Source: Tang, M. O., Oliffe, J. L., Galdas, P. M., Phinney, A., & Han, C. S. (2014). College
men's depression-related help-seeking: a gender analysis. Journal of Mental Health,
23(5), 219-224.
Link to publisher version:
http://informahealthcare.com/doi/abs/10.3109/09638237.2014.910639
© 2014 Shadowfax Publishing and Informa UK Limited
1
College Men’s Depression-Related Help-Seeking: A Gender Analysis
Abstract
Background: Men’s health help-seeking behaviours vary considerably depending on
context. The current empirical literature on the influence of masculinity on college men’s
attitudes towards mental health-related help-seeking is largely limited to investigations
involving psychology students.
Aim: To describe the connections between masculinities and college men’s depressionrelated help-seeking.
Methods: Qualitative interviews with 21 college men who were diagnosed or selfidentified as depressed. Constant comparison was used to inductively derive gendered
understandings about participants’ depression related help-seeking.
Results: Three themes were identified: (1) denying weakness; (2) limiting self-disclosure
and mustering autonomy; and (3) redefining strength.
Conclusion: The findings demonstrate connections between masculinities and helpseeking that can assist health care providers to understand the practices of college men
who experience depression.
2
Introduction
Social constructionist theories of gender suggest that many men experiencing depression
are reluctant to discuss or disclose their feelings or seek professional help for depressive
symptoms. Specifically, depression is seen as incongruent with masculine ideals, or
‘hegemonic masculinity’ which is characterized by stoicism, invulnerability and
competitiveness (Connell & Messerschmidt, 2005). Since depression can invoke feelings
of powerlessness and diminished control, many men also interpret depressive symptoms
as a failure to be a ‘real man’ (Branney & White, 2008). Likewise, needing professional
help for depression can contravene masculine ideals of self-reliance (Oliffe & Phillips,
2008). Men may therefore find ways of ‘doing’ depression through ineffectual actionorientated practices including aggression, substance overuse, self-harm and suicide
(Cochran & Rabinowitz, 2003).
College Men’s Depression and Masculinities
Depression is ranked among the top five health impediments of academic performance
among college-age men (American College Health Association, 2008). Michael et al.
(2006) studied the differential rates of depression and trends in treatment-seeking among
college men and women using the Depression Scale of the Symptom Checklist 90Revised (SCL-90-R; Derogatis, 1994) and found higher levels of depression in males. Of
the 99 men in the study, 17 had clinically significant depression scores; yet only five
were receiving some form of treatment. Depressed male college students are also more
likely than females to compound the risks associated with depression by concealing pain,
3
withdrawing socially and not seeking help (Courtenay, 1998). Other studies on college
men are consistent with the general men’s health literature suggesting that adherence to
masculine ideals can have a deleterious impact on mental health (Courtenay, 1998; Good
& Wood, 1995; Levant et al., 2009). Davies and colleagues (2000) similarly claimed
college men's ‘male socialization’ to be a potent inhibitor of health help-seeking,
whereby only severe emotional pain prompted men to access campus counselling
services as a last resort.
Much of the aforementioned evidence has illustrated linkages between
masculinity and men’s depression. However, recent work using Connell’s (2005)
masculinities framework, which acknowledges a range of gendered ideals and related
performances has shown that men’s health help-seeking varies considerably depending
on context (Galdas, 2009). The aim of the current study is to describe the connections
between masculinities and college men’s depression-related help-seeking.
Design
Interpretive description, an approach that draws on an array of established qualitative
approaches, was used to inductively derive findings from the interview data (Thorne,
2008).
Procedure
Sampling and Recruitment
Following University ethics approval, a total of 21 college men, self-identified or
formally diagnosed with depression, were recruited through advertisements at student
4
health centres, counselling services, and several campus buildings of a Western-Canadian
University (Please see Table 1: Participant demographic data). Semi-structured individual
interviews were conducted. Interview questions focussed on participants’ depressionrelated help-seeking, and included “What are the benefits and challenges to seeking
help?” and “What is the key to recovery?” Probing questions solicited additional details
and ensured the collection of comprehensive ‘help-seeking’ data from which findings are
drawn. Interviews lasted 60-90 minutes and were digitally recorded, transcribed, and
checked for accuracy.
Data Analysis
Participants’ interview transcripts were cleaned and labelled (i.e., D1- D21) to ensure
confidentiality. Transcripts were carefully read for participants’ descriptions of their
depression-related help-seeking experiences. From this ‘parent’ code, a coding schedule
was developed, initially assigning data to one or more categories. By partitioning
transcript data into topic-based segments, and then examining and categorizing data
within these segments, we were able to identify patterns reflecting broader themes or
concepts (Polit & Beck, 2008). Constant comparison was used throughout the analysis to
discern commonalities and differences and draw connections between potential themes
(Thorne, 2008). Consensus about the findings was reached through discussions among
the five authors. In theorizing the findings, we returned to the relevant empirical work on
masculinities to conceptually advance understandings about the connections between
masculinities and men’s depression-related help-seeking.
