Male depression: fiction or clinical reality? Analysis of the phenomenon from the perspective of suicidal practice
Authors: Merinov A.V. 
Published: December 2024

The existence of a connection between suicidal behavior and depressive experiences has long been established and no one is in doubt now: depressive affect mediates the action of most other predictors and factors of high suicidal risk that are known today. The existence of the male depressive syndrome is still controversial. This work is an attempt to revise existing ideas about male depression, the search of possible strong points of its early detection. Materials and methods. The article uses the results of previous studies concerning the detection of
depressive experiences in young people of both sexes, students of the medical university. Statistical data of the "Ryazan Regional Clinical Psychiatric Hospital named after N.N. Bazhenov" (Ryazan) for 2023 were used to assess the gender cross-section of psychiatric treatment. The analysis of interviews with practicing psychiatrists, narcologists and psychotherapists concerning the specifics of depressive syndrome in men was carried out. Results. According to student’s self-reports, 38% of boys and 49% of girls had previously noted depressive states. The results of M.I.N.I. (an interview aimed at identifying clinically occurring depressive episodes) are also equal (24.5% and 24.65% in the anamnesis and 1.96% and 2.33% currently, respectively). The HADS data also do not reveal significant gender differences (2.45% and 1.62%, respectively). However, a subjective assessment of the depressive episodes presence in the anamnesis (two weeks or more) in a personal interview before filling out HADS and M.I.N.I. reveals twice the lower results of self-diagnosis of depression in males (which is practically not observed in the female subgroup: 10.78% and 21.40%). That is, continuous studies rather demonstrate the uniformity of the affective pathology representation in men and women with a really lower incidence of men seeking medical help, with a tendency to ignore or minimize depressive symptoms. In turn, educational and cultural factors form in men a mindset to ignore depressive experiences that create the phenomenon of male silent suffering. There are probably psychological and age-related features of male depressions that are directly related
to the type of aging and value crisis periods (middle age, acceptance of non-fulfillment and fading prospects). The clinical peculiarity of depression in men is primarily due to the blurring of the "typical" clinical picture, which specialists usually focus on, the predominance of complaints of hypochondriacal, depersonalization derealization, hedonistic, amotivation and philosophical value levels, the frequency of somatic, neurological, therapeutic and other masks of "depression without depression", a noticeable tendency to rationalize symptoms and search for exogenously reactive causes of it. The selfish track of the development of depressive symptoms, the use of ineffective coping methods, the connection with alcohol abuse or formed alcohol dependence, insufficient awareness of the essence of depressive states, the frequency of primary external diagnostics (relatives, colleagues) and powerful displacing / devaluing mechanisms are not uncommon. Conclusions. Depression in men has a number of features that create significant difficulties in its timely detection and provision of adequate assistance. The observed blurring of the typical clinical picture leads to diagnostic errors and lengthening of the qualification period of the condition. The detectable affective-gender paradox of identifying depressive states is very
likely related only to the peculiarities of the diagnostic approach.
Keywords: depression, depression in men, hypothymia, suicide, suicide attempt, autoaggression, suicidology