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Jackson HM, Batterham PJ, Ohan JL, Calear AL, Farrer LM. Skill enactment and knowledge acquisition among community users of digital mental health interventions: qualitative study with thematic analysis. BMC Psychiatry 2024; 24:545. [PMID: 39090611 PMCID: PMC11293152 DOI: 10.1186/s12888-024-05953-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The acquisition of knowledge and use of skills from digital mental health interventions (DMHIs) are considered important for effectiveness. However, our understanding of user experiences implementing skills learned from these interventions is limited, particularly outside of research trials. This qualitative study aimed to investigate how community users learn and apply knowledge and skills from DMHIs based on cognitive behavioural therapy (CBT) in daily life. The study also examined factors influencing the selection and use of skills and explored perceived changes in mental health resulting from the intervention. METHODS Thirteen adults aged 26 to 66 years (10 females) were recruited using social media advertising and participated in semi-structured interviews by telephone or videoconference. All participants were living in Australia and had used a digital CBT program within the past 3 months. Interviews lasted on average 45 min. Transcripts were analysed using theoretical thematic analysis. RESULTS Participants demonstrated high levels of program engagement. Findings were organised into three topics with six major themes. Participants reported that their chosen intervention reinforced existing knowledge and fostered new skills and insights (Topic 1, Theme 1: knowledge consolidation). Most described actively applying skills (Topic 1, Theme 2: active approach to skill enactment), although the extent of learning and range of skills enacted varied across participants. Influences on skill selection included the perceived relevance of intervention strategies to the user's needs and personal characteristics (Topic 2, Theme 1: relevance of intervention strategies), as well as the perceived or experienced effectiveness of those strategies (Topic 2, Theme 2: perceived and experienced benefit). Challenges to ongoing skill enactment included time scarcity, prioritisation difficulties, and lack of motivation (Topic 2, Theme 3: navigating time constraints and low motivation). Improvements in mental health were generally modest and attributed mainly to participants' proactive efforts (Topic 3, Theme 1: perceived changes). CONCLUSIONS DMHIs may reinforce existing understanding of psychotherapeutic strategies, offer new knowledge, and encourage the application of skills in everyday life among community users who actively engage with these interventions. Future research should prioritise personalising DMHIs and investigating methods to optimise the acquisition, retention, and sustained application of knowledge and skills.
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Affiliation(s)
- Hayley M Jackson
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, Crawley, WA, Australia
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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McKenzie SK, Mathieson F, Das T, Genuchi MC, Oliffe JL. Understanding Men's Lived Experience of Mental Distress Through Metaphors. Am J Mens Health 2024; 18:15579883241260920. [PMID: 38888189 PMCID: PMC11186386 DOI: 10.1177/15579883241260920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
The use of tailored language, which involves a clinician's ability to adapt communication styles and employ accessible terms and concepts, has long been touted as key to engaging men with mental health services. Metaphors are one communication device that can provide men with ways through which to meaningfully express themselves and communicate their mental distress experiences. Using qualitative photovoice research, the current study examined how New Zealand-based men (n = 21) communicatively constructed their meaning of mental distress through metaphors. Analysis of interview data was used to derive three metaphor groupings men consistently drew on to articulate their lived experiences: metaphors of emotions (darkness and weight), metaphors of survival (battle and entity), and metaphors of disembodiments (debility and entrapment). The findings highlight the power of metaphors as a tool for men in communicating their experiences of mental distress and are valuable for health professionals to contemplate across an array of contexts. The implications and importance of a metaphor-enriched perspective for engaging men in professional health care settings and services are discussed.
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Affiliation(s)
- Sarah K. McKenzie
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Fiona Mathieson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Tiara Das
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Matthew C. Genuchi
- Department of Psychological Science, Boise State University, Boise, ID, USA
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, The University of Melbourne, Parkville, Melbourne, Australia
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Opozda MJ, Oxlad M, Turnbull D, Gupta H, Smith JA, Ziesing S, Nankivell ME, Wittert G. Facilitators of, barriers to, and preferences for e-mental health interventions for depression and anxiety in men: Metasynthesis and recommendations. J Affect Disord 2024; 346:75-87. [PMID: 37949238 DOI: 10.1016/j.jad.2023.11.015] [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] [Received: 04/20/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Little is known about men's use of online mental health (eMH) interventions and factors that promote their engagement or attrition. We aimed to synthesise the qualitative literature on men's preferences for, attitudes towards, and experiences of using eMH interventions for depression and anxiety, and develop recommendations from the findings. METHOD Systematic searches were conducted (Jan 2000-Oct 2020) in six databases; study quality was assessed using Qualsyst with a minimum total of 0.55 required for inclusion. Extracted data were synthesised using meta-aggregation. RESULTS Eight studies met inclusion criteria and three synthesised findings were generated. (1) Facilitators of men's eMH use: finding apps and technology motivating and convenient, support and encouragement from important others, and interventions allowing men to take action, gain control over their mental health, and resulting in positive outcomes; (2) Barriers to men's eMH use: lack of free time, predicted or experienced lack of benefit from use, and technical difficulties; (3) What men want in eMH: personalised, tailored, relevant interventions that are bright and easy to use, with information presented in multiple formats, psychoeducation, exercises, self-monitoring, information on further resources, and the option of clinician involvement, without any repetitive questioning, boring tools, or negative feedback. LIMITATIONS All included studies were conducted in high income, 'Western' countries; most data related to experiences of using an existing eMH intervention within a trial, rather than in 'real world' settings where eMH acceptability is generally lower and experiences may differ. CONCLUSIONS Practice, research, and policy recommendations are presented.
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Affiliation(s)
- Melissa J Opozda
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
| | - Melissa Oxlad
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia; School of Psychology, University of Adelaide, Adelaide, Australia
| | - Deborah Turnbull
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia; School of Psychology, University of Adelaide, Adelaide, Australia
| | - Himanshu Gupta
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, Australia
| | - James A Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, Australia
| | - Samuel Ziesing
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Murray E Nankivell
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
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Sims SA, Pereira G, Fatovich DM, Preen D, O'Donnell M. Assessing the utility of night-time presentations as a proxy for alcohol-related harm among young emergency department trauma patients. Emerg Med Australas 2024; 36:47-54. [PMID: 37577775 PMCID: PMC10952259 DOI: 10.1111/1742-6723.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To assess the usefulness of night-time presentations to measure alcohol-related harm (ARH) in young trauma patients, aged 12-24 years, attending Western Australian EDs. METHODS A retrospective longitudinal study examined alcohol-related ED presentations in Western Australia (WA; 2002-2016) among 12- to 24-year-olds. Data from the Emergency Department Data Collection, WA State Trauma Registry Database and Hospital Morbidity Data Collection were used to identify ARH through specific codes and text searches. These were compared to ARH estimates based on presentation time. Statistical analysis involved sensitivity and specificity calculations and Cox proportional hazards modelling. RESULTS We identified 2644 (17.8%) night-time presentations as a proxy measure of ARH among the 14 887 presentations of patients aged 12-24 years. This closely matched the 3064 (20.6%) identified as ARH through coding methods. The highest risk for an ARH presentation occurred during the night hours between 00.00 and 04.59 hours. During these hours, the risk was 4.4-5.1 times higher compared to presentations at midday (between 12.00 and 12.59 hours). However, when looking at individual patients, we observed that night-time presentations were not a strong predictor of ARH (sensitivity: 0.39; positive predictive value: 0.46). CONCLUSIONS Implementing targeted interventions during night hours could be beneficial in addressing ARH presentations. However, relying solely on the time of presentation as a proxy for ARH is unlikely to effectively identify ARH in young individuals. Instead, the present study emphasises the importance of implementing mandatory data collection strategies in EDs to ensure accurate measurement of ARH cases.