5
Results
Three inductively derived themes - (1) denying weakness, (2) limiting self-disclosure and
mustering autonomy, and (3) redefining strength - are described in what follows, linking
illustrative quotes to individuals using the participant’s age and area of college study.
Theme 1: Denying weakness
For most participants, dominant masculine discourses about being strong and stoic
featured as significant barriers to acknowledging their depression, let alone admitting a
problem for which they needed professional, peer or family help. Permeating the men’s
accounts were recursive references positioning weak people as predisposed to depression
amid suggestions that men formally diagnosed with depression were inferior to other men
(and women). In this regard a continuum of weakness levels emerged from being
susceptible to, as well as formally diagnosed with depression. As a 21-year-old arts
student confirmed, depression makes visible “people who are weak… persons within
inferior groups who are often neglected.” In equating depression with weakness, he went
on to explain that a formal diagnosis would render him even more vulnerable to being
depressed:
I have the mindset that if I get involved in the treatment then I will automatically
label myself as a person or a patient suffering from depression, that can maybe be
a vicious cycle to get recovery from, so I think if I can handle it myself, it’s better
not to go to treatment.
In this and many participants’ interviews, denying weakness publically and privately
afforded opportunities to embody strength through the concealment of their depression.
6
So powerful were these ideals that many participants who had sought help and/or
received treatment[s] were meticulous in their efforts to keep those details secret. A 24year-old electrical engineering graduate student explained that he eventually stopped
seeing his psychiatrist fearing he would be known as “crazy” if his friends found out:
The main reason I stopped going was that the psychiatrist was the main student
psychiatrist, so all my friends could easily know that I was going to a psychiatrist.
Seeking and agreeing to professional help risked revealing additional signs of weakness.
A 23-year-old international relations graduate argued against anti-depressant medications
as “the easy fix, the quick way out, the corporate, chemical solution” in detailing how
rising to the challenge oneself was the more manly action. Also revealed was how
refusing treatment was key to denying weakness by signalling strength of character and
mind to overcome depression induced challenges. Ideals about denying weakness were
learned and often reinforced by significant others. A 22-year-old chemistry student
explained how his father’s words, “no, you’re foolish, no, don’t do it, you will be okay”
influenced his beliefs that seeking professional help was unwise. Similarly, a 21-year-old
animal science student recounted his mother’s negative reaction to his use of
antidepressants, “you are healthy, don’t think you are sick… If you think you are healthy
then you’re fine.” Though shocked at first, he “kind of believed” his mother, eventually
conceding to the point that he discontinued his medications. While affirming that denying
weakness underpinned men’s need to avoid being publicly visible in their help-seeking,
family members may have also inadvertently denied men’s private requests for
assistance.
7
In sum, denying weakness can emerge in a relational context that repudiates
having depression, as well as needing and/or receiving professional help. Evident also is
that while participants did not necessarily have or even espouse the strength to overcome
their depression, denying weakness was key to quelling their concerns about having, and
being known to have, depression.
Theme 2: Limiting self-disclosure and mustering autonomy
Most participants were vigilant in their steadfast avoidance of inadvertently giving clues
that they had a depression. Fearing ostracism and ridicule, a 25-year-old engineering
graduate student asserted “nobody likes a depressed person. I mean ‘misery loves
company’, except they don’t.” Similarly, a 22-year-old engineering graduate student
confirmed that “boys don’t cry. … If I tell them [friends] I was really depressed last
week… they’re going to laugh at me.” The need to limit self-disclosure was especially
strong when mixing with other men. A 24-year-old interdisciplinary studies student
explained that despite wanting to discuss his depression with friends, he was worried that
it would reduce his worth within his peer group:
You’re not supposed to open up to other guys about that. You’re supposed to
seem confident and strong and you can accomplish things on your own and stuff
like that… That’s what proves your value to other people I think and so, by
discussing it with other people… it just lowers your value… so you just shouldn’t
talk about it.
Unfortunately, restraining self-disclosure about depression dislocated an
important potential source of peer-support. Playing into limiting self-disclosure were
8
participants’ concerns of being further marginalized by others. The 23-year-old
international relations graduate who had joined a fraternity explained that receiving
support, no matter how sincere and heartfelt, would ultimately further marginalize him as
a man:
Sympathy is good in small doses…but I think too much sympathy, and charity,
and patronage… becomes something that’s not empowering for men…I think it
can become very emasculating, and really remove a lot of sense of self-worth.
