Contrary to popular belief, women do not suffer from depression more than men. A study of medical students back in 1988 found equal rates of depression among males and females, and a few years later another study found that “medical practitioners were significantly less likely to identify depression in men than in women”. A study published in JAMA Psychiatry from October 2013 agrees that depression in men often goes undiagnosed.
The ICD-10 is the international standard for diagnosing mental conditions, though the United States uses the DSM-V. Symptoms of depression include anhedonia (loss of interest in pleasurable activities), fatigue, loss of appetite, sleep disturbance, guilt and self-blame, and suicidal ideation.
But men experience depression differently from women. Missing from the ICD-10 and the DSM-V are symptoms that could indicate depression, but which men experience disproportionally. Increased substance abuse, anger, risky behaviours such as reckless driving, escapism, and increased immersion in work are examples.
Untreated male depression is of great concern because the suicide rate is enormously higher for men. Note the blue bars in this graph from the United States’ Centers for Disease Control:
And it’s not just the States. Suicide is the seventh leading cause of death for Canadian men. In the United Kingdom, 18.2 men per 100,000 commit suicide compared to 5.6 per 100,000 for women, making men three-quarters of all suicides. Australia shows a similar pattern. Further, male suicide increases with age and is ten times higher among poor men relative to wealthy men.
Women attempt suicide more than men, but a cry for help shows one still has hope and doesn’t really want to die. Actually killing oneself is the loss of all hope. After an attempt one can get help, but after suicide the person is dead.
The British organization Samaritans identifies several reasons for the high male suicide rate:
- Male gender roles: Men are supposed to be strong and are often shamed by both men and women for asking for help.
- Shifting gender roles: Middle aged men particularly are caught in the middle of a cultural shift and often are expected to be more emotionally open while also being expected to be strong and silent.
- Men are still defined by their economic prospects in an era where many men’s economic prospects are decreasing due to shifts in the global economy.
- Relationship breakdown: Men’s suicide risk increases greatly after divorce. Men rely more on their partners for emotional support, and have fewer sources of emotional support besides their partners.
- The stigma for seeking therapy is greater for men.
What can be done about male suicide?
- Raise public awareness about male suicide.
- Teach doctors and therapists to recognize depression in men.
- Take men’s issues seriously. Too often men are shut down when they try to talk about issues that affect them deeply. Some of this is due to zero sum thinking: addressing men’s issues means not addressing women’s issues. But this is faulty thinking.
- Take men’s health as seriously as we take women’s health. In the United States, information about male suicide is found at womenshealth.gov because the US government has no similar resource for men’s health.
- Build upon therapeutic approaches of counselors such as Tom Golden that focus on male ways of healing. For example, men like to do things rather than sit and talk, and there’s no reason why a therapy session can’t happen while shooting hoops.
- Link alcohol and drug treatment with suicide prevention as the two significantly overlap.
- Focus on the emotional adjustment of boys when the gender suicide gap first begins to appear.
- Assess why boys are falling behind in school, and how our approach to education can be made more boy friendly to prevent them from falling behind economically as men.