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Affiliation(s)
- Scott A Sims
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Gavin Pereira
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Daniel M Fatovich
- Emergency Medicine, Royal Perth HospitalThe University of Western AustraliaPerthWestern AustraliaAustralia
- Centre for Clinical Research in Emergency MedicineHarry Perkins Institute of Medical ResearchPerthWestern AustraliaAustralia
| | - David Preen
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Melissa O'Donnell
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
- Australian Centre for Child ProtectionUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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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.
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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
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Lin C, Pham H, Hser YI. Mental Health Service Utilization and Disparities in the U.S: Observation of the First Year into the COVID Pandemic. Community Ment Health J 2023; 59:972-985. [PMID: 36609783 PMCID: PMC11329229 DOI: 10.1007/s10597-022-01081-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
This study examined mental health service utilization and disparities during the first year of COVID. We analyzed data from all adult respondents with any mental illness in the past year (n = 6967) in the 2020 National Survey on Drug Use and Health to evaluate if mental health service utilization differed by geographic areas, race/ethnicity, and age groups. Only 46% of individuals with any mental illness had received mental health treatment. Compared to non-Hispanic Whites, Asian and Hispanics were less likely to receive outpatient services and prescription medicine. Rural residents received less outpatient treatment compared to large metropolitan residents. No difference was found in telemedicine utilization across area types and race/ethnicity groups. Older individuals were less likely to utilize telemedicine services. Our findings highlighted continued mental health treatment disparities among race/ethnic minorities and other sub-populations during COVID. Targeted strategies are warranted to allow older populations to benefit from telemedicine.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA.
| | - Huyen Pham
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
| | - Yih-Ing Hser
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, USA
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Simons K, Bradfield O, Spittal MJ, King T. Age and gender patterns in health service utilisation: Age-Period-Cohort modelling of linked health service usage records. BMC Health Serv Res 2023; 23:480. [PMID: 37173743 PMCID: PMC10176675 DOI: 10.1186/s12913-023-09456-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Health service utilisation changes across the life-course and may be influenced by contextual factors at different times. There is some evidence that men engage less with preventive health services, including attending doctors' clinics, however the extent to which this varies temporally and across different age groups is unclear. This study aimed to describe age or cohort effects on engagement with GPs among employed mothers and fathers in Australia, and differences in these trends between men and women. METHODS We linked data from the 'Growing up in Australia: The Longitudinal Study of Australian Children' with administrative health service records from Medicare. We used a small-domain estimation Age-Period-Cohort method to describe patterns in health service use among working-age male and female parents in Australia while adjusting for employment status and controlling for time-invariant factors. Our small-domain method assumes a smooth response surface of Age, Period and Cohort. RESULTS Male parents have lower health service engagement than women of the same age at the same time period. Men's pattern of health service use across time is likely explained entirely by ageing. That is, we find that patterns in health service utilisation among men are largely driven by age effects, with no evidence of periods or cohort effects in health service engagement for men between 2002 and 2016. CONCLUSIONS Differences in health service utilisation between male and female parents at all age-period-cohort combinations highlight a need for more research to examine the extent to which this level of health service use among Australian men meets men's health needs, as well as barriers and enablers of health service engagement for men. Absence of evidence for period effects suggests that there is little shift in gendered patterns of health service utilisation during the observed period.
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Affiliation(s)
- Koen Simons
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health,University of Melbourne, 207 Bouverie Street, 3010, Melbourne, Australia.
| | - Owen Bradfield
- Centre for Health Policy, Melbourne School of Population and Global Health,University of Melbourne, Melbourne, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health,University of Melbourne, Melbourne, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health,University of Melbourne, Melbourne, Australia
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Browne CC, Korobanova D, Yee N, Spencer SJ, Ma T, Butler T, Dean K. The prevalence of self-reported mental illness among those imprisoned in New South Wales across three health surveys, from 2001 to 2015. Aust N Z J Psychiatry 2023; 57:550-561. [PMID: 35694738 DOI: 10.1177/00048674221104411] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The prevalence of mental illness among those in prison is much higher than in the community; however, very few studies have examined whether rates have changed over time, in line with increasing self-reported rates in the community. METHODS This study compares the prevalence of self-reported mental illness, self-harm and suicidal thoughts/behaviours, and drug and alcohol use across three waves (2001, 2009 and 2015) of health surveys involving men and women in New South Wales prisons and compared these rates with published community-level findings. RESULTS The prevalence of those reporting any mental health diagnosis increased significantly across the three surveys, even after adjustment for socio-demographic and criminal justice variables that also changed over time. Individuals surveyed in 2015 were more likely to report a mental health diagnosis than those surveyed in 2001 (adjusted odds ratio = 2.66, 95% confidence interval = [2.16, 3.27]). The prevalence of self-harm and suicidal thoughts and behaviours remained stable across the three surveys, while self-reported regular drug use decreased over the period. Women experienced a far greater burden of mental illness than men across all three surveys and experienced more growth in the prevalence of most psychiatric disorders. CONCLUSION These findings have important implications for public and prison health systems given the poor social, health and criminal justice outcomes of those imprisoned with mental illness, both in custody and post-release.
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Affiliation(s)
- Christie C Browne
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Daria Korobanova
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
- Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Natalia Yee
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Sarah-Jane Spencer
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Trevor Ma
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
| | - Tony Butler
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
- National Health and Medical Research Council, Centre of Research Excellence in Offender Health, Sydney, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
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9
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Baigent M, Smith D, Battersby M, Lawn S, Redpath P, McCoy A. The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess. J Ment Health 2023; 32:341-350. [PMID: 32394756 DOI: 10.1080/09638237.2020.1760224] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. AIMS This paper describes the clinical outcomes in the Australian health setting. METHODS Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. RESULTS Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. CONCLUSION NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.
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Affiliation(s)
- Michael Baigent
- Beyond Blue, Victoria, Australia.,Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - David Smith
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Malcolm Battersby
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paula Redpath
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Knox J, Morgan P, Kay-Lambkin F, Wilson J, Wallis K, Mallise C, Barclay B, Young M. Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review. CURRENT PSYCHOLOGY 2022; 42:1-16. [PMID: 36531196 PMCID: PMC9735062 DOI: 10.1007/s12144-022-04017-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/11/2022]
Abstract
The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression. Supplementary information The online version contains supplementary material available at 10.1007/s12144-022-04017-7.
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Affiliation(s)
- James Knox
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Philip Morgan
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Education, University of Newcastle, Callaghan, Australia
- Centre for Active Living and Learning, University of Newcastle, Callaghan, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jessica Wilson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Kimberley Wallis
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Carly Mallise
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Briana Barclay
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Education, University of Newcastle, Callaghan, Australia
- Centre for Active Living and Learning, University of Newcastle, Callaghan, Australia
| | - Myles Young
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
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11
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Tang S, Reily NM, Batterham PJ, Draper B, Shand F, Han J, Aadam B, Christensen H. Correlates of non-receipt of formal mental health services among Australian men experiencing thoughts of suicide. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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12
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Pai N, Vella SL, Castle D. A comparative review of the epidemiology of mental disorders in Australia and India. Asia Pac Psychiatry 2022; 14:e12517. [PMID: 35667856 DOI: 10.1111/appy.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Mental illness and substance use disorders have been increasing worldwide. Mental illness has a significant impact upon the lives of the individual as well as their loved ones. Mental disorders are known to result in a high level of disability. This article provides a comparative review of the epidemiology of mental disorders in Australia and India, summarizing and comparing prevalence rates in both countries based upon available data. Overall, it is evident that Australia has higher prevalence rates of mental disorders than India, across most diagnostic groups. Australia has the highest prevalence of anxiety disorders whereas India has the highest prevalence of substance use disorders; including tobacco use disorders. The next most prevalent mental disorders in India are depressive disorders. However, there are demographic parameters such as gender and age as well as service-provision differences across the countries that need to be factored into any interpretation of the data. There are also problems associated with different diagnostic instruments with language and cultural nuances that may impact comparisons. We suggest that a joint epidemiological survey between the two countries would help better understand and delineate the key similarities pertaining to the epidemiology of mental disorders in Australia and India. This will in turn assist with the development of policy and treatment of mental disorders.
