Masculinity and mental health treatment initiation for former political prisoners in Yangon, Myanmar – a qualitative investigation

Abstract

Background Men living in low- and middle-income countries are unlikely to seek mental health care, where poor healthcare infrastructure, differences in illness conceptualization, and stigma can impact treatment seeking. Vulnerable groups, such as former political prisoners, are more likely than others to experience potentially traumatic events that may lead to negative mental health outcomes. To improve the likelihood of successful engagement of vulnerable men in psychotherapy, it is necessary to identify factors that influence treatment adherence, and to better understand men’s attitudes surrounding decisions to seek and initiate care. The purpose of this investigation was to explore themes of masculinity, treatment seeking, and differences between male former political prisoners who accepted and declined therapy in an urban low-income context. Methods We conducted a qualitative, interview-based investigation with 30 former political prisoners in Yangon, Myanmar who were eligible to receive mental health counseling provided by the non-governmental organization (NGO), Assistance Association for Political Prisoners. Men were initially screened using a composite questionnaire with items related to depression, anxiety, and posttraumatic stress symptom severity. After screening, if potential clients were identified as having probable mental health problems, they were asked if they would like to participate in a multi-session cognitive behavioral therapy program. Semi-structured, open-ended interviews were conducted with 15 participants who accepted and 15 participants who declined therapy. Interviews were transcribed and translated by local partners and thematically coded by the authors. We used thematic analysis to identify and explore differences in treatment-seeking attitudes between men who accepted and men who declined the intervention. Results Men described that being a community leader, self-reliance, morality, and honesty were defining characteristics of masculinity. A focus on self-correction often led to declining psychotherapy. A general lack of familiarity with psychological therapy and how it differed from locally available treatments (e.g. astrologists) was connected to stigma regarding mental health treatment. Conclusions Masculinity was described in similar terms by both groups of participants. The interpretation of masculine qualities within the context of help-seeking (e.g. self-reliance as refusing help from others versus listening to others and applying that guidance) was a driving factor behind men’s decision to enter psychotherapy.

A social identity approach to mental health help‐seeking behaviour in prisoners: A systematic review

“…In total, 24 studies involving 7,557 participants were included (Abram et al, 2008;Costa et al, 2021;Deane et al, 1999;Durcan, 2008;Durrah, 2013;Galanek, 2015;Howerton et al, 2007;Hussain et al, 2020;Lakin et al, 2021;Meyer et al, 2013;Mitchell et al, 2016;Mitchell & Latchford, 2010;Morgan et al, 2004Morgan et al, , 2007Nesset et al, 2011;Skogstad et al, 2005Skogstad et al, , 2006Vandevelde et al, 2006;Vaughan & Stevenson, 2002;Wainwright et al, 2017;Walsh et al, 2011;Wennerstrom et al, 2022;Williams et al, 2001;Woods et al, 2020;Yasmeen et al, 2021; see Supporting Information for Table of Characteristics). Fourteen studies exclusively focused on male inmates, one study exclusively focused on female inmates, three studies included male and female inmates, while six studies did not specify participants' gender.…”

The impact of gender and the social determinants of health on the clinical course of people living with HIV in Myanmar: an observational study

“…All of these factors conspire to result in significantly higher mortality in men [ 8 ]. Similar concepts of masculinity exist in Myanmar and have an important impact on the way in which men access health care [ 9 , 10 ]. While gender has been linked to poorer outcomes in men living with HIV in Myanmar [ 3 ], its independent contribution to clinical outcomes is incompletely defined.…”