Supporting Men’s Mental Health

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Men’s mental health presents unique challenges for the clinician, in part due to gender roles and stigmas. Masculine gender roles, or gender norms, perpetuated in today’s society may carry risks for poor mental health, and these sex differences typically emerge in late childhood and adolescence.1-3 Traditional gender norms around masculinity often compel men to present themselves as strong, competitive, and in control—both physically and emotionally.1,3-4 Thus, the natural emotions characterized by vulnerability, including sadness, anxiety, and fear, often trigger shame in men and may become a barrier to seeking help.1 Systematic reviews and qualitative studies confirm the negative impact of gender norms on men’s attitudes toward depression and health-seeking.2-4

The stigma of men’s mental health may have wide-reaching and profound consequences.5 Stigma, a complex social process whose concepts are applied in mental illness research, has been described as a discrediting mark or attribute that reduces the status of the person in the eyes of society. Mental illness stigmas are associated with labeling, stereotyping, separating (where those experiencing mental illness are separated, “us” from “them”), and discrimination. A 2022 scoping review published in the American Journal of Men’s Health found that men who anticipated, perceived, and internalized mental illness–related stigma faced a range of consequences, including:

  • Reluctance to access and engage with mental health services
  • Poor treatment adherence
  • Social disconnection
  • Intensifying suicidal behavior
  • Heightened risk for severe mental illness5

Moreover, men are more likely to focus on the body’s physical symptoms (tiredness, irritability) and exhibit externalized behaviors (anger, substance use, risk-taking) that may not be recognized as by-products of mental health conditions.3 Because of this, men’s mental health issues may be hidden or overlooked, and often go unrecognized and undiagnosed.3

Consistent evidence has been found worldwide suggesting that men are far less likely to seek help for mental health challenges, irrespective of age, nationality, or ethnic or racial background.3 Globally, the rate of male suicide is two times that of females,3 and males fare poorly on indices of substance misuse, risk taking–related injury, conduct problems, violence, and aggression.1

Studies also show strong associations between alcohol abuse, depression, and suicidal behavior interacting with biological factors in men as well as alcohol consumption being used as a coping strategy for depression.4,6 This is supported by higher prevalence rates of substance use disorders in men.4 How can functional medicine clinicians utilize the therapeutic encounter to identify mental illness in men and develop personalized treatment plans that will engage them on their path to wellness?

Lifestyle Interventions for Men: Personalizing Treatment Plans

Evidence suggests that men will seek out and participate in health services when they are designed and delivered in ways that align with their preferences and interests.3,7 For example, activities that draw men together and that offer a context for integrating mental health promotion include sports, hobbies (gardening, woodworking, car mechanics), and other interests (mountain biking, surfing).3 Clinicians may consider tailoring lifestyle interventions to the unique patient, including physical exercise, enhanced nutrition, healthy sleep habits, and self-care. There is strong evidence that regular physical activity reduces anxiety and depression as well as ameliorating stress.8

A gender-tailored, three-month eHealth weight loss lifestyle intervention study in 209 overweight/obese Australian adult men (average age 46 years), both with and without depression, generated significant improvements in depressive symptoms compared to baseline.9 Program elements were socio-culturally targeted to appeal specifically to men and included printed materials, a DVD, motivational text messages, online- or app-based self-monitoring, and other weight loss tools (i.e., pedometer).9

Findings for the entire sample at posttest showed a mean decrease in depressive symptoms of 1.8 units (95% CI; 1.3 to 2.3; P<.001; d=0.5).9 For the subgroup of men with depression at baseline, these improvements were more noticeable with a reduction in depressive symptoms by 5.5 units (adjusted mean difference: -5.5 units, 95% CI -7.2 to -3.8; d=1.0). Furthermore, 72.2% (26/36) of this subgroup no longer met the criterion for depression at posttest. A corresponding smaller intervention effect on depressive symptoms was also observed in men without depression, with an adjusted mean difference of 1.0 units (P<.001; d=0.4).9

For more information on the link between exercise and anxiety and depression, please refer to this IFM article or listen to an IFM podcast on overcoming barriers to physical fitness. For stress reduction, obtaining adequate amounts of sleep has also been demonstrated to be an effective strategy to reduce stress, anxiety, and signs of depression.8 A deep dive into the science behind the multidirectional nature of mental illness, chronic disease, and sleep can be found here. Clinical strategies that include nutrition interventions also have potentially powerful impacts, not only for chronic mental health disorders but also for a patient’s overall mental wellness. For an in-depth look at how nutrition can impact mental health, please refer to this IFM article.

