5 6 7 8 9 10 11 12 13 14 15 43 - 71 32 32 37 43 32 27 28 31 White British White Slovenian White British White British White British White British White British White British White British White British White British Single Married Married Single Married Single Married Married Relationship Single Married Ended - Suicide Ongoing Ongoing Ended - Suicide Ongoing Ended – his mental health Ongoing Ongoing Ongoing Ended – his mental health Ongoing 30s 29-37 30-70 28-33 28-30 41 30+ 22-32 30+ 30 33 3 16 50 1 2 12 8 16 2 2 3 Depression OCD Depression Alcohol/Depression? Anxiety/Depression Anxiety/Depression Depression BPD/Bipolar Presumed Depression Bulimia/Depression PTSD/Depression Twitter Forum Facebook Twitter Facebook Twitter Twitter Facebook Recommendation Recommendation Facebook Data Collection Data was collected through one-to-one interviews, eight face-to-face and seven by telephone. An interview topic guide was developed by the researcher and supervisor, and external feedback on it was gained from a Counselling Psychologist and two Trainee Clinical Psychologists. The interview was adapted after 11 interviews in order to gain further information on some of the emerging themes. The women were interviewed for 30-50 minutes (Mean = 35 minutes). Ethical Issues Owing to the sensitive nature of the interview content, the ethical implications of this research were carefully considered and Ethical Approval was granted by The Faculty of Arts and Human Sciences at The University of Surrey (appendix 2). Procedure Potential participants were directed from social media or forums to the website providing information about the study, the researcher’s contact details and a secure electronic
mental health charities such as the Campaign Against Living Miserably (CALM), who could produce leaflets and web pages targeted at women living with men with mental health problems, or to offer support groups or couples therapy. This would provide opportunities to create support and sustain change. Although schools have guidance for teachers on noticing and managing mental health problems in pupils (Department for Education, 2015), there may be a role for schools in educating children and adolescents on the patterns of behaviour and expectations for living with someone with a mental health problem. This research suggests implications for the training of Clinical Psychologists. Currently in the UK, courses teach trainees to consider difference and diversity (The British Psychological Society, 2014). Men’s mental health may be overlooked in order to understand the broader agenda associated with the diversity of ethnic and cultural minorities. GPs are trained in supporting carers, however this is limited by the patient unless they give permission for the GP to talk to the carer (CarersTrust, 2011; Royal College of General Practitioners, 2013). Hidden elements of an individual’s distress which might indicate mental health problems are frequently not seen by the GP and calls from partners are not accepted as it may compromise confidentiality. Legally there needs to be some debate around how this is managed to protect confidentiality, whilst simultaneously ensuring a duty of care. Limitations This study benefitted from recruiting participants from a wide area of the UK, with sampling ensuring that participants brought diverse experiences to the interviews, although limited in cultural diversity. Male partners had a range of mental health issues and levels of severity and complexity associated with their psychological distress. As mentioned, two male partners committed suicide. The challenge within this research was in supporting the women
must have been between 30-44 years old at the time of the communications about his mental health. This age range has been chosen, as this is the most at-risk group for suicide amongst males (Samaritans, 2013). Recruitment will be via adverts on social media such as Facebook and Twitter and women’s health and support websites such as MumsNet. There will be a website designed specifically for the study which will contain full details of the study including participant information, a form to fill in which they can submit electronically, and contact details for the researcher., Data received will be securely stored on a password protected computer. Furthermore, the social media accounts will be set up to recruit potential participants and offer further information about the study; and which will also serve to promote the study to a wider group of participants through “shares” and “retweets” The webpage will link to complementary female orientated websites and forums. . When a pool of potential participants has been gathered, criterion sampling will be used to choose appropriate participants for interview. Interviews The study will be conducted by one-to-one interview, either in person or by telephone/Skype, following a semi-structured interview schedule for 30-40 minutes in order to gain an understanding of the strategies the women used to encourage their partner to seek help for a mental health problem. (See appendix 2 for a draft of the interview schedule).
