Mental health help‐seeking behaviour in men

Summary & key facts

This article reviews research on why men often do not seek help for mental health. It says men use health services less than women, especially between ages 16 and 60, and that mental health problems in men can go untreated. The authors describe barriers such as masculine norms (stoicism and self-reliance), stigma, lower mental health knowledge, poor communication with health staff, and social factors like unemployment or discrimination. They call for more research and for nursing and public-health approaches that are aware of gender and cultural differences.

Key facts:

• Globally, men have a lower life expectancy than women (cited in the paper).
• Non-consultation of health services is most common in men aged 16–60; children and older adults show much smaller gender differences.
• Research cited in the paper finds men are less likely than women to seek help for mental health problems across race, age and social status.
• The paper reports that men are more than three times as likely to die by suicide as women (Office for National Statistics, 2020).
• Overall prevalence of mental disorders is reported as lower in men than in women, but men are less likely to access psychological services such as NHS talking therapies.
• Common barriers to help-seeking for men reported in the paper include masculine norms (stoicism, self-reliance), stigma, lower mental health literacy, difficulty disclosing problems, and poor rapport with health professionals.
• The authors note higher rates in men of homelessness, going missing, and dependence on alcohol and drugs in cited sources, and link these to worse mental-health outcomes.
• The paper recommends more research and gender-specific nursing and public-health actions, including improving mental health literacy and reducing stigma for men.

