Mental illness affects over 50 million adults in the US every year. That’s one in five people of all races, ethnicities and ages. Serious mental illness affects one in 25 adults. While it occurs in both women and men, fewer men are diagnosed with mental illness. But men are also less likely to seek or receive treatment, which means they could be under- or even misdiagnosed.
Gender Differences
Besides asking for and receiving treatment less often than women, men are affected in gender-specific ways by mental health issues. Differences between the genders have been long noted in age at onset of symptoms, frequency of or differences in symptoms, and in long-term outcomes. But there are other important differences.
“Gender bias occurs in the treatment of psychological disorders. Doctors are more likely to diagnose depression in women compared with men, even when they have similar scores on standardized measures of depression or present with identical symptoms.”
The World Health Organization, 2020
While women are diagnosed more often with “internalized” disorders such as depression and anxiety, men more often show “externalized” evidence of distress, such as substance abuse and violence. Clinicians—and men themselves—may be less likely to judge these as symptoms of depression and anxiety in men. This pattern of “internal vs. external” begins in adolescence, with higher rates of depression and eating disorders among girls, and higher rates of acting out and high-risk behavior among boys.
Except for bipolar disorder, which affects men and women in equal numbers, prevalence of mental illness varies in adults over age 18. Within the past year, men were less likely to be diagnosed with these disorders:
- major depression – 5.3% of men vs. 8.7% of women
- anxiety disorders – 14.3% of men vs. 23.4% of women
- PTSD – 1.8% of men vs. 5.2% of women (who have a higher rate of PTSD triggered by sexual assault)
Men are more likely than women to be diagnosed as children with ADHD, and rates are higher among adult men (5.4% of men vs. 3.2% of women). Boys are more likely to be diagnosed with ADHD than girls (15.1% vs. 6.7%) and face harsher punishment in school. Rates of autism—which is generally diagnosed in childhood—are higher among boys than girls (3.0% vs. 0.7%).
Prevalence of any mental illness is higher among women (24.5%) than men (16.3%), and more women (49.7%) than men (36.8%) receive mental health services. The pattern is the same for severe mental illness. Prevalence among women is higher (6.5% vs 3.9%), and more women receive mental health treatment than men for severe mental illness (70.5% vs. 56.5%).
Warning Signs in Men
Men and women can experience different symptoms of the exact same mental health disorder. This might reflect differing views of mental health, both among health care providers and men themselves.
Men are more likely to seek help for physical symptoms of mental health disorders, such as fatigue. But they may dismiss emotional symptoms, masking the sadness of depression, for example, with anger, irritability or aggressive behavior. Self-medication with alcohol and substances is also common among men, which only worsens symptoms or creates other health problems.
The National Institute of Mental Health lists several symptoms that may be warning signs of mental illness in men, including:
- Anger, irritability or aggressiveness
- Changes in mood, energy level or appetite
- Difficulty sleeping or sleeping too much
- Difficulty concentrating, feeling restless or on edge
- Increased worry or feeling stressed
- Misuse of alcohol and/or drugs
- Feeling “flat,” sad or hopeless; suicidal thoughts
- Aches, headaches and/or digestive problems without a clear cause
- Unusual thinking or behaviors, including high-risk activities
Depression in Men
Because men may mask “uncomfortable” feelings and avoid seeking help, depression can go unrecognized and undiagnosed. Family and friends may be the first to recognize fatigue and irritability, or a loss of interest in activities or work, as a sign of something wrong. Men who are reluctant to seek out a therapist may be willing to see their family doctor because they feel tired and run down, a helpful first step in addressing depression.
“The depression became an entity that I was able to identify. Sometimes I would actively and aggressively pick fights because I thought maybe I could beat it…I could physically beat the way I felt out of me or have someone else beat it out of me. I thought that if I just received a great enough shock to my system and physical trauma…it would force the depression out of me.”
Melvin Martin, Marketing Executive
Because depression is a risk factor for suicide, treatment is important. It’s estimated that 60% of people who commit suicide have suffered from a mood disorder, including depression. While only 1% of women with a history of depression die from suicide, 7% of men do—a pronounced and troubling difference.
Challenges unique to men
Substance use. While women are as likely as men to develop a substance use disorder, men have higher rates of use and dependence. Men with substance use disorders are also more likely to wind up in the ER or die from overdoses, and more likely to complete a suicide attempt.
“I’d drink and I’d just get numb. I’d get numb to try to numb my head. I mean we’re talkin’ many, many beers to get to that state to where you could shut your head off. But then you wake up the next day and it’s still there. Because you have to deal with it. It doesn’t just go away.
Patrick McCathern, First Sergeant, U.S. Air Force, Retired Video series, “Real Stories of Depression,” National Institute of Mental Health, 2017
Stigma. Cultural and social stigma surrounding mental health is a barrier for both genders, but men seem to struggle with it more. For example, men are more likely than women to think that people with depression are dangerous or being self-indulgent. Men often put off seeking help because they are too embarrassed or feel that “real men” don’t seek out help. Studies have shown that the more “masculine” a man’s beliefs are, the more likely he is to engage in risky health behaviors and avoid seeking help with health issues.
Getting Treatment
Men may be less likely to seek mental health treatment because of social norms and a reluctance to discuss their problems, thinking that “it won’t help.” They may also downplay or mask symptoms, thinking that they should be able to control their feelings.
Treatment can help men with mental health illnesses and disorders from sliding into destructive behaviors that result in a downward spiral of worsening health. Medication, therapy, lifestyle changes and prevention measures can work together to reverse negative trends and establish a healthy equilibrium. Best Day’s counselors can assess your or your loved one’s needs and situation to determine the best course possible for a healthier, more productive life.
How We Can Help You?
Best Day Psychiatry and Counseling is here to help you have a better day and find a better way. We treat a wide range of psychiatric conditions for both children and adults. Contact us today, we’re ready to help:
Fayetteville: (910) 323-1543 • Fuquay-Varina: (919) 567-0684 • Raleigh: (919) 670-3939 • Greenville: (252) 375-3322 • Durham:(919) 659-8686