Men like being strong, silent types, according to a new study, but that might affect their ability to seek and receive treatment for depression. Older men identified in the study as “old school” or “John Wayne types” tended to believe there was a stigma attached to being diagnosed or labeled mentally ill, and they were less likely than women to seek help for depression.
The study, published in the October issue of the American Journal of Geriatric Psychiatry, also underscored several other depression-related barriers older men face, including having more difficulty than women recognizing or expressing anxiety or seeking referrals to treatment programs. Dr. Ladson Hinton, lead author and associate professor of psychiatry at the University of California at Davis, said the findings had significant implications for men aged 65 and older, who were almost eight times as likely to commit suicide than women; that translates to 31.8 per 100,000 compared with 4.1 per 100,000. “The way we think of ‘crazy’ or having a severe mental illness … is something that was not consistent with how they thought of themselves as being masculine,” Hinton said. “Talking about your feelings or reaching out for help is not consistent with their own views of being a man.”
Hinton said that doctors and mental health caregivers should be mindful of these potential psychological barriers when treating older men. Dr. Stuart Fischer, who didn’t work on the study, said he has found some male patients “internalize” their emotional problems and do not discuss them even with close family members. “There is a mental health stigma in our society,” said Fischer, whose practice is based in Manhattan. “Depression is similar to the shame of impotence. We have no shame telling a physician we are overweight … but when it comes to impotence or depression, it is viewed as a sign of weakness in men.”
Psychotherapist Sheenah Hankin welcomed the study’s findings but said that quite the opposite was occurring at her Manhattan-based practice. “I have had far more older men in the last two years than I have ever had,” Hankin said. “I think they are becoming more aware because of their wives and girlfriends’ helping making it more acceptable. It is becoming more culturally acceptable, and they do use the word ‘depression’ when they come in. ‘I am depressed. I can’t get out of it by myself.'”
Hinton said the reasons for the gender disparities in depression treatment were not fully known and required additional study. Previous studies have established that gender role identity and masculinity play a significant role in shaping how a man expresses depression and his reluctance to seek help or accept treatment.
To quantify older men’s resistance to depression treatment, Hinton said, researchers studied data from 1,800 depressed older adults from another study known as IMPACT, or Improving Mood: Providing Access to Collaborative Treatment for Depression. That study addressed the management of late-life depression. Researchers then conducted interviews with 30 IMPACT-connected doctors, depression-care managers, and study recruiters. They also examined gender differences, referral rates and histories of depression treatment, finding that older men were less likely than women to endorse depression symptoms such as feeling depressed or down (39 percent versus 47 percent of women), report having lost interest or pleasure in things they usually enjoy (37 percent versus 42 percent of women), or report fatigue (62 percent versus 67 percent of women).
BY CURTIS L. TAYLOR
Newsday Staff Writer