The Australian longitudinal study on male health-methods

Impact of informal caregiving on depressive symptoms among a national cohort of men

BACKGROUND

There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men.

METHODS

We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations.

RESULTS

In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses.

CONCLUSION

These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.

High Risk or Risky Highs: Understanding the Links Between Alcohol and Cannabis Use on the Transition From Suicidal Ideation to Attempts in Australian Men

Alcohol and cannabis use are consistently associated with greater risk of suicide, particularly among men and in higher-income countries (e.g., Australia). Adult data (n = 7,464) from waves 1 and 2 of Ten to Men: The Australian Longitudinal Study on Male Health were used to explore whether alcohol and/or cannabis use increased the longitudinal risk of a suicide attempt among suicidal ideators. Cannabis use was associated with increased risk of transitioning from suicidal ideation to making a suicide attempt; no association was found for alcohol. Broadly, these findings indicate that greater cannabis but not alcohol use may increase risk of transitioning to making a suicide attempt among those who are thinking about suicide.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

Preconception factors associated with postnatal mental health and suicidality among first-time fathers: results from an Australian Longitudinal Study of Men's Health

PURPOSE

Prospective evidence about men at risk of postnatal difficulties is rare-particularly for postpartum suicidal ideation. This study aimed to determine the extent to which first-time fathers reported depressive symptoms and suicidal ideation and behaviours in the first postnatal year, and to identify preconception risk factors for postnatal mental health difficulties.

METHODS

Secondary analysis of data from The Ten to Men Study-Australia's population-based prospective study of men's health was conducted. Participants were 205 men who became first-time fathers in the 12 months prior to wave 2 (2015/16). Regression analyses were used to ascertain preconception (mental and physical health, lifestyle) and demographic factors associated with postnatal depressive symptoms.

RESULTS

Postnatally, 8.3% of fathers reported moderate to severe depressive symptoms, 5% had suicidal thoughts, 3% had plans, and less than 1% had attempted suicide. Preconception depressive symptoms was the only factor significantly associated with postnatal depressive symptoms.

CONCLUSION

The transition into fatherhood is marked with significant psychological distress for some men. These results suggest that mental health screening and support in the preconception period is crucial to supporting the mental health of new fathers.

Like Father, Like Son: Empirical Insights into the Intergenerational Continuity of Masculinity Ideology

Scholarly work and public commentary point to the persistence of masculinity models characterized by a sense of entitlement, the exertion of dominance, and the justification of abusive behaviors. While there is abundant theoretical work on men and masculinities, fewer empirical studies have examined how young men develop their masculine ideals. In this study, we theorize the role of fathers’ adherence to masculinity ideology in influencing the development of young men’s masculine ideals. We then provide novel empirical evidence on intergenerational congruence between fathers’ and sons’ masculinities using unique data from an Australian national probability survey. Our results reveal moderate, positive associations between fathers’ and sons’ adherence to masculinity ideology. This pattern holds for an overall measure of masculinity, as well as for each of its subscales. Fathers’ religiosity amplified the magnitude of the intergenerational correlation. These findings suggest that interventions aimed at encouraging the development of healthy masculinities amongst young men should engage their paternal figures.

Examining Adult E-cigarette Use in Kentucky and Its Appalachian Region Using the Behavioral Risk Factor Surveillance System, 2016-2017

OBJECTIVES

Electronic cigarette (e-cigarette) use has increased steadily in the United States, but little research has examined its prevalence in states comprising Appalachia, a rural region known for high rates of tobacco use. This study assessed lifetime and current e-cigarette use among adults by sociodemographic characteristics, geographic region, and cigarette smoking in Kentucky, with a focus on the Appalachian region.

METHODS

We used data from the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys to calculate the prevalence of lifetime and current e-cigarette use, and we used weighted multivariable logistic regression analyses to examine the relative influence of other factors.

RESULTS

Among adults in Kentucky, 5.8% (95% CI, 5.2%-6.4%) were current e-cigarette users and 27.0% (95% CI, 25.9%-28.0%) were lifetime users, compared with state medians of 4.6% (95% CI, 4.0%-5.1%) and 21.4% (95% CI, 19.4%-23.5%) for the United States. Multivariable regression models showed similar patterns for all regions: higher prevalence odds of current e-cigarette use among adults aged 18-24, current conventional smokers, and adults unable to work. Generally, Appalachian residents of Kentucky did not have significantly higher rates of lifetime or current e-cigarette use as compared with other non-Appalachian residents of Kentucky. Hispanic residents of Appalachian Kentucky, however, had higher rates of e-cigarette use than Hispanic residents of other regions of Kentucky.

CONCLUSIONS

Rates of e-cigarette use were higher in Kentucky than in the United States but were not further elevated in Kentucky's Appalachian region. High rates of e-cigarette use among Hispanic residents of Appalachia indicate a need to focus future interventions in the region.

Discrimination experienced by Aboriginal and Torres Strait Islander males in Australia: Associations with suicidal thoughts and depressive symptoms

INTRODUCTION

Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms.

METHODS

We used cross-sectional data on 13,697 males aged 18-55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms.

RESULTS

Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination.

CONCLUSION

Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.

