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Depression and other mental health problems are common in men, but men often don’t receive proper diagnosis and treatment.

Mental health in men is a serious issue. An estimated six million men in the United States suffer from depression, according to the National Institute of Mental Health. Phobias, such as social phobias and panic attacks, are the second most common mental health condition in men older than 25. Although schizophrenia, a lifelong mental illness, strikes men and women in about equal numbers, it comes on earlier in men — symptoms appear in the late teens to early 20s in men compared to the mid-20s to early 30s in women. Most alarming, four times as many men as women die from the most serious consequence of mental health problems: suicide.

Fortunately, help is available for men with depression and other mental health conditions.

Men and Mental Health: Gender Differences

Studies have found that depression is twice as common in women as in men, but many experts believe depression in men may be under-reported.

“It’s well known that women are more likely to recognize that something is wrong and go to the doctor,” says Stephan Quentzel, MD, a family physician, psychiatrist, and assistant professor of medicine at Albert Einstein College of Medicine in New York City.

Because women are more likely to go to the doctor with mental health complaints, they’re diagnosed more often. Additionally, depression looks different in men. While a depressed woman may feel sad, cry easily, and lack energy, depression in a man is more likely to exhibit itself as aggression, anger, and irritability. He may get into fights, abuse his wife and children, or compulsively seek thrills in high-risk behavior. Often, a depressed man will cope by taking drugs or drinking too much. This can mask depression, making it less likely that a man will receive treatment for the underlying mental health condition. “For a variety of reasons, many men aren’t getting proper diagnosis and treatment for their depression, which can be life-saving,” says Dr. Quentzel.

Men and Mental Health: The Stigma of Depression in Men

Cultural expectations can make it hard for men to admit to mental health problems and seek help. Because a man may feel pressure to maintain a tough-guy image, he may suffer in silence or try to fight through his depression, using strategies like violence or drinking.

“There’s a stigma attached to depression in men,” says Quentzel. “Men can see being depressed as a sign of weakness.” The alarming suicide rate in men may be a reflection of the stigma of depression. Rather than seeking treatment, a man may choose suicide as the best way out of his pain and distress. While women actually make more suicide attempts than men, males are more often successful in their suicide attempts, partly because they’re more likely to use guns (women often take pills). Many experts believe that proper diagnosis and treatment of mental health problems in men could greatly reduce the suicide rate.

Men and Mental Health: The Benefits of Treatment

Many mental health conditions are highly treatable. Medications for phobias and schizophrenia are effective for most patients, though it may take some trial and error to find the right one; and depression can be treated in a variety of ways.

“At least 80 percent of adults with depression improve when they receive treatment with antidepressant medication, psychotherapy (talk therapy), or a combination of both,” says Quentzel. Electroconvulsive therapy (ECT) may be a treatment option for severe depression. Men should start by making an appointment with their primary care doctor, who may then refer them to a psychologist, psychiatrist, or other psycho therapist for appropriate diagnosis and treatment. With proper treatment, most men begin to feel better within six months.

Seeking help for mental health issues can lead to a happier and healthier life. Keep in mind that depression and other mental illnesses are real diseases that affect men as well as women. Getting treatment for a mental condition is not a sign of weakness. It may be the best thing a man can do for himself and his loved ones.

Findings reflect need for improved psychological services, researcher says.

TUESDAY, Sept. 27 (HealthDay News) — The number of Americans who say they suffer from mental health disabilities has jumped significantly over the past decade, a new study shows.

Researchers from the Johns Hopkins Bloomberg School of Public Health found the prevalence of self-reported mental health disability rose from 2 percent between 1997 and 1999 to 2.7 percent between 2007 and 2009. The increase amounts to nearly 2 million disabled adults, the study noted.

“These findings highlight the need for improved access to mental health services in our communities and for better integration of these services with primary care delivery,” said Dr. Ramin Mojtabai, an associate professor at the Bloomberg School of Public Health, in a university news release. “While the trend in self-reported mental health disability is clear, the causes of this trend are not well understood.”

In conducting the study, researchers examined information collected in the U.S. National Health Interview Survey involving 312,364 adults ranging in age from 18 to 64.

The increase in adults reporting mental health disabilities was mainly among people with significant psychological distress who did not seek out mental health services in the past year and in people who also reported disabilities related to other chronic conditions, the study noted.

Financial hardship may be to blame for lack of treatment. The number of people who did not receive mental health care due to financial reasons increased from 2 percent between 1997 and 1999 to 3.2 percent 10 years later, the researchers said.

The study was reported online Sept. 22 ahead of print publication in the American Journal of Public Health.

Fewer adults reported disability related to other chronic conditions than 10 years earlier, while roughly the same number experienced significant psychological distressat the start and end of the decade.

Apart from personality traits, people also tend to develop habitual modes and methods of managing stress and coping with upsetting emotions. By and large, these habitual methods do help people to manage and defuse stressful situations they find themselves in, but they are not all equally efficient at this task. Some work better than others. While some really do succeed in helping people to manage upsetting emotion, the lesser quality methods generally end up causing more problems than they solve.

