New directions in male-tailored psychotherapy for depression

Purpose of review Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men’s presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men’s help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders. Recent findings A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James’ Place program, a male-tailored community-based service, improved suicidal men’s overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners’ capacity to engage and support men in therapy. Summary Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.

[1]  Philip J. Osteen,et al.  Help-seeking and Man Therapy: The impact of an online suicide intervention. , 2022, Suicide & life-threatening behavior.

[2]  Philip J. Osteen,et al.  Effectiveness of man therapy to reduce suicidal ideation and depression among working‐age men: A randomized controlled trial , 2022, Suicide & life-threatening behavior.

[3]  U. Ehlert,et al.  Status loss due to COVID-19, traditional masculinity, and their association with recent suicide attempts and suicidal ideation. , 2022, Psychology of Men & Masculinities.

[4]  J. Ogrodniczuk,et al.  Men’s Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms? , 2022, Harvard review of psychiatry.

[5]  U. Ehlert,et al.  Association between psychotherapy use, sexual orientation, and traditional masculinity among psychologically distressed men. , 2022, Psychology of Men & Masculinities.

[6]  Douglas Gazarian,et al.  Masculine depression: A person-centric perspective. , 2022, Psychology of Men & Masculinities.

[7]  Michael J. Wilson,et al.  Pilot evaluation of the men in mind training program for mental health practitioners. , 2022, Psychology of Men & Masculinities.

[8]  J. Ogrodniczuk,et al.  An Evaluation of 5-Year Web Analytics for HeadsUpGuys: A Men’s Depression E-Mental Health Resource , 2021, American journal of men's health.

[9]  Daniel W Capron,et al.  Masculinity's association with the interpersonal theory of suicide among military personnel. , 2021, Suicide & life-threatening behavior.

[10]  A. Walther,et al.  Men’s Psychotherapy Use, Male Role Norms, and Male-Typical Depression Symptoms: Examining 716 Men and Women Experiencing Psychological Distress , 2021, Behavioral sciences.

[11]  U. Ehlert,et al.  Male depression risk, psychological distress, and psychotherapy uptake: Validation of the German version of the male depression risk scale , 2021 .

[12]  W. Rutz,et al.  Suicide in men , 2021, Oxford Textbook of Suicidology and Suicide Prevention.

[13]  A. Walther,et al.  Männliche Formen der Depression und deren Behandlung , 2020, PiD - Psychotherapie im Dialog.

[14]  J. Ogrodniczuk,et al.  Suicide risk, psychological distress and treatment preferences in men presenting with prototypical, externalising and mixed depressive symptomology , 2020, Journal of mental health.

[15]  J. Ogrodniczuk,et al.  What gets in the way? Men’s perspectives of barriers to mental health services , 2020, The International journal of social psychiatry.

[16]  Zohn Rosen,et al.  Association of High Traditional Masculinity and Risk of Suicide Death: Secondary Analysis of the Add Health Study. , 2020, JAMA psychiatry.

[17]  T. Kershaw,et al.  Dimensions of Masculine Norms, Depression, and Mental Health Service Utilization: Results From a Prospective Cohort Study Among Emerging Adult Men in the United States , 2020, American journal of men's health.

[18]  Michael J. Constantino,et al.  Patient characteristics and the therapist as predictors of depressed patients’ outcome expectation over time: A multilevel analysis , 2019, Psychotherapy research : journal of the Society for Psychotherapy Research.

[19]  J. Ogrodniczuk,et al.  Men’s Depression and Suicide , 2019, Current Psychiatry Reports.

[20]  R. Horton,et al.  Reducing the global burden of depression: a Lancet–World Psychiatric Association Commission , 2019, The Lancet.

[21]  J. Ogrodniczuk,et al.  Validity of the Male Depression Risk Scale in a representative Canadian sample: sensitivity and specificity in identifying men with recent suicide attempt , 2019, Journal of mental health.

[22]  J. Ogrodniczuk,et al.  Men, Masculinities, Depression: Implications for Mental Health Services From a Delphi Expert Consensus Study , 2019, Professional Psychology: Research and Practice.

[23]  S. Rice,et al.  Men In and Out of Treatment for Depression: Strategies for Improved Engagement , 2018, Australian Psychologist.

[24]  B. Wampold,et al.  Is psychotherapy effective? A re-analysis of treatments for depression , 2018, Epidemiology and Psychiatric Sciences.

[25]  J. Ogrodniczuk,et al.  HeadsUpGuys: Canadian online resource for men with depression. , 2018, Canadian family physician Medecin de famille canadien.

[26]  T. Vos,et al.  Global, regional, and national incidence and prevalence, and years lived with disability for 328 diseases and injuries in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017 .

[27]  H. Grabe,et al.  Trends in non-help-seeking for mental disorders in Germany between 1997–1999 and 2009–2012: a repeated cross-sectional study , 2017, Social Psychiatry and Psychiatric Epidemiology.

