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"Because older men tend not to endorse depressed mood or sadness, they were often felt to be more reluctant to accept the diagnosis of depression and the treatment recommendations," stated the UC Davis study.

Older men often described as "old school" or the "John Wayne type" were considered difficult to diagnose and treat "because they perceived the cultural meaning of depression to be in conflict with their own view of themselves as men," the study says. It noted that "clinicians made a direct connection between more traditional views of masculinity and difficulties with diagnosis and referral to specialty mental health."

One of the IMPACT clinicians said that in her view, "'giving up' these core masculine views was an important step in the treatment process." Another physician reported that some older men "just do not think that tough guys go talk to psychologists or psychiatrists, and fool around with that type of monkey business."

The association of depression with severe mental illness, or "craziness," was another barrier to care, although it was cited less frequently than the other obstacles. One depression care manager cited stigma to explain the greater tendency of men to express their depression in physical rather than emotional terms. The manager said, "They will not say, 'I feel sad' or 'I feel depressed.' They'll say, 'I have a stomach ache.'" A primary care physician described a depressed and psychotic older man who was expressing suicidal thoughts, but nevertheless was unwilling to see a psychiatrist because he feared it would "mark him as crazy."

Hinton and his team state that their findings suggest future avenues for education and intervention for older men with depression. When dealing with more traditional older depressed men, clinicians may need to tailor standard educational approaches to directly address the attitudinal barriers identified in the UC Davis study. One such initial ap
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Contact: David Ong
david.ong@ucdmc.ucdavis.edu
916-734-9049
University of California, Davis - Health System
27-Sep-2006