Masculinity and men's health service use across four social generations: Findings from Australia's Ten to Men study

There is a perception that traditional masculine ideals, usually thought deleterious for men's health outcomes, are no longer as relevant for younger social generations such as Millennials as they are for older social generations such as Baby Boomers. Yet, in Australia, there remains a disparity between younger men's and women's health outcomes and use of health services. Conformity to traditional masculinity is often cited as a barrier to men's positive health behaviours but conceptualisation of the construct is contested. We analysed a selected secondary dataset (n = 14,917) of Australian males aged between 15 and 55 years from Ten to Men: The Australian Longitudinal Study on Male Health. We examined the role of conformity to traditional masculine norms in predicting likelihood of regular primary and preventative health services use for different social generations. Analyses included mediated regression and adjusted logistic regression. Conformity to ten of the eleven specific traditional masculine norms predicted likelihood of increased or decreased regular health service use depending on the generation and health service type. Specific traditional masculine norms play a complex role in men's use of distinct health service types for different generations of Australian males. Practitioners wishing to increase men's engagement with health services should consider gender-sensitive approaches that leverage specific masculine norms relevant to the age cohort to drive positive outcomes in men's health.

Health Literacy in Male-Dominated Occupations

Low levels of health literacy are associated with poorer health outcomes. Both individual- and social-level factors have been identified as predictors of low health literacy, and men are known to have lower health literacy than women. Previous research has reported that men working in male-dominated occupations are at higher risk of accidents, injury, and suicide than other population groups, yet no study to date has examined the effect of gendered occupational contexts on men’s health literacy. The current article examined the association between occupational gender ratio and health literacy among Australian males. The Australian Longitudinal Study on Male Health (Ten to Men) was used to examine associations between occupational gender ratio (measured in Wave 1) and health literacy (measured in Wave 2) across three subscales of the Health Literacy Questionnaire. Multivariable linear regression analyses were used and showed that the more male dominated an occupational group became, the lower the scores of health literacy were. Results for the different subscales of health literacy for the most male-dominated occupational group, compared to the non-male-dominated group were: ability to find good health information, (Coef. −0.80, 95% CI [−1.05, −0.54], p < .001); ability to actively engage with health-care providers, (Coef. −0.35, 95% CI [−0.62, −0.07], p = .013); and feeling understood and supported by health-care providers, (Coef. −0.48, 95% CI [−0.71, −0.26],p = < .001). The results suggest the need for workplace interventions to address occupation-level factors as an influence on health literacy among Australian men, particularly among the most male-dominated occupational groups.

Associations between conformity to masculine norms and depression: age effects from a population study of Australian men

Background

Strict adherence to masculine norms has been associated with deleterious consequences for the physical and mental health of men. However, population-based research is lacking, and it remains unclear whether ageing influences adherence to masculine norms and the extent to which mental health problems like depression are implicated.

Methods

This study reports on data from 14,516 males aged 15–55 years who participated in Wave 1 of the Australian Longitudinal Study of Male Health (Ten to Men). Group differences in self-reported conformity to masculine norms (CMNI-22), current depressive symptoms (PHQ-9), and self-reported 12-month depression history were examined for males aged 15–17 years, 18–25 years, 26–35 years, 36–50 years, and 51–55 years. Generalised linear models were used to examine the relationships between these variables across age groups.

Results

Conformity to masculine norms decreased significantly with age. However, models predicting depression generally showed that higher conformity to masculine norms was associated with an increased risk of current depressive symptoms, especially in the oldest age group. Conversely, higher conformity was associated with a decreased likelihood of a self-reported 12-month depression history, although nuances were present between age groups, such that this trend was not evident in the oldest age group.

Conclusions

Findings provide important insights into the complex relationship between conformity to masculine norms and depressive symptoms across the lifespan and further highlight the importance of mental health campaigns that address the complexities of gendered help-seeking behaviour for men.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00533-6.

High prevalence of health and social risk behaviours among men experiencing suicidal thoughts and behaviour: The imperative to undertake holistic assessments

OBJECTIVE

We aimed to examine whether suicidal thoughts and behaviour were independently associated with a wide range of health and social risk behaviours.

METHODS

We conducted cross-sectional analyses of data collected from 13,763 adult males who participated in The Australian Longitudinal Study on Male Health. We fit generalised linear models to estimate the relative risk of engaging in a range of health and social risk behaviours across several domains by suicidal thoughts and behaviour status.

RESULTS

Men with recent suicidal ideation (relative risk range, 1.10-5.25) and lifetime suicide attempts (relative risk range, 1.10-7.65) had a higher risk of engaging in a broad range of health and social risk behaviours. The associations between suicidal thoughts and behaviour and health and social risk behaviours were typically independent of socio-demographics and in many cases were also independent of depressive symptoms.

CONCLUSION

Suicidal thoughts and behaviour overlaps with increased risk of engagement in a wide range of health and social risk behaviours, indicating the need for an alignment of broader public health interventions within clinical and community-based suicide prevention activities. The experience of suicidality may be an important catalyst for a broader psychosocial conversation and assessment of health and social risk behaviours, some of which may be modifiable. These behaviours may not carry an imminent risk of premature death, such as from suicide, but they carry profound health and social consequences if left unaddressed.

Comorbid Depression and Obesity: Correlates and Synergistic Association With Noncommunicable Diseases Among Australian Men

Introduction

Obesity and depression are among the leading causes of disease worldwide. Their bidirectional relationship often results in comorbid depression and obesity, which further increases the risk of adverse health outcomes. Further evidence is needed on the correlates and synergistic association with other noncommunicable diseases. The objective of our study was to examine the correlates and synergistic association of comorbid depression and obesity with other noncommunicable diseases in a large sample of Australian men.

