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The gender gap in mental health service use

Abstract

Purpose

This study examines why men engage less in mental health service use, by studying how gender is performed in interactions, following the doing gender perspective. We hypothesize that seeking help for mental illness may constitute a gendered role conflict among men since help seeking is associated with femininity. Therefore, we expect that men will recommend reliance on self-care options to other men, and in cases in which professional treatment is recommended, they will prefer medication to psychotherapy. We also expect that men will report greater stigmatizing attitudes.

Methods

The survey Stigma in a Global Context-Belgian Mental Health Study (2009) conducted interviews of a representative sample of the Belgian general population (N = 743). The vignette technique, depicting depressive and schizophrenic symptoms, was used. Multiple linear and logistic models were estimated in SPSS.

Results

In male vignettes, self-care is more likely to be recommended, both by male and female respondents. Men are less likely to acknowledge the helpfulness of psychotherapy and women rate psychotherapy as less helpful when judging a man compared to a woman. Men rate tranquilizers as more helpful for other males than that women do for other females. Furthermore, male respondents seem to ascribe more shame and blame to the situation.

Conclusions

The gender gap in mental health service use is due not only to men and their negative attitudes toward help seeking, but also to structured social norms that are reconstructed in interactions. Women also contribute to the maintenance of masculinity norms.

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References

  1. 1.

    Gouwy A, Christiaens W, Bracke P (2008) Mental health services use in the general Belgian population: estimating the impact of mental health and social determinants. Arch Public Health 66:50–68

    Google Scholar 

  2. 2.

    Addis ME, Mahalik JR (2003) Men, masculinity, and the contexts of help seeking. Am Psychol 58:5–14

    PubMed  Article  Google Scholar 

  3. 3.

    Fleury MJ, Grenier G, Bamvita JM, Perreault M, Caron J (2012) Determinants associated with the utilization of primary and specialized mental health services. Psychiat Quart 83:41–51

    PubMed  Article  Google Scholar 

  4. 4.

    Galdas PM, Cheater F, Marshall P (2005) Men and health help-seeking behavior: literature review. J AdvNurs 49:616–623

    Google Scholar 

  5. 5.

    Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE, Zaslavsky AM (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352:2515–2523

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  6. 6.

    Piccinelli M, Wilkinson G (2000) Gender differences in depression: Critical review. Brit J Psychiat 177:486–492

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Judd F, Armstrong S, Kulkarni J (2009) Gender-sensitive mental health care. Australas Psychiatry 17:105–111

    PubMed  Article  Google Scholar 

  8. 8.

    Holzinger A, Floris F, Schomerus G et al (2012) Gender differences in public beliefs and attitudes about mental disorder in western countries: a systematic review of population studies. EpidemiolPsychiatrSci 21:73–85

    CAS  Google Scholar 

  9. 9.

    West C, Zimmerman DH (1987) Doing gender. Gender Soc 1:125–151

    Article  Google Scholar 

  10. 10.

    Gerson JM, Peiss K (1985) Boundaries, negotiation, consciousness: Reconceptualizing gender relations. SocProbl 32:317–331

    Google Scholar 

  11. 11.

    Eagly AH, Wood W (1999) The origins of sex differences in human behavior: Evolved dispositions versus social roles. Am Psychol 54:408–423

    Article  Google Scholar 

  12. 12.

    Cornwall A, Lindisfarne N (eds) (1994) Dislocating masculinities. Routledge, London

    Google Scholar 

  13. 13.

    Sabo DF, Gordon DFE (1995) Men’s health and illness: gender, power, and the body. Sage Publications, Thousand Oaks

    Google Scholar 

  14. 14.

    Salonstall R (1993) Healthy bodies, social bodies: men’s and women’s concepts and practices of health in everyday life. Soc Sci Med 36:7–14

    Article  Google Scholar 

  15. 15.

    Courtenay WH (2000) Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. SocSci Med 50:1385–1401

    CAS  Article  Google Scholar 

  16. 16.

    Jorm AF, Griffiths KM (2006) Population promotion of informal self-help strategies for early intervention against depression and anxiety. Psychol Med 36:3–6

    PubMed  Article  Google Scholar 

  17. 17.

    Cooperstock R, Lennard HL (1979) Some social meanings of tranquilizer use. Sociol Health Ill 1:331–347

    Article  Google Scholar 

  18. 18.

    Pederson EL, Vogel DL (2007) Male gender role conflict and willingness to seek counseling: Testing a mediation model on college-aged men. J Couns Psycho 54:373–384

    Article  Google Scholar 

  19. 19.

    Jorm AF, Griffiths KM (2008) The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations? Acta Psychiat Scand 118:315–321

    CAS  PubMed  Article  Google Scholar 

  20. 20.

    Good GE, Thomson DA, Brathwaite AD (2005) Men and therapy: Critical concepts, theoretical frameworks, and research recommendations. J ClinPsychol 61:699–711

    Google Scholar 

  21. 21.

    Cole MG, Yaffe MJ (1998) Pathway to psychiatric care of the elderly with depression. Int J Geriatr Psych 11:157–161

    Article  Google Scholar 

  22. 22.

    Lauber C, Nordt C, Falcato L et al (2004) Factors influencing social distance toward people with mental illness. Community MentHlt J 40:265–274

    Google Scholar 

  23. 23.

    ten Have M, Oldehinkel A, Vollebergh W et al (2003) Does educational background explain inequalities in care service use for mental health problems in the Dutch general population? Acta PsychiatScand 107:178–187

    Article  Google Scholar 

  24. 24.