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Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Shae-Leigh Vella
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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13
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Broadbear JH, Rotella J, Lorenze D, Rao S. Emergency department utilisation by patients with a diagnosis of borderline personality disorder: An acute response to a chronic disorder. Emerg Med Australas 2022; 34:731-737. [PMID: 35352872 PMCID: PMC9790754 DOI: 10.1111/1742-6723.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with borderline personality disorder (BPD) are likely to attend the ED while experiencing crises and associated self-injury and suicidality. Our study describes the prevalence, features, and outcomes associated with ED presentations by patients diagnosed with BPD in Outer Eastern Melbourne, Australia. METHODS A retrospective electronic audit of 157 364 ED attendances identified 700 unique BPD-related ED presentations between May 2015 and April 2016. For the purpose of comparison, 583 (81% female) of these 700 cases were matched with 'depression only' cases. ED re-presentation data were also extracted. RESULTS The 583 matched BPD patients attended ED a total of 2807 times during the audit year compared with 1092 attendances for matched depression-only patients. BPD patients were more likely to: arrive by ambulance (50%); have comorbid substance abuse (44%); have a psychotic (15%) or bipolar disorder (17%); be under the care of a psychiatrist (31%); be case-managed (42%); and be admitted to an inpatient unit (21%). ED doctors saw 38% of BPD or depression patients within the recommended time according to their triage category. The majority (73%) of BPD patients attended ED more than once during the audit year (average 4.81 ± 6.63 times; range 2-78). CONCLUSION Repeated ED attendance of a subset of patients diagnosed with BPD highlights both the severity of their presentation and the inadequacy of community mental health services for meeting their complex needs. Development of effective ED referral pathways with follow-up to engage patients in BPD-appropriate treatment will reduce the likelihood of crises and reliance on hospital EDs for acute episodic care.
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Affiliation(s)
- Jillian H Broadbear
- Spectrum Personality Disorder ServiceMelbourneVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | | | - Donna Lorenze
- School of Nursing, Midwifery and Social SciencesCentral Queensland UniversityMackayQueenslandAustralia
| | - Sathya Rao
- Spectrum Personality Disorder ServiceMelbourneVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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14
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Herreen D, Rice S, Zajac I. Psychological inflexibility mediates the relationship between conformity to masculine norms and depression: Preliminary support for a transdiagnostic approach to working therapeutically with men. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Opozda MJ, Oxlad M, Turnbull D, Gupta H, Vincent AD, Ziesing S, Nankivell M, Wittert G. The Effects of Psychotherapeutic e-Mental Health Interventions on Male Depression and Anxiety: Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022. [DOI: 10.2196/40854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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16
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Seidler ZE, Wilson MJ, Toogood NW, Oliffe JL, Kealy D, Ogrodniczuk JS, Owen J, Mackinnon A, Le LKD, Mihalopoulos C, Pirkis J, Rice S. Protocol for a randomized controlled trial of the Men in Mind training for mental health practitioners to enhance their clinical competencies for working with male clients. BMC Psychol 2022; 10:174. [PMID: 35841082 PMCID: PMC9288021 DOI: 10.1186/s40359-022-00875-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although the proportion of men seeking professional mental health care has risen over the past two decades, on average, men continue to attend fewer sessions of psychotherapy and are more likely to drop out of treatment prematurely compared to women. Men account for three-quarters of suicide deaths; furthermore, over half of the males who die by suicide have engaged with mental health care in the 12 months prior to their death. These findings highlight a need to equip mental health practitioners with skills to improve male clients’ engagement and mental health outcomes. This article reports the protocol for a randomized controlled trial of Men in Mind, a self-paced online training program purpose-built to advance the clinical competencies of practitioners who provide psychotherapy to male clients. Methods A randomized controlled trial with two parallel groups will be conducted. Participating practitioners will be randomly allocated, on a 1:1 basis, to the intervention group (Men in Mind training) or a waitlist control group. The primary outcome, efficacy of the training, will be evaluated by pre- to post-training (T1 to T2) changes in scores on the Engaging Men in Therapy Scale (EMITS) in the intervention group, relative to the control group. Discussion This trial will provide evidence of the efficacy of Men in Mind training, as an interim step towards adjusting content and delivery of the intervention to maximize the potential for sustaining and scaling. Trial registration: The trial was registered prospectively with the Australian New Zealand Clinical Trials Registry on 3rd December 2021 (ACTRN12621001669886). Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00875-9.
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Affiliation(s)
- Zac E Seidler
- Orygen, Melbourne, VIC, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia. .,Movember, Melbourne, Australia.
| | - Michael J Wilson
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Nicholas W Toogood
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada.,Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jesse Owen
- Department of Counselling Psychology, University of Denver, Denver, USA
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Long Khanh-Dao Le
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Simon Rice
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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17
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Bergqvist E, Probert-Lindström S, Fröding E, Palmqvist-Öberg N, Ehnvall A, Sunnqvist C, Sellin T, Vaez M, Waern M, Westrin Å. Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records. BMC Health Serv Res 2022; 22:664. [PMID: 35581647 PMCID: PMC9115926 DOI: 10.1186/s12913-022-08044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. METHODS Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. SETTING All health care units located in 20 of Sweden's 21 regions. PARTICIPANTS All individuals residing in participating regions who died by suicide during 2015 (n = 949). RESULTS Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (≥ 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. CONCLUSION Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
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Affiliation(s)
- Erik Bergqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden.
- Psychiatric In-Patient Clinic, Hallands Sjukhus Varberg, Region Halland, 432 81, Varberg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Elin Fröding
- School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, 551 11, Jönköping, Sweden
- Region Jonköpings Län, Jönköping, Sweden
| | - Nina Palmqvist-Öberg
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychiatric Out-Patient Clinic, Region Halland, 432 43, Varberg, Sweden
| | - Charlotta Sunnqvist
- Faculty of Health and Society, Department of Care Science, Malmö University, 214 28, Malmö, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 701 82, Örebro, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychosis Clinic, Sahlgrenska University Hospital, Region Västra Götaland, 431 30, Mölndal, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
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18
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Fisher K, Seidler ZE, King K, Oliffe JL, Rice SM. Men's anxiety: A systematic review. J Affect Disord 2021; 295:688-702. [PMID: 34517242 DOI: 10.1016/j.jad.2021.08.136] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/27/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
AIM Anxiety disorders are amongst the most commonly diagnosed mental illnesses amongst men; however male-specific anxiety research is lacking. This review explores men's anxiety symptoms and disorders including help-seeking, coping and the role of masculinity. METHOD Four electronic database searches identified 8,333 citations, with 25 studies meeting inclusion criteria. Nineteen studies employed quantitative methods, five studies reported qualitative research, and one utilised mixed methods. RESULTS Unique profiles of anxiety, including psychosomatic symptoms, were identified and persisted over extended periods of time. Men commonly reported self-reliance over formal help-seeking, and typically managed anxiety symptoms through problem-based coping. Masculinity was related to anxiety in complex ways; adherence to norms of toughness could be protective against anxiety onset, while adherence to emotional restrictiveness and heterosexual presentation norms were positively associated with anxiety. The experience of, and help-seeking for anxiety transgressed many men's adherence to masculinity norms resulting in significant social and self-stigmas. LIMITATIONS The anxiety measurement scales utilised were inconsistent across included studies and there was limited scope of research into panic disorders, phobias and agoraphobia. CONCLUSION Findings demonstrate the enduring nature of anxiety for men and a potential under-reporting of symptoms, especially amongst younger men. To better tailor clinical care and public health resources to the needs of men with anxiety disorders, targeted research examining men's lived experiences of (and coping strategies for) anxiety is essential.
