Men’s mental health: what affects it, and how to improve support

Surveys from around the world show that men everywhere find it difficult to open up about mental health, though they are significantly more at risk of attempting suicide than women. Laura Calleja speaks to Amanda Farrugia, a medical doctor with special interest in psychiatry

Why are men afraid to talk about mental health?

Mental health issues are always a challenge to face and to speak up about mainly due to the stigma surrounding them. The stigma has always been a complex and prevalent issue throughout the population, but this is noticeably more prominent in the male gender mainly due to social stigma.

Only 1 in 4 men who suffer daily feelings of anxiety or depression actually speak up to mental health professionals. Social stigma is the culture of masculinity standards and norms that expect men to be dominant, powerful, self-sufficient, invulnerable and to always be in control. This is also affected by the expectation of men to display traditional gender roles such as being less forthcoming in opening up about their emotions and also to downplay their symptoms to take a stoic approach. Toxic masculinity may negatively impact one’s mental health and thus prevent men from reaching out for support and ultimately receiving treatment.

All these factors compounded, lead to health disparities between men and women as most men with mental health issues tend to suffer in silence, remain undiagnosed with missed warning signs and with some unfortunate cases being only identified when it is too late. This may lead us to falsely believe that mental health issues are less predominant in males compared to women.

Is depression different for men?

Depression is generally characterised by persistently low mood, lack of motivation, loss of pleasure, changes in appetite, sleep disturbances, hopelessness and helplessness which impact one’s daily living. Alternatively, symptomatology of depression in men may vary and men may display male-typical depressive symptoms which include destructive and risk-taking behaviours such as violence or substance misuse, aggression, irritability, negative parental behaviours, escapism as well as somatic complaints.

This difference in depression between genders may be due to biological sex and gender roles. Studies have shown that biological sex differences influence the way depression manifests itself as well as the treatment response. Western society’s traditional gender roles and identity effect the way people experience and express their emotions and thus may lead men to externalise depression as male-typical behaviours. Many a times, men seek help when they are at a crisis point because traditional symptoms of depression are at odds with the ideals of masculinity. Emphasis is made on the fact that most men with depression remain undiagnosed due to failure to seek help.

What are the warning signs for men’s mental health and who is the most at risk?

Warning signs tend to be specific to the mental health condition in question and thus can vary significantly. However, it is important to keep in mind that signs and symptoms of mental health conditions include a change in mood, energy levels, behaviour, appetite and sleeping habits. Others may include use of illicit substances or participation in risky activities, non-suicidal self-injury and thoughts of or attempts of suicide, to name a few. It is thus fundamental to seek medical help if you think you or a loved one are experiencing such symptoms because early treatment can prevent progression of the condition as well as lower the risk of complications.

While mental health issues tend to be more prevalent in vulnerable groups within the population, it is fundamental to keep in mind that mental health issues can affect people from all social strata. Vulnerable groups of men tend to be more predisposed to suffering from mental health issues and these include men with previous history of trauma such as physical or emotional trauma, men who are exposed to social stressors such as unemployment, marital breakdown and financial problems, men who misuse alcohol or illicit drugs, men with a history of or family history of mental health issues including suicide.

Why are men more likely to die by suicide than women?

It is very unfortunate but also very true that men are more likely to die by suicide than women, in fact men are more than 3.5 times likely to die from suicide than women especially in the less than 35-year age group. One of the reasons may be that men tend to be less open to seeking the appropriate help for their mental issues for fear of being ridiculed and are oftentimes embarrassed to admit that they need help. Furthermore, when mental health issues are identified in men, these tend to be more advanced and sometimes also too late.

It is also well known that men tend to have different coping mechanisms to dealing with mental health issues. Men tend to choose more lethal means such as the use of weapons or self-destructive behaviours such as the use of alcohol and illicit substances as well as participation in risky activities. Other culprits for suicide being a commoner cause of death in men than women, include the unrealistic societal expectations for men which were alluded to before and the stigma surrounding mental health. These lead to negative feelings of mental health issues spiralling out of control, becoming overwhelming and can lead to the unfortunate outcome of suicide.

What can we do in terms of prevention and awareness to remove the stigma?

The media can be a means to educate and provide the correct knowledge to the general population and also convey a message of hope to sufferers of mental health issues through sensitive and responsible reporting. The Maltese Association of Psychiatry has released guidelines for reporting on such issues, which are accessible on their website. Additionally, the media can increase awareness of the current mental health services which can be used nationally and which include: national support line 179, Richmond Foundation 1770, psychiatry team at Accident & Emergency Department within Mater Dei Hospital, and online resources such as www.kellimni.com, amongst others.

As an individual in society, one should be active in discussions about mental health and suicide in men. We should respect those who are passing through difficult moments and avoid shaming and blaming vulnerable individuals for their behaviour. Society should trash out-dated male stereotypes such as “real men don’t cry” because in reality people who speak up and seek help are more likely to receive proper care and support.

On an individual and personal level, it is fundamental to educate ourselves on mental health issues so as to be more equipped to identify those who are in need and to provide help and support as needed. It is important to be there for each other, listen and understand and avoid being judgemental in any way. More importantly, it is essential to value yourself, surround yourself with good people and always, be kind to yourself.