Depression in Men

Original Editor - Matt Huey

Top Contributors - Matt Huey, Lucinda hampton and Rucha Gadgil  

Introduction[edit | edit source]

Depression is in the top ten burdens of disability worldwide and the leading cause for nonfatal disorders[1]. It has been primarily diagnosed in women, with findings of a 2:1 ratio[2]. It is believed, however, that this may not be accurate. It is believed that man are more likely to "mask" their depression and not seek treatment leading to underreports of the diagnosis. This underreporting may be due to the difference in presentation compared to men and women. In the physical therapy setting, men could have an underlying depression due to a life event that is affecting their reports of pain and functional status.

Difference in Presentation[edit | edit source]


Men often do not present with the textbook signs and symptoms of depression, which include sadness, anxiety, feeling of hopelessness, or loss of interest in hobbies or activities that the person once enjoyed. A man's presentation of depression early on may present with the following symptoms[3]:

  • Irritability
  • Anger
  • Hostility
  • Abusive Behaviors
  • Substance Abuse
  • Escaping Behavior

Men do not often seek out medical help for their feelings of depression and if they do see a medial profession, will not discuss their emotions. They instead will "act out" to cover up their feelings. These actions may be to numb or distract themselves to the underlying problem or feelings. Common examples are men putting in more work at their job or abusing alcohol or even extramarital affairs.

Triggers of Depression in Men[edit | edit source]

The trigger for these behaviors could be in the societal gender norms that men have in themselves. Young boys are often prohibited from showing emotions such as sadness or helplessness. They are taught to be independent and in control of their life.

Major life events can occur that cause men to become conflicted with their inward feelings versus the expected outward appearance[4][5].

  • Physical illness
  • Loss of a partner or paternal bond
  • Loss of status and/or prestige with employment
  • Financial problems

Events such as these can challenge a man's ideal view of masculinity. Men can believe that they are now weak, a failure or undesirable. For example, a man may experience depression from a injury which causes him to not be able to work therefore cannot provide himself or family financial stability.

Effects of Untreated Depression[edit | edit source]

As stated before, men do not want to be viewed as weak or undesirable. They will ignore their internal feelings and avoid discussing their feelings with friends, family members, or physicians. Men will feel they need to rely upon themselves to overcome their feelings. If left untreated men can develop alcohol dependency and commit suicide. Women are twice as likely to attempt suicide but men are 4 times more like to die from a suicide attempt[6].

Erectile Dysfunction[edit | edit source]

Impotence or erectile dysfunction can be a trigger of depression in men, and unfortunately it can also be a side effect of many antidepressant medications.

  • Men with sexual function problems are almost twice as likely to be depressed as those without.
  • Depression increases the risk of erectile dysfunction.
  • Many men are reluctant to acknowledge sexual problems, thinking it’s a reflection on their manhood rather than a treatable problem caused by depression[7].

Effects of Depression on Physical Therapy Outcomes[edit | edit source]

It has been found that patients do present to physical therapy with significant depression symptoms. It has been found that depression significantly effects reports of pain intensity and functional ability[8]. Men presenting to physical therapy after experiencing a major life event which loss of masculine ideals have occurred should be addressed.

How Therapists can Help[edit | edit source]

Physical therapists and physical therapist assistants are positioned to be a useful resource in identifying early depression symptoms and directing patients to appropriate care. There are some steps that can be taken to help patients identified as possibly having depression.

  • Do not ignore the symptoms. Men will deal with symptoms much longer before reaching out for help if they reach out at all.
  • Do not directly ask if they are depressed. Men view depression as an issue women deal with so may brush off the symptoms.
  • There are screening tools available to utilize. In one study the 2-item screening test taken from the Primary Care Evaluation of Mental Disorders Procedure (PRIME-MD) was found to be better at identifying patients' with depression[9].
  • Assist in directing patients to appropriate mental health professionals.

References[edit | edit source]

  1. Friedrich MJ. Depression Is the Leading Cause of Disability Around the World. JAMA. 2017 Apr 18;317(15):1517. doi: 10.1001/jama.2017.3826. PMID: 28418490.
  2. Addis, M. E. (2008). Gender and depression in men. Clinical Psychology: Science and Practice, 15(3), 153.
  3. Cochran, S. V., & Rabinowitz, F. E. (2003). Gender-sensitive recommendations for assessment and treatment of depression in men. Professional Psychology: Research and Practice, 34(2), 132.
  4. Branney, P., & White, A. (2008). Big boys don't cry: Depression and men. Advances in Psychiatric Treatment, 14(4), 256-262.
  5. Oliffe, J. L., & Phillips, M. J. (2008). Men, depression and masculinities: A review and recommendations. Journal of Men's Health, 5(3), 194-202.
  6. Addis, M. E. (2008). Gender and depression in men. Clinical Psychology: Science and Practice, 15(3), 153.
  7. Help guide org Depression in men Available: (accessed 12.5.2022)
  8. Wideman, T. H., Scott, W., Martel, M. O., & Sullivan, M. J. (2012). Recovery from depressive symptoms over the course of physical therapy: a prospective cohort study of individuals with work-related orthopaedic injuries and symptoms of depression. journal of orthopaedic & sports physical therapy, 42(11), 957-967.
  9. Sonia Haggman, Christopher G Maher, Kathryn M Refshauge, Screening for Symptoms of Depression by Physical Therapists Managing Low Back Pain, Physical Therapy, Volume 84, Issue 12, 1 December 2004, Pages 1157–1166