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

Mental Health Among LGBTQ+ Farmers in the United States

OBJECTIVES

The objective of the current study is to describe mental health among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people who work in agriculture in the U.S.

METHODS

This study uses a survey of LGBTQ+ adults who work in agriculture in the U.S. (N = 148), including questions about LGBTQ+ identity, farming background, depression symptoms (PHQ-8) and diagnosis, anxiety symptoms (GAD-7) and diagnosis, suicide risk, and stress. Data were analyzed using SPSS, including descriptive statistics, chi-square tests, and Mann-Whitney U tests.

RESULTS

Over one-third (36.1%) had probable depression (PHQ-8 ≥ 10), and 71.9% were experiencing mild to severe depression symptoms. Nearly half (46.2%) had probable anxiety disorder (GAD-7 ≥ 8), and 69.7% experienced mild to severe anxiety symptoms. Over half (51.7%) were at significant risk for suicide. Greater proportions of men had probable anxiety disorder, probable depression, and suicide risk compared to non-men. Greater proportions gay participants had probable depression, as did beef producers. Perceived stress was higher for men, lesbian and gay participants, transgender participants, and those in beef production. Resilient coping was highest among participants who were genderqueer or genderfluid, bisexual, and those in field crop production.

CONCLUSION

LGBTQ+ farmers in the current sample experienced depression and anxiety at higher rates than general farming or general LGBTQ+ samples, although suicide risk was lower than for general LGBTQ+ samples. Future research should explore how working in agriculture may be protective against suicide risk for LGBTQ+ farmers, as well as how specific farm stressors are related to LGBTQ+ farmer mental health.

Shame and depressive symptoms in men: The moderating role of environmental mastery and purpose in life

BACKGROUND

Feelings of shame are linked to increased risk for depression. Little is known about protective factors that may buffer this effect, particularly in men. Using prospective data from a community sample of Australian men, we examine the extent to which shame is associated with depressive symptoms, and the protective role of psychological wellbeing, specifically environmental mastery and purpose in life.

METHODS

Participants (n = 448) were from the longitudinal Men and Parenting Pathways (MAPP) Study. Measures were the Event Related Shame and Guilt Scale for shame, the DASS-21 for depressive symptoms and Ryff's Scales of Psychological Well-Being for environmental mastery and purpose in life. Linear regressions were used to test associations between shame and depressive symptoms concurrently and 1-year later, and the moderating effects of mastery and purpose in life.

RESULTS

Shame was strongly associated with concurrent depressive symptoms (βunadj = .76, p < .001; βadj = .63, p < .001). This effect was weaker in men with high compared to low environmental mastery (β+1SD = .46, p < .001; β-1SD = .55, p < .001) and purpose in life (β+1SD = .48, p < .001; β-1SD = .62, p < .001). Shame also predicted subsequent depressive symptoms after adjustment for prior depressive symptoms (βunadj = .59, p = .001; βadj = .34, p = .004), although environmental mastery or purpose in life did not moderate these associations.

CONCLUSIONS

Our findings suggest that promoting a sense of psychological wellbeing in men may confer protective proximal effects in the context of shame, potentially attenuating depression severity. The current study aligns with calls for strength-based approaches to reducing mental health problems in men.

Suicidal incidence and gender-based discrepancies in prolonged grief disorder: insights from a meta-analysis and systematic review

Background

In the aftermath of bereavement, our research explores the subtleties of Prolonged Grief Disorder (PGD), focusing particularly on its correlation with suicidal behaviors and their variation across genders. This study seeks to elucidate the impact of gender on these behaviors among individuals suffering from PGD, thereby enhancing our understanding and facilitating the development of tailored therapeutic interventions.

Methods

By November 24th, 2023, we had rigorously reviewed key databases such as PubMed, Web of Science, Cochrane Library, PsycINFO, and Embase. Independently, two researchers conducted detailed interviews and filled out questionnaires with participants to gather demographic information and record instances of prolonged grief disorder. The study also meticulously tracked occurrences of suicidal ideation, suicide attempts, suicide deaths, and self-injury among the participants.

