Crew Health Advice: Breaking the Dangerous Silence Masking Depression in Men

In this article, we look at why depression and anxiety in men so often go undetected and unrecognised, especially in male-dominated environments such as seafaring, and what can be done to address this issue. 

*TW: This article deals with the topic of depression and suicide.

Good mental health is a critical factor to wellbeing, a state that strongly correlates with high self-esteem, healthy relationships, higher productivity and the ability to deal effectively with life stressors, leading to a higher quality of life. While mental health issues do not discriminate between men and women, research shows that men are less likely compared to women to seek help or use mental health services, even in the presence of a mental disorder. This under-utilisation of services has often been explained by traditional masculinity ideology, - the societal expectations in terms of roles, behaviours and attributes that are considered appropriate for boys and men.

Traditional masculinity

Men are socialised to be strong, dominant and independent. They learn from an early age to keep up the image defined by the widely held expectations of 'dominance' that follow them to adulthood and reinforcing the traditional masculine ideology. They must be self-sufficient, emotionally restrained and avoid being vulnerable - factors that contribute to the masking of symptoms and the avoidance of seeking treatment when struggling with mental health issues. 

Research suggests that men who cannot speak openly about their emotions may be less able to recognise the symptoms of poor mental health and therefore are less likely to reach out for help. Surveys have shown that 40% of men struggling with depression never speak about it, preferring instead to mask their symptoms using harmful coping methods such as drugs or alcohol. In general, men are less likely to talk to family and friends about their mental health. Some of the reasons for this include feelings of embarrassment, the stigma associated with mental illnesses, and not wanting to admit that they need support and be seen as weak or vulnerable. 

According to recent data, the prevalence of major depression is higher for women, with an annual global rate reported as 5.5% for women compared to 3.2% for men. Yet, compared to women, men are 3.5 times more likely to die by suicide. The disparity between suicide and depression rates amongst men and women may attest to the fact that depression in men is underreported or oftentimes undetected. 

Recognising the symptoms

Although mental disorders cannot be categorised according to gender, the experience and symptoms of them may differ between men and women. While women suffering with depression tend to present signs of hopelessness, guilt, worthlessness etc., men suffering with depression are more prone to engage in 'acting out' or 'masculine' behaviours such as reacting with extreme anger or irritability and demonstrating poor impulse control. Men also seem to be more prone to severe substance and drug abuse to deal with depression and anxiety, generally using 'avoidance' behaviours.

The most common symptoms that help in recognising depression and anxiety are:

• Feeling restless, moody or irritable
• Spending time alone
• Not enjoying activities that you normally enjoyed in the past
• Feeling unmotivated
• Thinking you are a failure
• Being aggressive
• Experiencing suicidal thoughts
• Unexplained headaches, backaches or other physical pain
• Stomach problems, nausea, changes in bowel habits
• Significant changes in appetite, weight loss or gain
• Changes in your sex drive

Risk factors

A key point that demonstrates the effects of the social group of the 'traditional male' is the reality of male-dominated workforce groups, in which higher levels of depression among workers are detected, bearing witness to the oppressive nature of such gender norms. 

Seafaring is traditionally a male-dominated industry. Studies of male-dominated industries - those comprising greater than 70% men - have identified higher levels of depression among men in these environments. Established risk factors for mental illness commonly found in these industries, include isolated/solitary work, excessive or irregular workloads, poor physical conditions, lack of control and monotonous tasks. 

Assessing and addressing the prevalence of mental health issues among men working in male dominated industries has been largely overlooked; however, it requires focused attention to address the salient mental health risk factors as they interact with traditional masculine ideology.

Raising awareness

Organisations can help break the stigma of silence imposed by the traditional male stereotypes by implementing strategies and programmes to raise awareness of mental health issues - prevent the recognised risk factors and support workers with mental health issues. 

Good mental health is fundamental element of wellbeing. The Jefferson Center offers these tips for engaging in a conversation with men about mental health issues:

• Pointing out the changes you have noticed in his behaviour and then express you concern: "I notice you seem a little stressed out lately? Is everything okay?"
• Normalise the conversation by sharing your personal experiences and struggles, and make him feel safe and secure: "I have had a hard time dealing with anxiety in the past, have you been feeling like this lately?"
• Initiate the talk about mental health while doing some activity, instead of taking a sit-down approach. Intervention-style conversations can feel intimidating, so try to engage in a conversation while doing an activity such as walking. 
• Acknowledge the difficulties he may be experiencing: "I know you have been having a hard time, but I am here if you want to talk."
• Most of the time when you ask a man about his mental health or problems, he will tell you that he is fine, so make an effort, without insisting, to ask twice: "How are you really? I am here for you."
• Listen empathetically and attentively
• Remain open and objective
• Do not try to impose your views or judgments
• Be genuine and respectful.

Sometimes just knowing that someone is there to listen can help break the dangerous silence embedded in traditional masculine ideology. Encouraging men to openly talk about mental health issues can help prevent negative mental health implications. 

Resources

“I’m Fine”: How to Talk to the Men in Your Life About Their Mental Health - Jefferson Center - Mental Health and Substance Use Services (jcmh.org)