Working to Understand Men's Mental Health

Men are much less likely to seek help for mental health issues than are women - and this fact severely limits what we know about men and their issues. Slowly, however, this is changing.

Working to understand men's mental health

More can be done to help men in this little studied area of wellbeing

Men's mental health is a particularly salient issue in these troubled times. Worldwide, more than one million people kill themselves each year. In the UK, men are four times more likely than women to kill themselves and there have been over 6,500 male suicides in the past six years.

Incidence data from the last century show suicide rates have peaked during past economic recessions. Gay men are two to three times more likely to have a mental health problem and 4.3 times more likely to attempt suicide than straight men, and have around double the rate of depression and anxiety. 94% of young offenders are male and 80-90% have mental health problems.

Furthermore, while the rate of deliberate self-harm is higher in females (associated with problems in interpersonal relationships), it is four times more likely to lead to suicide in males, and is associated with alcohol, employment, financial and housing difficulties. One question is, will we see an escalation of distress and suicide in males during the current economic downturn?

Men's mental health is a dramatically understudied and poorly understood area of human wellbeing. Men are half as likely as women to be diagnosed with depression, yet twice as likely to abuse alcohol and drugs.

What's going on here? One compelling possibility is that what society teaches men about what it means to be a man leads us to express our pain in ways that differ from women. Among the more striking differences is that men are more likely to keep their problems to themselves. We frequently suffer in silence, and sometimes with dire consequences. Our research at Clark University in the US has shown that men who are more likely to value self-reliance and stoicism are more likely to have significant symptoms of depression; they are also more likely to report feeling ashamed of being depressed, and more likely to keep the problem to themselves.

Factors that may lead to mental wellbeing or ill-health are multiple and have complex interrelationships. Comparatively little is understood about how these manifest in men differently to women. There is lack of public knowledge about mental health problems generally. During their lifetime, 25% of the population will experience a mental health difficulty. However, when asked, half of company bosses estimated levels at 0% in their workforce.

Stigma is associated with mental health problems and their perceived effect on employment. In western cultures, boys are taught that it is better to express emotions such as anger than fear or pain and there are cultural sanctions for those who deviate from this. Depression and anxiety may get expressed as anger. Men are socialised to fix problems. As one service user put it "men deal with it – I'm not dealing with it, therefore I'm not a man". No wonder men may have a tendency to play down their problems, overestimate their ability to deal with them and have a reluctance to seek help. Nor is it surprising that it is commonly hard for those around them to spot the symptoms.

So, what can be done? Men and women need educating in what symptoms to look out for in themselves and others. Signs may include inability to concentrate; being unable to engage with people; a change in appetite; feelings of worthlessness or hopelessness; change in sleeping patterns; and increase in use of alcohol or drugs.

Some men have faulty perceptions about, and place low value on, therapy. As a society, we need to associate help-seeking with strength and courage. Media campaigns in the UK, such as Time to Change, aim to start addressing this. The effects of redundancy on men and women need consideration and employers need educating. At Clark University there are plans to establish the first centre devoted to the study of men's mental health.

Half of people experiencing depression, after a relatively short course of therapy, go on to make a full and lasting recovery. However, sitting and talking about problems is not what many men are comfortable doing. Therapists need to develop more effective methods of engaging them.

The national strategy, Increasing Access to Psychological Therapies (IAPT), is aimed at identifying and treating anxiety and depression more effectively in the general population. Early statistics show lower take-up of this service among men. While research indicates that higher numbers of women experience mental health difficulties than men, it is unclear whether this is because it is a hidden problem and self-referral to the new IAPT services might help. Linking commissioning of educatio n, social care and health care services may lead to men's needs being more comprehensively addressed in future.

• Michael Addis is professor of psychology at Clark University, Massachusetts

Tags: masculinity, psychology, health, Michael Addis, men, mental health, anxiety, depression, Guardian UK, suicide