Results

The findings indicate that 22.34% of males reported suicidal ideation (95% CI: 21.33-23.35), a figure that rises to 26.84% among females (95% CI: 25.99-27.69). Notably, 12.11% of males attempted suicide (95% CI: 11.49-12.72), marginally surpassing the 9.60% observed in females (95% CI: 9.17-10.04). More striking disparities were observed in suicide deaths, with rates for males at 3.66% (95% CI: 3.32-4.00) compared to a notably higher 7.12% for females (95% CI: 6.44-7.81). Furthermore, the incidence of self-injury was lower among males, at 2.48% (95% CI: 2.03-2.94), than in females, who reported a rate of 5.09% (95% CI: 4.69-5.49). These patterns underscore the critical need for gender-specific interventions aimed at reducing these significant disparities.

Conclusion

This study distinctly underscores the profound impact of gender on the manifestation of suicidal behaviors in individuals afflicted with prolonged grief disorder. It reveals that females are more prone to suicidal ideation, self-injury, and suicide deaths, while males predominantly exhibit a higher incidence of suicide attempts and risk-taking behaviors. These unmediated trends highlight the necessity for gender-specific clinical interventions tailored to address particular behaviors and modify prevalent patterns that typically resist conventional approaches.

Systematic review registration

PROSPERO (york.ac.uk), identifier CRD42023480035.

Exploring the Role of Discrepancy Stress and Muscle Dysmorphia in the Association Between Gender Role Discrepancy and Masculine Depression in Israeli Men

Guided by the dynamic model of masculinity and men's psychopathology, the current study aimed to explore the mediating role of masculine discrepancy stress and each of the muscle dysmorphia dimensions (drive for size, appearance intolerance, and functional impairments) in the association between masculine gender role discrepancy and masculine depression. For the present study, 936 Israeli men completed a structured self-report questionnaire. Masculine discrepancy stress and some of the muscle dysmorphia dimensions were found to partially mediate the association between masculine gender role discrepancy and masculine depression. The findings demonstrate how the internalization of social gender expectations and men's gender role discrepancy is reflected in the gap between perception of self and the typical man, which is eventually related to mental health outcomes. In turn, men attempt to mitigate the stress through what they perceive as masculine, reflecting muscle dysmorphia: drive for size, appearance intolerance, and functional impairments, which in turn predict masculine depression. Therefore, mental and physical health professionals are advised to be aware of these mechanisms, in order to recognize the negative mental health outcomes arising from traditional societal gender role expectations and provide specific solutions for them.

Stop being a wuss: People's perceptions of men experiencing grief in Australia

ISSUE ADDRESSED

Three years have passed since the Australian Government's Department of Health released its National Men's Health Strategy 2020-2030. Presently, little evidence is available to show whether the strategy has achieved success in rectifying men's mental-ill health, particularly the experience of stigma when expressing vulnerable emotions such as grief. Concurrently, research within the field of psychology continues to show that men experience significant pressure to conform faithfully to their socialised gender role. Given the focus to better men's mental health in Australia, this study ascertained people's perceptions of men experiencing grief.

METHODS

The study adopted social constructionism to explore how participants perceived a fictious character living with grief using a hypothetical vignette by way of convenience sampling. Nine males and seven females who resided in Australia participated in answering seven questions concerning the character's experience of grief.

RESULTS

Inductive thematic analysis yielded three themes which collectively represented perceptions of masculinised grief. Notably, avoid stigma by fixing grief, avoid stigma by quickly getting over grief, and avoid stigma by suppressing the expression of grief. SO WHAT?: The study suggests that a stronger research focus should be targeted towards rectifying stigma resulting from men's expression of vulnerable emotions by incorporating in depth interviews in order to create worthwhile public awareness initiatives. Such initiatives should seek to minimise societal pressures that are placed upon men to ensure conformity to dominant masculine ideologies and their socialised gendered role when experiencing and expressing vulnerable emotions such as grief.