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Affiliation(s)
- Krista Fisher
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Zac E Seidler
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Kylie King
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.
| | - John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Simon M Rice
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
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19
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Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies. J Affect Disord 2021; 293:148-158. [PMID: 34192629 DOI: 10.1016/j.jad.2021.05.115] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicidal ideation (SI) and suicide planning (SP) are associated with an increased risk of future suicide. We performed a meta-analysis of observational studies to estimate the prevalence of SI and SP in patients with major depressive disorder (MDD) and its associated factors. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Web of Science from their commencement date until 7 October 2020. Original studies containing data on the prevalence of SI and SP in individuals with MDD were analyzed. RESULTS Forty-six articles covering 53,598 patients were included in the meta-analysis. The overall prevalence of SI was 37.7% (95% confidence interval (CI): 32.3-43.4%) and the pooled prevalence of SP was 15.1% (95% CI: 8.0--26.8%). Subgroup analyses revealed that the timeframe over which SI was assessed, source of patients, study design, and diagnostic criteria were significantly associated with the pooled prevalence of SI. Meta-regression analyses revealed that the Hamilton Depression Rating Scale (HAMD) score and percentage of male participants were positively associated with the pooled prevalence of SI. Study quality and mean age were negatively associated with the pooled prevalence of SI. In contrast, survey year and study quality were negatively associated with pooled prevalence of SP LIMITATION: SI and SP were self-reported and subject to recall bias and impression management. CONCLUSIONS SI and SP are common in patients with MDD, especially among inpatients. Preventive measures and treatments focusing on factors associated with SI and SP may reduce the risk of suicide in patients with MDD.
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20
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Seidler ZE, Wilson MJ, Walton CC, Fisher K, Oliffe JL, Kealy D, Ogrodniczuk JS, Rice SM. Australian men's initial pathways into mental health services. Health Promot J Austr 2021; 33:460-469. [PMID: 34328689 DOI: 10.1002/hpja.524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Many men are challenged by barriers to mental health help-seeking and engagement. For men who do access care, their pathways to engaging services can offer important insights to what might constitute gender-specific care. METHODS Data were drawn from an online cross-sectional survey of N = 2009 Australian men (aged 16-85; M = 43.5) reflecting on their initial pathways to mental health services, including their reasons for help-seeking, how they first located a therapist and the source of any initial recommendation for engaging with services. Respondents were recruited with targeted advertisements via Movember's Facebook page. RESULTS A relatively even age distribution was observed, with most respondents residing in metropolitan areas (60.4%), a majority employed full time (47.7%), and 25.7% identifying as gay or bisexual. Participants tended to be self-motivated to seek help, with referrals by general practitioners to specialist mental health services. The most common underpinning precipitant for seeking help was anxiety, particularly for younger men, whereas older men tended to have sought help more commonly for familial, relationship or work-related factors. Older men were also more likely to report self-motivated help-seeking, whereas younger men more commonly sought help on the recommendation of a family member. CONCLUSIONS There are varied pathways for men's initial mental health help-seeking journeys that require an ongoing examination to ensure health promotion efforts are appropriately tailored and responding to men's needs. SO WHAT As more men access mental health services, having a nuanced understanding of their likely pathways to care can inform the help-seeking efforts of other men as well as guide improved services and systems to reduce barriers.
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Affiliation(s)
- Zac E Seidler
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Wilson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Courtney C Walton
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Krista Fisher
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon M Rice
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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21
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Seidler ZE, Wilson MJ, Kealy D, Oliffe JL, Ogrodniczuk JS, Rice SM. Men’s preferences for therapist gender: Predictors and impact on satisfaction with therapy. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1940866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Zac E. Seidler
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Michael J. Wilson
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | | | - Simon M. Rice
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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22
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Rice SM, Oliffe JL, Kealy D, Seidler ZE, Ogrodniczuk JS. Men's Help-Seeking for Depression: Attitudinal and Structural Barriers in Symptomatic Men. J Prim Care Community Health 2021; 11:2150132720921686. [PMID: 32410489 PMCID: PMC7232115 DOI: 10.1177/2150132720921686] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Men with depression are known to have significant
challenges with health service engagement. The current study sought to better
understand attitudinal and structural mental health care barriers among those
men identified as symptomatic for symptoms of major depression.
Design: Cross-sectional study with data provided by Canadian
men via a nationally representative online survey. Outcomes examined depression,
suicide risk, and barriers to mental health services. Participants:
A total of 117 men (mean age = 42.36 years) reporting symptoms of major
depression consistent with moderate severity as identified by the Patient Health
Questionnaire–Depression Module (PHQ-9). Results: In all, 51.3% of
the sample reported previously receiving counselling or psychotherapy for mental
health concerns. The majority (63.2%) reported past 2-week suicide or self-harm
ideation; however, only a small proportion (8.5%) were currently engaged with
professional mental health support. Logistic regression indicated that men’s
attitudinal barriers to mental health help-seeking had a greater predictive
effect than structural barriers (33% vs 0% of items, respectively). In
particular, lower likelihood of help-seeking was associated with men’s
reluctance to disclose mood-related symptoms to their physician/family doctor
(adjusted odds ratio [AOR] = 0.37), a tendency for self-reliance and solving
one’s own problems (AOR = 0.34), and uncertainly about the process of
psychotherapy (AOR = 0.29). Conclusion: Gender-transformative
approaches to primary health care may be key to improving men’s rates of
disclosure and increasing detection for depression and suicide risk.
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Affiliation(s)
- Simon M Rice
- Orygen, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - John L Oliffe
- The University of Melbourne, Melbourne, Victoria, Australia.,University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Zac E Seidler
- Orygen, Parkville, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia.,The University of Sydney, Sydney, New South Wales, Australia
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23
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Men's Psychotherapy Use, Male Role Norms, and Male-Typical Depression Symptoms: Examining 716 Men and Women Experiencing Psychological Distress. Behav Sci (Basel) 2021; 11:bs11060083. [PMID: 34199633 PMCID: PMC8228644 DOI: 10.3390/bs11060083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 01/15/2023] Open
Abstract
Men as compared to women are half as often affected by depressive and anxiety disorders and seek significantly less help for mental health issues than women. Adherence to traditional male role norms (AtTMRN) may hinder men from describing prototypical depression symptoms and from seeking psychotherapy. The current study compared whether AtTMRN, gender role identity, or the experience of prototypical or male-typical externalizing mental health symptoms were associated with psychotherapy use in men and women. In an anonymous online survey, 716 participants (37% men) reporting to currently experience psychological distress were examined. Information was obtained on psychotherapy use, depression and anxiety symptoms, gender role identity, and traditional male role norms. Although experiencing similar levels of depression, men compared to women showed a reduction in psychotherapy use by 29%. Masculine role identity was directly associated with reduced psychotherapy use in men (β = −0.41, p = 0.029), whereas AtTMRN was not (men: β = −0.04, p = 0.818; women: β = −0.25, p = 0.064). Higher externalizing depression symptomatology (β = −0.68, p = 0.005), but not prototypical depression symptomatology (β = −0.02, p = 0.499), was associated with reduced psychotherapy use in men but not women (p > 0.05). Interactions revealed that men, but not women, with high AtTMRN use psychotherapy only when exhibiting elevated symptom levels. The results corroborate previous reports showing reduced psychotherapy use in men as compared to women and identify elevated masculine role identity and male-typical externalizing depression symptomatology as direct factors associated with reduced psychotherapy use in psychologically distressed men. AtTMRN interacts with mental health symptoms to predict psychotherapy use, indicating that men with high AtTMRN only use psychotherapy when exhibiting high symptomatology.