[28]  L. Abramson,et al.  Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms , 2017, Psychological bulletin.

[29]  S. Rice,et al.  The role of masculinity in men's help-seeking for depression: A systematic review. , 2016, Clinical psychology review.

[30]  Aaron Rochlen,et al.  Men's depression: Endorsed experiences and expressions , 2016 .

[31]  A. Cooper,et al.  Dropout from individual psychotherapy for major depression: A meta-analysis of randomized clinical trials. , 2015, Clinical psychology review.

[32]  D. Coleman.  Traditional Masculinity as a Risk Factor for Suicidal Ideation: Cross-Sectional and Prospective Evidence from a Study of Young Adults , 2015, Archives of suicide research : official journal of the International Academy for Suicide Research.

[33]  L. Sher.  Suicide in men. , 2015, The Journal of clinical psychiatry.

[34]  J. O'neil,et al.  Men's Gender Role Conflict: Psychological Costs, Consequences, and an Agenda for Change , 2014 .

[35]  Z. Segal,et al.  GENDER AS PREDICTOR AND MODERATOR OF OUTCOME IN COGNITIVE BEHAVIOR THERAPY AND PHARMACOTHERAPY FOR ADULT DEPRESSION: AN “INDIVIDUAL PATIENT DATA” META‐ANALYSIS , 2014, Depression and anxiety.

[36]  J. Prasko,et al.  Perspectives on perceived stigma and self-stigma in adult male patients with depression , 2014, Neuropsychiatric disease and treatment.

[37]  S. Rice,et al.  Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men. , 2013, Journal of affective disorders.

[38]  M. Englar-Carlson,et al.  Affirming the Strengths in Men: A Positive Masculinity Approach to Assisting Male Clients , 2013 .

[39]  Harold W Neighbors,et al.  The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. , 2013, JAMA psychiatry.

[40]  J. O’Neil.  Gender Role Conflict Research 30 Years Later: An Evidence-Based Diagnostic Schema to Assess Boys and Men in Counseling , 2013 .

[41]  K Bennett,et al.  Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression. , 2013, Journal of affective disorders.

[42]  Jennifer K. Bosson,et al.  Hard won and easily lost: A review and synthesis of theory and research on precarious manhood. , 2013 .

[43]  S. Bartle-Haring,et al.  Trajectories of Therapeutic Alliance in Couple Versus Individual Therapy: Three-Level Models , 2012, Journal of sex & marital therapy.

[44]  S. Cochran,et al.  Men and Depression: Current Perspectives for Health Care Professionals , 2011 .

[45]  G. Simon,et al.  Predictors of early dropout from psychotherapy for depression in community practice. , 2010, Psychiatric services.

[46]  D. Nahon,et al.  The Effectiveness of Gender Role Re-Evaluation and Non-Gender-Focused Group Psychotherapy in the Treatment of Recently Separated Men , 2010 .

[47]  M. Addis,et al.  The Men's Stress Workshop: A Gender-Sensitive Treatment for Depressed Men , 2010 .

[48]  M. Addis.  Gender and Depression in Men , 2008 .

[49]  D. Vogel,et al.  Male gender role conflict and willingness to seek counseling : Testing a mediation model on college-aged men , 2007 .

[50]  A. Kroska.  Gender Ideology and Gender Role Ideology , 2007 .

[51]  J. Ogrodniczuk.  Men, women, and their outcome in psychotherapy , 2006 .

[52]  Doug Thomson,et al.  Men and therapy: critical concepts, theoretical frameworks, and research recommendations. , 2005, Journal of clinical psychology.

[53]  M. Addis,et al.  Linking Gender-Role Conflict to Nonnormative and Self-Stigmatizing Perceptions of Alcohol Abuse and Depression. , 2005 .

[54]  J. Mahalik.  Interpersonal psychotherapy with men who experience gender role conflict. , 1999 .

[55]  Jack W. Sattel,et al.  The Forty-Nine Percent Majority: The Male Sex Role , 1976 .

[56]  The James’ Place model: Application of a novel clinical, community-based intervention for the prevention of suicide among men , 2022 .

[57]  D. Kavanagh,et al.  Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis , 2017, Harvard review of psychiatry.

[58]  R. Levant,et al.  The gender role strain paradigm and masculinity ideologies. , 2016 .

[59]  W. Halford,et al.  The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness. , 2016, Journal of marital and family therapy.

[60]  M. Addis,et al.  Men, masculinity, and the contexts of help seeking. , 2003, The American psychologist.

[61]  Joseph H. Pleck,et al.  The gender role strain paradigm: An update. , 1995 .

[62]  J. Pleck,et al.  Masculinity ideologies: A review of research instrumentation on men and masculinities. , 1995 .

[63]  Joseph H. Pleck,et al.  The myth of masculinity , 1981 .