Community gender norms, mental health, and suicide ideation and attempts among older Japanese adults: a cross-sectional study

OBJECTIVES

Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes.

DESIGN

Cross-sectional.

SETTING

This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study.

PARTICIPANTS

In total, 25,937 participants aged 65 years or older in 61 municipalities.

MEASUREMENTS

Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman."

RESULTS

The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes.

CONCLUSIONS

Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.

Australian men's help-seeking intentions for anxiety symptoms: The impact of masculine norm conformity and gender role conflict

Research highlights a discrepancy between the number of men experiencing mental illness and those seeking professional help, particularly for anxiety. Conformity to masculine norms (CMN) and gender role conflict (GRC) have been recognised as barriers to men's mental health help-seeking, but few studies have examined these relationships for anxiety. This study aimed to examine the relationship between anxiety severity and help-seeking intentions in Australian men, and the additional impact of CMN and GRC. A total of 610 Australians aged 18-89 years (M = 46.02, SD = 17.14) participated in an online survey, which included demographic information and four standardised questionnaires measuring anxiety, help-seeking intentions, CMN, and GRC. CMN but not GRC was found to fully mediate the relationship between anxiety severity and anxiety-related help-seeking intentions. The results have theoretical implications for the study of masculinity and clinical implications for therapeutic approaches for men with anxiety symptoms.

A mixed method study exploring gender differences in dementia caregiving

Few studies have investigated the experience of male carers of people with dementia and fewer specifically examined whether male and female carers of people with dementia differ in their approach to the caring role. As such, this research set-out to investigate whether male carers of people with dementia approach the caring role differently to female carers. Data from 167 survey participants (24 males and 143 females) were analysed using a mixed research methodology. Participants' demographics and scores on standardised burden and coping scales were analysed using linear regression. Participants' written responses to open-ended questions were analysed using thematic analysis anchored in theories of hegemonic masculinity. No significant gender differences were identified in carers' coping strategies or self-reported carer burden. However, qualitative analysis revealed strong thematic gender differences like: gendered barriers to help-seeking; gendered service preference; gendered considerations about residential care; gendered expression of burden; and themes of the absent son and exhausted daughter. This research identified that male carers of people with dementia approach help-seeking differently to female carers, typically focusing on addressing functional tasks and refraining from showing emotions, this despite reporting similar carer burden. Rapport building with male carers should start with conversations around functional issues rather than assessing the emotional impact of the caring role. The findings reinforce the need for more qualitative research into the unmet needs of male carers of people with dementia, to inform the design of male-friendly interventions which could facilitate timely access to services by male carers.

Review: Recommendations for male-friendly counselling with adolescent males: A qualitative systematic literature review

BACKGROUND

There are growing calls to tailor counselling practices for adolescent males, a population reluctant to engage in psychological treatment despite concerning rates of mental illness. The objective of this systematic review (PROSPERO: CRD4202125547) was to collate and synthesise recommendations for individual counselling with adolescent males (12-18 years).

METHOD

The databases Psychology and Behavioural Science Collection, PsycArticles, PsycINFO, Academic Search Complete, EBSCO eBook Collection, Wiley Science Collection, Taylor and Francis Collection and ProQuest One Academic were searched for articles published between 1995 and November 2021. The quality of evidence was assessed using the JBI critical appraisal checklists, and thematic analysis was employed to synthesise findings across the literature.

RESULTS

A total of 1625 texts were identified, of which 16 met the inclusion criteria. Generated themes included (a) therapist knowledge of masculinity, gender socialisation, and male-relational styles; (b) necessity of therapists to address masculinity in the therapeutic space; and (c) customising engagement and treatment practices to appeal to adolescent males.

