Suicide risk, psychological distress and treatment preferences in men presenting with prototypical, externalising and mixed depressive symptomology

J Ment Health. 2022 Jun;31(3):309-316. doi: 10.1080/09638237.2020.1755026. Epub 2020 May 13.

Abstract

Background: The prevalence of depression in men is significantly lower than women despite male suicide being higher. Therefore, improving the understanding and detection of depression in men is an important research and clinical aim.

Aims: To examine the prevalence of prototypic, externalising and mixed depressive symptoms and their relation to mental illness and suicide risk.

Methods: Quantitative data were obtained through a survey of N = 1000 Canadian males (median age = 49.63 years, SD = 14.60). A range of validated scales were incorporated including the PHQ-9, K6, SBQ-R and MDRS.

Results: Using established cut-off scores, the proportions classified into distinct symptom groups were: not depressed (69%), prototypical (8%), mixed (12%) and externalising (11%). Risk of mental illness and suicidal risk was significantly elevated in all depressed groups. Compared to the not-depressed group, those experiencing only externalising symptoms and those with mixed symptomology were at significantly increased risk of mental illness as well current suicide risk.

Conclusion: These results highlight the clinical importance of considering a broad range of potential presentations of depression in men, all of which are associated with increased suicide risk.

Keywords: Externalising symptoms; masculine depression; masked depression; mental illness; suicidal behaviour.

MeSH terms

  • Canada / epidemiology
  • Depression / psychology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychological Distress*
  • Suicidal Ideation
  • Suicide Prevention*
  • Surveys and Questionnaires