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Background: Many studies indicate that men are more reluctant to seek help for mental health problems than women. Traditional ideas of masculinity are often seen as a cause of this phenomenon. However, little is known about the diversity of experiences during the processes of help-seeking and service use among men with depression who have already utilized mental health services.

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This study aims to explore men's experiences and attitudes toward depression, help-seeking, and service use in order to develop gender-sensitive services. Interview topics included individual experience with depression, help-seeking behavior, and mental health Male seeking asian Teesside use. Transcripts were analyzed using qualitative content analysis. : Before seeking treatment, men's help-seeking behavior was negatively affected by internalized masculine norms.

However, findings indicate a change of attitudes toward depression after mental health service use. Men with depression emphasized a salutogenic perspective toward mental health problems and critically reflected on masculine norms. The positive function of men-only groups were described as key for successful service use. Conclusions: Men with depression reported experiences toward help-seeking and service use on four different levels: i attitudes toward depression, ii perception of societal views on depression, iii experiences within the family context and iv experiences with mental health services.

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Peer-led men-only groups may increase participants' self-esteem and assist in disclosing weaknesses. In the context of GPs' mediating role, training for health professionals concerning the impact of masculine norms on mental health is recommended.

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There is broad evidence of men's reluctance to seek help for mental health problems. Studies support the generally-held assumption that men are less likely than women to get assistance from mental health professionals for problems 1. A body of empirical research has explored reasons for help-seeking decisions as well as service use behavior among men with depression.

Research often suggests that men's help-seeking behavior regarding depression is attributed to traditional masculine norms such as being strong, successful, self-reliant, in control, and capable, along with an emphasis on avoiding emotions 2.

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of a systematic review of qualitative studies on men's views of depression confirmed the impact of norms concerning masculine roles on men's attitudes toward depression and help-seeking 4. Further studies of a systematic review refer to the adverse effects of male role expectations and social pressures to perform well as family providers and fathers with consequences for help-seeking behavior.

Depression was frequently perceived as a threat to men's roles as family provider and many participants reported feelings of inadequacy and incapability compared to their situation before depression 4. A meta-analytic review on effects of paternal depression on fathers' parenting behaviors supports this assumption. Studies indicated that paternal depression has ificant, though small, effects on parenting, with depressed fathers demonstrating decreased positive and increased negative parenting behaviors i.

In contrast Male seeking asian Teesside the adverse effects of family role expectations, research highlighted the supportive function of the family during the help-seeking process 78. In addition to the impact of expectations regarding male roles on help-seeking behavior, studies revealed positive as well as negative experiences of mental health service use among men with depression. A recent qualitative study referred to conflicts that men experienced in relation to antidepressant use 9.

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On the one hand, medication was perceived as a way in which men asserted their control over difficulties; on the other hand, antidepressants were seen as an obstacle to emotional and physical vitality, for example by undermining sexual function. Further findings referred to the role of general practitioners GPs in the context of treating men's depression. Although studies pointed out that men were repeatedly found to be half as likely to seek help for mental Male seeking asian Teesside concerns from a GP compared to women 7others emphasized GPs' function as a pathway to mental health services Further studies revealed ways men communicate their depression within in- and outpatient services.

While discussions about depression with health care providers were described as atypical for men 11studies explored whether a change of setting improved access Male seeking asian Teesside treatment for common mental disorders in the context of mental health services. Research found that a higher proportion of men with mental health problems sought help via psychotherapeutic consultation in the workplace compared to standard psychosomatic outpatient care Even though traditional masculine norms play an important role in reinforcing men's reluctance to seek help, qualitative studies showed that some men seemed to benefit from just the same norms by perceiving these ideals as a healthy resource While some men associated depression with powerlessness and lack of control, others described the recovery as a heroic struggle from which they emerged much stronger 3.

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Furthermore, there is some evidence that men do not necessarily subscribe to traditional ideals but demonstrate alternative forms of masculinity 4. These studies suggested that some men dissociated themselves from traditional masculine norms by emphasizing their sensitivity in coping with and utilizing in- and outpatient services due to depressive symptoms 3.

Despite emerging evidence for the diversity of men's experiences of help-seeking and service use, many studies provide a one-dimensional understanding of mental health behavior among men with depression, including reduced service use.

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Beyond this, there is a lack of knowledge on how men's specific needs in cases of depression are addressed by mental health services. Moreover, the impact of norms concerning traditional masculine roles for men with depression who have already utilized mental health services is unclear.