CONCLUSIONS

The themes highlighted the unique developmental, and sociocultural considerations practitioners should be aware of when working with young men. Through a multicultural counselling competency framework, masculinity and adolescent male identity are expressions of diverse sociocultural identities that psychological assessment and intervention should ideally be tailored to suit. The findings of the review suggest that empirical research focusing on the experiences of adolescent males receiving psychological treatment is sparse. Further research is needed to inform the development of practicable, gender-sensitive adaptions to counselling practice for young men.

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.

Psychiatric disorders among adult deliberate self-harm patients and subsequent risk of dying by suicide, mental and behavioural disorders and other external causes

INTRODUCTION

Deliberate self-harm (DSH) treated in general hospital is a well-established risk factor for suicide and other cause mortality. However, few studies have used population data to investigate the differential impact of specific psychiatric disorders on the risk of subsequent suicide, by sex and age of the patient in the context of previous DSH episodes.

METHOD

All patients aged 18 and older treated for DSH in general hospitals during the period 2008-2018 were identified through national registers. Cox proportional hazards regression was used to ascertain the associated risk of death by suicide, mental and behavioural disorder and other external causes.

RESULTS

The cohort consisted of 39 479 patients of which 878 died by suicide, 461 by mental and behavioural disorders and 1037 by other external causes. Overall, schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide. Large gender and age differences were identified in the risk of suicide associated with personality disorders and affective disorders. Alcohol use disorders and dementia increased the risk of dying by mental and behavioural disorders and alcohol use disorders and other substance use disorders increased the risk of death by external causes.

CONCLUSION

Schizophrenia spectrum disorders, affective disorders and personality disorders increased the risk of suicide among DSH patients, but the effect varied by gender, age and history of previous DSH. Psychiatric evaluation of all DSH patients and treatment tailored to the patient's specific needs is essential to reduce the risk of premature death.

Suicidal Ideation in the Australian Construction Industry: Prevalence and the Associations of Psychosocial Job Adversity and Adherence to Traditional Masculine Norms

BACKGROUND

Suicide in the Australian Construction Industry (ACI) is a significant issue, however minimal understanding of suicidal ideation prevalence, as well as the potential role psychosocial job adversity and increased adherence to traditional masculine norms may play in its presence, is apparent.

METHOD

A representative sample of Australian men (n = 11,132) were used to create initial understandings of prevalence of suicidal ideation (past two weeks), psychosocial job adversities and level of adherence to traditional masculine norms for the ACI (n = 1721) in comparison to a general population comprised of the remaining employed males from Other Industries (n = 9411). Additionally, due to their reported increased suicide vulnerability investigation of associations between suicidal ideation, psychosocial job adversities and adherence to traditional masculine norms for the ACI were undertaken.

RESULTS

No difference in suicidal ideation prevalence was reported between the ACI and those employed in Other Industries (p > 0.05), however, increased prevalence of psychosocial job adversities (p ≤ 0.001) and adherence to traditional masculine norms (p ≤ 0.001) for the ACI was seen. Significant multivariate associations between suicidal ideation, psychosocial job adversities (OR = 1.79, 95%CI [1.12-2.85]) and two domains of traditional masculine norms, self-reliance (OR = 1.29, 95%CI [1.09-1.51]) and risk-taking (OR = 1.20, 95%CI [1.01-1.41]), were reported.

CONCLUSION

Results suggest need for increased understanding of later stage suicidal trajectory drivers in the ACI. Findings indicate need for prevention group/industry concentration on mitigation of psychosocial job adversities, as well as a more nuanced and increased discussion of the negative role of self-reliance and risk-taking domains of traditional masculine norms may play in ACI suicidal ideation, as opposed to the construct as a whole.

Associations between wives' and husbands' attitudes towards women's economic participation and depressive symptoms, poor subjective health, and unemployment status in married women: A Korean longitudinal study (2014–2020)

Introduction

Previous research has investigated the relationship between an individuals' gender role attitudes (GRAs) and their psychological health. We hypothesized that holding traditional GRAs or having a husband who holds traditional GRAs may adversely affect a woman's health.