    Corrigan PW, Watson AC (2007) The stigma of psychiatric disorders and the gender, ethnicity and education of the perceiver. Community MentHlt J 43:439–458

    Google Scholar 

  25. 25.

    Lauber C, Nordt C, Rössler W (2005) Lay beliefs about treatments for people with mental illness and their implications for anti-stigma strategies. Can J Psychiat 50:745–752

    Google Scholar 

  26. 26.

    Alexander LA, Link BG (2003) The impact of contact on stigmatizing attitudes toward people with mental illness. J Ment Health 12:271–289

    Article  Google Scholar 

  27. 27.

    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiat 51:8

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    AAPOR [http://www.aapor.org/Response_Rates_An_Overview1.htm]

  29. 29.

    Leong FT, Zachar P (1999) Gender and opinions about mental illness as predictors of attitudes toward seeking professional psychological help. Brit J Guid Couns 27:123–132

    Article  Google Scholar 

  30. 30.

    Shill MA, Lumley MA (2002) The psychological mindedness scale: factor structure, convergent validity and gender in a non-psychiatric sample. Psychol Psychother-T 75:131–150

    Article  Google Scholar 

  31. 31.

    Ettorre E, Klaukka T, Riska E (1994) Psychotropic drugs: long-term use, dependency and the gender factor. Soc Sci Med 39:1667–1673

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Phillips DL (1964) Rejection of the mentally ill: The influence of behavior and sex. Am Sociol Rev 29:679–687

    Article  Google Scholar 

  33. 33.

    Rüsch N, Müller M, Ajdacic-Gross V, Rodgers S, Corrigan PW, Rössler W (2014) Shame, perceived knowledge and satisfaction associated with mental health as predictors of attitude patterns towards help-seeking. Epidemiol Psichiat S 18:1–11

    Google Scholar 

  34. 34.

    Umberson D (1992) Gender, marital status and the social control of health behavior. Soc Sci Med 34:907–917

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Loring M, Powell B (1988) Gender, race, and DSM-III: A study of the objectivity of psychiatric diagnostic behavior. J Health Soc Behav 29:1–22

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Potts MK, Burnam MA, Wells KB (1991) Gender differences in depression detection: a comparison of clinician diagnosis and standardized assessment. Psychol Assessment 3:609

    Article  Google Scholar 

  37. 37.

    Van Der Waals FW, Mohrs J, Foets M (1993) Sex differences among recipients of benzodiazepines in Dutch general practice. Brit Med J 307:363

    PubMed Central  PubMed  Article  Google Scholar 

  38. 38.

    Connell RW (1995) Masculinities. CA, University of California Press, Berkeley

    Google Scholar 

  39. 39.

    Berger JM, Levant R, McMillan KK, Kelleher W, Sellers A (2005) Impact of Gender Role Conflict, Traditional Masculinity Ideology, Alexithymia, and Age on Men’s Attitudes Toward Psychological Help Seeking. Psychol Men Masc 6:73

    Article  Google Scholar 

  40. 40.

    Rosenfield S (1982) Sex roles and societal reactions to mental illness: the labeling of ‘deviant’ deviance. J Health Soc Behav 23:18–24

    CAS  PubMed  Article  Google Scholar 

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Acknowledgments

We wish to thank Bernice Pescosolido for the opportunity to collaborate on this project and the Brocher Foundation to provide a stimulating environment to work on this paper. This project was supported by a grant from the Research Foundation (FWO) Flanders, and from the Special Research Fund of Ghent University (BOF).

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to E. Pattyn.

Appendix

Appendix

The depression vignette was as follows: Jan/Marie/Ahmed/Fatima is a Belgian/Turkish man/woman. For the last several weeks NAME has been feeling really down. She/he wakes up in the morning with a sad mood and heavy feeling that sticks with her/him during the rest of the day. She/he is not enjoying things the way she/he normally would. In fact, nothing seems to give him/her pleasure. Even when good things happen, they do not seem to make NAME happy. The smallest tasks are difficult to accomplish. She/he finds it hard to concentrate on anything. She/he feels out of energy and cannot do the things she/he usually does. And even though NAME feels tired, when night comes she/he cannot go to sleep. NAME feels worthless, very discouraged and guilty. NAME’s family has noticed that she/he has lost appetite and weight. She/he has pulled away from the family and just does not feel like talking.

The psychosis vignette was as follows: Jan/Marie/Ahmed/Fatima is a Belgian/Turkish man/woman. Up until a year ago, life was pretty okay for NAME. But then, things started to change. He/she thought that people around him/her were making disapproving comments, and talking behind his/her back. NAME was convinced that people were spying on him/her and that they could hear what she/he was thinking. NAME last his/her drive to participate in his/her usual work and family activities and retreated to his/her home, eventually spending most of his/her time on his/her own. NAME became so preoccupied with what she/he was thinking that she/he skipped meals and stopped bathing regularly. At night, when everyone else was sleeping, she/he was walking back and forth at home. NAME was hearing voices even though no one else was around. These voices told him/her what to do and what to think. She/he has been living this way for 6 months.

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Pattyn, E., Verhaeghe, M. & Bracke, P. The gender gap in mental health service use. Soc Psychiatry Psychiatr Epidemiol 50, 1089–1095 (2015). https://doi.org/10.1007/s00127-015-1038-x

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Keywords

  • Gender
  • Mental illness
  • Help seeking
  • Stigma
  • Role conflict