Helping young men get help for depression calls for gender-relevant strategies, say researchers - photo by Martin Dee

UBC Reports | Vol. 53 | No. 4 | Apr. 5, 2007

Big Boys Don’t Cry

By Hilary Thomson

It’s a tragic paradox -- more women report being depressed, but more men kill themselves.

Two UBC researchers want to find out what lies behind this alarming puzzle, a phenomenon seen in most western countries.

John Oliffe, an assistant professor of Nursing and John Ogrodniczuk, an assistant professor of Psychiatry, have teamed up as principal investigators in a pilot project that will examine the relationship between depression and masculinity.

“We want to learn about young men’s experiences of depression and identify what works and doesn’t work for them in terms of getting help,” says Oliffe. “The answers will help create more effective, gender-relevant interventions.”

Suicide rates are four times higher among men than women in Canada, with men aged 20-29 having the highest rate of suicide, according to Health Canada. Among Canadians of all ages, four out of every five suicides are male, according to the Public Health Agency of Canada. Statistics Canada reports that in 2003, the last year for which data is available, more than 2,900 men committed suicide.

The relationship between men’s low rate of reported depression and high suicide rates generates many questions about men’s beliefs, their mental health “literacy” and behaviours and how their complaints of depression symptoms are being regarded by general practitioners, say the researchers.

In the only study of its kind in Canada, the researchers will begin by recruiting 15 men from UBC, or other universities or colleges, with more participants added as the project develops. Participants will be of diverse backgrounds, aged 19-25, with access to mental health care services and who have been diagnosed or have self-identified as being depressed.

Oliffe and Ogrodniczuk want to find out how these men interacted with services, their own coping strategies, and the characteristics of their depression. Some factors that can contribute to depression in college-age men include academic competition, social isolation, cultural pressures and issues around sexual orientation. Unhealthy coping mechanisms can include violent behaviour, risky sexual behaviour and over-drinking.

Commonly described masculine ideals such as stoicism and self-reliance and expected roles as protector and provider are well known to influence men’s health-care experiences, says Oliffe.

“Society says men are supposed to be robust -- to risk rather than promote their health to demonstrate physical and sexual prowess,” adds Ogrodniczuk, who is also a member of the UBC Institute for Mental Health and Vancouver Coastal Health Research Institute (VCHRI). “They tend to operate on a performance-based model of health.”

The perceptions can lead to denial of illness, self-monitoring of symptoms and reluctance to go to the doctor, meaning symptoms are often severe when attention is finally sought.

“There is also stigma associated with having depression with implications for attracting a partner and for success in work and study. So, some men might not want the diagnosis,” Ogrodniczuk says.

A key aspect of the research is to look at mental health care services from a client perspective and to give men an opportunity to provide feedback on how services do and do not work for them. The researchers expect that pilot data will help develop an improved screening tool for men in distress.

For example, typical diagnostic questions about crying frequency may be irrelevant to a man’s experience of depression and therefore not a reliable criterion. Also, the researchers hope to produce gender-appropriate treatment approaches that may include workshops, coaching, mentoring or online chat rooms and support.

Following the pilot, Oliffe and Ogrodniczuk will apply for research funding for a multi-site province-wide project that will look at depression in men aged 20-29 in the general population.

For more information on the pilot study, contact Oliffe at oliffe@nursing.ubc.ca. Participants will receive an honorarium of $30 to acknowledge the 1-1.5 hours spent completing a confidential questionnaire and individual interview.

The project is funded by the B.C. Mental Health and Addictions Research Network.

VCHRI is the research body of Vancouver Coastal Health and the fourth largest research institute in Canada. In academic partnership with UBC, VCHRI brings innovation and discovery to patient care, advancing healthier lives in communities across B.C., Canada and beyond.

Suicide Facts

• 4,000 Canadians commit suicide each year
• For men, suicide rates are highest in the 20s and after 60
• In Canada, suicide rates are highest in August and late July
• Of people with severe depression, 15 per cent commit suicide
• Suicide accounts for 24 per cent of all deaths among Canadians aged 15-24; 16 per cent for those aged 25-44

Potential Depression Symptoms

• Reduced energy and diminished activity
• Poor self-esteem or self-confidence
• Decreased interest in sex
• Crying for no reason
• Poor appetite
• Ideas of guilt and unworthiness
• Pervasive low mood
• Poor concentration
• Disturbed sleep

Suicide Risk Factors

• Age
• Unemployment
• Social isolation
• Chronic illnesses

Sources: Mood Disorders Society of Canada; Dr. Ciaran Mulhollan.