Methods

Our cross-sectional study used data on 13,763 men aged 18 to 55 from the first wave (2013–2014) of the Australian Ten to Men study. Body mass index was calculated from self-reported weight and height. The Patient Health Questionnaire-9 was used to assess depression. We calculated the weighted prevalence of depression, obesity, and comorbid depression and obesity and examined correlates of comorbid depression and obesity by using logistic regression. We used the synergy index to measure the synergistic association of depression and obesity with other noncommunicable diseases.

Results

The weighted prevalence of depression, obesity, and comorbid depression and obesity among Australian men were 12.5%, 22.2%, and 3.7%, respectively. Age, marital status, area-level socioeconomic index, educational attainment, household income, employment status, and physical activity were significantly associated with comorbid depression and obesity. Men with comorbid depression and obesity, compared with men without comorbid depression and obesity, had 7.6 times the risk of diabetes and 6.7 times the risk of hypertension.

Conclusion

Co-occurrence of depression and obesity among Australian men is associated with a set of individual- and area-level correlates and a higher risk of noncommunicable diseases. The correlates identified in our study are useful in planning interventions and screening in primary care settings.

Expressions of masculinity and associations with suicidal ideation among young males

BACKGROUND

Adolescent boys and young men are at particular risk of suicide. Suicidal ideation is an important risk factor for suicide, but is poorly understood among adolescent males. Some masculine behaviors have been associated with deleterious effects on health, yet there has been little quantitative examination of associations between masculinity and suicide or suicidal ideation, particularly among boys/young men. This study aimed to examine associations between conformity to masculine norms and suicidal ideation in a sample of adolescents.

METHODS

A prospective cohort design, this study drew on a sample of 829 Australian boys/young men from the Australian Longitudinal Study on Male Health. Boys were 15-18 years at baseline, and 17-20 years at follow-up. Masculine norms (Wave 1), were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Suicidal ideation (Wave 2) was a single-item from the Youth Risk Behavior Survey. Logistic regression analysis was conducted, adjusting for available confounders including parental education, Indigenous Australian identity and area disadvantage.

RESULTS

In adjusted models, greater conformity to violent norms (OR = 1.23, 95% Confidence Interval [CI]: 1.03-1.47) and self-reliance norms (OR = 1.40, 95% CI: 1.15-1.70) was associated with higher odds of reporting suicidal ideation. Greater conformity to norms regarding heterosexuality was associated with reduced odds of reporting suicidal ideation (OR = 0.80, 95% CI: 0.68-0.91).

CONCLUSIONS

These results suggest that conforming to some masculine norms may be deleterious to the mental health of young males, placing them at greater risk of suicidal ideation. The results highlight the importance of presenting young males with alternative and multiple ways of being a male. Facilitating a relaxation of norms regarding self-reliance, and encouraging help-seeking, is vital. Furthermore, dismantling norms that rigidly enforce masculine norms, particularly in relation to heteronormativity, is likely to benefit the broad population of males, not only those who do not conform to heterosexual and other masculine norms.

Physical activity and depression in men: Increased activity duration and intensity associated with lower likelihood of current depression

OBJECTIVES

Depression is a significant public health issue for men, however men are less likely to use mental health services. Alternative interventions, such as physical activity, may be of value for this population. This study sought to determine what levels and intensity of physical activity are associated with lower depression prevalence in Australian men.

METHODS

Using baseline data from 13,884 participants in the Australian Longitudinal Study on Male Health we compared current depression in men who completed the recommended 150 min of physical activity in the past week with men who did not. Duration of activity was examined using logistic regression with restricted cubic splines. Intensity of physical activity was examined by isotemporal substitution of hours of moderate activity with hours of vigorous activity.

RESULTS

Men who completed at least 150 min/week of activity had lower odds of moderate/severe depression symptoms. Duration of activity was inversely associated with moderate/severe depression symptoms. Among physically active men, each additional hour of moderate activity replaced with vigorous activity was associated with lower odds of depression.

LIMITATIONS

This is a cross-sectional study and so cannot determine causal direction in the relationship between physical activity and depression symptoms observed. Self-report measures of physical activity are widely used but are not as accurate as biometric measurement.

CONCLUSIONS

In adult men, meeting minimum recommendations is associated with lower current depression. Increased duration and greater intensity of activity were both associated with further reduction in prevalence. Promoting higher levels of physical activity is potentially an intervention for improving men's mental wellbeing.

Does masculinity moderate the relationship of height with height dissatisfaction? Findings from an Internet forum for short statured men

Research suggests that height is fundamental to Western conceptualisations of masculinity. However, researchers are yet to examine whether individual differences in conformity to Western masculine norms can help to explain why men experience height dissatisfaction. Thus, we investigated conformity to Western masculine norms as a moderator of the relationship between men's height and height dissatisfaction. Men experiencing height dissatisfaction (N = 249) were recruited from an Internet forum that functions as a discussion space for short-statured individuals. Results indicated that shorter men and more masculine men reported greater height dissatisfaction. As hypothesised, we observed a significant interaction between height and masculinity, such that the strength of the relationship of short stature with height dissatisfaction was stronger for more masculine men. Crucially, results from a Johnson-Neyman analysis indicated that it was only for men extremely low in their endorsement of masculine norms (i.e., the 2^nd percentile or lower) that the relationship of height with height dissatisfaction was nonsignificant, suggesting that, in the near-absence of masculine norm conformity, height no longer contributes to male body dissatisfaction. Whilst acknowledging that our findings require further exploration, we propose that conformity to masculine norms may be an influential factor in males' experience of height dissatisfaction.

