Authors Proudfoot J, Fogarty AS, McTigue I, et al.
Review Date December 2015
Citation BMC Public Health, 2015; 15: 1135
Three of every five deaths by suicide in Australia are men. The vast majority experience depression prior to death despite it being one of the most preventable mental illnesses: it is estimated that 22% of new cases per year can be prevented with evidence-based interventions. There is a need to understand men’s adaptive responses to depression to inform public health programs that facilitate men’s uptake of such interventions. While much research has focused on men’s use of unhelpful coping strategies to prevent and manage depression (e.g. self-medication with alcohol, risk-taking behaviour), there has been little emphasis on men’s use of positive strategies.
To examine 1) the positive strategies men use to prevent and manage depression, 2) whether strategy use varies according to demographic factors, and 3) whether strategy use predicts depression risk and symptoms.
An online survey was developed based on findings from previous qualitative investigation by the authors. Respondents selected options from a designated list of 26 positive prevention and management strategies; there was also additional space to record any strategies used that were not on this list. For each strategy, they were asked whether they used it and how often they used it or their openness to using it. Standard demographic data were collected and participants were also asked whether they had experienced stressful life events in the previous year. Depression risk was assessed using the Male Depression Risk Scale (MDRS) and depression symptoms by the Patient Health Questionnaire-9 (PHQ-9).
Men were eligible to participate if they were aged 18 years or older and were a resident in Australia. Participants were recruited through several strategies including advertisement on social media, a press release, and promotion via several radio stations.
Of the 689 men who were eligible and consented for the study, 465 men completed the survey (response rate = 67%). Participants ranged in age from 18 to 74 years old (mean = 40.6 years). Approximately half (56.8%) were in a relationship and (49.0%) held a bachelor degree. The majority (78.1%) lived in a metropolitan area. The vast majority (93.5%) reported ever having experienced depression, with 54.6% reporting that they had received treatment for depression.
Prevention and management strategies
The mean number of prevention strategies used was 16.8. The five most regularly used prevention strategies were:
- Eating healthy (54.2%)
- Exercising (44.9%)
- Keeping myself busy (50.1%)
- Using humour to reframe my thoughts/feelings (41.1%)
- Doing something to help another person (35.7%).
Additional strategies listed by men typically belonged to one of the following categories: 1) specific pleasurable activities, 2) relationships and/or social connections, and 3) improving physical health.
The mean number of management strategies used was 15.4. The five most regularly used management strategies were:
- Take some time out (35.7%)
- Reward myself with something enjoyable (35.1%)
- Keeping myself busy (35.1%)
- Exercising (33.3%)
- Spending time with a pet (32.7%)
Additional management strategies listed by men included looking at photos or videos from happier moments, lots of rest and ‘quiet time’, avoiding people until feeling better, and making plans for the future.
Openness to using new strategies
Overall, men reported being open to trying new strategies. The top five prevention strategies men were most open to were:
- Maintaining a relationship with a mentor (58.3%)
- Joining a group, club or team (48.0%)
- Meditation, mindfulness or gratitude (46.5%)
- Seeing a health professional (40.9%)
- Focusing on life’s purpose (38.7%)
The top five management strategies men were most open to were:
- Contacting a mentor when feeling down (57.8%)
- Joining a group club or team (47.3%)
- Meditation, mindfulness or gratitude (45.2%)
- Setting goals for the future (41.7%)
- Seeing a health professional (41.3%).
Strategy use and demographic factors
For prevention strategies, younger men tended to use more cognitive strategies, single and divorced men tended to use more pleasure strategies, and men with a university degree were more likely to use self-care and achievement strategies. For management strategies, older men were more likely to use self-care strategies, single men were more likely to use pleasure strategies, and men with a university degree were more likely to use cognitive and self-care strategies.
Regularly used prevention strategies and risk of depression
In multivariate analyses, lower MDRS scores were significantly and independently associated with older age, experiencing fewer stressful events, and using self-care, achievement and cognitive strategies regularly. The use of regularly used prevention strategies accounted for 18% of the variance in MDRS scores.
Regularly used management strategies and depression symptoms
In multivariate analyses, being unemployed, not tertiary educated, and experiencing more stressful events predicted 18% of the variance in PHQ-9 scores. After entering regularly used management strategies, the total variance explained was 22%. Three factors were found to be significantly and independently associated with lower PHQ-9 scores: being employed, having a university degree and regularly using cognitive management strategies.
Men use a variety of strategies to prevent and manage depression. The breadth of these strategies demonstrate that men view their mental health as being connected to their physical health, social connections, helping others, and recognising the need for ‘rewards’. Health professionals should note that not all prevention strategies could be used for management purposes; once symptomatic, men reported that managing symptoms through cognitive strategies was important. Public health programs for reducing depression may be more successful with the inclusion of positive strategies derived from men.
Points to Note
- This study is unique in its focus on men’s use of positive strategies (as opposed to negative strategies) to prevent and manage depression.
- Men used a variety of strategies to prevent and manage depression, and were open to trying several new strategies. Regular use of self-care, achievement and cognitive prevention strategies were associated with reduced risk of depression, while regular use of cognitive management strategies were associated with reduce depression symptoms.
- The survey sample consisted of more men with depression, tertiary education and who lived in a metropolitan area than in the general population; the findings of this study may not generalise to the population. Some strategies may be effective with only occasional use; this study considered regular use of strategies only. Causal relationships strategy use and depression cannot be derived from this study due to the use of a cross-sectional design.
- Health professionals should note that not all prevention strategies could also be used for management purposes. Public health programs may be more effective with the inclusion of these prevention and management strategies that men have identified with.