Abstract

Despite significant advances in health care in recent decades, men do not appear to have benefited equally. Globally, men have a lower life expectancy than women (Thornton, 2019). Across a range of measures, men's general health is poorer than that of women (Mursa et al., 2022). Biological characteristics, occupational factors and health behaviours may all contribute to this gender-related difference; however, it has also been posited that the help-seeking behaviour of men plays a significant role (Sagar-Ouriaghli et al., 2020). It is widely assumed, across all age groups, that women are more likely to consult health professionals and use health services than men; however, rigorous gender-comparative evidence to back this assumption is lacking. In those studies that have been conducted, men have consistently been seen to have a greater reluctance to consult health professionals for health problems. This reinforces the presumption that men may often delay consultation for health-related problems, when medical conditions may become more advanced and potentially harder to treat. Interestingly, there appears to be very little gender differences between children and older adults, and non-consultation occurs most commonly in men aged between 16 and 60 years. In this age group, men experience poorer health outcomes than women in several areas, including mental health (Australian Institute of Health and Welfare, 2019). Evidence suggests, once again, that men are less likely to seek assistance for mental health problems than women, across race, age and social status (Seidler et al., 2016). Although mental health problems are extremely common, stigma is still attached to them, often making them difficult to talk about. Despite women and men experiencing stigma in response to help-seeking for mental health issues, there would appear to be gender-specific influences on men's reluctance to seek help. For men, non-consultation may also be linked to the mental distress and stigma that may result from the inability to perform in occupational and family roles, whilst coping with mental distress (Staiger et al., 2020). Non-consulting by men may be particularly problematic in this area, as mental health issues, like loneliness and chronic stress, may often be overlooked in males. Indeed, the mental and emotional health of men has been described as a 'silent crisis' (Affleck et al., 2018). Although the overall prevalence of mental disorders is lower in men than in women, men are less likely to access psychological support, like the National Health Service talking therapies service in the United Kingdom, than women (NHS Digital, 2021). Mental health problems regularly go untreated in men, despite public health concerns that depression and suicide are leading causes of death in men, with men more than three times more likely to die by suicide than women (Office for National Statistics, 2020). In addition, men are far more likely to sleep rough, go missing and become dependent on alcohol and drugs than women (Center for Behavioral Health Statistics and Quality, 2017). These trends should create a sense of urgency in identifying and supporting men who struggle with mental illness, so dangerous and unhealthy behaviours might be mitigated (Chatmon, 2020). More research is needed to drive identification, support and empowerment of men with mental health issues, as outlined by Tofthagen et al. (2022) in a review of men's experiences of self-harm. Despite considerable levels of interest, there is a shortage of nursing research that explores why males are less likely to seek help for mental health problems than females. When exploring the reasons why men do not seek help for mental health issues, masculine norms, such as being strong and in control, are commonly cited. These traditional gender roles of masculinity, including stoicism and self-reliance, can lessen the likelihood of men seeking support. Stereotypically, having mental health issues, like depressive illness, would appear to be in conflict with traditional views of masculinity, such as, lack of control, incapability and weakness. This belief was echoed by Mursa et al. (2022), who identified masculinity and feeling unwelcome as key barriers to preventive health care. Additionally, men have been known to trivialize or play down mental health symptoms, display difficulty disclosing issues, which in turn, can also inhibit their help-seeking behaviour (Sullivan et al., 2015). Symptoms of anxiety, distress and fear, need for emotional control, seeing symptoms as minor, and poor rapport and communication with healthcare personnel have also been outlined as obstacles to help-seeking in men (Seidler et al., 2020). Moreover, lower mental health literacy has been noted in men with mental health disorders (Lee et al., 2020), influencing the likelihood of them seeking help. Possessing higher levels of mental health literacy has been associated decreasing the impact of mental health problems; however, men with lower levels of mental health literacy often do not perceive the need to seek help for mental health, refraining from seeking care (Hadjimina & Furnham, 2017). For populations who have been historically minoritized, it is essential to address interactions with the healthcare services that may impact their help-seeking behaviour for men with mental health concerns. Addison et al. (2022) examined the mental challenges that Black men may encounter after incarceration, due to poor treatment by police and difficulty finding employment. Employment difficulty has been cited as a chronic or acute stressor that impacts mental health in these men (Affleck et al., 2018). Higher rates of suicide are also found in minority communities, including gay men and men from BAME. In the Journal of Advanced Nursing, Callan et al. (2022) outlined the importance of empathy, education and effective communication in working with historically minoritized groups, including gay and bisexual men. Spirituality, a complex subjective human experience, is a concept which is understudied in men, can have important interdependent effects for physical, mental and psychosocial health. As with mental health, the ways in which spirituality and religiosity is experienced, assessed and addressed may differ for men. As such, it is important for nurses to understand and respect male experiences of spirituality in different cultures and contexts. For example, in studies with prostate cancer patients, spiritual practices and spirituality dimensions were key including prayer, receiving support, trusting and compassion (Chien et al., 2020). Although applying the concepts of spirituality in nursing practice may be challenging, adopting a person-centred holistic approach to nursing care is important to help safeguard the mental health and overall well-being of men. At the forefront of health service provision, nurses would appear to be ideally positioned to address and improve help-seeking behaviour in men with mental health issues. There is the scope for the development of more gender-specific nursing interventions, including identifying ways to reduce the impact of stigma in men. Importantly, attention needs to be given to preferred types of health services for men. Research to enhance the understanding of men's beliefs, values and their response to health-related issues, including consultation for mental health issues, could help to inform nursing practice. Despite increasing attention to this issue, more research into diverse nature of masculinity in different cultures and in ethnically diverse populations is required to help inform health policy and nursing practice. Ways should be found to help men reach out for help to decrease gender-based stigma and the hazards that men may experience from their perceptions of mental illness. Public mental health campaigns may be helpful in changing the apparent negative view of mental illness within society, as well as raising the awareness of mental health issues in men. Higher levels of mental health literacy may help to improve men's ability to recognize mental health issues. This could be addressed through gender-specific interventions focused on mental health literacy. Indeed, public mental health initiatives may assist in shifting societal discourse that averts men from help-seeking, reinforcing positive aspects of men's health. By looking at issues of silence and invisibility and learned maladaptive behaviours, we can understand more fully how to support men and their inner lives, which ultimately has benefits for their holistic well-being. Help-seeking behaviours may not be consistent with traditional masculine stereotypes. Strategies to address this might include protecting male vulnerability, providing a masculine narrative of help-seeking and focused interventions for men's health (Vickery, 2021). In the provision of health care, approaching the inner lives of men to increase help-seeking for mental health issues requires commitment from nurses and other members of the healthcare team. Nurses can also make an important contribution to the wider cultural conversation about what it means to be masculine. The authors declare that they have no competing interests that could have appeared to influence the work in this study.

Topics

Adolescent and Pediatric Healthcare Gender Roles and Identity Studies Sex and Gender in Healthcare

Categories

Gender Studies Social Sciences

Tags

Economic growth Economics Environmental health Gerontology Health care Health equity Law Life expectancy Medicine Mental health Nursing Political science Population Presumption Psychiatry Psychology Public health Race and health

Conditions & symptoms

Addiction Anxiety Depression Substance abuse disorder Addiction or harmful habbits Anxiety or worry Feeling disconnected from others Lack of energy or motivation Poor sleep Sadness or low mood