Recent proposals for revisions to the 11th edition of the International Classification of Diseases (ICD-11) posttraumatic stress disorder (PTSD) diagnostic criteria have argued that the current symptom constellation under the Diagnostic and Statistical Manual of Mental Disorders-5 is unwieldy and includes many symptoms that overlap with other disorders. The newly proposed criteria for the ICD-11 include only six symptoms. However, restricting the symptoms to those included in the ICD-11 has implications for PTSD diagnosis prevalence estimates, and it remains unclear whether these six symptoms are most strongly associated with a diagnosis of PTSD. Network analytic methods, which assume that psychiatric disorders are networks of interrelated symptoms, provide information regarding which symptoms are most central to a network. We estimated network models of PTSD in a national sample of veterans of the Iraq and Afghanistan wars. In the full sample, the most central symptoms were persistent negative emotional state, efforts to avoid external reminders, efforts to avoid thoughts or memories, inability to experience positive emotions, distressing dreams, and intrusive distressing thoughts or memories; i.e., three of the six most central items to the network would be eliminated from the diagnosis under the current proposal for ICD-11. An empirically-defined index summarizing the most central symptoms in the network performed comparably to an index reflecting the proposed ICD-11 PTSD criteria at identifying individuals with an independently-assessed DSM-5 defined PTSD diagnosis. Our results highlight the symptoms most central to PTSD in this sample, which may inform future diagnostic systems and treatment.

Despite there being effective clinical treatments for a range of mental health issues (U.S. Department of Health and Human Services, 1999, Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services), men have a particularly low rate of help-seeking from mental health professionals (U.S. Department of Health and Human Services, 2002, The NHSDA report: Serious mental illness among adults. Rockville, MD: National Institute of Mental Health). A variety of contextual factors may be associated with why men are resistant to professional help-seeking (Addis, M. E., & Mahalik, J. R., 2003, Men, masculinity, and the contexts of help-seeking, American Psychologist, 58, 5–14). The current project recruited a diverse community sample and used two observational rating measures to assess men’s verbal reactions to common mental health labels (“anxiety” and “depression”), different forms of help-seeking (medication, psychotherapy, friends and family, and “other forms of help-seeking”), and different sources of help-seeking advice (romantic partner, doctor, and psychotherapist) within the context of a clinical-style interview. The findings indicated that men prefer talk-therapy with a psychotherapist compared to other forms of professional help-seeking and that many men, particularly those who adhere to hegemonic masculine norms, are more resistant to taking medication. Men were also found to react more positively to seeking professional treatment at the suggestion of a psychotherapist compared with a medical doctor or romantic partner. Finally, the study confirmed previous self-report findings that adherence to masculine norms is negatively associated with men’s willingness to seek professional help.

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There has been limited research on interventions addressing the psychosocial barriers to men’s underutilization of formal and informal help. To address this gap in the literature, we report on the development of Gender-Based Motivational Interviewing (GBMI) for men with internalizing symptoms and present the findings of a pilot trial. GBMI is a single session of assessment and feedback that integrates gender-based and motivational interviewing principles. Community-dwelling men (N = 23) with elevated internalizing symptoms and no recent history of formal help-seeking were randomized to either GBMI or control conditions and were followed for three months. The effect of GBMI on internalizing and externalizing symptoms ranged from small to large across follow-ups. GBMI had a small to moderate effect on stigma. There was no effect on help-seeking attitudes or intentions. GBMI increased use of informal help seeking (e.g. parents and partners) and had no effect on formal help seeking. None of these findings were statistically significant. Study weaknesses included baseline differences in help-seeking variables between conditions. This initial evaluation suggested that GBMI shows promise for improving mental health functioning while further research is need to determine its effect on help-seeking.

Men are considerably less likely to seek professional and nonprofessional help for mental disorders. Prior findings indicate that adherence to masculine norms contributes to stigma about internalizing disorders and help seeking. There are currently no empirically supported interventions for increasing help seeking in men with internalizing symptoms. To address this need, we conducted a pilot study of gender-based motivational interviewing (GBMI) for men with internalizing symptoms. GBMI is a single session of assessment and feedback integrating gender-based and motivational interviewing principles (Addis, 2012). College men (N = 35) with significant internalizing symptoms and no recent help seeking were randomized to either GBMI or a no-treatment control and were followed for 2 months. GBMI had a significant effect on seeking help from parents and a trend for seeking professional help, but did not have a significant effect on seeking help from friends or partners. The size of the effect of GBMI on professional and nonprofessional help seeking ranged from small to medium. GBMI shows promise for improving men's help-seeking behaviors and warrants further development and investigation.