Table of papers reviewed AUTHOR AND DATE TITLE TYPE DEMOGRAPHIC POWER PROCEDURE OUTCOME CONCLUSIONS LIMITATIONS THEMES Berger, J. L., Addis, M. E., Green, J. D., C., Goldberg, V. (2013) Men's reactions to mental health labels, forms of and sources of help-seeking advice interview N = 85 Age – 19-77 years old. M = 45.4 Gender – males 97.5% of sample identified as heterosexual Harvard national depression screening scale Psychiatric diagnostic screening questionnaire Response to mental health rating system Articulated thoughts in simulated situations paradigm. Beck depression inventory II Beck anxiety inventory Conformity to masculine norms inventory Perceived problems in living Help-seeking behaviour scale. Not stated Interview. Recordings of actors in 3 conditions (romantic partner, psychotherapist, medical doctor) Observational rating measures to assess verbal reactions to mental health labels. Men responded most positively to help seeking advice given by psychotherapist compared to medical doctor or romantic partner. Lowest willingness in romantic partner scenario. Seeking help from friends or family was not found to relate to adherence to masculine norms. Acceptance of help from family and friends negative relationship with emotional control. Adherence to masculine norms related to men's willingness to seek help in romantic partner and doctor condition. Non-professional help seeking was found to have the weakest relationship with adherence to masculine norms. Those who followed a norm of chasing women were less likely to adhere when suggested by romantic partner Sampling bias, not clinically based. Emotional Intimacy Control Chuick, C. D., Greenfield, J. M., Greenberg, A Qualitative Investigation of Depression in Men N = 15 initially, 8 at follow up Age - Mid 20s to late 50s, M = 44.6 Interview schedule included in paper Not stated Grounded Theory Analysis Initial interview and follow up The men studied did not display typical diagnostic symptoms. Symptoms escalated over time. Methods for coping with Disclosing mental health problems to someone supportive, and being influenced to References to men using support to enable professional Control Emotional Intimacy seeking
S. T., Shepard, S. J., Cochran, S. V. & Haley, J. T. (2009) Gender – males Sexuality not given interview. Grounded theory analysis distress were maladaptive Supportive relationships improved mood Increasing personal responsibility for resolving issues helped recovery Strategies that pulled men out of depression were having someone to influence them to address their issues differently, most often spousal but one stated parents. address issues were key in recovery. Men’s distress would escalate until they took control of coping help seeking are limited. Participants had all been treated previously. Participants not tested for depression but asked if they had it or not. Cusack, J., Deane, F. P., Wilson, C. J., Ciarrochi, J. (2004) Who influence men to go to therapy? Reports from men attending psychological services - N = 73 Age - 21-69 years old Gender – males Sexuality not given general help seeking questionnaire, help-seeking influences questionnaire Not stated Friedman test, Wilcoxon signed-rank tests questionnaire of attitudes Intimate partners and GPS provided greater degree of influence than friends and family (ns) 37% would not seek help without others Theory of planned behaviour is influenced by social pressure to engage in behaviour. Men put greater importance on intimate partners Statistics are bare Emotional Intimacy Emslie, C., Ridge, D., Ziebland, S. & Hunt, K. (2006) Men’s accounts of depression: or resisting hegemonic masculinity? analysis N = 16 Age – 31-75 years old Gender – males 5 of the 16 men identified as homosexual Interview topics list included in paper Not stated Initial modified grounded theory analysis followed by Qualitative Secondary Analysis Open ended interviews based on a topic list. Qualitative secondary analysis Reconstructing a sense of masculinity is important. Re-establishing control necessary for recovery. Suicide as means of establishing control. Men are not always silent, and will discuss depression. Reconstructing help seeking as taking control is important Men who identified as homosexual included in the sample. Secondary analysis is novel and large amount of debate around it Control
