Men as compared to women are half as often affected by depressive and anxiety disorders and seek significantly less help for mental health issues than women. Adherence to traditional male role norms (AtTMRN) may hinder men from describing prototypical depression symptoms and from seeking psychotherapy. The current study compared whether AtTMRN, gender role identity, or the experience of prototypical or male-typical externalizing mental health symptoms were associated with psychotherapy use in men and women. In an anonymous online survey, 716 participants (37% men) reporting to currently experience psychological distress were examined. Information was obtained on psychotherapy use, depression and anxiety symptoms, gender role identity, and traditional male role norms. Although experiencing similar levels of depression, men compared to women showed a reduction in psychotherapy use by 29%. Masculine role identity was directly associated with reduced psychotherapy use in men (β = −0.41, p = 0.029), whereas AtTMRN was not (men: β = −0.04, p = 0.818; women: β = −0.25, p = 0.064). Higher externalizing depression symptomatology (β = −0.68, p = 0.005), but not prototypical depression symptomatology (β = −0.02, p = 0.499), was associated with reduced psychotherapy use in men but not women (p > 0.05). Interactions revealed that men, but not women, with high AtTMRN use psychotherapy only when exhibiting elevated symptom levels. The results corroborate previous reports showing reduced psychotherapy use in men as compared to women and identify elevated masculine role identity and male-typical externalizing depression symptomatology as direct factors associated with reduced psychotherapy use in psychologically distressed men. AtTMRN interacts with mental health symptoms to predict psychotherapy use, indicating that men with high AtTMRN only use psychotherapy when exhibiting high symptomatology.

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Objective: The perimenopause is associated with increased hormone fluctuations and an elevated risk of depression. A number of predictors of depressive symptoms in the menopausal transition have previously been suggested. The purpose of this study was to investigate a set of biopsychosocial predictors of depressive symptoms in perimenopausal women. Methods: This cross-sectional study, investigating 114 perimenopausal women (according to the STRAW criteria) aged 40-56 years, was conducted within the scope of the Swiss Perimenopause Study. Multiple regression analyses were performed to identify the most accurate model predicting perimenopausal depressive symptoms. Depressive symptoms were assessed with the German version of the Center of Epidemiologic Studies Depression Scale (CES-D). Validated questionnaires were used to examine psychophysiological complaints, stress, self-esteem, self-compassion, body image, and social support. Estradiol (E2) and progesterone (P4) were assessed through saliva samples, and follicle-stimulating hormone and luteinizing hormone were determined through dried blood spot samples. Seven saliva samples per participant were used to investigate absolute levels and fluctuations of sex steroids. All other variables were measured once. Results: Multiple regression analyses revealed that E2 fluctuations (β=0.15, P = 0.015), history of depression (β=0.14, P = 0.033), menopausal symptoms (β=0.47, P < 0.0001), perceived stress (β=0.17, P = 0.014), body image (β= −0.25, P = 0.014) and self-esteem (β=−0.35, P < 0.0001) were predictive of perimenopausal depressive symptoms (R 2 = 0.60). P4 fluctuations and absolute levels of hypothalamic-pituitary-gonadal hormone were not statistically significant. Conclusions: E2 fluctuations were shown to be predictive of depressive symptoms in the perimenopause. Moreover, the presence of burdensome complaints and chronic stress as well as a poor self-evaluation seem to promote depressive symptoms in perimenopausal women.

Heterosexual-identified men, as compared to non-heterosexual-identified men, are less likely to seek out psychotherapy when experiencing psychological distress. Stronger endorsement of traditional masculinity ideologies (TMI) has been reported to be associated with reduced psychotherapy use among men. However, the relationship between psychotherapy use, TMI, and sexual orientation needs to be explored. A total of 728 psychologically distressed men (59.9% heterosexual-identified, 40.1% non-heterosexual-identified) from German-speaking parts of Europe completed an online questionnaire asking about current psychotherapy use, endorsement of TMI, experienced gender role conflict (GRC), prototypical depression symptoms, and externalizing depression symptoms. In total 34.5% (n = 251) of the men were currently using psychotherapy, of which 47.4% (n = 119) identified as heterosexual and 52.6% (n = 132) as non-heterosexual. Heterosexual-identified men used psychotherapy less than non-heterosexual-identified men, while exhibiting lower prototypical depression symptoms but comparable externalizing depression symptoms. Additionally, heterosexual-identified men exhibited higher endorsement of TMI across all domains and experienced more masculine GRC, especially in the domains Success Concerns and Restricted Affection. Endorsement of TMI was associated with increased externalizing depression symptoms only among heterosexual-identified men. Logistic regression analyses showed stronger endorsement of TMI, increased externalizing depression symptoms, and identifying as heterosexual to be associated with reduced psychotherapy use. Men identifying as heterosexual with strong endorsement of TMI, and high externalizing depression symptoms have a reduced likelihood to use psychotherapy. Thus, challenging TMI and advocating for alternative masculinities that include health promoting behavior can especially help heterosexual-identified men with strong TMI.

Public Significance StatementStatus loss due to the COVID-19 pandemic, particularly among men with strong endorsement of traditional masculinity ideologies, may play a critical role in understanding the elevated suicide rates in the aftermath of the most acute phase of the COVID-19 pandemic. Health care policy should specifically target men with experienced status loss due to the COVID-19 pandemic in suicide prevention programs and swiftly design mental health care campaigns tailored to the group of men with strong endorsement of traditional masculinity ideology.