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24
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Seidler ZE, Wilson MJ, Kealy D, Oliffe JL, Ogrodniczuk JS, Rice SM. Men's Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span. Am J Mens Health 2021; 15:15579883211014776. [PMID: 34041980 PMCID: PMC8165839 DOI: 10.1177/15579883211014776] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
While increasing numbers of Australian men are accessing mental health services, the sustainability of their therapy engagement varies significantly, with many men being lost to follow-up. The current study investigated dropout rates in a large community-based male sample to highlight the reasons for, and potential predictors of, men dropping out of mental health care services. Data were drawn from an online survey of 1907 Australian men (aged 16–85; M = 44.1 years) reflecting on their broad experiences in mental health therapy. Participants responded to bespoke items assessing their past dropout experience and reasons for dropping out, the odds of which were modeled in relation to demographics and predictors (e.g., therapist engagement strategies, alignment to traditional masculinity and pre-therapy feelings of optimism, shame, and emasculation). The overall dropout rate from therapy was 44.8% (n = 855), of which 26.6% (n = 120) accessed therapy once and did not return. The most common reasons for dropout were lack of connection with the therapist (54.9%) and the sense that therapy lacked progress (20.2%). Younger age, unemployment, self-reported identification with traditional masculinity, the presence of specific therapist engagement strategies, and whether therapy made participants feel emasculated all predicted dropout. Current depressive symptoms and suicidality were also higher amongst dropouts. Therapists should aim to have an honest discussion with all clients about the importance of therapy fit, including the real likelihood of dropout, in order to ensure this does not deter future engagement with professional services.
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Affiliation(s)
- Zac E Seidler
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael J Wilson
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Simon M Rice
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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25
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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.
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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
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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,
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Seidler ZE, Rice SM, Dhillon HM, Cotton SM, Telford NR, McEachran J, Rickwood DJ. Patterns of Youth Mental Health Service Use and Discontinuation: Population Data From Australia's Headspace Model of Care. Psychiatr Serv 2020; 71:1104-1113. [PMID: 32790590 DOI: 10.1176/appi.ps.201900491] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Young people (ages 12-25) experience the highest risk of developing mental disorders; however, their uptake of and engagement with treatment is low. The study explored sociodemographic predictors of attendance and discontinuation of mental health services in a large, population-based sample. METHODS Data were from the minimum data set collected from young people (ages 12-25) who attended headspace, Australia's National Youth Mental Health Foundation, from 2013 to 2017 (N=80,502). Data on key demographic and clinical variables and practitioner ratings of need for ongoing care were analyzed. Cox regression was used to examine the association between sociodemographic factors and rates of discontinuation based on practitioner-rated need for ongoing treatment. RESULTS The mean±SD number of sessions attended during the first episode of care was 4.6±4.4 sessions (median=3). Session-by-session discontinuation rates ranged from 14% to 19% across 10 sessions. The proportion discontinuing treatment before session 11 was 71.2%. Analysis of a subgroup (N=40,039) showed that 24% of those who discontinued treatment later returned to the same headspace center for a second episode of care. Those who were most at risk of discontinuation were older (ages 18-25), male, heterosexual, Aboriginal or Torres Strait Islander, and living in a rural location. CONCLUSIONS Sociodemographic factors were found to be associated with treatment discontinuation, and some young people followed a pathway in and out of mental health treatment. Further exploration is needed to determine the appropriate length and type of care for specific sociodemographic groups and how best to tailor treatment accordingly.
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Affiliation(s)
- Zac E Seidler
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Simon M Rice
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Haryana M Dhillon
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Sue M Cotton
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Nic R Telford
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Juliet McEachran
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
| | - Debra J Rickwood
- Orygen, Centre for Youth Mental Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne (Seidler, Rice, Cotton); Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, Australia (Dhillon); headspace, National Youth Mental Health Foundation, Melbourne (Telford, McEachran, Rickwood); Faculty of Health, University of Canberra, Canberra, Australia (Rickwood)
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Listabarth S, Vyssoki B, Glahn A, Gmeiner A, Pruckner N, Vyssoki S, Wippel A, Waldhoer T, König D. The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries-An ecological study. Eur Psychiatry 2020; 63:e85. [PMID: 32892754 PMCID: PMC7576527 DOI: 10.1192/j.eurpsy.2020.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicide risk in patients is markedly elevated during psychiatric inpatient care, as well as after discharge. However, it is unclear whether, and to what extent, this increased suicide risk varies between sex. Thus, the aim of this study was to analyze sex differences for suicides during and after psychiatric hospitalization in various countries. METHODS National suicide mortality rates and inpatient-related suicide rates (three intervals: during psychiatric inpatient treatment, 1 month, and 1 year after discharge) from 12 countries for 2000-2016 were analyzed, and a logistic model was used to quantify the effect of sex. RESULTS Persons admitted to or discharged from psychiatric inpatient care exhibited significantly increased rates of suicide compared to those in the general population. Furthermore, increase of suicide risk was significantly higher for females than for males for all investigated time intervals (inpatient suicide odds ratio [OR] 1.85; suicide within 1 month after discharge-OR 1.94; suicide within 1 year after discharge-OR 2.04). CONCLUSION Analysis confirmed the time during and after psychiatric inpatient care to be significantly associated with an elevated risk for suicide. Further, a significant sex effect was observed, with females in this population being at a proportionally higher risk for suicide during psychiatric inpatient treatment as well as the year following discharge. Our study implicates that more effective suicide preventive measures during inpatient stay, focusing on female patients, are needed.
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Affiliation(s)
- Stephan Listabarth
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Glahn
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical University of Hannover, Hannover, Germany
| | - Andrea Gmeiner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nathalie Pruckner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Sandra Vyssoki
- Department of Health Sciences, St. Pölten University of Applied Sciences, Sankt Pölten, Austria
| | - Andreas Wippel
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Waldhoer
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Sagar-Ouriaghli I, Godfrey E, Bridge L, Meade L, Brown JSL. Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. Am J Mens Health 2020; 13:1557988319857009. [PMID: 31184251 PMCID: PMC6560805 DOI: 10.1177/1557988319857009] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Compared to women, men are less likely to seek help for mental health
difficulties. Despite considerable interest, a paucity in evidence-based
solutions remains to solve this problem. The current review sought to synthesize the specific techniques within
male-specific interventions that may contribute to an improvement in
psychological help-seeking (attitudes, intentions, or behaviors). A systematic
review identified 6,598 potential articles from three databases (MEDLINE,
EMBASE, and PsycINFO). Nine studies were eligible. A meta-analysis was
problematic due to disparate interventions, outcomes, and populations. The
decision to use an innovative approach that adopted the Behavior Change
Technique (BCT) taxonomy to synthesize each intervention’s key features likely
to be responsible for improving help-seeking was made. Of the nine studies, four
were engagement strategies (i.e., brochures/documentaries), two randomized
controlled trials (RCTs), two pilot RCTs, and one retrospective review.
Regarding quality assessment, three were scored as “strong,” five as “moderate,”
and one as “weak.” Key processes that improved help-seeking attitudes,
intentions, or behaviors for men included using role models to convey
information, psychoeducational material to improve mental health knowledge,
assistance with recognizing and managing symptoms, active problem-solving tasks,
motivating behavior change, signposting services, and, finally, content that
built on positive male traits (e.g., responsibility and strength). This is the
first review to use this novel approach of using BCTs to summarize and identify
specific techniques that may contribute to an improvement in male help-seeking
interventions, whether engagement with treatment or the intervention itself.
Overall, this review summarizes previous male help-seeking interventions,
informing future research/clinical developments.
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Affiliation(s)
- Ilyas Sagar-Ouriaghli
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Emma Godfrey
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - Livia Bridge
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Meade
- 2 School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, UK
| | - June S L Brown
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Seidler ZE, Rice SM, Kealy D, Oliffe JL, Ogrodniczuk JS. Once bitten, twice shy: Dissatisfaction with previous therapy and its implication for future help-seeking among men. Int J Psychiatry Med 2020; 55:255-263. [PMID: 32019361 DOI: 10.1177/0091217420905182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Men can be reluctant to disclose distress and many men have ambivalence toward seeking help for depression, leading to poor uptake of and engagement in psychotherapy. The present study sought to explore whether a previously dissatisfying therapy experience leads to greater doubts about the effectiveness of treatment, in turn impacting on a man's willingness to disclose their distress in future. METHOD An online survey of 133 Canadian men was conducted to investigate their current depressive symptoms, previous experience of, and belief in, the effectiveness of psychotherapy and likelihood of disclosing distress to their physician. A regression model with mediation was employed to analyze the relationship between these responses. RESULTS The regression model highlighted a significant negative association between satisfaction with previous therapy and doubt about the effectiveness of therapy (t = -7.299, 99% confidence interval [-.537, -.254], p < .001). There was also a significant indirect effect, such that doubt about the effectiveness of therapy mediated the association between previous satisfaction and willingness to disclose distress to a physician (t = 3.748, 99% confidence interval [.123, .690], p < .001). CONCLUSIONS Providing treatment for depression that men find engaging and satisfying may improve their confidence that psychotherapy can help, make them more likely to reach out for assistance in the future and in turn, benefit their long-term mental health outcomes.
