Stereotypes keep depressed men from care

NEW YORK (Reuters Health) - Depressed older men are much less likely than depressed older women to recognize their depression and seek treatment for it, a study confirms.

Several themes that help to explain these disparities also emerged in the study, conducted by Dr. Ladson Hinton of the University of California-Davis School of Medicine and colleagues.

Men tend to experience and express their depression differently than women, they report in the American Journal of Geriatric Psychiatry. Men less often express common symptoms of depression, such as depressed mood or sadness, and may actively try to conceal or mask their depression, whereas women tend to be more open about their depressed mood.

Men are also more apt to express their depression through anger, rage and risky behavior.

The stereotypical "tough-guy" image, which can make men unwilling to admit to feeling blue, is another key factor that keeps many older depressed men from being diagnosed and treated, the team found.

"Old school" or "John Wayne type" older men are difficult to diagnose and treat because they perceive depression to conflict with their masculinity, Hinton and colleagues have observed. For this subgroup, depression connotes vulnerability or weakness and is in direct conflict with an image of men as self-sufficient, tough and stoic.

Consistent with prior studies, Hinton's group has found that the stigma of depression is an important barrier to care in men, particularly its association with severe mental illness.

The team's observations are based on an analysis of data from 1,800 depressed adults age 60 years or older participating in a study of depression, as well as interviews with 30 trial physicians, depression care managers and study recruiters.

"The public health importance of improving care for depression among older men is clear," conclude the researchers. "Older men experience higher rates of completed suicide than any other age and gender group (approximately eight times higher than older women)," they write. The men in this study were also more likely than women have suicidal thoughts.

"Because depression is one of the most important suicide risk factors," they add, "elucidating gender-specific aspects of depression care has the potential to reduce this disparity, close the gender gap in depression treatment, and lessen the enormous burden of suffering for older adults and their families caused by depression in older men."

SOURCE: American Journal of Geriatric Psychiatry, October 2006.