The Influence of Masculine Norms and Mental Health on Health Literacy Among Men: Evidence From the Ten to Men Study

BACKGROUND

Adherence to masculine norms, such as self-reliance, has been thought to predict lower health literacy. Additionally, males with poor mental health may have low health literacy. Using two waves of the Ten to Men cohort, the current study examined whether masculinity and depressive symptomology explained three aspects of health literacy among men.

METHODS

Three subscales of the Health Literacy Questionnaire were used as the outcomes: Ability to find good health information; Ability to actively engage with healthcare providers, and Feeling understood and supported by healthcare providers. Exposures were masculine norms, measured by the Conformity to Masculine Norms Inventory (CMNI-22), and depressive symptoms, measured by the Patient Health Questionnaire (PHQ). We controlled for confounders of the relationship between exposure and outcome. Ordinary least squares regression was used to assess the CMNI and depressive symptoms (measured in Wave 1) on health literacy (measured in Wave 2).

RESULTS

Across all three health literacy scales, increased global conformity to masculine norms was associated with a decrease in health literacy. Moderate-to-severe depressive symptoms were likewise associated with a decrease in health literacy on all three scales, with the effects particularly strong for "Ability to engage with healthcare providers" (coef. -1.54, 95% CI [-1.84, -1.24], p value < .001).

CONCLUSIONS

The results of this article highlight that both conformity to masculine norms and depressive symptoms may be predictors of health literacy among men. The results of this study suggest the need for health literacy media campaigns that address the complexities of gendered help-seeking behaviors.

TRIAL REGISTRATION

Not applicable.

Sexual Functioning in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men

INTRODUCTION

Studies on sexual function in men with disabilities have mainly relied on clinical samples; population-based evidence on this topic is limited.

AIM

The aim of this study was to compare aspects of sexual function between disabled and nondisabled men using a representative sample.

METHODS

We used data from Ten to Men, a national cohort study of Australian men aged 18-55 years. We first compared the prevalence of 15 sexual function-related difficulties in disabled vs non-disabled men. Next, we used Poisson regression to examine associations between disability and sexual function. The main analytic sample had 8,496 men. Weights and adjustments appropriate to the sampling methodology were applied. Models adjusted for potential confounders. Results were reported as prevalence ratios (PRs). P values of < .05 were considered statistically significant.

MAIN OUTCOME MEASURE

Outcomes were 15 individual items from the National Survey of Sexual Attitudes and Lifestyles-Sexual Function, a validated measure of sexual function with items in 3 domains: physio-psychological aspect; relational aspect; and global self-rating (the 16th item on help-seeking was excluded). These were coded as binary variables denoting past-year sexual problems.

RESULTS

Disabled men had higher prevalence of all outcomes than nondisabled men. 25.6% of men with disabilities and 15.1% of nondisabled men experienced at least 2 of 15 difficulties. The most prevalent problems were "orgasmed too early" (43.8% of disabled men, 37.1% of nondisabled men), imbalance of sexual desire between partners (47.6% of disabled men, 39.2% of nondisabled men), and overall sexual dissatisfaction (39.4% of disabled men, 26.7% of nondisabled men). All adjusted PRs were > 1.00 for disability; associations were statistically significant except "partner experienced sexual difficulties" (PR = 1.23; 95% CI = 0.99-1.53; P = .058) and "orgasmed too early" (PR = 1.16; 95% CI = 1.00-1.35; P = .050). "Presence of discomfort/pain" had the largest adjusted PR for disability (PR = 2.77; 95% CI = 1.89-4.06; P < .001).

CLINICAL IMPLICATION

This population-based analysis on the relationship between disability and sexual function contextualizes evidence from clinical studies. Findings suggest that disparities between men with and without disability exist but are not uniform across different aspects of sexual function.

STRENGTHS & LIMITATIONS

Two major strengths of this study are that the sample included a nondisabled reference group and results are generalizable to Australian men. A key limitation is that disability and sexual function measures are self-reported.

CONCLUSION

This study provides a broad foundation of population-based evidence about sexual function in men with disabilities, relative to men without, showing positive associations between disability and 13 of 15 sexual difficulties. Bollier A-M, King T, Shakespeare T, et al. Sexual Functioning in Men With and Without Disabilities: Findings From a Representative Sample of Australian Men. J Sex Med 2019;16:1749-1757.