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Affiliation(s)
- Zac E Seidler
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Simon M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Fee A, McIlfatrick S, Ryan A. Examining the support needs of older male spousal caregivers of people with a long-term condition: A systematic review of the literature. Int J Older People Nurs 2020; 15:e12318. [PMID: 32367662 DOI: 10.1111/opn.12318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/06/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of this review was to identify and synthesise literature reporting on support needs of older male caregivers, who are providing care for a chronically ill spouse/partner at home. BACKGROUND Traditionally, informal caregiving has been perceived as a feminised activity. Consequently, caregiving research has been dominated by female samples, and male caregivers are grossly under-represented. Given the growing recognition of caregiving as a gendered concept, and the rise in number of male caregivers, particularly in later life, the need for better understanding of the needs of male caregivers is important in order to plan effective support for this population. DESIGN A systematic literature review. METHODS Four electronic databases and grey literature were systematically searched. RESULTS The systematic search resulted in 3,646 papers, eligibility criteria were applied to the full texts of 104 papers, and 11 papers met the inclusion criteria. Two core themes were identified: the need to maintain masculinity and the provision of social support. CONCLUSION Findings suggest that men may have a gendered approach to caregiving based on dominant masculine norms. This can be manifested in a reluctance to ask for or accept help and a desire to retain control over caregiving. Findings also revealed isolation and loneliness experienced by older male caregivers, along with a preference for support to address this within a male-specific context. It is suggested that healthcare professionals should be cognisant of the male caregiver approach and should have an increased awareness of male caregivers support preferences, and of their own gendered assumptions, in order to provide effective support for this population. IMPLICATIONS FOR PRACTICE Nurses have a key role in providing family support. Findings from this review suggest that nurses should be aware of the specific needs of older male spousal caregivers if they are to provide effective care and support to this population group.
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Affiliation(s)
- Anne Fee
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sonja McIlfatrick
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
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Øyeflaten I, Maeland S, Haukenes I. Independent medical evaluation of general practitioners' follow-up of sick-listed patients: a cross-sectional study in Norway. BMJ Open 2020; 10:e032776. [PMID: 32193258 PMCID: PMC7202711 DOI: 10.1136/bmjopen-2019-032776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The study was designed to examine the sufficiency of general practitioners' (GPs) follow-up of patients on sick leave, assessed by independent medical evaluators. DESIGN Cross-sectional study SETTING: Primary health care in the Western part of Norway. The study reuses data from a randomised controlled trial-the Norwegian independent medical evaluation trial (NIME trial). PARTICIPANTS The intervention group in the NIME trial: Sick-listed workers having undergone an independent medical evaluation by an experienced GP at 6 months of unremitting sick leave (n=937; 57% women). In the current study, the participants were distributed into six exposure groups defined by gender and main sick leave diagnoses (women/musculoskeletal, men/musculoskeletal, women/mental, men/mental, women/all other diagnoses and men/all other diagnoses). OUTCOME MEASURE The independent medical evaluators assessment (yes/no) of the sufficiency of the regular GPs follow-up of their sick-listed patients. RESULTS Estimates from generalised linear models demonstrate a robust association between men with mental sick leave diagnoses and insufficient follow-up by their regular GP first 6 months of sick leave (adjusted relative risk (RR)=1.8, 95% CI=1.15-1.68). Compared with the reference group, women with musculoskeletal sick leave diagnoses, this was the only significant finding. Men with musculoskeletal diagnoses (adjusted RR=1.4, 95% CI=0.92-2.09); men with other diagnoses (adjusted RR=1.0, 95% CI=0.58-1.73); women with mental diagnoses (adjusted RR=1.2, 95% CI=0.75-1.77) and women with other diagnoses (adjusted RR=1.3, 95% CI=0.58-1.73). CONCLUSIONS Assessment by an independent medical evaluator showed that men with mental sick leave diagnoses may be at risk of insufficient follow-up by their GP. Efforts should be made to clarify unmet needs to initiate relevant actions in healthcare and work life. Avoiding marginalisation in work life is of the utmost importance. TRIAL REGISTRATION NUMBER NCT02524392; Post-results.
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Affiliation(s)
- Irene Øyeflaten
- Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
- NORCE Norwegian Research Centre AS, Bergen, Norway
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Getting Them Through the Door: a Survey of Men’s Facilitators for Seeking Mental Health Treatment. Int J Ment Health Addict 2019. [DOI: 10.1007/s11469-019-00147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
PURPOSE OF REVIEW To explore recent research evidence addressing men's depression and suicide. Included are discussions of recent literature investigating male depression symptoms, and men's depression and suicidality help-seeking and engagement with professional mental health care services. RECENT FINDINGS Specific externalizing symptoms of substance misuse, risk-taking, and poor impulse control among men indicate the need for gender-sensitized depression screening and risk assessments. The reticence of some men for seeking professional health care has drawn public awareness raising and de-stigmatizing efforts, while clinical guidelines for working with boys and men have been offered to better serve men seeking help for depression and/or suicidality. There is a strengthening case for male depression comprising specific externalizing symptomology, and these findings, along with high male suicide rates (including men who are seemingly in care), indicate the need for tailored approaches to men's depression and suicide prevention.
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Affiliation(s)
- John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada.
| | - Emma Rossnagel
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Zac E Seidler
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Simon M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth, Mental Health, The University of Melbourne, Melbourne, Australia
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Reavley NJ, Milner AJ, Martin A, Too LS, Papas A, Witt K, Keegel T, LaMontagne AD. Depression literacy and help-seeking in Australian police. Aust N Z J Psychiatry 2018; 52:1063-1074. [PMID: 29402134 DOI: 10.1177/0004867417753550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. METHODS All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. RESULTS Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported 'talking to the person' although leaders were more likely to facilitate professional help. Leaders' willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. CONCLUSION Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health.
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Affiliation(s)
- Nicola J Reavley
- 1 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Allison J Milner
- 2 Centre for Health Equity, Melbourne School of Population and Gloabl Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Angela Martin
- 3 The Tasmanian School of Business and Economics, University of Tasmania, Hobart, TAS, Australia
| | - Lay San Too
- 1 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alicia Papas
- 4 Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Katrina Witt
- 5 Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tessa Keegel
- 6 School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia.,7 Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, VIC, Australia
| | - Anthony D LaMontagne
- 2 Centre for Health Equity, Melbourne School of Population and Gloabl Health, The University of Melbourne, Melbourne, VIC, Australia.,4 Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
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Bilsker D, Fogarty AS, Wakefield MA. Critical Issues in Men's Mental Health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:590-596. [PMID: 29673272 PMCID: PMC6109879 DOI: 10.1177/0706743718766052] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This narrative review highlights key issues in men's mental health and identifies approaches to research, policy and practice that respond to men's styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to service provision designed to improve men's accessing of care, with an emphasis on Canadian programs. The main conclusion is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional. There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are made to address men's mental health through: healthcare policy that facilitates access; research on tailoring interventions to men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is sensitive to the expression of mental health problems in men and that responds in a relevant manner.
