June is Men’s Health Month, and this year, as we emerge from the COVID-19 epidemic, more than ever, there is a compelling need to focus on male patients’ overall health, emphasizing their mental health as a key to their wellbeing.

Mental health is a significant problem among men

There are approximately 151 million males in the U.S.; six million of them are affected by depression each year, with over three million men diagnosed with anxiety disorder annually. Unfortunately, because of the unique ways men present to their doctors, they often go undiagnosed. A little-known fact is that males account for an estimated 10 percent of patients with anorexia or bulimia and about 35 percent of those with binge-eating disorder. When it comes to suicide among men, the statistics are quite concerning.  Male suicides have been on the rise, and suicide is now the 7th leading cause of death among males.  More than four times as many men as women die by suicide.  Gay and bisexual men are at an increased risk for suicide attempts, especially before the age of 25.

Despite this significant burden of illness, men are less likely to access psychological therapy than women. For example, only 36 percent of the English National Health Service referrals for talk therapy are for men.

Why are men reluctant to seek help for health issues?

It is important to realize that men’s reluctance to seek help for mental health problems is part of a broader reluctance to seek medical care across the board.  A study revealed that men often don’t seek help until a disease has progressed.  For example, deaths from melanoma are 50 percent higher in men than in women despite a lower incidence of the disease.  Another study showed that consultations with primary care were 32 percent lower in men than in women.

Much research has been devoted to understanding this reluctance to seek general care as well as mental health care on the part of men. Societal expectations and traditional gender roles explain why men are less likely to discuss or seek help for all health issues and specifically mental health problems.

Men also tend to have lower health literacy which could contribute to the tendency to present later in the course of illness than women do. Another barrier to seeking care is that many physician offices are staffed predominantly by women as “gatekeepers,” and men are reluctant to explain the reason for the visit to a female nurse or receptionist if they perceive the reason for the visit to be “embarrassing” or “uncomfortable” thus avoiding making an appointment entirely.  There are also physician contributing factors. A study showed that physicians spend less time with male patients during a primary care consultation.

When it comes to mental health struggles, men are unfortunately also more likely to engage in “self-medication” with alcohol and drugs and are three times more likely than women to become dependent on alcohol and drugs in this context.

What can be done?

Awareness and education are keys to affecting change that will invite men into the health system earlier and more readily for all symptoms, particularly for mental health concerns.  An awareness on the part of clinicians that men might present with atypical signs of depression and anxiety will improve providers’ ability to identify and treat these conditions more effectively.  The availability of virtual visit modalities offers tangible hope that it creates more easily accessible avenues for men to seek care in less threatening and more gender-appropriate ways.  It is also important that health plans are creative, offering incentives for preventive services to be performed by men, including screening for depression and substance use disorders.   It is imperative that we bridge this significant health inequity which, after all, is “man-made.”

Betty Rabinowitz is chief medical officer, NextGen Healthcare. She can be reached on Twitter @DrBettyR.

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