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.
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.
In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men’s health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.
The present study translated the 30-item Conformity to Masculine Norms Inventory (CMNI-30) from English to German. Indices for measurement invariance across gender and sexual orientation, test-retest reliabilities, and indicators of convergent (positive correlations with the Male Role Norms Inventory-Short Form and the Gender Role Conflict Scale-Short Form) and discriminant (no correlations with the Marlowe-Crowne Social Desirability Scale) validity were estimated. Working from a sample of 1,012 German-speaking persons (63.9% cisgender men and 36.1% cisgender women; age: M = 40.4 years, SD = 15.5) in Europe, multigroup structural equation modeling confirmed the 10-factor structure of the German-language version of the CMNI-30. Across gender, at least partial scalar invariance can be assumed and across sexual orientation strict invariance was detected. The German-language version of the CMNI-30 showed adequate evidence for convergent validity and test-retest reliability. Discriminant validity was only partially supported. Taken together, the CMNI-30 measures similar concepts in women and men as well as in heterosexually identified and sexual minority persons and can be recommended for research and practice for the assessment of different domains of conformity to masculinity ideologies in German-speaking individuals. Public Significance StatementThe present study translated the Conformity to Masculine Norms Inventory−30 (CMNI-30) from English to German. The CMNI-30 assesses to what degree a person endorses and enacts behaviors that are traditionally expected by men. The study reveals that the instrument is reliable and valid in men and women as well as in heterosexually identified and sexual minority persons. Therefore, the Germanlanguage version of the CMNI-30 is recommended for research and practice for the assessment of conformity to masculinity ideologies in German-speaking individuals.
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