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Affiliation(s)
- Dan Bilsker
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Andrea S. Fogarty
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Matthew A. Wakefield
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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Affleck W, Carmichael V, Whitley R. Men's Mental Health: Social Determinants and Implications for Services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:581-589. [PMID: 29673270 PMCID: PMC6109884 DOI: 10.1177/0706743718762388] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Numerous scholars have stated that there is a silent crisis in men's mental health. In this article, we aim to provide an overview of core issues in the field of men's mental health, including a discussion of key social determinants as well as implications for mental health services. Firstly, we review the basic epidemiology of mental disorders with a high incidence and prevalence in men, including suicide and substance use disorder. Secondly, we examine controversies around the low reported rates of depression in men, discussing possible measurement and reporting biases. Thirdly, we explore common risk factors and social determinants that may explain higher rates of certain mental health outcomes in men. This includes a discussion of 1) occupational and employment issues; 2) family issues and divorce; 3) adverse childhood experience; and 4) other life transitions, notably parenthood. Fourthly, we document and analyze low rates of mental health service utilization in men. This includes a consideration of the role of dominant notions of masculinity (such as stubbornness and self-reliance) in deterring service utilization. Fifthly, we note that some discourse on the role of masculinity contains much "victim blaming," often adopting a reproachful deficit-based model. We argue that this can deflect attention away from social determinants as well as issues within the mental health system, such as claims that it is "feminized" and unresponsive to men's needs. We conclude by calling for a multipronged public health-inspired approach to improve men's mental health, involving concerted action at the individual, health services, and societal levels.
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Affiliation(s)
- William Affleck
- 1 Department of Psychiatry, McGill University, Montreal, Quebec
| | | | - Rob Whitley
- 1 Department of Psychiatry, McGill University, Montreal, Quebec.,2 Douglas Mental Health University Institute, Montreal, Quebec
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Seidler ZE, Rice SM, Ogrodniczuk JS, Oliffe JL, Dhillon HM. Engaging Men in Psychological Treatment: A Scoping Review. Am J Mens Health 2018; 12:1882-1900. [PMID: 30103643 PMCID: PMC6199457 DOI: 10.1177/1557988318792157] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tailoring psychological treatments to men's specific needs has been a topic of concern for decades given evidence that many men are reticent to seek professional health care. However, existing literature providing clinical recommendations for engaging men in psychological treatments is diffuse. The aim of this scoping review was to provide a comprehensive summary of recommendations for how to engage men in psychological treatment. Four electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO) were searched for articles published between 2000 and 2017. Titles and abstracts were reviewed; data extracted and synthesized thematically. Of 3,627 citations identified, 46 met the inclusion criteria. Thirty articles (65%) were reviews or commentaries; 23 (50%) provided broad recommendations for working with all men. Findings indicate providing male-appropriate psychological treatment requires clinicians to consider the impact of masculine socialization on their client and themselves, and how gender norms may impact clinical engagement and outcomes. Existing literature also emphasized specific process micro-skills (e.g., self-disclosure, normalizing), language adaption (e.g., male-oriented metaphors) and treatment styles most engaging for men (e.g., collaborative, transparent, action-oriented, goal-focused). Presented are clinical recommendations for how to engage men in psychological treatments including paying attention to tapping the strengths of multiple masculinities coexisting within and across men. Our review suggests more empirically informed tailored interventions are needed, along with formal program evaluations to advance the evidence base.
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Affiliation(s)
- Zac E Seidler
- 1 School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Simon M Rice
- 2 Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John S Ogrodniczuk
- 3 Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- 4 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Haryana M Dhillon
- 5 Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Australia
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Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis. Harv Rev Psychiatry 2018; 25:29-38. [PMID: 28059934 DOI: 10.1097/hrp.0000000000000128] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While some studies suggest that men and women report different symptoms associated with depression, no published systematic review or meta-analysis has analyzed the relevant research literature. This article aims to review the evidence of gender differences in symptoms associated with depression. METHODS PubMed, Cochrane, and PsycINFO databases, along with further identified references lists, were searched. Thirty-two studies met the inclusion criteria. They included 108,260 participants from clinical and community samples with a primary presentation of unipolar depression. All 32 studies were rated for quality and were tested for publication bias. Meta-analyses were conducted on the 26 symptoms identified across the 32 studies to assess for the effect of gender. RESULTS The studies indicate a small, significant association of gender with some symptoms. Depressed men reported alcohol/drug misuse (Hedges's g = 0.26 [95% confidence interval (CI), 0.11-0.42]) and risk taking/poor impulse control (g = 0.58 [95% CI, 0.47-0.69]) at a greater frequency and intensity than depressed women. Depressed women reported symptoms at a higher frequency and intensity that are included as diagnostic criteria for depression such as depressed mood (g = -0.20 [95% CI, -0.33 to -0.08]), appetite disturbance/weight change (g = -0.20 [95% CI, -0.28 to -0.11]), and sleep disturbance (g = -0.11 [95% CI, -0.19 to -0.03]). CONCLUSIONS Results are consistent with existing research on gender differences in the prevalence of substance use and mood disorders, and of their co-occurrence. They highlight the potential utility of screening for substance misuse, risk taking, and poor impulse control when assessing depression in men. Future research is warranted to clarify gender-specific presentations of depression and co-occurring symptoms.
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Seidler ZE, Rice SM, River J, Oliffe JL, Dhillon HM. Men’s Mental Health Services: The Case for a Masculinities Model. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1060826517729406] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Simon M. Rice
- The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Jo River
- The University of Sydney, New South Wales, Australia
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Gender differences in quality of life and functional disability for depression outpatients with or without residual symptoms after acute phase treatment in China. J Affect Disord 2017; 219:141-148. [PMID: 28550766 DOI: 10.1016/j.jad.2017.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/29/2017] [Accepted: 05/04/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is associated with substantial personal suffering and reduced quality of life and functioning. The aim of this study was to investigate gender differences on quality of life and functional impairment of outpatients with depression after acute phase treatment. METHODS 1503 depression outpatients were recruited from eleven hospitals in China. Subjects were evaluated with sociodemographic characteristics, history and self-report instruments, related to severity of symptoms, function and quality of life. All data were analyzed to determine the gender differences. RESULTS Men had a younger age at onset and the first onset age, higher education compared to women in total patients and with or without residual symptoms group. Using regression analysis, it was found that gender was significantly statistically related to severity scores of SDS and had no correlation with Q-LES-Q-SF total scores. In the residual symptoms group, greater functional impairment was noted by men in the area of work and social life. Significant gender differences of mood, work and sexual life in quality of life were observed. LIMITATIONS This is a cross-sectional study of depressed outpatients and duration of acute phase treatment may not an adequate time to measure changes. CONCLUSIONS Depression appears to affect men more seriously than women after acute phase treatment. Men had a younger age at onset and the first onset age, higher education, more functional impairment and lower satisfaction of quality of life in mood, work and sexual life. Gender differences affect acute treatment, remission and recovery.
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Fogarty AS, Spurrier M, Player MJ, Wilhelm K, Whittle EL, Shand F, Christensen H, Proudfoot J. Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data. Health Expect 2017; 21:261-269. [PMID: 28806484 PMCID: PMC5750756 DOI: 10.1111/hex.12611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 12/02/2022] Open
Abstract
Background Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men. Objective To explore the views of at‐risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved. Design Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation. Setting and participants A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved. Results Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services. Conclusion Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.
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Affiliation(s)
- Andrea S Fogarty
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael Spurrier
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael J Player
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kay Wilhelm
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Faces in the Street, St Vincent's Hospital, St Vincent's Urban Mental Health Research Institute, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Erin L Whittle
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Shand
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Judith Proudfoot
- Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Fogarty AS, Proudfoot J, Whittle EL, Clarke J, Player MJ, Christensen H, Wilhelm K. Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men's Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning. JMIR Ment Health 2017; 4:e33. [PMID: 28798009 PMCID: PMC5571234 DOI: 10.2196/mental.7769] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men's mental health needs are required. OBJECTIVE This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. METHODS A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. RESULTS A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. CONCLUSIONS This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.
