Detecting Depression in Men: A Matter of Guesswork
Brownhill, Suzanne, Wilhelm, Kay, Barclay, Lesley, Parker, Gordon, International Journal of Men's Health
Key Words: depression; men, focus groups
Most patients consider it appropriate to turn to their physician for help with emotional distress (Brody, Khaliq, & Thompson, 1997). However, some estimate that primary care physicians overlook or do not recognize the symptoms of about half of their patients who suffer with depression (Kessler, Lloyd, Lewis, & Gray, 1999; Paykel, 1989; Simon, Goldberg, Tiemens, & Ustun, 1999). In concert with physicians' low detection rates, less than half of patients disclose health-affecting psychosocial problems to their physicians (Gulbrandsen, Fugelli, & Hjortdahl, 1998).
There are a number of reasons why patients do not disclose their depressive symptoms including embarrassment (Priest, Vize, Roberts, Roberts, & Tylee, 1996), shame, and concern that the physician will not have (or take) time to listen (Paykel, 1992) or that the physician will be unable to deal with the patient's emotional problems (Cape & McCulloch, 1999). These reasons are especially relevant to men (Moller-Leimkuhler, 2002). Men also think it more acceptable to present with somatic symptoms rather than with emotional problems (Bridges, Goldberg, Evans, & Sharpe, 1991; Turner, 2001), or that they should be strong enough to cope with emotional problems without professional help (Wells, Robins, Bushnell, Jarosz, & Oakley-Browne, 1994).
Patients' reluctance to talk may be matched by physicians' reluctance to explore non-biological aspects, or physicians' belief that psychological intervention may not help (Turner, 2001) or that it would be time intensive. Physicians who maintain a pessimistic view of depression (Ross, Moffat, McConnachie, Gordon, & Wilson, 1999) or use emotional distancing from patients as a response in reducing their own stress (McManus, Winder, & Gordon, 2002) may also overlook depressive symptoms in their patients. Physicians may also be oriented to medical tasks or medical tests (Arborelius & Timpka, 1991) and to attach greater importance to somatic symptoms (Ogden, Boden, Caird, Chor, Flynn, Hunt, et al., 1999), to physical agendas (Campion, Butler, & Cox, 1992), or to prescribing drugs (Ross et al., 1999). Despite different orientations and disparate or conflicting views, physicians depend on patients to self-disclose in order to fulfill their professional task (Arborelius & Timpka, 1991; Salmon, Peters, & Stanley, 1999), and patients depend on physicians to provide an accurate diagnosis (Ong, de Haes, Hoos, & Lammes, 1995).
Accurate diagnosis of depressive symptoms may be hindered by structural barriers to the consultation (Burkitt, 1999), sex, age, and socio-economic bias between patients and physicians, complicating factors such as alcohol abuse (Blacker & Clare, 1993), or when symptoms are avoided, denied, or camouflaged (Warren, 1983). These issues are particularly salient for men who tend to view seeking help as a "sign of weakness" (Heifner, 1997; Moller-Leimkuhler, 2002). Moreover, physicians have been found to be less likely to recognize symptoms of depression in men (Borowsky, Rubenstein, Meredith, Camp, Jackson-Triche, & Wells, 2000; Kennedy, 2001; Potts, Burnam, & Wells, 1991; Redman, Webb, Hennrikus, Gordon, & Sanson-Fisher, 1991), which is reinforced by an increased expectance of depression in women due to higher reported rates (Blacker & Clare, 1987; Kessler, McGonagle, Zhao, Nelson, Hughes, Eshelman et al., 1994). Higher reported rates of depression in women, generated from community studies, may mean that men are either comparatively healthy or silent about their experience of depression.
We hypothesize that, relative to women, men are more likely to fall into the "undetected" group of primary care patients because their "silence" leads to some symptoms of depression being less likely to be detected. We sought to investigate the experience of depression, coping, and help seeking through the language used by men (and women) and to determine issues of relevance to men. …