Reduced Emotional Awareness and Distress Concealment: A Pathway to Loneliness for Young Men Seeking Mental Health Care

Background: Loneliness, the painful affective state that reflects perceived deficits in social relationships, is a significant health issue requiring further understanding. Individual differences in awareness and disclosure of emotional concerns may contribute to loneliness, and may do so diversely according to gender and age. The present study examined a hypothesized mediation pathway from emotional awareness abilities to loneliness through distress concealment, with moderation by gender and age, in a sample of adults attending outpatient mental health services.Methods: In a cross-sectional study design, 244 patients attending Canadian community mental health clinics completed study assessments at the commencement of care. Conditional process modeling examined interactions between gender and age and both emotional awareness and distress concealment in mediation models predicting loneliness.Results: A significant three-way interaction between gender, age, and distress concealment was observed, along with significant conditional moderated mediation. The indirect effect of emotional awareness on loneliness through the mediating effect of distress concealment was significant for young- and mid-adulthood men, but not for women or older men.Limitations: The study was limited by exclusive use of self-report assessment, and cross-sectional design precluding representation of causal sequencing over time.Conclusion: Findings suggest the pathway to loneliness from reduced emotional awareness through distress concealment to be particularly salient for younger men. Thus, intervention targeting restricted awareness and disclosure of emotional concerns should be considered in helping young men to address the pain of loneliness

Men’s Psychotherapy Dropout is Associated with Conformity to Traditional Masculinity Ideologies

Objective: High conformity to traditional masculinity ideologies (TMI) is associated with lower use of psychotherapy, higher self-stigmatization and poor mental health outcomes amongst men. However, the role of conformity to TMI in relation to psychotherapy dropout is still unclear. Aim: The present study aims to clarify the relationship between conformity to TMI and premature termination of psychotherapy (dropout) in men. Method: Data was used from an anonymous online survey in German-speaking Europe. Participants with previous psychotherapy experience provided information on sociodemographics, mental health, TMI, and their past experiences with psychotherapy. Discontinuation of psychotherapy was assessed by self-report and further differentiated into discontinuation with or without consulting the therapist. Men with an unconsulted therapy ending were defined as psychotherapy dropouts. Conformity to TMI was assessed using the Conformity to Masculine Norms Inventory. Results: Of the 266 men (mean [SD] age, 46.1 [13.6]) with psychotherapy experience, 30.5% (n = 81) reported having discontinued psychotherapy at least once, whereas 17.7% (n = 47) of the total sample reported dropout. These 47 men showed significantly higher conformity to TMI than men who did not report past dropout. The sub-scales of self-reliance and playboy showed the strongest associations with psychotherapy dropout. Conclusions: Dropout from psychotherapy was significantly associated with higher conformity to TMI. Therapists should consider, and where necessary, work to flexibly adapt to TMI which may influence how men engage in mental health care. Such an approach would likely improve men’s ongoing engagement in psychotherapy, promoting opportunities to prevent avoidable psychotherapy dropout for men most at risk of deleterious mental health outcomes

“I could hang up if the practitioner was a prat”: Australian men’s feedback on telemental healthcare during COVID-19

The COVID-19 pandemic restrictions, uncertainties and management inconsistencies have been implicated in men’s rising distress levels, which in turn have somewhat normed the uptake of telemental healthcare services (i.e., phone and/or video-conference-based therapy). Given past evidence of poor engagement with telemental health among men, this mixed-methods study examined Australian men’s use of, and experiences with telemental health services relative to face-to-face care during the pandemic. A community sample of Australian-based men (N = 387; age M = 47.5 years, SD = 15.0 years) were recruited via Facebook advertising, and completed an online survey comprising quantitative items and open-response qualitative questions with the aim of better understanding men’s experiences with telemental healthcare services. In total, 62.3% (n = 241) of participants reported experience with telemental health, and regression analyses revealed those who engaged with telemental health were on average younger, more likely to be gay and university educated. Men who had used telemental health were, on average, more satisfied with their therapy experience than those who had face-to-face therapy. Among those who had telemental healthcare, marginally lower satisfaction was observed among regional/rural based relative to urban men, and those who had to wait longer than 2 months to commence therapy. Qualitative findings highlighted positive aspects of telemental healthcare including comfort with accessing therapy from familiar home environments and the convenience and accessibility of telemental health alongside competing commitments and COVID-19 restrictions. Conversely, drawbacks included technical limitations such as crosstalk impeding therapeutic progress, disconnects and audio-visual lag-times and the ’impersonal’ nature of telemental healthcare services. Findings broadly signal COVID-19 induced shifts norming of the use of virtual therapy services, with clear scope for improvement in the delivery of therapeutic practice using digital modalities, especially among help-seeking men

Job Satisfaction and Psychological Distress among Help-Seeking Men: Does Meaning in Life Play a Role?

