“Women seek help—men die.” This conclusion was drawn from a study of suicide prevention by Jules Angst & Celile Ernst. They found that 75% of those who sought professional help in an institution for suicide prevention were female. Conversely 75% of those who committed suicide in the same year were male. Why do so many men die from suicide?
Douglas Bremner, M.D. is Professor of Psychiatry and Radiology and Director Emory Clinical Neuroscience Research Unit (ECNRU) conducted an experiment that offers real insights into the different ways men and women experience depression and what they do when they become depressed. In a very interesting experiment he gathered a group of former depression patients. With their permission, he gave them a beverage that was spiked with an amino acid that blocks the brain’s ability to absorb serotonin.
What I found fascinating were the gender specific differences in the way men and women reacted to the potion that blocked the effects of the serotonin. Typical of the males was John, a middle-aged businessman who had fully recovered from a bout of depression, thanks to a combination of psychotherapy and Prozac. Within minutes of drinking the brew, however, “He wanted to escape to a bar across the street,” recalls Bremner. “He didn’t express sadness … he didn’t really express anything. He just wanted to go to Larry’s Lounge.”
Contrast John’s response with that of female subjects like Sue, a mother of two in her mid-thirties. After taking the cocktail, “She began to cry and express her sadness over the loss of her father two years ago,” recalls Bremner. “She was overwhelmed by her emotions.”
It’s not difficult to guess which person is most likely to get help and which person is most likely to continue having problems.
If Depression Rates Are Twice as High for Women, Why Are Suicide Rates So High For Men?
Depression and suicide are major problems throughout the world. According to the World Health Organization (WHO), more than 350 million people of all ages suffer from depression world-wide. Further, every year almost one million people take their own lives.
One of the most consistent findings in studies conducted throughout the world is the gender gap in depression. Many studies indicate that depression is approximately twice as prevalent among women as it is among men. Yet suicide rates are 2 to 6 times higher for males than for females. Clinicians and researchers have wondered why so many more women are thought to be depressed, but so many more men commit suicide.
New Research Indicates Males May Be As Depressed as Females, But Are Under-diagnosed and Under-Treated
As a clinician who has been treating men and women for more than 40 years, I felt that many depressed men were not being recognized and hence their depression went untreated. We focus on such things as erectile dysfunction in men, but often are blind to male-type depression. Since there’s no blood test for depression, the only way we determine if someone is clinically depressed is to interview them and ask questions. However, if the questions we were asking and the scales used for determining depression were flawed, we would miss many people who were depressed and many of them would go on to commit suicide.
In 2000 I began a research study to see if the questions we were asking depressed men and depressed women might be biased towards the way women experience depression. I reported my initial findings in the book, The Irritable Male Syndrome: Understanding and Managing the 4 Key Causes of Depression and Aggression. I concluded, “I think male depression is being masked. Millions of men are depressed but don’t know it. Millions more know it but are afraid to show it. It isn’t ‘manly’ to be depressed.”
I continued my research and conducted a more scientific study on depression which I reported in my book Male vs. Female Depression: Why Men Act Out and Women Act In. The research demonstrated that male depression has been under-diagnosed and that traditional depression scales leave out symptoms such as irritability, anger, and aggression, that are often present in depressed men.
A new study by Lisa A. Martin, PhD and colleagues at University of Michigan and Vanderbilt University published in the Journal of the American Medical Association (JAMA), lends credence to these earlier findings that men and women express depression through different symptoms. 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.
Martin and her colleagues summarized a number of their important findings:
- The goal of this analysis was to explore whether the ways in which men and women experience depression is different from the way depression currently is identified in community surveys. The current depression criteria may be biased toward detecting symptoms that are more common in women.
- Our findings showed that men are willing to endorse the alternative depression symptoms, leading to the elimination of sex differences in the prevalence of depression.
- Our findings highlight that male-type symptoms also are fairly common in women.
- Gender is likely to play an important role in how men and women conceptualize and experience depression. Therefore, further study is needed to clarify which symptoms truly describe men’s experiences of depression. This study suggests that asking about irritability, anger, and substance abuse is important when assessing depression in men and women.
“We know that men are less likely than women to seek treatment, even when they recognize that they are depressed,” says Martin. “Incorporating these symptoms may not only identify depression in more men, it may lead to ways to entice more men to get help.”
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