HEA 3060 Module 3 Men's Depression and Suicide Paper: How Distress Is Missed and What Prevents Deaths Example

Angry, Not Sad: Recognizing Depression in a Laid-Off Machinist and Preventing a Suicide

Student Name

B.S. in Health Studies, Thomas Edison State University

HEA-3060: Men's Health

Mentor Name

Month Day, Year

Angry, Not Sad: Recognizing Depression in a Laid-Off Machinist and Preventing a Suicide

Introduction

Suicide kills American men at several times the rate it kills women, and middle-aged men account for a large share of suicide deaths. Yet women are diagnosed with depression about twice as often as men. One explanation is that depression in men is missed: men may feel and show it in other ways, and they ask for help less often. This paper examines how men's depression can look, why men do not seek help and which prevention strategies have the strongest evidence.

The Man

Ray is invented for this paper. He is 51 and worked for twenty-six years as a machinist at a plant in Phillipsburg that closed last spring. He has applied for jobs without success. Since then he stays in bed until noon, has quit his bowling league and drinks six or seven beers most nights. He snaps at his wife and adult son over small things and recently punched a hole in the garage wall. He owns two hunting rifles. When his wife suggested he talk to someone, he said there was nothing wrong with him except that no one would hire him.

How Depression in Men Can Look

Oliffe and Phillips (2008) reviewed research on men, depression and masculinities. They found that many men experience depression in ways that do not match the standard picture of sadness and tearfulness. Irritability, anger, aggression, risk taking, overwork, withdrawal and heavy drinking or drug use may mask or accompany low mood. Masculine ideals of self-reliance and emotional control can lead men to hide sadness and to treat distress with alcohol or work rather than with care. Standard screening questions focused on sadness may miss these men.

Ray's anger, drinking, withdrawal from friends and changed sleep fit this pattern. His job loss also struck at a central part of his identity as a provider and skilled worker.

Why Men Delay

Galdas et al. (2005) reviewed the literature on men's help seeking. They found consistent evidence that men delay seeking help for both physical and emotional problems, and that traditional masculine beliefs, such as the need to be strong and in control, were a common explanation. However, they also found that help seeking varied by age, socioeconomic status, ethnicity and sexuality, and that men's reluctance was not universal. Some men found it easier to seek help when the problem was framed as physical, such as sleep problems, or when they reached a crisis.

What Prevents Suicide

Mann et al. (2005) systematically reviewed suicide prevention strategies. Two had the strongest evidence. Educating physicians to recognize and treat depression reduced suicide rates in several regions. Restricting access to lethal means, such as firearms, certain medications and jumping sites, also reduced suicides by those methods, and many people did not substitute another method. Other strategies, including public awareness campaigns, screening and gatekeeper training for people such as clergy or employers, had less evidence, though some were promising.

Risk Factors in Ray's Life

Ray has several risk factors: middle age, recent job loss, heavy drinking, social withdrawal, anger and access to firearms. Firearms are the most common method in men's suicides in the United States and kill a far larger share of those who use them than most other methods, so a crisis that might otherwise pass can become fatal.

What Could Help Ray

Following Galdas and colleagues, his wife might frame a doctor's visit around his poor sleep and drinking rather than his mood. His primary care clinician, if trained to recognize depression in men, could ask about anger, drinking and hopelessness as well as sadness. If Ray is at risk, the clinician or a counselor can discuss safety planning, including storing his rifles outside the home with a relative or a gun shop while he recovers, a step that follows from Mann and colleagues' evidence on lethal means.

Ray could also be reached through his former workplace. Union and dislocated worker programs may offer counseling and job retraining, and reconnecting with his bowling league or a men's group could restore social ties.

Community and Policy

Plant closures put whole communities at risk. Programs that pair job retraining with mental health services, crisis lines such as the national 988 Suicide and Crisis Lifeline and outreach in places men gather can reach men before a crisis.

His Family's Part

Ray's wife and son see the changes first. Families can learn the warning signs of suicide, which include talk of being a burden, giving away possessions, sudden calm after a period of distress and increased drinking. They can ask directly whether he has thought about ending his life, a question that research has not found to increase risk and that often brings relief. Asking him to let his brother keep the rifles for a while, framed as a temporary favor during a hard time, may be easier for him to accept than a demand. Families also need support, since living with a depressed and angry man is exhausting.

Limits

Studies of men's depression use different definitions, and the idea of a distinct male depression is debated. Mann and colleagues' review is from 2005, and newer studies have added evidence on safety planning and follow-up after crises. Ray's story is invented.

Conclusion

Ray's anger and drinking after losing his job could easily be read as frustration rather than depression. Oliffe and Phillips explain why depression in men often looks this way, Galdas and colleagues explain why men delay help and Mann and colleagues point to the strategies most likely to prevent suicide. Recognition by his doctor, a conversation about his rifles and support from the people around him are the steps most likely to keep him safe.

References

Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing, 49(6), 616-623. https://doi.org/10.1111/j.1365-2648.2004.03331.x

Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U., Lonnqvist, J., Malone, K., Marusic, A., Mehlum, L., Patton, G., Phillips, M., Rutz, W., Rihmer, Z., Schmidtke, A., Shaffer, D., Silverman, M., Takahashi, Y., . . . Hendin, H. (2005). Suicide prevention strategies: A systematic review. JAMA, 294(16), 2064-2074. https://doi.org/10.1001/jama.294.16.2064

Oliffe, J. L., & Phillips, M. J. (2008). Men, depression and masculinities: A review and recommendations. Journal of Men's Health, 5(3), 194-202. https://doi.org/10.1016/j.jomh.2008.03.016