Participation in male-only social support groups may decrease depressive symptoms in men

This correlational study explored the relationship between men’s involvement in male-only support groups and self-reported depressive symptoms. The researcher obtained a convenience sample of 94 adult participants recruited from two local private universities and men’s groups with members throughout the United States. Sixty-eight percent (n=64) of respondents belonged to a male-only social support group. All participants completed a demographic questionnaire and self-report measures on their sense of well-being. Participants who belonged to a male-only group were instructed to fill out a questionnaire regarding their perceptions of support from their group. The researcher hypothesized that men who belong to male-only support groups would have lower depressive symptoms (as measured by the CES-D scale) than men who do not. The researcher did not identify a statistically significant difference in depressive symptoms between men who belong to male-only groups and those who do not. MALE SUPPORT MAY DECREASE MEN’S DEPRESSION INTRODUCTION In 1998, Terrance Real published a book entitled I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression. This important publication identified depressive behaviors unique to men, perhaps providing the general public their first real opportunity to recognize that depression is not just a women’s health issue – men can and do struggle with depression, too. Depressive disorders are characterized by “persistent feeling[s] of sadness and loss of interest [in] normal day-to-day activities” (Mayo Clinic, 2015, p.1). While it may be referred to as depression, clinical depression, or major depressive disorder, the common denominator of this condition is its ability to affect “how you feel, think and behave” and its potential to “lead to a variety of emotional and physical problems” (Mayo Clinic, 2015, p.1). According to U.S. census data, 6.4 million men were affected by a depressive disorder during 1998 – the year Mr. Real’s book was published (NIMH, 2001). The National Institute of Mental Health (NIMH) website claims that this level of depression among men remains, with over six million men affected (NIMH, 2015); yet, the number of men being accurately diagnosed with depression seems out of sync with these statistics. For example, men are diagnosed with depression far less often than their female counterparts, yet suicide rates among men are as much as four times greater than among women (Rochlen, Whilde, & Hoyer, 2005). This may support the possibility that that strong gender role expectations of men may interfere with them seeking help. According to Wester, Christianson, Vogel and Wei (2007), men are expected to face challenges alone, restrict their emotional expression and maintain a level of independence. MALE SUPPORT MAY DECREASE MEN’S DEPRESSION 2 In 2003, an effort to reach out to men at a national level was coordinated by the NIMH. The campaign, entitled Real Men, Real Depression, included public service announcements, a central website, and marketing materials that provided education and information for men potentially suffering from depression (but not seeking formal treatment), or for family members aware of male relatives exhibiting symptoms of depression (Rochlen et al., 2005). The website alone recorded over eight-million visits within its first year, a response which may imply that men with depression indeed have unmet needs in regards to education, information and support. Studies indicate that depression is a growing problem in general. Statistics from 2001-2002 indicated approximately 5.3% of adults experienced major depressive disorder (Hasin, Goodwin, Stinson, & Grant, 2005) while information gathered ten years later, in 2012, showed that 6.9% of adults in the United States had experienced a major depressive episode (NIMH, 2015). The 2012 study also reported that just 5.2% of those reporting a major depressive episode (approximately 832,000 respondents) were men. It is unlikely that these numbers represent the true population of men having depressive symptoms; such low numbers may be due in part to barriers men perceive in coming forward to seek help. Studies have found that men who experience symptoms of depression are resistant to seeking treatment or other formal types of support (Vogel & Wester, 2003). Contrary to patterns observed among women who experience anxiety, depression, or other mental health symptoms, men tend to worry that asking for help will make them appear weak or less than masculine (Kilmartin, 2005; Vogel, Wester, & Larson, 2007). These circumstances may contribute to the general under-diagnosing of depression among men. MALE SUPPORT MAY DECREASE MEN’S DEPRESSION 3 Since cultural gender roles can influence how men experience depressive symptoms, men may experience more typical symptoms of depression like sadness, becoming withdrawn, and losing