Positive Strategies Men Regularly Use to Prevent and Manage Depression

A National Survey of Australian Men

Judy Proudfoot; Andrea S. Fogarty; Isabel McTigue; Sally Nathan; Erin L. Whittle; Helen Christensen; Michael J. Player; Dusan Hadzi-Pavlovic; Kay Wilhelm

Disclosures

BMC Public Health. 2015;15(1136) 

In This Article

Background

Men are four times more likely to die by suicide than women,[1] with proportionally higher rates in men who are displaced and separated, unemployed, have physical illnesses and mental health disorders, particularly depression.[2–4] One in eight adult men experience depression in their lifetime,[5] although major depression can be masked in males[6] and expressed as risk-taking, antisocial and externalising behaviours, such as anger, aggression, violence, risky sexual encounters, gambling, drink-driving, road rage, deliberate self-harm, or as somatic complaints.[7,8] Sickness absences, excessive drug and alcohol use to "numb" emotional distress, and overwork to distract from problems are also common.[9] Men are also more likely to delay or avoid seeking help for mental health issues.[10,11] Despite recent improvements in the rates of men accessing services for mental disorders (e.g., in Australia from 32 % in 2006–2007 to 40 % in 2011–2012[12]) service utilization rates are still low and a gender gap remains.

Research to date has predominantly focused on the barriers to help-seeking for men, such as the constraints imposed by social expectations of masculinity[13] and on the unhelpful responses some men make to stress, depression and crisis. Little research has investigated the positive, helpful or adaptive strategies used by men to prevent or manage depression. This was confirmed in our recent review of qualitative studies exploring men's experiences of depression and suicidal behaviour, which found that where positive strategies were mentioned, it was usually only incidental to the main focus of the paper.[14]

Yet, depression is one of the most preventable mental disorders.[15] At least 22 % of new cases can be prevented each year using evidence-based interventions[16] and an up to 50 % prevention rate has been reported with a stepped care approach.[17] Further, according to the World Health Organization, improving self-management "may have a far greater impact on the health of the population than any improvement in specific medical treatments".[18] Thus, there is a need to identify men's adaptive responses to depression and stress, so that public health programs can be developed and disseminated, especially to men who may otherwise avoid help-seeking. In particular, it is important to understand the strategies that men use day to day, within their behavioural repertoire, to prevent and cope with depression.

The current study aims to fill this gap by investigating the positive strategies that men use to successfully manage their mental health and wellbeing and prevent depression. Our secondary aim was to explore whether strategy use varies according to demographic factors and in particular, whether use of prevention strategies predicts depression risk and whether use of management strategies predicts depression symptoms.

The study was informed by an initial qualitative phase involving interviews and focus groups with men from a variety of backgrounds and experiences, including those with and without mental health concerns.[19] Findings indicated that men used a very broad variety of different self-help strategies for their mental health. Some of these strategies had previously been endorsed by health professionals and people with a history of depression as likely to be helpful for sub-threshold depression.[20] The qualitative data extended this by establishing those strategies which men self-nominated as most effective in maintaining their mental health and wellbeing. The men differentiated between strategies for preventing and for managing depression[19] and reported using different strategies at different times, depending on their mood and the presence or severity of symptoms. Prevention strategies identified by the male participants emphasised good physical health, pleasurable routines and social connections, while management strategies focused on problem solving, deploying additional resources and attempts to reframe their thoughts and perspectives.

Building on this preliminary phase, the current study investigates, within a national sample of men, the positive coping strategies used by men for the prevention and self-management of depression. To our knowledge, no previous study has looked at the positive coping strategies that men use spontaneously in the course of their day-to-day lives.

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