Methods

Data were obtained from a nationally representative longitudinal survey. Women's negative attitudes towards women's economic participation and husbands' negative attitudes towards their wives' economic participation were measured. The associations between the two and depressive symptoms, poor subjective health, and unemployment status in married women was estimated using a generalised estimating equation. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated.

Results

Women's negative attitudes towards women's economic participation was associated with depressive symptoms (OR [95% CI]: 1.19 [1.09–1.31]), poor subjective health (1.14 [1.04–1.25]) and unemployment status (1.10 [1.05–1.15]) in married women. In addition, there were significant associations between husbands' negative attitudes towards their wives working and depressive symptoms (1.41 [1.23–1.60]), poor subjective health (1.69 [1.48–1.92]), and unemployment (1.80 [1.69–1.92]) in their wives. The effect was strongest when both wives and their husbands have negative attitudes. In addition, the models considering cumulative years of negative attitudes showed that wives holding negative attitudes towards women's economic participation for 3 years or more was associated with depressive symptoms (1.70 [1.42–2.04]), poor subjective health (1.28 [1.04–1.57]), and unemployment status (1.39 [1.22–1.58]). Similarly, husbands' holding 3 years or more of negative attitudes towards their wives' economic participation was associated with depressive symptoms (1.32 [1.02–1.72])), poor subjective health (1.81 [1.40–2.35]), and unemployment status (9.02 [7.97–10.21]) in their wives.

Conclusions

Our results show that one's own or one's husband's attitude towards women's economic participation affects not only the employment status of married women but also their mental and subjective health. Policymakers should implement policies that encourage positive attitudes towards women's economic activities.

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Traditional gender role attitudes increase the odds of depressive symptoms.

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Traditional gender role attitudes increase the odds of poor subjective health.

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Husbands who oppose their wives working increase their wives' risk for depression.

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Husbands who oppose their wives working increase their wives' risk for poor health.

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A longer duration of traditional or negative attitudes increases the impact.

Extending the Male Depression Risk Scale for use with older men: the effect of age on factor structure and associations with psychological distress and history of depression

OBJECTIVES

The Male Depression Risk Scale (MDRS-22) is a self-report scale that assesses externalising and male-typical depression symptoms with promising psychometric properties reported in young-to-middle aged men. However, studies are yet to consider the psychometric properties of the MDRS-22 in older men. This study examined the psychometric properties of the MDRS-22 in both younger and older males and its relationship to prototypic depression symptoms and self-reported depression history.

METHOD

A community sample of younger (n = 510; 18-64 years) and older (n = 439; 65-93 years) males completed the original 82 MDRS items from which the MDRS-22 was derived, the Patient Health Questionnaire (PHQ-9), and provided information regarding previous depression diagnoses. Exploratory and confirmatory factor analyses were used to examine factor structure. Generalised linear models examined the relationship between externalised and male-typical symptoms with prototypic depression symptoms in younger and older men.

RESULTS

Model fit indices demonstrated that the MDRS-22 performs well in older males. Results also revealed that the MDRS-22 is associated with prototypic depression symptoms and a previous depression diagnosis in both age groups.

CONCLUSION

Results support the psychometric validity of the MDRS-22 as a measure of externalising and male-typical depression symptoms in older men. Use of scales such as the MDRS-22 may help to improve the detection of depression in men across the lifespan and may also identify factors that put men at risk of poor physical and mental health outcomes.

Exploring Teacher and Parent Perspectives on School-Based Masculinities in Relation to Mental Health Promotion

The capacity for boys’ and young men’s mental health promotion to act via shifting masculine norms that are linked to poor mental health outcomes, highlights the need to improve the extent to which school-based programs can promote mental health through leveraging more positive embodiments of masculinity. To-date, the perspectives of parents and teachers on such processes are understudied. This qualitative study presents teacher and parent views regarding adolescent masculinities and avenues for school-based developmental programming for boys and young men. In this study, 16 individual qualitative interviews were undertaken with 10 parents (six females, four males), and six teachers (three females, three males), recruited from an independent all-boys’ grammar school in Melbourne, Australia. Thematic analysis of parents’ and teachers’ perspectives indicated their perception of the role of context-dependent “public” and “private” masculinities, the influence of Australian masculinity norms, and the role of private boys’ school cultures in the development of adolescent masculinities. Additionally, strategies for development encompassed participants’ appetite for boys’ exposure to positive role models, in addition to consistent and relevant developmental programming to support positive masculinity development. Findings have implications for efforts to support prosocial masculine identity development via school-based initiatives, as an avenue to promoting mental health of boys and young men.

