''I also take my car to a specialist garage.'' factors that facilitate treatment entry among men with depression: a qualitative study

Background: Men with depression seek professional treatment less frequently and at a later stage than women. Previous studies have primarily focused on barriers to accessing treatment, which is why the present study investigates factors facilitating therapy initiation in men with depression. Methods: Semi-structured interviews were conducted online with men with depression (n = 60). Transcripts were evaluated using qualitative content analysis, which included deductive pre-structuring, inductive coding, and consensual validation. Results: Improving one’s own crisis situation and restoring one’s agency are key motivations for entering treatment. Men often initiated treatment after abandoning their own coping strategies in favor of professional help, or when no other option remained. Men follow the recommendations of those working in the professional care system and recognize psychotherapists and psychiatrists as “professionals” who, in contrast to personal contacts, are able to provide more adequate support. Patients’ private spheres also play a crucial role in the decision to start treatment. Respondents noted that those in their personal lives may demand that treatment be started, but mentioned that their personal lives can also become a point of reference for seeking treatment independently. Treatment experiences of people from the private environment can facilitate therapy initiation by enabling normalization and access to the support system. Conclusions: By restoring men’s agency, conventional masculine norms can be adapted to assist treatment entry. There is also evidence that normalizing mental illness is having an immediate effect on men’s perspectives. Professionals from the healthcare system can play a mediating role in helping men undergoing treatment by actively addressing mental health in a broader context. Clinical Trial Registration: This study is registered in the German Clinical Trial Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00031065).

Depression; Men; Help-seeking; Mental health; Qualitative study

[1] Gosling R, Parry S, Stamou V. Community support groups for men living with depression: barriers and facilitators in access and engagement with services. Home Health Care Services Quarterly. 2022; 41: 20–39.

[2] DeBate R, Gatto A, Rafal G, Bleck J. A qualitative assessment of mental health literacy and help-seeking behaviors among male college students. Discover Mental Health. 2022; 2: 23.

[3] Staiger T, Stiawa M, Mueller-Stierlin AS, Kilian R, Beschoner P, Gündel H, et al. Masculinity and help-seeking among men with depression: a qualitative study. Frontiers in Psychiatry. 2020; 11: 599039.

[4] Cramer H, Horwood J, Payne S, Araya R, Lester H, Salisbury C. Do depressed and anxious men do groups? What works and what are the barriers to help seeking? Primary Health Care Research & Development. 2014; 15: 287–301.

[5] Klineberg E, Biddle L, Donovan J, Gunnell D. Symptom recognition and help seeking for depression in young adults: a vignette study. Social Psychiatry and Psychiatric Epidemiology. 2011; 46: 495–505.

[6] Möller-Leimkühler AM. Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders. 2002; 71: 1–9.

[7] Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. Journal of Advanced Nursing. 2005; 49: 616–623.

[8] Nübel J, Müllender S, Hapke U, Jacobi F. Epidemic of depression?: Development of prevalence and help-seeking behaviour. Der Nervenarzt. 2019; 90: 1177–1186. (In German)

[9] Mahalik JR, Dagirmanjian FR. Working-class men’s constructions of help-seeking when feeling depressed or sad. American Journal of Men’s Health. 2019; 13: 1557988319850052.

[10] Pedersen SC, Maindal HT, Ryom K. “I wanted to be there as a father, but I couldn’t”: a qualitative study of fathers’ experiences of postpartum depression and their help-seeking behavior. American Journal of Men’s Health. 2021; 15: 15579883211024375.

[11] Reczek C, Thomeer MB, Gebhardt-Kram L, Umberson D. “Go see somebody”: how spouses promote mental health care. Society and Mental Health. 2020; 10: 80–96.

[12] Johnson JL, Oliffe JL, Kelly MT, Galdas P, Ogrodniczuk JS. Men’s discourses of help-seeking in the context of depression. Sociology of Health & Illness. 2012; 34: 345–361.

[13] Rice SM, Aucote HM, Parker AG, Alvarez-Jimenez M, Filia KM, Amminger GP. Men’s perceived barriers to help seeking for depression: longitudinal findings relative to symptom onset and duration. Journal of Health Psychology. 2017; 22: 529–536.

[14] Seidler ZE, Dawes AJ, Rice SM, Oliffe JL, Dhillon HM. The role of masculinity in men’s help-seeking for depression: a systematic review. Clinical Psychology Review. 2016; 49: 106–118.

