Older Men Resist Depression Treatment

Researchers Say Masculine Self-Image And Fear Of Stigma Prevent Many From Seeking Care

(WebMD) 
The study also showed that older men were also significantly less likely than older women to report classical emotional symptoms of depression such as periods of crying or feeling sad or fatigued.

Older men were also less likely to say that they had other symptoms of depression, such as loss of interest or pleasure in daily activities or having appetite problems — which made them more difficult to diagnose.
One manager quoted in the study said: "They will not say, 'I feel sad' or 'I feel depressed.' They'll say, 'I have a stomach ache.'"

Hinton's team identified a subset of older men who were especially resistant to being labeled as depressed, getting treatment for depression, or enrolling in depression studies.

According to the health care providers interviewed for the study, such men tended to have an old-school, "John Wayne" image of masculinity, which teaches men to view depression as a "woman's problem," conceal emotional symptoms, and cope with emotional problems on their own.

"Older men saw depression as a moral weakness or something that should be overcome on one's own, limiting their tendency to seek help," Depp says. "Their desire to 'tough it out' was coupled with a fear that a psychiatric diagnosis would stigmatize them as being mentally ill or label them as 'crazy.'"

Although some health care providers said that older men need to "give up" these core masculine values in order to receive appropriate treatment, many others said that clinicians themselves need to change their approach.

"Many of the primary care providers we interviewed emphasized the need to be more flexible in dealing with older men who have a traditional sense of masculinity," Hinton says. "They cited the need to negotiate a way to talk about depression that is acceptable to older men and allows clinicians to treat their depression."

Such strategies may include using an open-ended interview style, helping neutralize stigma by using less-threatening direct or clinical language, and involving family members in all phases of treatment, according to the study.

"It may be useful to ask them if they're feeling more irritable or socially withdrawn," Hinton says. "We may also want to focus on complaints about physical symptoms and stress."

"Although this study did not specifically investigate the effectiveness of strategies to surmount the barriers to engagement in depression, the authors rightly note that educational or screening initiatives need to be tailored to directly assess the barriers identified in this study," Depp says.

"The next study might be to use a similar qualitative approach, but, as the authors suggest, gather data from the older men themselves," Depp says. "We would want to know about what might persuade older men to believe depression can sometimes be as tough as they are."

"Clearly, engaging men in depression treatment is a problem across the age spectrum," Hinton says. "That's why the National Institute of Mental Health recently launched its 'Real Men, Real Depression' campaign to reach out to depressed men."

"But even though there's been a lot of talk about men, depression, and stigma, there's been less focus on older men," Hinton says. "Because of the high suicide rates among older men, we need to understand more about this difficult-to-reach group and reach them with effective treatments. We particularly need to understand more about older minority men who are making up an increasing share of the overall elderly population."

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SOURCES: Ladson Hinton, M.D., University of California-Davis. Colin Depp, M.D., Sam and Rose Stein Institute for Research on Aging at the University of California-San Diego; VA San Diego Healthcare System. Hinton, L. American Journal of Geriatric Psychiatry, October 2006; Vol. 14: pp. 884-892.