Brief assessment of male depression in clinical care: Validation of the Male Depression Risk Scale short form in a cross-sectional study of Australian men

OBJECTIVES

To develop and validate a short form of the Male Depression Risk Scale (MDRS-22) for use in primary care, examining associations with prototypic depression symptoms, psychological distress and suicidality.

DESIGN

Cross-sectional study with 8-month follow-up.

SETTING

Community-based.

PARTICIPANTS

A community sample of younger (n=510; 18-64 years) and older (n=439; 65-93 years) men residing in Australia (M age=58.09 years, SD=17.77) participated in the study. A subset of respondents (n=159 younger men; n=169 older men) provided follow-up data approximately eight months later.

PRIMARY AND SECONDARY OUTCOME MEASURES

Quantitative data were obtained through a survey comprising a range of validated measures, including the MDRS-22, the Patient Health Questionnaire (PHQ-9) and the Kessler Psychological Distress Scale (K10). The MDRS-22 was refined using exploratory and confirmatory factor analysis in line with best practice guidelines. Analysis of variance and generalised linear models were conducted to explore relationships between variables.

RESULTS

The short-form MDRS consisted of seven items (MDRS-7) and captured all of the domains in the original tool. Participants with mixed symptoms (PHQ-9 ≥ 10 and MDRS-7 > 5) had significantly higher risk of mental illness (K10 ≥ 25) and current suicidality (PHQ-9 item 9 ≥ 1) than those with exclusively prototypic symptoms (PHQ-9 ≥ 10 and MDRS-7 ≤ 5). Furthermore, the MDRS-7 was shown to be effective at predicting elevated symptoms of depression at follow-up, after controlling for previous depression diagnosis.

CONCLUSIONS

Findings provide preliminary evidence of the potential utility of the MDRS-7 as a screening tool for externalised and male-type symptoms associated with major depression in men. Field trials of the MDRS-7 in primary care settings may facilitate identification of men at risk of suicide and psychological distress who do not meet cut-off scores for existing measures of major depression symptoms.

Protocol for a cluster randomized control trial of the impact of the Breaking the Man Code workshops on adolescent boys' intentions to seek help

BACKGROUND

Males in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men's wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in the Breaking the Man Code workshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop.

METHODS

A stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group.

DISCUSSION

The Breaking the Man Code workshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need for Tomorrow Man to introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12620001134910 ). Registered on 30 October 2020.

Male-type depression symptoms in young men with a history of childhood sexual abuse and current hazardous alcohol use

The prevalence of male-type or externalising depression symptoms (e.g., anger, risk-taking, emotion suppression) were examined with cross-sectional online convenience sample of 1,277 help-seeking young men (M=23.64, SD=3.61 years). Almost a quarter (21.9%) of the sample reported childhood sexual abuse (CSA) exposure, and most (68.8%) endorsed past 2-week suicide ideation. All male-type depression symptoms were frequently (>30%) endorsed across the sample, and were positively correlated with past 2-week suicide ideation. An adjusted CSA exposure × alcohol risk interaction (p=.013) indicated elevated male-type depression scores for those with a CSA history and hazardous alcohol use. Results are interpreted in line with young men's adherence to masculine norms, which may be particularly complex for young men reporting a CSA exposure history. Findings support the need for enhanced screening efforts, especially among young men with a history of CSA and hazardous alcohol use, with a need to also improve gender-sensitive service offerings for young men with a CSA exposure history.

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.