Along with limiting self-disclosure, participants focussed on mustering autonomy toward
self-managing their depression in undetectable ways. As the 24-year-old electrical
engineering graduate student confirmed that “men are self-fighters to depression.”
Central to many men’s aspirations for effective self-management was avoiding
medication therapy. A 20-year-old natural resource conservation student confirmed “it’s
the type of thing where it requires a lot of effort on my behalf, which is why, in a lot of
ways, I don’t buy medication… you know, ‘take this… problem solved.” Similarly, the
20-year-old natural resource conservation student who had used antidepressants
explained, “it’s not so much that they weren’t helping …but it felt forced, not authentic
and not the right way of going about it.” He elaborated that:
Nothing that the body can actually produce on its own, can just as perfectly be
synthesized in a pill… I just refuse to accept that. Just like Ecstasy is fake
happiness to the extreme sense… some type of prescription medication that I get
from my doctor that has serotonin in it or whatever is just as much bullshit to me.
9
In rejecting prescription medications these participants also detailed an array of
philosophical standpoints and/or specific self-management strategies. In this respect,
even among participants who had been treated for depression, the desire to self-manage
their depression on their own terms was strongly evident. A 21-year-old arts student
conceded professional help was “temporarily useful” while a 20-year-old natural resource
conservation student chronicled, self-management strategies focussed on “taking care of
myself like, you know, doing everything that’s healthy… being outside in the sun a lot…
eating well… exercising well.” Maintaining physical health and fitness was a way for
him to preserve his autonomy as he recovered from depression. The 23-year-old
international relations graduate believed that he could overcome depression:
I like doing things myself, and you know, like being in power of my own abilities.
I don’t like making excuses and expecting other people to solve my problems for
me. … And I thought if I build my own mind to, you know, think productively,
and not be so negative, and stop making excuses, that I can, you know, overcome
it naturally.
For many participants, limiting self-disclosure and mustering autonomy reinstated some
control to their lives, though they were more forthcoming about the details of what they
did not do (e.g., confide in others, take medications) rather than detailing specific selfmanagement regimens for their depression.
Theme 3: Redefining Strength
A few participants traversed many of the somewhat restrictive masculine ideals detailed
in the first two themes. Though less predominant than the first two themes, the findings
10
within “redefining strength” afford important insights to why and how some men sought
help for their depression. Key to redefining strength as inclusive of depression related
help-seeking was the permission of other people (especially family and other men),
and/or knowledge that men experience depression. Indeed, the affirmation of others was a
potent normalizer of both men’s depression and help-seeking. A 24-year-old electrical
engineering graduate student reported that his mother, who had also experienced
depression, assured him “there’s nothing to be ashamed about having depression because
it runs in the family essentially.” Similarly, a 23-year-old international relations student
explained how he had always been supported and supportive in talking about a range of
issues with family and friends:
I’m not unique, but I have a different experience because I guess my best friend in
high school came out in the middle of grade eleven and so I spent hundreds of
hours talking to him about feelings and what not… Also, my family is very much
open with how things should feel. I definitely sense it’s not typical for guys.
Revealed was how this participant’s upbringing and past experiences had allowed him to
normalize talking through potentially challenging personal issues. While acknowledging
that most men “will just deal with it (depression), or think they can deal with it on their
own without telling people”, and that talking about depression could be seen as “a sign of
vulnerability,” he knowingly and unapologetically acted differently:
My entire experience with health care aspects that I’ve been delivered have been
excellent. I can go in and talk to my GP and sort of talk about these sorts of things
with him to the same extent I can talk about this with my counsellor.
11
In crediting his parents, he also defended interactions with health care providers as
genuine, therapeutic and strength based. Similarly, a few participants talked about the
benefits of antidepressants. The 23-year-old international relations student said:
Without the medications depression feels like clouds just blocking out
everything… so, sort of looking back at it… it would sort of be like it was without
colour or without music. Just very bland… not so much sad but just bland like
there was no stimulus coming in.
The 24-year-old electrical engineering graduate student confided that having peers “in the
same boat” made it easier to seek and accept help. Moreover, he suggested that rather
than women guiding men’s health, the permission of other men was the most potent
driver for normalizing men’s depression-related help-seeking:
I think the thing that would help the most to convey the message to guys are other
guys… rather than women….[if] you’ve got this big huge burly guy that’s sharing
his feelings with you and trying to tell you, ‘Hey, go seek counselling’… I
probably think it would help more than having some puny little girl.
Evident here are examples of how masculine strength can be recast in specific contexts.
Essentially, by positioning help-seeking as a strength-based action among manly men,
rather than a passive response to women’s insistence towards professional help,
masculine ideals of strength and autonomy are argued as affirming depression-related
help-seeking. The few participants who argued help-seeking as a manly virtue remind us
how health-harming masculine ideals can be redefined within specific contexts.