Richie, D. (1999) Young Men's perceptions of emotional health: research and practice analysis N = 18 Age range - 16-35 years old Gender – males Sexuality not given vignettes and focus groups Not stated Thematic analysis focus groups and vignettes themes of structures of society, personal sense of control, work role and identity, male image, use of alcohol/drugs, emotional health, help seeking in crisis, the nature of male friendships. All help perceived as last resort Difficulty accessing confiding male friendships, fear of ridicule. Second part of the study which looked at health promotion was not fully described. Young group. Discussion not thorough. Emotional Intimacy Control Rochlen, A. B., Paterniti, D. A., Epstein, R. M., P., Willeford, L., Kravitz, R.L., (2010) Barriers in diagnosing and treating men with depression: a focus group report analysis N = 45 Age range - 24-64 years old Gender – males Sexuality not given Interview with a focus group Not stated Thematic analysis Focus group interview Aspects of the male role interfere with experience of depression. Discussing with a friend, family or professional would be challenging. Lacking emotion vocab, Men act in different ways to express mental health problems to women - more somatic and problematic Professionals are last resort; want to solve problems without help. Maintaining control is important Sexuality of sample not stated. Range in types and severity of depression not accounted for e.g. some of the sample disclosed bipolar depression and use of drugs. Emotional Intimacy
Han, C., Oliffe, J. L., (2014) among depressed men old Gender – males 84.62% of sample identified as heterosexual (influenced by grounded theory) interview recognised by men. Want reciprocity, others can restrict or broaden help self-management, losing identity and control. Positive support increases help seeking them ostracized or lose personal identity. Men take the risk to gain control and report that positive feedback helps them help seek diagnosed with depression - self sampling group. Control Reciprocity Sullivan, L., Camic, P. M., Brown, J. S. L. (2014) Masculinity, alexithymia, and fear of intimacy as predictors of UK men's attitudes towards seeking professional psychological help online survey N = 581 Age –18-over-65 years old Gender – males 86% of sample identified as heterosexual Fear of intimacy scale normative male alexithymia scale male role attitudes scale attitudes towards seeking professional psychological help scale Not stated Regression analysis online survey Traditional masculine ideology negatively correlated with help seeking, normative alexithymia negatively correlated with help Alexithymia and low education sig associated with attitudes to seeking help. Greater fear of intimacy correlated with negative attitudes. Fully mediated by male alexithymia. Psychological interaction uncomfortable for men who struggle with intimacy and expressing emotions Self-report, self-selecting sample. Depression level not stated. Men who identified as homosexual included in sample. Emotional Intimacy Vogel, D. L., S. R., Hammer, J. H., Hubbard, A. (2011) "boys don't cry": Examination of the links between endorsement of masculine norms, and help-seeking attitudes for men from diverse backgrounds N = 4773 Age - 18-79 years old Gender – males 84.2% of sample identified as heterosexual conformity to masculine norms inventory Self-stigma of help scale Attitudes towards seeking professional psychological help scale Centre for epidemiological studies depression scale Not stated Correlation and ANOVA, mediation model masculinity norms correlated with self-stigma Questionnaire Men with higher endorsement of dominant masculine beliefs have less favourable attitudes towards seeking help mediated by self-stigmatisation. Men identifying as homosexual included in sample; although differences in results discussed Emotional Intimacy
Vogel, D. L., Wade, N. G., Wester, S. R., Larson, L., & Hackler, A. H. (2007) Seeking help from a mental health professional: the influence of one's social network N = Study 1 = 780, Study 2 = 746 No age but college year shown Gender – males and females Sexuality not given Study 1 = presence of MH problem, help seeking previously, Disclosure expectations scale, Social norm measure. Study 2 = disclosure expectations scale, attitudes toward seeking professional psychological help scale, intentions to seek counselling inventory Not stated Questionnaires. Frequency analysis Study 1 = 75% prompted by others to seek help. 26% women prompted, only 13% men. Study 2 = 27% prompted to seek help. 47% referred by mum, 5% from dad. Those who sought help were prompted to 74-78% of the time. No separation of statistics for men and women Emotional Intimacy Vogel, D. L., Wester, S. R., Hammer, J. H., and