Other strategies that may mitigate the negative effects of mental health stigma in men include:

  • Peer support/social connectedness
  • Increasing mental health literacy
  • Reframing mental illness and help-seeking
  • Utilizing behavioral change techniques
  • Psychoeducational materials4,5

Research has found that men may develop positive coping strategies after utilizing mental health services by gaining a greater personal awareness during the recovery process, which may lead to a new perspective.2 Engagement strategies utilizing brochures and documentaries also have demonstrated significant improvements in help-seeking.4 Furthermore, psychoeducational materials may help men understand their current difficulties and the possible long-term outcomes of mental health conditions.4 Tangible, solution-focused approaches have been reported to be effective for changing other behaviors, such as increasing physical activity and adhering to a healthy diet.4,10

The functional medicine model emphasizes a multi-pronged approach to health and wellness, engaging patients in a deep therapeutic partnership that can help the clinician identify and unravel the root cause of mental illness. Functional medicine clinicians educate patients about lifestyle interventions that can have a profound impact on mental health and quality of life. IFM has created a number of handouts for clinician and patient use, as well as other resources that can help the patient cope, manage, and navigate a path to recovery. Patient handouts can be found in the IFM Toolkit, including the following:

  • Male Intake Questionnaire
  • Depression, Anxiety, & Stress Scales Score Sheet
  • Diet, Nutrition, and Lifestyle Journal
  • Health Benefits of Social Support and Relationships
  • Self-Care Questionnaire
  • Goal Setting for Behavior Change
  • Cultivating Self-Awareness
  • Tips to Incorporate Mindful Movements Every Day

To access these educational resources, log in to the IFM website and select “My Toolkit,” then search for each of the titles above. To learn more about how lifestyle interventions can influence men’s mental health trajectories, please consider attending IFM’s foundational course, Applying Functional Medicine in Clinical Practice (AFMCP), which synthesizes the latest medical research with a model of care that integrates each patient’s individual history, genetics, and lifestyle factors. AFMCP equips clinicians to design effective, personalized treatments for each patient and teaches you how to use IFM’s tools to improve patient outcomes.

Learn More About Functional Medicine

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  1. Rice S, Oliffe J, Seidler Z, et al. Gender norms and the mental health of boys and young men. Lancet Public Health. 2021;6(8):E541-e542. doi:1016/S2468-2667(21)00138-9
  2. Staiger T, Stiawa M, Mueller-Stierlin AS, et al. Masculinity and help-seeking among men with depression: a qualitative study. Front Psychiatry. 2020;11:599039. doi:3389/fpsyt.2020.599039
  3. Sharp P, Bottorff JL, Rice S, et al. “People say men don’t talk, well that’s bullshit”: a focus group study exploring challenges and opportunities for men’s mental health promotion. PLoS One. 2022;17(1):e0261997. doi:1371/journal.pone.0261997
  4. Sagar-Ouriaghli I, Godfrey E, Bridge L, Meade L, Brown JSL. Improving mental health service utilization among men: a systematic review and synthesis of behavior change techniques within interventions targeting help-seeking. Am J Mens Health. 2019;13(3):1557988319857009. doi:1177/1557988319857009
  5. McKenzie SK, Oliffe JL, Black A, Collings S. Men’s experiences of mental illness stigma across the lifespan: a scoping review. Am J Mens Health. 2022;16(1):15579883221074789. doi:1177/15579883221074789
  6. Otten D, Tibubos AN, Schomerus G, et al. Similarities and differences of mental health in women and men: a systematic review of findings in three large German cohorts. Front Public Health. 2021;9:553071. doi:3389/fpubh.2021.553071
  7. Owen J, Wong YJ, Rodolfa E. Empirical search for psychotherapists’ gender competence in psychotherapy. Psychotherapy (Chic). 2009;46(4):448-458. doi:1037/a0017958
  8. Rippe JM. Lifestyle medicine: the health promoting power of daily habits and practices. Am J Lifestyle Med. 2018;12(6):499-512. doi:1177/1559827618785554
  9. Young MD, Morgan PJ. Effect of a gender-tailored eHealth weight loss program on the depressive symptoms of overweight and obese men: pre-post study. JMIR Ment Health. 2018;5(1):e1. doi:2196/mental.8920
  10.  Hunt K, Wyke S, Gray CM, et al. A gender-sensitized weight loss and healthy living program for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomized controlled trial. Lancet. 2014;383(9924):1211-1221. doi:1016/s0140-6736(13)62420-4

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