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studies on mental health professionals' view about the impact of male gender for the treatment of men with depression stress the need to develop gender-sensitive services On Male seeking asian Teesside one hand, refer to the need of awareness of the role of gender and that its implications for mental health treatment should be an integral part of mental health professionals' education and the everyday practice of mental health treatment.

On the other hand, more evidence is needed to develop mental health services based on the experiences of men with depression. This study therefore aims to explore experiences and attitudes toward depression, help-seeking and service use among men with depression who have already utilized mental health services in order to develop gender-sensitive services. The study aims for a comprehensive analysis of men's constructions of masculinity and the consequences for their mental health behavior.

Through an analysis of the diversity of concepts of masculinity, the study contributes to a more detailed picture of depression among men.

Masculinity and help-seeking among men with depression: a qualitative study

In the first step, based on a sample of men with depression, a latent class analysis was performed and three types of a combination of masculinity orientation and job-related attitudes were identified In the second step, twelve biographical interviews with four representatives of each class were conducted in order to get a deeper understanding of class membership in respect to subjective illness theories and coping processes among men with depression In a third step, these interviews were re-analyzed in order to gain a deeper understanding of men's subjective perspectives on help-seeking barriers and facilitators of service use irrespective of class membership.

This article focuses on this third step by addressing men's perspectives on help-seeking decisions and Male seeking asian Teesside use experiences. Participants were recruited both inside and outside healthcare settings in Southern Germany. Eligible patients were asked by doctors or other clinical staff about their willingness to participate in the study. After expressing their willingness to participate, research workers contacted the patients, informed them about the aims of the study and verified Male seeking asian Teesside patients according to the following inclusion criteria: patients must be male, aged between 18 and 64, diagnosed or self-identified as having depression and sufficient German language skills.

We conducted narrative-biographical interviews Table 1 in which interviewees were given as much time as required to talk about their experiences during the help-seeking and service use process in their own words Participants were encouraged to talk about their experience of depression, help-seeking behavior, and service use. In Male seeking asian Teesside additional part of the interview, we used a semistructured interview guide, which included the topics of illness theories, the social consequences of depression and personal coping strategies.

At the end of the interviews, respondents were asked to describe whether and how masculine norms influenced their help-seeking decisions and service use experiences. One pilot interview was conducted with no changes for the interview guide.

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Twelve interviews were conducted by a researcher Male seeking asian Teesside between March and June The place for the interviews was chosen by the respondents. Interviews took place either at home or in the facilities of Ulm University, from which audio was recorded, transcribed verbatim, and anonymized.

The duration of the interviews was between 27 and min, with a mean of 75 min. Respondents were asked to answer socio-demographic questions at the end of the interview. Interview transcripts were analyzed using qualitative content analysis 18 via the following steps: i potential were defined, derived deductively from the research question and theoretical background e.

Discordant coding was discussed in a qualitative research group until consensus was reached. It should be reflected that the interviewer was a male researcher.

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Against the background of interactionism, male participants might answer in a specific way depending on the gender of the interviewer for e. To try to control this bias a qualitative research group with several perspectives men and women, different professions etc.

The mean age was 52 range from 30 to Three participants had a general qualification for university entrance, five an advanced technical college entrance qualification, three an intermediate Male seeking asian Teesside certificate, and one participant had a certificate of secondary education. Interviewees were employed in technical professions, public administration, marketing, social profession, or transportation.

Five participants were unemployed, on sick leave, or participating in occupational rehabilitation. Before being on sick leave, in rehabilitation or unemployed these interviewees were employed in manufacturing and construction, human services, and marketing. One participant was single, two were divorced and nine were married. Seven participants had children and two lived together with them.

Table 2. Based on the qualitative analysis, we summarized themes which refer to men's i attitudes toward depression; ii perception of societal views on depression; iii Family environment: between role expectations and social support; and iv experiences with mental health services Table 3. These main themes contained 20 with 58 sub and will be presented in more detail in the following section, using pseudonyms and participant's age range to preserve confidentiality.

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Table 3. The majority of interviewees reported that masculine norms influenced their attitudes toward depression as well as their decision to seek help. Most participants reported having tried to solve mental health problems on their own instead of seeking mental health services. Along these lines, some interviewees described their own as well as men's socialization in general as having an emphasis on avoiding feelings, appearing strong and never crying.

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In order to meet traditional masculine norms concerning societal roles, respondents decided not to disclose their mental health problems and to post-pone their own needs:. You have to play your part in the world of business. This means you can rarely be honest anywhere. That's the main thing, not to actually show how you're really doing Steve, 50—54 y. Interviewees explained low levels of help-seeking behavior as being a means of maintaining their employability as well as to safeguard career options.