Men Don’t Always Look Depressed

Source: Dusan Petkovic/Shutterstock

Healthcare providers struggle to assess men's depression because screenings focus on obvious symptoms, missing those who do not acknowledge their struggles or view them as serious. Helping men connect their depressed state with underlying behaviors, thoughts, and emotions requires more than a checklist.

While it is often reported that men are four times more likely to die by suicide than women, a critical point is that 87% of those men who died by suicide had visited a healthcare provider in the past year. Most likely, these men completed a depression screening during their medical visit. Does inadequate screening contribute to these deaths?

Social stigma and cultural pressure complicate identifying depression in men, but a deeper issue lies in men's struggle to connect thoughts and feelings. Building trust and investing time are essential for them to recognize depression.

In countless interviews with men, I have described the negative cognitive triad associated with depression:

• Negative view of self—I am inadequate. I am not enough. I don’t measure up.
• Negative view of the world—I am judged negatively by others. I am not valued by others. People ignore me.
• Negative view of the future—Things are not going to change. I have no power to make things better. Things will get worse.

Many men will hear this short summary and completely agree that these three mindsets characterize them. However, when I comment that people who have these beliefs are depressed, men will typically reply, “Oh, I’m not depressed. I don’t feel bad about those things. Life is just hard sometimes. So what?”

At this point in the conversation, I often ask about the pressures, challenges, responsibilities, and general satisfaction with life, work, and relationships. This is the part of assessing depression that takes time and trust. Men connect their sense of worth and value to the contributions they make. Research has demonstrated that when men have lower job satisfaction, they are more likely to report reduced meaning in life and, as a result, experience increased anger, depression, and anxiety.

Rather than only relying on the typical symptoms of depression, such as poor sleep, appetite, energy, and interest in usual activities, I also inquire about behaviors and symptoms men might experience but not connect directly with depression. Here are seven topics that are worth discussing:

1. Screen Time—There is a difference between using electronic devices to get work done and simply being online to be distracted. Video games, sports, YouTube, and movies are often used for distraction.
2. Alcohol—About one-third of people who are depressed drink excessive amounts of alcohol. Alcohol use, when combined with depression, increases the risk of suicide and poor social functioning. It is worth asking whether a person has switched to a different drink, such as vodka or whisky, rather than beer.
3. Pain—Back pain, stomach pain, and headaches might seem to be a normal part of life from time to time, but depression will increase pain sensitivity, making increased pain another common sign of depression.
4. Risky Behavior—Getting a quick burst of dopamine comes in many forms, and risky behavior with motor vehicles or sexual activity is one way to find it for some men. Like other forms of distraction, risky behavior is a fast way to temporarily feel less bad.
5. Money—While men are not known for spending hours shopping in a mall, they can be impulsive when it comes to spending money on a hobby or special interest. When savings are compromised or significant debt develops, this can be a sign of depression.
6. Work—Some men simply work a great deal as a course of life, but this does not mean working long hours is healthy. It is not what we do that matters; it is why we do what we do. Work is a powerful way to avoid other areas of life where responsibilities and relationships are not going well.
7. Concentration—Being able to focus and sustain attention is a key mental ability that underlies memory and many other functions. If a person is constantly losing their keys, wallet, and other items, or is making mistakes in their work, depression could be an underlying factor.

If you are wondering if you are depressed, you can learn more by clicking here.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.