An intersectional approach to understandings of mental health inequalities among men with disability

Disability is a key social identity or social category that is associated with significant social disadvantage. For men, having a disability can be discordant with their masculine identity. Self-reliance is one component of masculinity that is known to be important to men with disabilities, however it is also known to be associated with adverse mental health outcomes in the broader adult male population. Intersectionality approaches offer a means of examining the way that the effect of self-reliance on mental health might vary between those with and without a disability. Among a sample of 12,052 men aged 18-55 years from the Ten-to-Men study, we used effect measure modification (EMM) to examine the way that self-reliance modifies the relationship between disability and depressive symptoms. Disability was assessed using the Washington Group Short Set of questions, which capture functional limitations. Results showed that men with disabilities who reported higher conformity to self-reliance norms had much worse mental health than non-disabled men with low conformity to self-reliance, as measured in terms of depressive symptoms (PRR: 9.40, 95%CI 7.88, 11.22, p-value<0.001). We found evidence of positive EMM of depressive symptoms by conformity to self-reliance on the additive scale (RERI: 2.84, 95%CI 1.26, 4.42, p-value<0.001). These results provide evidence that high conformity to self-reliance norms exerts a particularly damaging effect on the mental health of men with disabilities. Given that men with disabilities are more likely to rely on help and support from others, these results provide important insights for the delivery of services to men with disability.

Male-Dominated Occupations, Employment Status, and Suicidal Behaviors Among Australian Men

Background: Suicide rates are higher among unemployed men as well as those employed in male-dominated occupations such as construction. There has been less research on whether these patterns are similar for suicide ideation and attempt. Aims: In a cohort of 13,892 Australian males, this study examined the relationship between employment status and occupational gender ratio on reported thoughts of suicide and suicide attempts. Method: Men reporting suicide ideation or attempts at Wave 1 were removed from the sample. Logistic regression was used to examine Wave 1 employment status and occupational gender ratio and Wave 2 reported suicide ideation and attempts, controlling for confounders (measured in Wave 1). We conducted a sensitivity analysis controlling for mental health status. Results: Those who were unemployed or not in the labor force had elevated rates of suicide ideation (unemployed OR = 1.91, 95% CI [1.30, 2.82], p = .001; not in the labor force OR = 1.68, 95% CI [1.09, 2.60], p = .020). Those who were not in the labor force had greater odds of attempts (OR = 2.32, 95% CI [1.05, 5.12], p = .037). There was no association between occupational gender ratio and suicide ideation or attempt. Limitations: We only had single item measures of ideation and attempts. Conclusion: There is a need for further investigation into risk factors for suicide among males, both when they are in and out of employment.

Job Stressors and Employment Precarity as Risks for Thoughts About Suicide: An Australian Study Using the Ten to Men Cohort

Aims

Past research suggests that adverse experiences at work (such as job stressors and precarious employment) are associated with thoughts about suicide, especially among males. A limitation of this research is that it is largely cross-sectional. Thus, it is unknown whether job stressors are a prior cause of thoughts about suicide. This study examined the baseline association between adverse experiences at work and thoughts about suicide at follow-up in a large nationally representative cohort of employed men.

Methods

We used data from the Australian Longitudinal Study on Male Health (Ten to Men). The outcome was thoughts about suicide in the prior 12 months (reported in wave 2) and the key exposure variables were: high job demands, low job control, job insecurity, perceived unfairness of pay, occupational skill level, and employment arrangement (all reported in wave 1). We adjusted for possible confounders, including mental health and suicidal thoughts (wave 1).

Results

In a sample of 8379 and after adjustment, job insecurity (OR 1.35, 95% CI 1.13-1.61, P = 0.001), low job control (OR 1.19, 95% CI 1.06-1.33, P = 0.004), and employment on a casual or on a fixed term basis (OR 1.30, 95% 1.01-1.67, P = 0.041) were associated with a greater odds of thoughts about suicide at follow up. Results for all by job control were maintained after removing those who reported thoughts of suicide at baseline.

Conclusion

This study suggests that experiences at work may be risk factors for thoughts about suicide among employed men. More research is needed to unpack the complex associations between, employment, and experiences of suicide.

The relationship between disability and suicide: prospective evidence from the Ten to Men cohort

Background

People with disabilities often face a range of social and economic adversities. Evidence suggests that these disadvantages result in poorer mental health. Some research also indicates that people with disabilities are more likely experience thoughts about suicide than people without disability, although most of this research is based on small cross-sectional samples.

Methods

We explored the relationship between self-reported disability (measured at baseline) and likelihood of reporting thoughts of suicide (measured at follow up) using a large longitudinal cohort of Australian males. A logistic regression model was conducted with thoughts of suicide within the past 12 months (yes or no) as the outcome and disability as the exposure. The models adjusted for relevant confounders, including mental health using the SF-12 MCS, and excluded males who reported thoughts of suicide at baseline.

Results

After adjustment, there was a 1.48 (95% CI: 0.98–2.23, P = 0.063) increase in the odds of thoughts of suicide among men who also reported a disability. The size of association was similar to that of being unemployed.

Conclusions

Males reporting disability may also suffer from thoughts of suicide. We speculate that discrimination may be one explanation for the observed association. More research on this topic is needed.

Treatment seeking by employment characteristics among Australian males: a longitudinal study from the Ten to Men study

OBJECTIVES

Men are less likely to seek treatment for mental health problems than women; however, the structural employment-related factors influencing this relationship are unknown.

STUDY DESIGN

This is a prospective cohort study.

METHODS

Using the Australian Ten to Men cohort (N = 6447), we examined the relationship between being in a male-dominated occupation and treatment seeking from a mental health professional compared to being in a gender-equal occupation. Models were fit using logistic regression.

RESULTS

There was some evidence of a stepwise gradient between male-dominated occupations and treatment seeking for mental health problems. However, results were only significant for the most male-dominated occupations after adjustment (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.52 to 0.94, P = 0.017). We also found evidence that individuals who more strongly adhered to masculine norms had a lower likelihood of treatment seeking (OR = 0.97, 95% CI 0.95 to 0.99, P = 0.004).