[15] Sierra Hernandez CA, Han C, Oliffe JL, Ogrodniczuk JS. Understanding help-seeking among depressed men. Psychology of Men & Masculinity. 2014; 15: 346–354.

[16] Staiger T, Stiawa M, Mueller-Stierlin AS, Kilian R, Beschoner P, Gündel H, et al. Men and depression: illness theories and coping—a biographical narrative study. Psychiatrische Praxis. 2020; 47: 65–70. (In German)

[17] Hoy S. Beyond men behaving badly: a meta-ethnography of men’s perspectives on psychological distress and help seeking. International Journal of Men’s Health. 2012; 11: 202–226.

[18] Caperton W, Butler M, Kaiser D, Connelly J, Knox S. Stay-at-home fathers, depression, and help-seeking: a consensual qualitative research study. Psychology of Men & Masculinities. 2020; 21: 235–250.

[19] House J, Marasli P, Lister M, Brown JSL. Male views on help-seeking for depression: a Q methodology study. Psychology and Psychotherapy. 2018; 91: 117–140.

[20] Davenport CJ, Swami V. Getting help as a depressed dad: a lived experience narrative of paternal postnatal depression, with considerations for healthcare practice. Journal of Psychiatric and Mental Health Nursing. 2023; 30: 1–7.

[21] Wirback T, Forsell Y, Larsson JO, Engström K, Edhborg M. Experiences of depression and help-seeking described by young Swedish men. Psychology of Men & Masculinity. 2018; 19: 407–417.

[22] Seidler ZE, Rice SM, Oliffe JL, Fogarty AS, Dhillon HM. Men in and out of treatment for depression: strategies for improved engagement. Australian Psychologist. 2018; 53: 405–415.

[23] Tang MOT, Oliffe JL, Galdas PM, Phinney A, Han CS. College men’s depression-related help-seeking: a gender analysis. Journal of Mental Health. 2014; 23: 219–224.

[24] Rochlen AB, Paterniti DA, Epstein RM, Duberstein P, Willeford L, Kravitz RL. Barriers in diagnosing and treating men with depression: a focus group report. American Journal of Men’s Health. 2010; 4: 167–175.

[25] Brownhill S, Wilhelm K, Barclay L, Parker G. Detecting depression in men: a matter of guesswork. International Journal of Men’s Health. 2002; 1: 259–280.

[26] Kravitz RL, Paterniti DA, Epstein RM, Rochlen AB, Bell RA, Cipri C, et al. Relational barriers to depression help-seeking in primary care. Patient Education and Counseling. 2011; 82: 207–213.

[27] Emslie C, Ridge D, Ziebland S, Hunt K. Men’s accounts of depression: reconstructing or resisting hegemonic masculinity? Social Science & Medicine. 2006; 62: 2246–2257.

[28] Chuick CD, Greenfeld JM, Greenberg ST, Shepard SJ, Cochran SV, Haley JT. A qualitative investigation of depression in men. Psychology of Men & Masculinity. 2009; 10: 302–313.

[29] Kuckartz U, Rädiker S. [Qualitative content analysis: methods, practice, and computer-assisted analysis]. 5th edn. Beltz Juventa: Weinheim. 2022. (In German)

[30] Kuckartz U, Rädiker S. [Focused interview analysis with MAXQDA: step by step]. 2nd edn. Springer VS: Wiesbaden. 2024. (In German)

[31] Mckenzie SK, Jenkin G, Collings S. Men’s perspectives of common mental health problems: a metasynthesis of qualitative research. International Journal of Men’s Health. 2016; 15: 80–104.

[32] Gough B. Men’s depression talk online: a qualitative analysis of accountability and authenticity in help-seeking and support formulations. Psychology of Men & Masculinity. 2016; 17: 156–164.

[33] Connell RW, Messerschmidt JW. Hegemonic masculinity. Gender & Society. 2005; 19: 829–859.

[34] Scholz B, Crabb S, Wittert G. “Males don’t wanna bring anything up to their doctor”: men’s discourse of depression. Qualitative Health Research. 2017; 27: 727–737.

[35] Skärsäter I, Dencker K, Häggström L, Fridlund B. A salutogenetic perspective on how men cope with major depression in daily life, with the help of professional and lay support. International Journal of Nursing Studies. 2003; 40: 153–162.

[36] Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science & Medicine. 2000; 50: 1385–1401.

[37] Griffith DM. An intersectional approach to men’s health. Journal of Men’s Health. 2012; 9: 106–112.

[38] van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. Journal of Health Communication. 2013; 18: 172–184.