Objective To investigate men's experience of depression. MethodA non-clinical sample of male teachers and students was recruited from a tertiary education institution to participate in a series of focus groups. Women were recruited from the same context to examine issues common to men. The men's data were analysed using a grounded theory approach to illuminate men's experience of depression. Theoretical sampling of biographical accounts of a small group who had experienced clinical depression (the 'clinical' group) was conducted to explicate the core category. Content analysis was then used to examine the women's data for similarities and contrasts and issues common to men. Standard measures of mood and dispositional optimism (together with sociodemographic and behavioural data) were collected to confirm the non-clinical status of the sample. ResultsThe key results were as follows:(i)The non-clinical sample of men and women in this study reported all the symptoms of depression classified by the Diagnostic Statistical Manual of Mental Disorders (Version IV). (ii)In addition, men reported experiencing social withdrawal, and an escalation and intensification of negative emotion that may be triggered by negative thoughts or external events leading to anger and violence towards the self and others.(iii)The trajectory of emotional distress, conceptualised as the 'big build', links men's experience and expression of depression. (iv)'Intensified constraint', illuminating the process of the 'big build', helps to explain the 'battle' between individual and social forces that influences hidden depression in men.(v)'Intensified constraint' may be considered a state (emotional condition) characterising men or a symptom (subjective experience) of depression common to men.(vi)Non-resolution of problems, exacerbated by social conditioning of men to suppress emotion, leads to delayed help-seeking. (vii)The women's data were in concordance with the men's data that suggest that men and women experience depression similarly (with reference to DSM-IV criteria).(viii)The 'big build', as a trajectory of emotional distress and maladaptive strategies to ameliorate depressive symptoms, has salience for women.(ix)Gender differences in depression may be explained by the expression of depressive symptoms, and the time frame in which the symptoms are managed.DiscussionThis study arose out of the commonly held view that women report depressive symptoms at higher rates than men yet men demonstrate higher rates of drug and alcohol abuse and self-harm, referred to as 'depressive equivalents'. This generally accepted disparity of prevalence rates of depression in community samples makes certain assumptions about the mental health of men and women. Women are assumed to have a certain 'pathology' or vulnerability to depression while men are assumed to be either comparatively healthy or 'silent' to their experience. The perception of depression as a 'feminine' problem by men, exacerbated by social conditioning of men (by men and women) to suppress emotional distress and to hide signs of weakness, may influence men's reporting of depressive symptoms and may help to explain the gender disparity. The non-clinical group of men and women in this study has taken us to a point in their descriptions of depression as an objectified or reified 'it' that is something difficult to articulate but which is psychologically painful, to be avoided, numbed or from which to escape. The biographical accounts of a small group of people who have experienced clinical depression (the 'clinical' group) have explicated the meaning of depression even further. Depression, viewed by this articulate small group as 'beyond description', is elucidated by their use of metaphor. The data from the non-clinical group, informed by the 'clinical' group and the literature surrounding depression in men, is synthesised, analysed and interpreted. The findings inform three propositions - the 'big build', 'intensified constraint', and 'averting negative consequences' - that offer new ways of thinking about depression in men. ConclusionThe inextricable link between the experience and expression of depression as described by men, confirmed by women and supported by the literature and clinicians' impressions, may explain the existing gap between the 'meaning', 'manifestation' and 'measurement' of depression in men. Questions that tap in to men's trajectory of emotional distress, incorporating a state or symptom of intensified constraint common to men, could narrow the gender differences in reported depressive symptoms. This has implications for the design of measurement instruments and approaches to depressed men in clinical practice.
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