interest in activities as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). Men who experience depression also may react with irritability and aggression, compulsive work habits, drinking or eating more than normal (perhaps to self-medicate), engaging in high risk activities, blaming or becoming suspicious of others, becoming vulnerable to road rage, or creating interpersonal conflict (Robinson, Smith and Segal, 2015). Anger is an especially strong symptom of depression. Men can be court ordered to attend anger management treatment, especially following incidents of road rage or domestic violence, thus acquiring skills to manage their displays of anger without ever addressing the underlying emotional conflicts at the root of their depression. “Behaviors such as aggression and violence and drug and alcohol abuse, road rage and suicide (usually attributed to men), have been termed ‘depressive equivalents’ or ‘masked depression’ which suggests some association with being depressed but not labeled as depressive symptoms” (Brownhill, Wilhelm, Barclay, & Schmied, 2005, p.2). Depression in men continues to be under-researched, “probably. because anxiety disorders and depression are conditions associated with women” (Emslie, Ridge, Ziebland, & Hunt, 2006, p.3). The need for ongoing research has been recognized by Dr. Dennis Charney, Chief of Mood and Anxiety Disorders for NIMH. According to Charney, depression in men is “an important area of research” in order to “understand how men respond to stress and symptoms associated with depression, and how to alert physicians to better recognize and treat depressive disorders in men” (NIMH, 2003, p.2). MALE SUPPORT MAY DECREASE MEN’S DEPRESSION 4 As depression in men has been linked to destructive behaviors such as substance abuse, infidelity, aggression, violence, and risk-taking activities (including committing crimes), there are significant reasons to direct research at this problem (Kilmartin, 2005). General research on the treatment of depression has found a reduction in depressive symptoms among people with strong social support systems (Sarason, Levine, Basham, & Sarason, 1983; Krull, 2012). A comprehensive strategy to help reduce depressive symptoms may be a combination of therapy, medication and building some form of social support, as recommended by both the NIMH (Rochlen et al., 2005) and Harvard Health Publications (Robison, Smith & Segal, 2014). Given the resistance to formal treatment that has been documented among men with depression, social support may be an especially valuable strategy to help reduce symptoms. Social support has the benefit of an informal approach, offering men who resist formal medical treatment a way to receive help for their symptoms (Vogel & Wester, 2003). Mankowski, Maton, Burke and Stephan (2014) learned that men who participate in social support organizations – also referred to as mutual support groups – are not looking for a therapist, but rather want to interact with men with similar interests who can “guide, challenge and support” one another (p.56). This may explain why men may reach out to fraternal organizations in order to experience being challenged, supported and guided by their brethren. A fraternal organization or guild is a brotherhood or formal association of members who freely associate for a mutually beneficial purpose such as for social, professional or honorary values (Merriam-Webster, 2014). Men may seek out such formal associations for the purpose of feeling accepted and valued by other men. As explained by Sam Keen, author of Fire in the Belly (1992), “[men] need same MALE SUPPORT MAY DECREASE MEN’S DEPRESSION 5 sex friends because there are types of validation and acceptance that we receive only from our gendermates” and “only men understand the secret fears that go with the territory of masculinity” (p.175). Support groups can also provide opportunities for behavioral change especially for men who do struggle with anger and aggression. “Most men do not consciously acknowledge their underlying pain, and one of the most devastating ways in which they respond to these dilemmas is through abusive behavior” (Longwood, 2006, p. 5). A study on batterer invention programs reported that a balance of both support and accountability was an important process of change in abusive behavior (Silvergleid & Mankowski, 2006). Men who struggle with or who never learned healthy expressions of anger can benefit from a mutual support group with a special focus on anger management. Dr. David J. Decker’s program in Minnesota, as an example, provides an environment specifically for men to help other men manage anger effectively to significantly improve their relationships with women, children, and other men (Decker, 1999). The feeling of shame can also play a role in depression and affect men’s ability to receive help due to the risk of being perceived as weak (Shepard & Rabinowitz, 2013). Shepard and Rabinowitz (201