CONCLUSIONS

This supports the idea that occupational-related factors influence male treatment seeking for mental health problems.

Multilevel Regression and Poststratification: A Modeling Approach to Estimating Population Quantities From Highly Selected Survey Samples

Investigators in large-scale population health studies face increasing difficulties in recruiting representative samples of participants. Nonparticipation, item nonresponse, and attrition, when follow-up is involved, often result in highly selected samples even in well-designed studies. We aimed to assess the potential value of multilevel regression and poststratification, a method previously used to successfully forecast US presidential election results, for addressing biases due to nonparticipation in the estimation of population descriptive quantities in large cohort studies. The investigation was performed as an extensive case study using baseline data (2013-2014) from a large national health survey of Australian males (Ten to Men: The Australian Longitudinal Study on Male Health). Analyses were performed in the open-source Bayesian computational package RStan. Results showed greater consistency and precision across population subsets of varying sizes when compared with estimates obtained using conventional survey sampling weights. Estimates for smaller population subsets exhibited a greater degree of shrinkage towards the national estimate. Multilevel regression and poststratification provides a promising analytical approach to addressing potential participation bias in the estimation of population descriptive quantities from large-scale health surveys and cohort studies.

Suicidal behaviour in Indigenous compared to non-Indigenous males in urban and regional Australia: Prevalence data suggest disparities increase across age groups

OBJECTIVES

We compare the prevalence of suicidal thoughts and attempts between Indigenous and non-Indigenous males in urban and regional Australia, and examine the extent to which any disparity between Indigenous and non-Indigenous males varies across age groups.

METHODS

We used data from the baseline wave of The Australian Longitudinal Study on Male Health (Ten to Men), a large-scale cohort study of Australian males aged 10-55 years residing in urban and regional areas. Indigenous identification was determined through participants self-reporting as Aboriginal, Torres Strait Islander or both. The survey collected data on suicidal thoughts in the preceding 2 weeks and lifetime suicide attempts.

RESULTS

A total of 432 participants (2.7%) identified as Indigenous and 15,425 as non-Indigenous (97.3%). Indigenous males were twice as likely as non-Indigenous males to report recent suicidal thoughts (17.6% vs 9.4%; odds ratio = 2.1, p < 0.001) and more than three times as likely to report a suicide attempt in their lifetime (17.0% vs 5.1%; odds ratio = 3.6; p < 0.001). The prevalence of recent suicidal thoughts did not differ between Indigenous and non-Indigenous males in younger age groups, but a significant gap emerged among men aged 30-39 years and was largest among men aged 40-55 years. Similarly, the prevalence of lifetime suicide attempts did not differ between Indigenous and non-Indigenous males in the 14- to 17-years age group, but a disparity emerged in the 18- to 24-years age group and was even larger among males aged 25 years and older.

CONCLUSION

Our paper presents unique data on suicidal thoughts and attempts among a broad age range of Indigenous and non-Indigenous males. The disparity in the prevalence of suicidal thoughts increased across age groups, which is in contrast to the large disparity between the Indigenous and non-Indigenous suicide rates in younger age groups.

Socio-Economic Position and Suicidal Ideation in Men

People in low socio-economic positions are over-represented in suicide statistics and are at heightened risk for non-fatal suicidal thoughts and behaviours. Few studies have tried to tease out the relationship between individual-level and area-level socio-economic position, however. We used data from Ten to Men (the Australian Longitudinal Study on Male Health) to investigate the relationship between individual-level and area-level socio-economic position and suicidal thinking in 12,090 men. We used a measure of unemployment/employment and occupational skill level as our individual-level indicator of socio-economic position. We used the Index of Relative Socio-Economic Disadvantage (a composite multidimensional construct created by the Australian Bureau of Statistics that combines information from a range of area-level variables, including the prevalence of unemployment and employment in low skilled occupations) as our area-level indicator. We assessed suicidal thinking using the Patient Health Questionnaire (PHQ-9). We found that even after controlling for common predictors of suicidal thinking; low individual-level and area-level socio-economic position heightened risk. Individual-level socio-economic position appeared to exert the greater influence of the two; however. There is an onus on policy makers and planners from within and outside the mental health sector to take individual- and area-level socio-economic position into account when they are developing strategic initiatives.

Sleep apnoea in Australian men: disease burden, co-morbidities, and correlates from the Australian longitudinal study on male health

Background

Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors.

Methods

We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18–55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI).

Results

Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18–25 years to 7.8 % in the age 45–55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all). Sleep apnoea was significantly associated with older age (p < 0.001), unemployment (p < 0.001), asthma (p = 0.011), chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002), diabetes (p < 0.001), hypercholesterolemia (p < 0.001), hypertension (p < 0.001), heart attack (p < 0.001), heart failure (p < 0.001), angina (p < 0.001), depression (p < 0.001), post-traumatic stress disorder (p < 0.001), other anxiety disorders (p < 0.001), schizophrenia (p = 0.002), overweight/obesity (p < 0.001), insufficient physical activity (p = 0.006), smoking (p = 0.005), and high alcohol consumption (p < 0.001).

