.3390/ijerph17217797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022]
Abstract
Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants.
Collapse
Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
- Correspondence: ; Tel.: +31-6136-34476
| | - Dick L. Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands;
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
| | - Jeanine L. Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
| |
Collapse
|
46
|
Milner A, Disney G, Byars S, King TL, Kavanagh AM, Aitken Z. The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1311-1321. [PMID: 32055895 DOI: 10.1007/s00127-020-01844-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need. METHODS We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model. RESULTS Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was - 0.045 (95% CI - 0.056, - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of - 0.033 (95% CI - 0.048, - 0.018) and the natural indirect effect - 0.012 (95% CI - 0.022, - 0.0027). CONCLUSION Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.
Collapse
Affiliation(s)
- Allison Milner
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - George Disney
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Sean Byars
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.,Melbourne Disability Institute, The University of Melbourne, Victoria, 3010, Australia
| | - Tania L King
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Anne M Kavanagh
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Zoe Aitken
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.
| |
Collapse
|
47
|
Handlovsky I, Bungay V, Johnson J, Oliffe J. Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1566-1580. [PMID: 32579289 DOI: 10.1111/1467-9566.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.
Collapse
Affiliation(s)
| | | | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
| | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
| |
Collapse
|
48
|
Hamilton SL, Maslen S, Watkins R, Conigrave K, Freeman J, O'Donnell M, Mutch RC, Bower C. 'That thing in his head': Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1581-1596. [PMID: 32579286 DOI: 10.1111/1467-9566.13146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person's capacity and status.
Collapse
Affiliation(s)
- Sharynne L Hamilton
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Sarah Maslen
- Faculty of Business, Government and Law, University of Canberra, Canberra, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Katherine Conigrave
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jacinta Freeman
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Raewyn C Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
49
|
Umberson D, Thomeer MB, Pollitt AM, Mernitz SE. The Psychological Toll of Emotion Work in Same-Sex and Different-Sex Marital Dyads. JOURNAL OF MARRIAGE AND THE FAMILY 2020; 82:1141-1158. [PMID: 35992218 PMCID: PMC9387901 DOI: 10.1111/jomf.12686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/17/2020] [Indexed: 06/13/2023]
Abstract
Objective This study considers how the provision of daily emotion work may affect the psychological well-being of the emotion worker, and how this linkage may vary for men and women in same- and different-sex marriages. Background Emotion work-work intended to bolster a spouse's well-being by reading and managing the spouse's emotional needs-is common within marital relationships and often gendered, with women more aware of and concerned with emotion work than men. Yet, the psychological cost of performing emotion work is largely unexplored. Method This study relies on 10 days of daily experiences data from spouses in same- and different-sex marriages (n = 756 individuals). Mixed effects multilevel regression modeling is used to examine how the provision of emotion work is associated with the emotion workers' psychological well-being. Results Providing emotion work is inversely associated with emotion workers' psychological well-being, especially when provided for a spouse with elevated depressive symptoms. These estimated effects are generally similar for men and women but greater for those married to a man than for those married to a woman, whether in a same- or different-sex marriage. Conclusion Emotion work appears to adversely affect the worker's own psychological well-being, especially when a spouse has elevated depressive symptoms and when one's spouse is a man. These results point to the importance of dyadic approaches and consideration of gendered relationship dynamics of same- as well as different-sex couples in studies of emotion work and other marital processes.
Collapse
|
50
|
Oliffe JL, Broom A, Rossnagel E, Kelly MT, Affleck W, Rice SM. Help-seeking prior to male suicide: Bereaved men perspectives. Soc Sci Med 2020; 261:113173. [PMID: 32736099 DOI: 10.1016/j.socscimed.2020.113173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/12/2019] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Abstract
Male suicide is a significant issue globally, and implicated are men's challenges around help-seeking and engagement with peer or professional mental health care. While men's reticence for help-seeking predominates as an explanatory gendered dimension for male suicide, there are significant caveats and complexities to fully understanding those practices in the context of men's mental illness and suicidality. The current photo-voice study offers considerable insight into such issues - through the eyes of the bereaved - retrospectively exploring accounts of the deceased's mental health help-seeking prior to the death. Using an interpretive design, and based on semi-structured individual photo-elicitation interviews with 20 men who had lost a male friend, family member or partner to suicide, three key dimensions were identified: 1) Entrapped by secrecy and concealing the need for help, in which the deceased hid their suicide risk and need for peer or professional mental health care; 2) Overwhelming illness that couldn't be helped, wherein the deceased had previously connected with an array of social supports and medical services but was estranged from peer and professional help ahead of the suicide, and 3) Services and systems providing ineffectual help, whereby the deceased was connected with mental health care shortly before the suicide. These themes reveal complex relations to help, and help-seeking in men lost to suicide, as well as bereaved men's reliance on normative masculinities as an explanatory framing of these practices. Discussed within a critical masculinities framework, the current study highlights the need to destigmatize men's mental illness and help-seeking as well as address significant health inequities to aid the efficiencies of men's suicide prevention programs.
Collapse
Affiliation(s)
- John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada; Department of Nursing, University of Melbourne, Victoria, 3010, Australia.
| | - Alex Broom
- Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Emma Rossnagel
- School of Nursing, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Mary T Kelly
- School of Nursing, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - William Affleck
- School of Nursing, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Simon M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, 3010, Australia
| |
Collapse
|