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Affiliation(s)
| | | | | | | | | | | | - Kay Wilhelm
- St Vincent's Hospital, Faces in the Street, Darlinghurst, Australia
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44
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Brandstetter S, Dodoo-Schittko F, Speerforck S, Apfelbacher C, Grabe HJ, Jacobi F, Hapke U, Schomerus G, Baumeister SE. Trends in non-help-seeking for mental disorders in Germany between 1997-1999 and 2009-2012: a repeated cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1005-1013. [PMID: 28456871 DOI: 10.1007/s00127-017-1384-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/10/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE This study sought to examine trends in non-help-seeking for mental disorders among persons with a prevalent mental disorder (12-month prevalence) in Germany between 1997-1999 and 2009-2012. METHODS We examined data from 1909 persons aged 18-65 years who participated in two independent, repeated cross-sectional surveys (German National Interview and Examination Study 1997-1999, German Health Interview and Examination Survey for Adults 2009-2012) conducted 12 years apart. Prevalent mental disorders (12-month prevalence) were determined using the Composite International Diagnostic Interview, which included information on lifetime help-seeking for mental health problems. Correlates of self-reported help-seeking were analyzed according to Andersen's Behavioral Model. Multivariable Poisson regression models were used to assess time trends in the directly standardized and model-adjusted prevalence of non-help-seeking across strata of socio-economic and clinical variables. RESULTS The proportion of people with a prevalent mental disorder who have never sought help in their lifetime decreased significantly from 62% (95% CI 58.7-64.7) to 57% (95% CI 52.2-60.9) between 1997-1999 and 2009-2012 in adults aged 18-65 years in Germany. Downward trends in non-help-seeking occurred in all investigated strata and reached statistical significance in women, in people who were living alone, people with medium educational level, people living in middle-sized communities, people with non-statutory health insurance, smokers, and people with co-existing somatic conditions. CONCLUSION Despite a downward trend over the course of 12 years, a large proportion of people suffering from mental disorders are still not seeking treatment in Germany. Further efforts to increase uptake of help-seeking for mental disorders in hard-to-reach groups are warranted to continue this trend.
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Affiliation(s)
- Susanne Brandstetter
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.
| | - Frank Dodoo-Schittko
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Ulfert Hapke
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian E Baumeister
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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45
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Davey CG, Chanen AM. The unfulfilled promise of the antidepressant medications. Med J Aust 2017; 204:348-50. [PMID: 27169968 DOI: 10.5694/mja16.00194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/17/2016] [Indexed: 11/17/2022]
Abstract
Australia has one of the highest rates of antidepressant use in the world; it has more than doubled since 2000, despite evidence showing that the effectiveness of these medications is lower than previously thought. An increasing placebo response rate is a key reason for falling effectiveness, with the gap between response to medications and placebo narrowing. Psychotherapies are effective treatments, but recent evidence from high-quality studies suggests that their effectiveness is also modest. Combined treatment with medication and psychotherapy provides greater effectiveness than either alone. The number of patients receiving psychotherapy had been declining, although this trend is probably reversing with the Medicare Better Access to Mental Health Care initiative. Antidepressant medications still have an important role in the treatment of moderate to severe depression; they should be provided as part of an overall treatment plan that includes psychotherapy and lifestyle strategies to improve diet and increase exercise. When medications are prescribed, they should be used in a way that maximises their chance of effectiveness.
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Affiliation(s)
- Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
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Cavanagh A, Wilson CJ, Caputi P, Kavanagh DJ. Symptom endorsement in men versus women with a diagnosis of depression: A differential item functioning approach. Int J Soc Psychiatry 2016; 62:549-59. [PMID: 27335340 DOI: 10.1177/0020764016653980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is some evidence that, in contrast to depressed women, depressed men tend to report alternative symptoms that are not listed as standard diagnostic criteria. This may possibly lead to an under- or misdiagnosis of depression in men. AIMS This study aims to clarify whether depressed men and women report different symptoms. METHODS This study used data from the 2007 Australian National Survey of Mental Health and Wellbeing that was collected using the World Health Organization's Composite International Diagnostic Interview. Participants with a diagnosis of a depressive disorder with 12-month symptoms (n = 663) were identified and included in this study. Differential item functioning (DIF) was used to test whether depressed men and women endorse different features associated with their condition. RESULTS Gender-related DIF was present for three symptoms associated with depression. Depressed women were more likely to report 'appetite/weight disturbance', whereas depressed men were more likely to report 'alcohol misuse' and 'substance misuse'. CONCLUSION While the results may reflect a greater risk of co-occurring alcohol and substance misuse in men, inclusion of these features in assessments may improve the detection of depression in men, especially if standard depressive symptoms are under-reported.
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Affiliation(s)
- Anna Cavanagh
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Coralie J Wilson
- Illawarra Health and Medical Research Institute, Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Peter Caputi
- Centre for Health Initiatives, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - David J Kavanagh
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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Meurk C, Leung J, Hall W, Head BW, Whiteford H. Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research. J Med Internet Res 2016; 18:e10. [PMID: 26764181 PMCID: PMC4730106 DOI: 10.2196/jmir.4827] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/12/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. OBJECTIVE We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. METHODS Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. RESULTS The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. CONCLUSIONS Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary.
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Affiliation(s)
- Carla Meurk
- School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Herston, Australia.
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48
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Proudfoot J, Fogarty AS, McTigue I, Nathan S, Whittle EL, Christensen H, Player MJ, Hadzi-Pavlovic D, Wilhelm K. Positive strategies men regularly use to prevent and manage depression: a national survey of Australian men. BMC Public Health 2015; 15:1135. [PMID: 26573270 PMCID: PMC4647287 DOI: 10.1186/s12889-015-2478-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/07/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Men are at greater risk than women of dying by suicide. One in eight will experience depression--a leading contributor to suicide--in their lifetime and men often delay seeking treatment. Previous research has focused on men's use of unhelpful coping strategies, with little emphasis on men's productive responses. The present study examines the positive strategies men use to prevent and manage depression. METHOD A national online survey investigated Australian men's use of positive strategies, including 26 strategies specifically nominated by men in a previous qualitative study. Data were collected regarding frequency of use or openness to using untried strategies, depression risk, depression symptoms, demographic factors, and other strategies suggested by men. Multivariate regression analyses explored relationships between regular use of strategies and other variables. RESULTS In total, 465 men aged between 18 and 74 years participated. The mean number of strategies used was 16.8 (SD 4.1) for preventing depression and 15.1 (SD 5.1) for management. The top five prevention strategies used regularly were eating healthily (54.2 %), keeping busy (50.1 %), exercising (44.9 %), humour (41.1 %) and helping others (35.7 %). The top five strategies used for management were taking time out (35.7 %), rewarding myself (35.1 %), keeping busy (35.1 %), exercising (33.3 %) and spending time with a pet (32.7 %). With untried strategies, a majority (58 %) were open to maintaining a relationship with a mentor, and nearly half were open to using meditation, mindfulness or gratitude exercises, seeing a health professional, or setting goals. In multivariate analyses, lower depression risk as measured by the Male Depression Risk Scale was associated with regular use of self-care, achievement-based and cognitive strategies, while lower scores on the Patient Health Questionnaire-9 was associated with regular use of cognitive strategies. CONCLUSIONS The results demonstrate that the men in the study currently use, and are open to using, a broad range of practical, social, emotional, cognitive and problem-solving strategies to maintain their mental health. This is significant for men in the community who may not be in contact with professional health services and would benefit from health messages promoting positive strategies as effective tools in the prevention and management of depression.
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Affiliation(s)
| | | | | | - Sally Nathan
- School of Public Health and Community Medicine, UNSW, Sydney, Australia.
| | | | | | | | - Dusan Hadzi-Pavlovic
- Black Dog Institute, UNSW, Sydney, Australia.
- School of Psychiatry, UNSW, Sydney, Australia.
| | - Kay Wilhelm
- School of Psychiatry, UNSW, Sydney, Australia.
- Faces in the Street, St Vincent's Urban Mental Health and Wellbeing Research Institute, Sydney, Australia.
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