T. M. (2013) Referring men to seek help: the influence of gender role conflict and stigma structural modelling N = 216 Age - m = 19.87 Gender – males Sexuality not given RE and RABBM subscales of the Gender Role Conflict Scare-short form, perceived devaluation-discrimination scale, discussing other's concerns inventory. Not stated Structural modelling. GRC and stigma explains 45% variance in willingness to refer. Men in traditional gender roles deter psychological issues as they want to fix problems without help and withhold emotional expression and discourage them referring other men. Increased restrictive affectionate behaviour between men = more stigma of help seeking. Increased Restricted emotionality increased willingness to talk and reduced stigma Self-report. No mention of measures for sample having mental health problems Emotional Intimacy Reciprocity
Webster, G. (2013 A Grounded Theory Approach Exploring Men’s Access to IAPT Services and Accounts of Psychological Help Seeking – Grounded Theory N = 11 Age range 38- 48 years old Gender – males Sexuality not given Semi-structured interview Not stated Grounded theory Themes were stigma and endorsement of masculinity scripts, chronic suffering with mental health, of mental health, acknowledgement of difference, threshold of concern about symptoms, acknowledgement that difference concerns mental state, cognitive evaluation of risks of not addressing mental state, service prioritisation of health need, GP communication style and responsiveness, solutions offered, cognitive evaluation of solution acceptability, ongoing monitoring of solution effectiveness, cognitive shift perceptions of receiving help Social support is important in the pathway to help seeking – men may feel dismissed by others when disclosing mental health problems, or may be promoted to seek help by others. The professional support system is sought at last resort Small age range in the sample. Some of the sample were using drugs and alcohol. The diagnosis of the men is not accounted for Wellstead, P. (2011) Information behaviour of Australian men experiencing stressful life events: the role of social networks and confidants N = 15 Age – 32-63 Gender – males Sexuality not given Narrative style, interview. Self-report sheet for participants to send in confidential information they did not want to discuss – covered themes of confidant availability and social network strength Not stated Narrative, and Thematic analysis and individual responses to the questions asked in interview Men needed to normalise help seeking. The primary sources of help were family, friends and colleagues including spouse. Secondary sources such as leaflets and books were used alongside peer support. For many men, women were conduits to help. The men questioned credibility info, however credible help made the men feel their credibility was being questioned, and Women were key confidants. Talking to friends = reciprocity. The paper does not make it clear how the results of the interviews were analysed. Reciprocity
time those in distress have to cope on their own, which has been featured in the media recently in the new “Time to Change” campaign promoting people talking about mental health problems. (Time to Change, 2008). Gaps in the literature which could be further explored have been identified in this review. The author questions, in what way does gender role conflict interact with the intimacy level of the relationship in which a male may disclose? What role may women take in encouraging men to seek help, or what forms of encouragement may they use, such as threats or “nagging”. Using discourse analysis, Seymour-Smith et al. (2002) interviewed medical professionals about men accessing health care, and there appeared to be a theme of female partners “forcing” the men to attend and being very responsible for their partners’ help seeking, whilst positioning the men as childlike, passive and ignorant. This exposes interesting questions regarding how men’s’ perceptions of their control interplay with their partners taking control. It would be interesting if this model also applies to mental health. Although this review focuses on the barriers to men help-seeking and could potentially show a “weakness” in men as they are less able to verbalise mental health problems and seek help; the male gender have many strengths to draw from, and a positive aspect of coping whilst maintaining masculine norms may be done through other, more positive means such as humour to dilute the impact of distress (Mental Health Foundation, 2010).