Role of the Gender-Linked Norm of Toughness in the Decision to Engage in Treatment for Depression

Abstract

Objective Given their prevalence and persuasive power in our culture, gender norms— commonly described as socially reinforced, learned expectations of what it means to be a man or a woman—likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment (``wait-and-see” approach). Methods Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions. Results Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=−.70, p<.01). Men’s greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.05). Conclusions Men’s greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women’s treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.

“I can’t have it; I am a man. A young man!” – men, fibromyalgia and masculinity in a Nordic context

“…The onset and development of chronic widespread pain can be a threatening experience to one's gender identity. Research shows that gender has a significant impact on health behaviour such as help seeking or on expression of physical symptoms (Boerner et al, 2018;Ek, 2013;Flurey et al, 2017;O'Brien, Hart, & Hunt, 2007;O'Brien, Hunt, & Hart, 2005;O'Loughlin et al, 2011). Concerning chronic pain, research shows that men tend to adopt a "wait and see" approach more often than women, especially if the symptoms are perceived as minor and not life threatening (Keogh, 2015;Paulson, Danielsson, & Söderberg, 2002;Paulson, Norberg, & Danielson, 2002).…”

The relationship between geographic remoteness and intentions to use a telephone support service among Australian men following radical prostatectomy

“…The findings of the current study indicate that addressing stoic attitudes might be a key element of providing support for men following treatment for prostate cancer. It has been suggested that hegemonic masculine norms be used to advantage in promoting help seeking, by reframing such acts as demonstrating strength, independence and having the courage to tackle a problem . Others argue, however, that this approach might merely serve to reinforce hegemonic traits, particularly stoicism, and perpetuate the norm that men should not show any emotional vulnerability .…”

Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial

“…11,[17][18][19][20][21][22][23][24][25][26] Patients generally report openness to inquiry about suicide thoughts, 27 yet PCCs inquire rarely and inconsistently and may detect only 10-20% of suicidal patients. [28][29][30] Factors contributing to this "conspiracy of silence" include gender-linked norms, 31,32 stigma, 33 the belief that PCCs are not equipped to handle mental health issues, 34 fear of psychiatric hospitalization, 35 and competing demands during visits. 36 While interventions targeted to PCCs increased the detection of suicidal patients, many still went unrecognized.…”