For nearly 50 years I have been helping men and women to live fully, love deeply, and make a difference in the world. My professional journey began on November 21, 1969 when my son, Jemal, was born. After coaching my wife through twenty-four hours of labor with the techniques we learned in the Lamaze child birth classes, it was time for her to go into the delivery room. “It’s time for you go to waiting room,” the nurse informed me. We had been told the rules of Kaiser hospital at the time. The doctor decides whether the father will be allowed in the delivery room and the doctor on duty when it was our time felt that fathers would cause more harm than good.
I kissed my wife and gave her a hug. “I’ll see you and the baby soon,” I told her. She went left to the deliver room and I turned right down the hall to the waiting room. But as I approached the doors I couldn’t go through them. Some force was pulling me back. I turned and walked down the hallway and into the delivery room. I felt the call of my unborn child. “I don’t want a waiting room father. Your place is with us.”
Our son was born shortly afterwards and as they handed him to me, amidst my tears of joy, I made a promise. I vow to be a different kind of father than my father was able to be for me and to do everything I can to change the rules so that fathers and families are not needlessly separated. I have been working ever since to fulfill the promise I made to my son.
My own father separated from our family when I was five years old. After years trying to find work in his chosen profession he became increasingly depressed and took an overdose of sleeping pills. Although he didn’t die, our lives were never the same. The dictates of the Man Box to become the sole breadwinner nearly killed him. The depression that followed could have been treated if doctors had understood the true causes.
As the son of a depressed and suicidal father and a man who has suffered from depression and bipolar disorder himself, its not surprising that I have focused a great deal of my professional work on preventing and treating depression in men. In conducting my PhD study on gender and depression I found that one of the most consistent findings in the social epidemiology of mental health is the gender gap in depression. Many studies indicate that depression is approximately twice as prevalent among women as it is among men.
Yet, the suicide statistics show that more males than females commit suicide in every age group from pre-teen to old age:
Male and Female Suicide Death Rates and Gender Difference (Ratios)
By Age Group
| Age Group | Male Rate | Female Rate | Ratio Male/Female |
| 10-14 | 1.4 | 0.8 | 1.8 |
| 15-19 | 10.9 | 2.7 | 4.0 |
| 20-24 | 21.4 | 4.0 | 5.4 |
| 25-29 | 19.5 | 4.7 | 4.2 |
| 30-34 | 18.3 | 5.2 | 3.5 |
| 35-44 | 23.9 | 6.8 | 3.5 |
| 45-54 | 25.8 | 8.8 | 2.9 |
| 55-64 | 21.4 | 7.0 | 3.1 |
| 65-74 | 21.5 | 3.4 | 6.3 |
| 75-84 | 27.3 | 3.9 | 7.0 |
| 85+ | 38.6 | 2.2 | 17.5 |
| All ages | 17.8 | 4.6 | 3.9 |
Suicide rates per 100,000 U.S. Population
Source: Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 58, 1, 2009
Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2010). [cited 2012 Oct 19] Available from www.cdc.gov/injury/wisqars/index.html.
I wondered whether males suffered depression at half the rate of females or whether we were using diagnostic tools that didn’t take into account the ways that males experienced depression. I got my first clues from talking with Ronald C. Kessler, PhD, Professor of Health Care Policy at Harvard Medical School. He said, “When you study depression among children, they don’t talk about being sad, they talk about being angry and irritable,” he said. “Children don’t have the cognitive capacity to make sense of all their feelings. There’s a great similarity between children and men. Men get irritable; women get sad.”
I created my own diagnostic scale that I believed would assess depression in men better than traditional scales being used throughout the world. I developed a three-factor depression scale that took into account symptoms like male irritability and anger. The results were summarized as follows:
Three Factors from the Diamond Male Depression Scale–Emotional Acting-In, Emotional Acting-Out, and Physical Acting-Out–were identified. Both depressed and non-depressed men scored significantly higher than depressed and non-depressed women on Factor 2, Emotional Acting-Out and Factor 3, Physical Acting-Out. There was a significant relationship between suicide risk and Factor 1, Emotional Acting-In.
The study adds credence to the concept of a “male depressive syndrome” with atypical symptoms that relate to depression and suicide risk. The three factor Diamond Male Depression Scale may be a useful tool for assessing depression and suicide risk. Further research is needed to validate the scale.
Although my study was a small one, with slightly more than 1,000 study subjects, my findings were validated by Lisa A. Martin, PhD and colleagues at University of Michigan and Vanderbilt University published in the Journal of the American Medical Association (JAMA). “The study found that men reported higher rates of anger attacks/aggression, substance abuse, and risk taking compared with women. Analyses using the scale that included alternative, male-type symptoms of depression found that a slightly higher proportion of men (26.3%) than women (21.9%) met criteria for depression. Analyses using the scale that included alternative and traditional depression symptoms found that men and women met criteria for depression in almost equal proportions: 30.6% of men and 33.3% of women.
If women and men throughout the world suffer from depression at equal rates, but we are using assessment scales that are biased in favor of the ways the women typically experience depression, we are mis-diagnosing millions of men who suffer from depression but go unrecognized and untreated. That could help account for the higher suicide rate in males. Using a diagnostic scale, such as the one I developed, could save millions of men’s lives.
“Over 375,000 lives would be saved in a single year in the U.S. alone if men’s risk of dying was as low as women’s,” says University of Michigan researcher, Daniel J. Kruger, PhD. “Being male is now the single largest demographic factor for early death,” says Kruger’s colleague, Randolph M. Nesse, M.D.
Dr. Nesse concludes,
“If you could make male mortality rates the same as female rates, you would do more good than curing cancer.”
Understanding, and more effectively preventing and treating male-type depression would go a long way towards improving men’s lives through early diagnosis, prevention, and treatment of depression. That’s a health hack worth living for.
If you’d like more information on my work preventing and treating male depression, drop me at note and put “male depression” in the subject line.