Conclusion

Health professional-diagnosed sleep apnoea is relatively common, particularly in older males. Associations between sleep apnoea and cardiovascular, metabolic, respiratory, and psychiatric disorders have important clinical and public health implications. As men are especially vulnerable to sleep apnoea as well as some of its chronic co-morbidities, they are potentially a priority group for health interventions. Modifiable lifestyle related factors such as smoking, alcohol consumption, level of physical activity and BMI are possible key foci for interventions.

Life stress and suicidal ideation in Australian men - cross-sectional analysis of the Australian longitudinal study on male health baseline data

Background

Suicide is a leading cause of death in Australian males aged 18 to 55. Non-fatal suicidal behaviours and thoughts are indicators of increased risk for future suicide. Suicidal behaviour is complex and multi-determined. Research supports the involvement of stressful life events in suicide and suicidal behaviour, however the evidence regarding suicidal thoughts is less developed. This study investigates stressful life events in relation to suicidal ideation in a large cohort of adult males recruited into Ten to Men, the Australian Longitudinal Study on Male Health.

Methods

Baseline data from a national cohort of 13, 884 males aged 18–55 years on suicidal behaviour, psychiatric disorder and life events was used. Multivariable logistic regressions were conducted with current suicidal ideation as the outcome and 12 month life events, 12 month depression, anxiety and harmful/hazardous alcohol use, and socio-demographics as covariates. Further logistic regression models investigated the relative risk of life stress alone, depression/alcohol/anxiety alone and co-occurring life stress and depression/alcohol/anxiety.

Results

In multivariable models there was an independent contribution to suicidal ideation for six of 24 life events (ORs 1.27–1.95), 12 month depression (OR 4.49) harmful alcohol use (OR 1.38) and anxiety disorders (OR 1.27). Life events co-occurring with depression (OR 10.3) was higher risk than either alone (depression OR 6.6; life stress OR 2.6). There was a lesser effect for co-occurrence in the anxiety and harmful alcohol use models.

Conclusion

Life events appear to be related to suicidal ideation independent of depression, anxiety and harmful alcohol use in adult males, however if life events occur in the context of depression that risk is substantially increased.

Why do men go to the doctor? Socio-demographic and lifestyle factors associated with healthcare utilisation among a cohort of Australian men

BACKGROUND

Men use health services less often than women and frequently delay seeking help even if experiencing serious health problems. This may put men at higher risk for developing serious health problems which, in part, may explain men's higher rates of some serious illnesses and shorter life span relative to women. This paper identifies factors that contribute to health care utilisation in a cohort of Australian men by exploring associations between socio-economic, health and lifestyle factors and the use of general practitioner (GP) services.

METHODS

We used data from Ten to Men, the Australian Longitudinal Study on Male Health. Health care utilisation was defined in two ways: at least one GP visit in the past 12 months and having at least yearly health check-ups with a doctor. Associations between these two measures and a range of contextual socio demographic factors (education, location, marital status, country of birth, employment, financial problems etc.) as well as individual health and lifestyle factors (self-rated health, smoking, drinking, healthy weight, pain medication) were examined using logistic regression analysis. The sample included 13,763 adult men aged 18 to 55 years. Analysis was stratified by age (18 to 34 year versus 35 to 55 years).

RESULTS

Overall, 81 % (95 % CI: 80.3-81.6) of men saw a GP for consultation in the 12 months prior to the study. The odds of visiting a GP increased with increasing age (p < 0.01), but decreased with increasing remoteness of residence (p < 0.01). Older men, smokers and those who rate their health as excellent were less likely to visit a GP in the last 12 months, but those on daily pain medication or with co-morbidities were more likely to have visited a GP. However, these factors were not associated with consulting a GP in the last 12 months among young men. Overall, 39 % (95 % CI: 38.3-39.9) reported having an annual health check. The odds of having an annual health check increased with increasing age (p < 0.01), but showed no association with area of residence (p = 0.60). Across both age groups, the odds of a regular health check increased with obesity and daily pain medication, but decreased with harmful levels of alcohol consumption.

CONCLUSION

The majority of men (61 %) did not engage in regular health check-up visits, representing a missed opportunity for preventative health care discussions. Lower consultation rates may translate into lost opportunities to detect and intervene with problems early and this is where men may be missing out compared to women.

Inequalities in socio-economic characteristics and health and wellbeing of men with and without disabilities: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health

BACKGROUND

Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability.

METHODS

We analysed baseline data from Ten to Men - an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18-55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index.

RESULTS

Men with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing.

CONCLUSION

Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.

Introducing Ten to Men, the Australian longitudinal study on male health

We are very pleased to introduce Ten to Men, the Australian Longitudinal Study on Male Health. Ten to Men is, to our knowledge, the largest national all-male cohort study in the world. It involves 15,988 males who were aged between 10 and 55 years when we recruited them in 2013/14. Together, the articles in this collection provide an overview of the study’s methods, examples of some of the key questions it can answer, and guidance for researchers wishing to use it. Perhaps most importantly, the articles demonstrate the enormous potential Ten to Men has to make a real difference to our understanding of male health and the factors that influence it.

Health and lifestyle factors associated with sexual difficulties in men - results from a study of Australian men aged 18 to 55 years

Background

Sexual difficulties (SD) are common among men of all ages and can have considerable impact on quality of life and indications for future health. SD are associated with mental and physical wellbeing and with relationship satisfaction, yet they are rarely discussed with medical professionals who are often ill equipped to assess and manage them. This paper provides an updated overview on the status of SD in Australian men from 18 to 55 years of age and will form a baseline comparison for future analyses of SD based on Ten to Men data.

