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Evid Based Nurs 9:126 doi:10.1136/ebn.9.4.126
  • Qualitative

The masculine concepts of control, strength, and responsibility to others were important to men with depression


 
 Q How does depression influence men’s gender identities?

DESIGN

Qualitative secondary analysis.

SETTING

Interviews were conducted for use on a UK website that reports personal experiences of health and illness (www.dipex.org).

PARTICIPANTS

16 men ⩾18 years of age (range 30–75 y) who identified themselves as having depression and were well enough to participate in an interview. 5 men were homosexual, 3 were from ethnic minorities, and 5 had bipolar depression.

METHODS

Open ended, indepth interviews lasting 90–180 minutes were conducted by an experienced male researcher. Participants were encouraged to focus on issues about depression that were important to them and to discuss specific topics, such as the depression experience, social consequences, and strategies for help seeking and personal coping. The interviews were recorded, transcribed, and analysed in 2 phases. In the first phase, emerging themes were identified and coded using a modified grounded theory approach. In the secondary analysis phase, themes related to masculinity and gender identity were identified from the original transcripts to answer the new research question.

MAIN FINDINGS

(1) Experiencing depression. Many men felt that their depression stemmed from childhood or teenage years, when they had experienced multiple threats to their sense of masculinity through insults from family and peers and the expectation to be “macho.”

(2) Reconstructing identity around hegemonic (culturally dominant) masculinity. Some men stated that becoming “one of the boys” was helpful in their recovery from depression, whereas others felt that the pressures of conforming to the standard of hegemonic masculinity made their depression worse and even led to suicide attempts to prove their courage. The men emphasised the importance of the masculine traits of regaining control of the situation and re-establishing independence from drugs and healthcare professionals. On the other hand, some men viewed drugs as a weapon that they controlled in their battle against depression. Some men saw suicide as the ultimate way to gain control. Although the support of partners and feelings of responsibility to family helped some men recover from depression and resist suicidal urges, the pressures of gendered social roles could also hinder recovery.

(3) Constructing “difference” as advantageous. For a few men, the fact that their depression made them different from other men was a good thing—an indication of greater intelligence and sensitivity. Men who were homosexual or from a minority ethnic group were particularly experienced in constructing difference. 1 man stressed the importance of establishing his gender identity in the middle ground between macho and weak, with acknowledgement of vulnerability.

CONCLUSIONS

The masculine concepts of control, strength, and responsibility to others were important to men with depression. Some men were able to construct identities that resisted the traditional definitions of dominant masculinity, whereas others reinterpreted aspects of the potentially feminising experience of depression as masculine.

Commentary

  1. Paul Michael Galdas, RN, PhD
  1. University of Sheffield
 Sheffield, UK

      The concept of masculinity and what it means to men who are depressed has often been overlooked by clinicians and researchers. The study by Emslie et al attempts to fill this gap in the research literature and provides an important insight into the gendered nature of depression in men. Consistent with wider evidence on men’s experiences of illness and health help-seeking behaviour,1 the main findings of the study draw attention to the potentially deleterious influence of hegemonic masculinity on some men’s recovery from depression. However, in contrast to previous studies, the findings of Emslie et al also show that some men can, and will, talk about depression and their feelings and that other forms of (non-dominant) masculinity can have positive effects on men’s mental health. These findings cohere with emerging evidence2 that highlights the complex nature of masculinities and how they interplay with men’s recovery from ill health.

      Overall, the study by Emslie et al stresses the need for nurses to consider the problems that may arise among depressed men who feel pressure to “live up to” hegemonic masculine attributes. It offers nurses direction for providing support to men with depression by explicitly addressing their beliefs about forms of masculinity that emphasise strength and stoicism and helping them to re-interpret their experience as being “masculine.” Ultimately, the study leads to the conclusion that common generalisations, such as all depressed men will feel pressured to be “strong and silent,” are overly simplistic and misleading.

      References

      Footnotes

      • For correspondence: Dr C Emslie, MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. C.Emslie{at}msoc.mrc.gla.ac.uk

      • Source of funding: Mental Health Task Force.

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