Perhaps not surprisingly, there is a relationship between people’s emotional maturity and the sort of coping methods they prefer. Less emotionally mature people tend to prefer rather primitive and often inefficient coping methods , while more mature folks lean towards more sophisticated and more useful methods. The less mature methods also tend to have in common that their use is not premeditated or conscious in nature, but rather fairly reactive, not well thought out, and unconscious. As coping methods increase in maturity and sophistication, they become correspondingly more deliberate and conscious in nature, and also tend to be used more proactively, rather than simply reactively.

The study of coping methods has a long history. The topic was originally described by psychodynamic psychotherapists (including Dr. Freud) who called them defense mechanisms. The defense mechanism literature was largely focused on mental illness and the ways that various primitive mechanisms served largely to maintain serious illness rather than help reduce it. Later, more cognitively oriented researchers began a separate study of coping that focused more on mental health, and ways that mature coping methods could be taught to enhance health. Though some authors suggest that the term defense mechanisms should be reserved for describing primitive, immature coping strategies, and the term “coping methods” for more mature, useful coping efforts, it doesn’t really matter what label is used to describe the different coping methods from our perspective; they are all just people’s attempts at coping.

The most primitive of the defense mechanisms are considered to be primitive because they fundamentally rely on blatant misrepresentation or outright ignoring of reality in order to function. These mechanisms flourish in situations (and minds) where emotion trumps reason and impulsivity rules the day. Children use them naturally and normally, but then again, children are by definition emotionally immature and not held to a higher standard as are adults. When adults use these methods on a regular basis, it is an indication that their emotional development is at some level delayed.

• Denial; an outright refusal or inability to accept some aspect of reality that is troubling. For example: “this thing has not happened” when it actually has.
• Splitting; a person cannot stand the thought that someone might have both good and bad aspects, so they polarize their view of that person as someone who is “all good” or “all bad”. Any evidence to the contrary is ignored. For example: “My boss is evil”, after being let go from work, when in reality, the boss had no choice in the matter and was acting under orders herself. Splitting functions by way of Dissociation, which is an ability people have in varying amounts to be able to wall off certain experiences and not think about them.
• Projection; a person’s thought or emotion about another person, place or thing is too troubling to admit, and so, that thought or emotion is attributed to originate from that other person, place or thing. For example: “He hates me”, when it is actually the speaker who hates. A variation on the theme of Projection is known as “Externalization”. In Externalization, you blame others for your problems rather than owning up to any role you may play in causing them.
• Passive-aggression; A thought or feeling is not acceptable enough to a person to be allowed direct expression. Instead, that person behaves in an indirect manner that expresses the thought or emotion. For example: Failing to wash your hands before cooking when you normally would, and happen to be cooking for someone you don’t like.
• Acting out; an inability to be thoughtful about an impulse. The impulse is expressed directly without any reflection or consideration as to whether it is a good idea to do so. For example: a person attacks another person in a fit of anger without stopping to consider that this could seriously wound or disfigure that other person and/or possibly result in legal problems.
• Fantasy; engaging in daydreams about how things should be, rather than doing anything about how things are. For example: Daydreaming of killing a bully, instead of taking concrete action to stop the bully from bothering you.

An intermediate level of defense mechanisms (the “neurotic” mechanisms) are defined by a more ambivalent relationship with reality. Reality is recognized here to a larger extent, even if it is put off or avoided.

• Displacement; An unacceptable feeling or thought about a person, place or thing is redirected towards a safer target. For example, it may feel unsafe to admit anger towards a parent, but it is perfectly safe to criticize the neighborhood he or she lives in.
• Isolation/Intellectualization; Overwhelming feelings or thoughts about an event are handled by isolating their meaning from the feelings accompanying the meaning, and focusing on the meaning in isolation. For example, you cope with the recent death of a parent by reading about the grieving process.
• Repression; A milder form of denial; You manage uncomfortable feelings and thoughts by avoiding thinking about them. You are able to admit that you feel a certain way (unlike in denial), but you can’t think of what might have led up to that feeling, and don’t really want to think about it anyway.
• Reaction Formation; You react to uncomfortable, unacceptable feelings or ideas that you have (but aren’t quite conscious of really), by forming the opposite opinion. For example; you unconsciously hate your parent, but your experience is to the contrary; you are only aware of loving feelings for your parent.

To this historical list of intermediate, “neurotic” mechanisms, we can add a few modern ones as well:

• Rationalization; where you choose to do something on emotional grounds (because it feels good) but you don’t want to admit that, so you make up reasons after the fact to justify your choice.
• Workaholism; where you avoid dealing with problems by burying yourself in work. Workaholism could be considered a form of Distraction (see below), but distraction is something you choose to do, and many workaholics don’t perceive their devotion to the office as a choice so much as a duty.