Men’s low job satisfaction has been shown to be associated with greater symptoms of psychological distress. Meaning in life may be an important factor in this relationship, but its role as a mediator has not been reported. The present study investigated meaning in life as a mediator in the relationship between job satisfaction and psychological distress among men. A total of 229 employed Canadian men participated in a cross-sectional survey, completing measures of depression and anxiety symptoms, anger severity, job satisfaction, and the presence of meaning in life. Zero-order correlations were calculated, and regression with mediation analyses were conducted; two models were tested: one for anxiety/depression symptoms and one for anger, as the dependent variables. Both mediation models emerged as significant, revealing a significant mediating effect for job satisfaction on the symptoms of psychological distress (anxiety/depression symptoms, anger) through meaning in life, even while controlling for salient confounding variables including COVID-related impacts. Lower job satisfaction was associated with less meaning in life, which in turn was associated with more symptoms of depression, anxiety, and anger. The findings highlight the importance of job satisfaction in the promotion of a sense of meaning in life among men, leading to improved psychological well-being both inside and outside of the workplace

“Appreciate the Little Things”: A Qualitative Survey of Men’s Coping Strategies and Mental Health Impacts During the COVID-19 Pandemic

The COVID-19 pandemic has presented a suite of circumstances that will simultaneously affect mental health and mobilize coping strategies in response. Building on a lack of research specifically exploring men’s mental health impacts during the COVID-19 pandemic, this study presents the results of a qualitative survey exploring men’s self-reported aspects of the pandemic giving rise to mental health challenges, alongside their diverse coping strategies applied during this time. The sample comprised 555 men from North America (age M = 38.8 years; SD = 13.5 years), who participated via an online survey with two open-ended qualitative questions assessing, respectively, the aspects of the pandemic affecting their mental health, and the strategies used to manage these challenges. Free-text responses were coded using inductive content analysis. Results pertaining to the mental health impacts of COVID-19 were categorized into two overarching themes: far-reaching ramifications of COVID-19 encompassing consequences for lifestyle, work, and functioning, alongside novel anxieties related to health risks and daily uncertainty. In addition, coping strategies reported were categorized into two broad themes: efforts to avoid, dull or distract oneself from distress, alongside adapting and doing things differently, which encompassed largely approach-oriented efforts to flexibly ameliorate distress. Results signal the far-reaching impacts of COVID-19, alongside profound flexibility and diverse enactments of resilience among men in adapting to unprecedented challenges. Findings have implications for mental health promotion that should aim to leverage men's adaptive coping to encourage opportunities for social connectedness in response to the mental health impacts of the various psychosocial challenges of the COVID-19 pandemic

Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation

The COVID-19 pandemic is causing extensive job loss leading to a loss of social status in many men. Endorsement of traditional masculinity ideology may render some men particularly sensitive to status loss and thereby to an increased risk for suicidality. In this anonymous online survey conducted in German-speaking European countries, 490 men completed questionnaires regarding loss of social status due to the COVID-19 pandemic, past-month and lifetime suicide attempt and suicidal ideation. Furthermore, endorsement of traditional masculinity ideology and prototypical and male-typical externalizing depression symptoms were measured. Out of a total of 490 men, 14.7% of men reported experiencing status loss due to the pandemic. These men were more than four times as likely to have attempted suicide in the past month (OR = 4.48, 95% CI [1.72, 11.67]) and more than twice as likely to report suicidal ideation during the past 2 weeks (OR = 2.47, 95% CI [1.42, 4.28]), than men not reporting status loss. Status loss, but not endorsement of traditional masculinity ideology, was associated with suicide outcomes. However, when male-typical externalizing depression symptoms and prototypical depression symptoms were included in the models, they exhibited the only direct associations with suicide outcomes (e.g., for past-month suicide attempt: male-typical externalizing depression symptoms OR = 2.18, 95% CI [1.31, 3.62], prototypical depression symptoms OR = 2.41, 95% CI [1.13, 5.12]). A significant interaction between status loss and endorsement of traditional masculinity ideology further suggests an enhancing moderating effect of traditional masculinity on the relationship between status loss and past-month suicide attempts (OR = 3.27, 95% CI [1.16, 9.27]). Status loss due to the COVID-19 pandemic emerges as risk factor for suicide in men. Men who experience status loss due to the COVID-19 pandemic while concomitantly exhibiting strong endorsement of traditional masculinity ideology have an additional increased risk of suicide

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone

BACKGROUND: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). AIM: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. METHODS: The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. EXPECTED RESULTS: Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. DISCUSSION: This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT05435222

Männliche Formen der Depression und deren Behandlung

Halb so hohe Prävalenzraten depressiver Störungen und dreifach erhöhte Suizidraten bei Männern weisen auf die Bedeutung von Geschlechterrollen für die Präsentation und den Verlauf depressiver Störungen hin. Konformität zu traditionellen Geschlechterrollen führt bei Männern zu atypischer Symptomatik und erschwert die Identifikation depressiver Störungen und die Psychotherapieaufnahme. Implikationen für eine männerspezifische Diagnostik und Therapie werden diskutiert