Methods

We used data from Ten to Men, the Australian Longitudinal Study on Male Health. SD was measured using eight items capturing specific sexual difficulties. We examined associations of a range of health and lifestyle factors (smoking, alcohol consumption, illicit drug use, obesity and new sexual partners, self-rated health status, disability, pain medication, diagnosed physical and mental health conditions) with each SD using logistic regression. The sample included 12,636 adult males who had previously been sexually active. Analysis was stratified by age (18–34 years versus 35–55 years).

Results

This paper shows that experiencing SD is relatively common among Australian men – overall half the sample (54 %; 95 % CI: 0.53–0.55) experienced at least one SD for more than 3 months over the past 12 months. While more common in older men aged 45 to 55 years, almost half the 18 to 24 year old men (48 %) also reported at least one SD highlighting that SD affects men of all ages. We found that SDs were associated with both lifestyle and health factors, although the strongest associations were observed for health factors in both age groups, in particular poor self-rated health, having a disability and at least one mental health condition. Lifestyle factors associated with SDs in men of all ages included smoking, harmful alcohol consumption and drug use in the past 12 months. Obesity was only associated with an increased rate of SD in men aged 35 to 55 years.

Conclusion

Sexual difficulties are common among men of all ages and increasingly more prevalent as men grow older. They are strongly associated with both health and lifestyle factors. With previous literature showing that SDs can be a precursor of an underlying or developing physical and mental health condition, it is imperative that sexual health and sexual functioning is discussed with a doctor as part of a standard health check and across the lifespan.

Psychosocial job quality, mental health, and subjective wellbeing: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health

BACKGROUND

Employment status and working conditions are strong determinants of male health, and are therefore an important focus in the Australian Longitudinal Study on Male Health (Ten to Men). In this paper, we describe key work variables included in Ten to Men, and present analyses relating psychosocial job quality to mental health and subjective wellbeing at baseline.

METHODS

A national sample of males aged 10 to 55 years residing in private dwellings was drawn using a stratified multi-stage cluster random sample design. Data were collected between October 2013 and July 2014 for a cohort of 15,988 males, representing a response fraction of 35 %. This analysis was restricted to 18-55 year old working age participants (n = 13,456). Work-related measures included employment status, and, for those who were employed, a number of working conditions including an ordinal scale of psychosocial job quality (presence of low job control, high demand and complexity, high job insecurity, and low fairness of pay), and working time-related stressors such as long working hours and night shift work. Associations between psychosocial job quality and two outcome measures, mental ill-health and subjective wellbeing, were assessed using multiple linear regression.

RESULTS

The majority of participants aged 18-55 years were employed at baseline (85.6 %), with 8.4 % unemployed and looking for work, and 6.1 % not in the labour force. Among employed participants, there was a high prevalence of long working hours (49.9 % reported working more than 40 h/week) and night shift work (23.4 %). Psychosocial job quality (exposure to 0/1/2/3+ job stressors) prevalence was 36 %/ 37 %/ 20 %/ and 7 % of the working respondents. There was a dose-response relationship between psychosocial job quality and each of the two outcome measures of mental health and subjective wellbeing after adjusting for potential confounders, with higher magnitude associations between psychosocial job quality and subjective wellbeing.

CONCLUSIONS

These results extend the study of psychosocial job quality to demonstrate associations with a global measure of subjective wellbeing. Ten to Men represents a valuable new resource for the longitudinal and life course study of work and health in the Australian male population.

Diabetes in young adult men: social and health-related correlates

Background

Diabetes is a global public health issue. It is associated with significant disability, morbidity and mortality risks and substantial healthcare costs. Of great concern is the fact that its prevalence is rising, particularly amongst the young, while epidemiological data regarding the incidence, prevalence and complications of early-onset type 2 diabetes is noted to be sparse.

Methods

We used data from the baseline wave of Ten to Men, a national cohort study of Australian males, to investigate the social and health-related correlates of Australian males aged 18–49 years reporting being diagnosed with diabetes.

Results

The estimated prevalence of a self-reported diabetes diagnosis amongst Australian males aged 18–49 years was 2.95 % (95 % CI: 2.54–3.43 %). Within this age group, approximately 75 % of those diagnosed with diabetes are expected to be living with a known diagnosis of type 2 diabetes; the remainder are expected to be living with type 1 diabetes. Of the 20 social and health-related factors considered, we found evidence to support the association of eighteen factors after adjusting for age and body mass index. The strongest correlates of reporting a diabetes diagnosis, associated with a ≥2-fold increase in the odds of reporting diabetes were being aged 35–49 years, being unemployed, being obese, seeing a doctor for a check-up more frequently, reporting comorbid high blood pressure or physical or mental health comorbidities and worse self-rated and physical health status.

Conclusion

Australian males aged 18–49 years who are living with a known diagnosis of diabetes are more likely to be socio-economically disadvantaged and suffer substantially worse health status than Australian males aged 18–49 years living without a diabetes diagnosis. Based on the associations detected in this study, older, single males living in regional areas who are socioeconomically disadvantaged, obese and/or who have other comorbidities may be an important subgroup to target for diabetes screening, disease management and prevention efforts.