Editor's note: This story was updated on January 22, 2018.
Symptoms of depression often manifest differently in men than they do in women, Elizabeth Bernstein writes for the Wall Street Journal.
About 5 percent of adult men in 2014 had suffered from at least one major depressive episode in the past year, compared with about 8 percent of adult women, according to the Substance Abuse and Mental Health Services Administration. However, some believe the prevalence of depression in men is underreported, as men are less likely to say they feel depressed and less likely to seek treatment than women.
Jeffrey Borenstein, president of the Brain and Behavior Research Foundation, said gender roles may play a role. "There is that sense that [men] should be in control of their emotions and that being depressed can be viewed as a sign of weakness," he said.
Experts told Bernstein that women "often internalize depression—focusing on the emotional symptoms, such as worthlessness or self-blame." By contrast, Bernstein says men are more likely to externalize depression: they "feel numb and complain of insomnia, stress, or loss of energy" and they "become irritable and angry."
That can negatively affect both the person with depression and the people around them. Research has found that, while marital problems precede depression in women, men are more likely to become depressed and then suffer from marital problems. In other words, "The male response to depression is to push away, which can lead a partner to feel helpless and alone," explained psychologist Wendy Troxel.
Ways to reach out
Bernstein shares several ways that loved ones can reach out to men who are depressed.
First, it's important to normalize the experience, said Michael Addis, a professor of psychology at Clark University. "Look up men and depression on the internet—you will be amazed at what you see," he said, noting that famed historical figures such as Abraham Lincoln and Buzz Aldrin suffered from depression.
Bernstein writes it's also important to "speak carefully" and not criticize someone who has depression. Psychologist Joshua Coleman said, "Be sensitive to the way his depression feels profoundly humiliating to him."
Bernstein cites research that found men can become defensive when they hear the word "depression" applied to them. "Encourage [men] to seek help for the symptom [they are] describing," such as insomnia or anxiety, rather than suggesting they might be depressed, Bernstein says.
But while it's important to be careful about how you discuss depression, Bernstein stresses that you shouldn't shy away from the conversation. "Don't be shy about asking a man if he has thoughts of hurting himself," she writes, noting that men are about four times more likely than women to die from a suicide attempt.
It's important to be persistent, even if your loved one is pushing you away, Bernstein writes. However, she stresses that, as much as you care for someone, you need to set your own limits. "It is important to realize that you don't need to be on the receiving side of a depressed man's anger or blame—or be the only one showing up for the relationship," she writes (Bernstein, Wall Street Journal, 9/19).
More ways to reach behavioral health patients
Adoption of telebehavioral health services has surged over the past five years, with Medicare-billed behavioral health encounters nearly tripling between 2009 and 2013.
Learn the emerging trends that are driving telebehavioral health adoption, how reimbursement works, the business case for offering these services, and more.