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Discussion
Findings from the current study confirm that wanting to pass as depression-free can lead
college men to avoid completely and/or conceal their help-seeking efforts. Gender
constraints are predominant in this regard; however, evident also are how masculinities
and depression-related help-seeking are contextual, relational, and therefore subject to
change. For example, consistent with Kimmel’s (2008) observation that many young men
rely on peers to validate their masculinity and initiate them to manhood, our findings
highlight that many men deny weakness and limit self-disclosure as the conduit toward
mustering autonomy for managing their depression. This finding supports Courtenay’s
(2000) assertion that men are taught to uphold values including self-reliance and that
college men, in particular, avoid dependence on social supports (Courtenay, 2004). Also
reflected are the O’Brien et al. (2007) results reporting a key practice of masculinity to be
the endurance of pain without complaining, and how exhibiting signs of, or expressing
emotional distress is avoided because it contravenes masculine norms. Additionally,
many participants in our study did not feel safe to reveal to anyone their fears and
vulnerabilities, a finding that echoes Heifner’s (1997) results.
While the restrictive nature of masculine ideals permeates our study findings, the
contextual and relational nature of masculinities, and the means by which ideals and
norms shift, offers important insights about hearing men who operate outside what
13
O’Brien et al. (2007) label the “culture of silence” (p. 193). In this regard our findings
resonate with Addis and Mahalik’s (2003) and Emslie et al. (2006) observations that
men’s help-seeking is highly variable in different contexts. For example, redefining
strength signals the diversity with which masculine ideals can be embodied in the context
of depression-related help-seeking. Though fewer in number, our findings chronicle how
some men critically examine and redefine help-seeking as a strength-based enterprise
rather than signalling weakness. That said, it was also evident that redefining helpseeking was contingent on the permission of significant others – especially family and
male peers. These findings remind us of the relational aspects of masculinities and how
college men’s actions toward and away from help-seeking are co-constructed. Resonating
with Emslie et al. (2006), some men valued independence in managing their depression,
and willingly accepted professional help to maintain autonomy.
Clinical implications
Clinicians can be supported by gender-sensitive mental health policies as suggested by
Bergin, Wells and Owen (2012) and recognition of three findings detailed within the
current study and the wider masculinities and men’s depression literature. First, as
Courtenay (2000) articulated, “masculinity requires compulsive practice, because it can
be contested and undermined at any moment” (p. 1393). Therefore, men seeking
professional help for depression may attempt to downplay their distress even when
seeking-help (Wide et al., 2011). Second, related to this, clinicians must explicitly
provide permission for men to talk about their mental health concerns (Brownhill, 2003).
Open-ended, loop and prompt questions are important strategies for encouraging men to
articulate depressive symptoms. Third, key to men’s depression self-management is on14
going access to reliable resources, and some evidence suggests that young men
effectively use the internet for health information (Robinson & Robertson, 2010).
Therefore, formal planning and evaluation of gender-specific mental health promotion
interventions, as advocated by Svedberg (2011), is key for clinicians to provide direction
to reputable online resources that will engage men beyond time-limited face-to-face
consultations.
Limitations
Though the current study is novel in reporting the help-seeking of college men who selfidentify and/or are formally diagnosed with depression future work might benefit by
focusing on issues including health literacy, social class and socio-economic status
among college men as well as across diverse sub-groups of college age men. These
approaches could make available comparative studies, the findings from which might
guide targeted interventions. The current study limitations of a small sample size and
cross-sectional analysis also provide important direction for future research focused on
college men’s depression. For example, study designs including longitudinal data
collection and mixed methods approaches could illuminate patterns prevailing across
college men who are at risk of or experiencing depression. These descriptive studies are
important to developing and formally evaluating much needed college men’s mental
health care services.
Conclusion
At a time of rising unemployment and economic uncertainty, many emergent factors can
add to the pressures college men experience. In this regard, while some men may have
15
experience with depression, many college men can be vulnerable to developing
depression. Making available findings such as ours provides important insights and a
foundation on which to build understandings about how masculinities can work for and
against college men’s depression-related help-seeking.
16
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Table 1: Participant Demographic Data
N
Age (years)
Mean
Range
Ethnicity
Anglo-Canadian
European-Canadian
East-Indian/South Asian
Chinese
Latino
Middle Eastern
Mixed
Sexual Orientation
Heterosexual
Homosexual
Bisexual
Area of study
Arts
Engineering
Sciences
Commerce
Years in University
Undergraduate programs
Graduate programs
Formal diagnosis of
depression
Treatment for
depression
Beck Depression
Inventory Scores
Minimal
Mild
Moderate
Severe
21
22.3
19-25
5
1
6
5
1
1
2
18
2
1
7
8
5
1
12
9
12
13
3
7
5
6
20