Depression puts Men at Risk for Suicide

The numbers illustrate the problem quite clearly. Half as many men as women seek psychotherapy. Half as many men as women are diagnosed with depression. Yet men commit suicide up to eight times more often than women.

The solution is not so obvious.

A new book, "Men and Depression: Clinical and Empirical Perspectives" (Academic Press 2000), helps clinicians identify and treat mood disorders in their male clients, addressing an issue that has been neglected by researchers and therapists alike. The authors are Frederic Rabinowitz, professor of psychology at the University of Redlands, and Sam Cochran, director of clinical services at the University of Iowa. Rabinowitz also has a private practice specializing in men's therapy.

According to Rabinowitz, an understanding of learned gender roles is especially important in identifying and treating men's depression.

"Depression in men often can be traced to cultural expectations of the male role," he said. "Men must be successful. They must restrict their emotions. They must be in control. Men's depression, therefore, often can be attributed to issues of self-criticism, while depression in women tends to be related to issues of dependency."

Cultural expectations may mask manifestations of depression, such as aggression and anger, that are viewed as acceptable "tough guy" behavior.

"The vast majority of perpetrators of violence are men," the authors write. "Indeed, more than 90 percent of homicide-suicide offenders are men...How many men who are desperately depressed ultimately end their pain and shame in such a fashion?"

Gender roles also keep men away from therapy, which is seen as a sign of weakness. And some drug therapies for depression can be threatening, as some anti-depressants have been shown to decrease libido.

Rabinowitz and Cochran pay particular attention to assessment and treatment of suicidal tendencies. Suicide is the third leading cause of death for white males between the ages of 15 and 24, and the rates increase dramatically as men age.

"There is simply no reason for the numbers of men who commit suicide to continue to be ignored. Were this any other health problem, it would be decried as a major public health crisis in our country," they write.

The authors challenge their colleagues to educate psychology students to apply gender-sensitive insights and better appreciate working with male clients.

"Many therapists are used to the talkative patient who describes 'her' feelings freely and has some intellectual insight about the psychological nature of the problems being experienced," Rabinowitz said. "There is less gratification from the male patient, who seems to often not make the same kind of psychological connections between emotional states and behavior."

"By emphasizing the positive value in working with men, perhaps more men will begin to see that help is available and that psychotherapy or pharmacotherapy are not instruments designed to induce shame and guilt but rather are the means by which we can eliminate suffering and loss of life. We owe this to the men in our lives and in our communities."

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