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World Health Day: Unmasking Male Depression

Why depression in men may be under-diagnosed and under-recognized.

Friday April 7th is World Health Day, officially sponsored by the World Health Organization. This day is celebrated every year to raise awareness of a specific health problem. This year, the chosen health problem is depression.

Depression is one of the leading causes of disability and ill-health worldwide. It can have a devastating effect on the quality of life of the afflicted person, involving intense psychological suffering as well as severe functional impairment.

Research indicates that approximately one in five people will experience an episode of depression during their lifetime. Interestingly, epidemiological surveys routinely indicate that men have a much lower prevalence of depression than women. Indeed, women are two to three times more likely to be diagnosed with depression, leading to a common impression that depression is generally a woman’s disease.

But is it?

Some scholars are now forcefully arguing that rates of depression may be very similar between men and women, and that male depression is under-diagnosed and under-recognized due to a variety of factors.

Firstly, research suggests that men are much less likely to acknowledge and report possible symptoms of depression. Likewise, men often judge that symptoms of depression are less severe in comparison to women.

This led Yale Professor Susan Nolen-Hoeksema to declare that women ‘amplify’ and men ‘blunt’ possible symptoms of depression. In other words, men are much more likely to downplay their suffering, both to themselves as well as others.

This means that doctors, as well as epidemiologists, may easily fail to detect the presence of depression in men. This can result in inaccurately low prevalence rates, as well as numerous ‘false negatives’, where men with actual depression are misdiagnosed as mentally healthy.

Secondly, it has been argued that depression can manifest itself very differently in men, in a way that is not captured by existing methods of diagnosis. This is based on data suggesting that women tend to ‘act in’ when faced with deep personal suffering, while men ‘act out’.

Acting-in is a psychological state where the sufferer is overwhelmed by feelings of guilt, worthlessness, hopelessness, helplessness and emptiness. Acting out is a behavioral state which often involves high levels of alcohol and drug misuse, increased risk-taking, poor impulse control, and increased anger and irritability.

It has been argued that these acting-out variables are ‘depressive equivalents’ concealing a pathological sadness, loneliness, and alienation in the afflicted men. This correlates with the notion of ‘masked depression’.

Thirdly, scholars remain confused at the so-called ‘gender paradox’ in suicide rates. Depression is one of the strongest predictors of suicide, and men make up around 75% of completed suicides. However official statistics suggest that depression is much less common in men than women.

The disconnect between low rates of depression diagnosis and high rates of suicide in men is further evidence that conventional measures of depression may be missing the mark when it comes to identifying male cases of depression.

World Health Day is an opportune time to reflect on the toll that depression takes on individuals, their families and society as a whole. There is a need for further investigation and action regarding depression in men, which may be underreported and undertreated.

This will ensure that vulnerable men are given the services and supports they deserve, enabling them to live healthy, productive and fruitful lives.