Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression

Möller-Leimkühler, Anne Maria

doi:10.1016/s0165-0327(01)00379-2

Cited by 851Gender Roles and Identity StudiesMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression

Möller-Leimkühler, Anne Maria·2002·Journal of Affective Disorders

DOI 10.1016/s0165-0327(01)00379-2

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Abstract

Consultation rates and help-seeking patterns in men are consistently lower than in women, especially in the case of emotional problems and depressive symptoms. Empirical evidence shows that low treatment rates for men cannot be explained by better health, but must be attributed to a discrepancy between perception of need and help-seeking behavior. It is argued that social norms of traditional masculinity make help-seeking more difficult because of the inhibition of emotional expressiveness influencing symptom perception of depression. Other medical and social factors which produce further barriers to help-seeking are also examined. Lines of future research are proposed to investigate the links between changing masculinity and its impact on expressiveness and on the occurrence and presentation of depressive symptoms in men.

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Boys are socialized to endure silently and disregard symptoms, which raises the bar for showing pain or sensitivity and leads to emotional constriction.
“Simply put, “boys are taught to be stoical and to ignore symptoms (“boys don't cry”), the threshold for expressing pain and emotional sensitivity (especially related to emotions like weakness, uncertainty, helplessness, and sadness) is heightened and results in emotional restriction” (Möller-Leimkühler, 2002).”
From The Disclosure Experiences of Male Child Sexual Abuse Survivors (2016) · cites this paper as Möller-Leimkühler, 2002
The literature confirms that help-seeking is challenging for males, generally due to social constructs of masculinity.
“The literature confirmed that help-seeking was found to be challenging for males, however it was generally due to social constructs of masculinity”
From The Disclosure Experiences of Male Child Sexual Abuse Survivors (2016) · cites this paper as Möller-Leimkühler, 2002
Men cope with mental health difficulties differently from women, showing an increased tendency to self-medicate with alcohol and drugs to alleviate emotional distress.
“Men cope with mental health difficulties differently compared to women, demonstrating an increased tendency to self-medicate with alcohol and drugs to alleviate emotional distress”
From Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking (2019) · cites this paper as Möller-Leimkühler, 2002
Compared to women, men are less likely to seek help for mental health difficulties.
“Compared to women, men are less likely to seek help for mental health difficulties.”
From Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking (2019) · cites this paper as Möller-Leimkühler, 2002
There are clear gender differences in help-seeking tendencies, particularly for emotional problems and depression, where men's reluctance to seek help is more pronounced.
“studies have also indicated clear gender differences with regards to help-seeking tendencies. This is particularly the case for emotional problems and depression”
From A systematic review of the factors associated with delays in medical and psychological help-seeking among men (2015) · cites this paper as Moller-Leimkuhler, 2002

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BackgroundResultInfluential
Men, depression and masculinities: a review and recommendations
Oliffe, J. L., & Phillips, M. J. (2008) · Journal of Men's Health · doi:10.1016/j.jomh.2008.03.016 · Cited by 253 · see citing works
Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial
Cheng, P., Luik, A. I., Fellman-Couture, C., Peterson, E. L., Joseph, C. L. M., Tallent, G., Tran, K. M., Ahmedani, B. K., Roehrs, T., Roth, T. G., et al. (2018) · Psychological Medicine · doi:10.1017/s0033291718001113 · Cited by 183 · see citing works
“There is evidence that females are more likely to engage in health-seeking behaviors in both a traditional clinical setting (Möller-Leimkühler, 2002) and on the Internet (Ybarra and Suman, 2006).”
Background
Help-Seeking Experiences and Attitudes among African American, Asian American, and European American College Students
Masuda, A., Anderson, P. L., Twohig, M. P., Feinstein, A. B., Chou, Y.-Y., Wendell, J. W., & Stormo, A. R. (2009) · International Journal for the Advancement of Counselling · doi:10.1007/s10447-009-9076-2 · Cited by 182 · see citing works
“In general, females tend to have more favorable attitudes toward seeking professional psychological services than males (e.g., Fischer and Farina 1995 ;M asudaet al. 2005) and to seek psychological services for their emotional issues more frequently than males (e.g., Moller-Leimkuhler 2002; Rabinowitz et al. 1999).”
Background
Do women consult more than men? A review of gender and consultation for back pain and headache
Hunt, K., Adamson, J., Hewitt, C. E., & Nazareth, I. (2010) · Journal of Health Services Research & Policy · doi:10.1258/jhsrp.2010.009131 · Cited by 178 · see citing works
A systematic review of unified protocol applications with adult populations: facilitating widespread dissemination via adaptability
Cassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala, S. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101852 · Cited by 179 · see citing works
“, depression, anxiety-related, borderline personality, eating disorders) are more common in female populations (Kessler, Chiu, Demler, & Walters, 2005), and data suggest women seek treatment at higher rates than men (Möller-Leimkühler, 2002).”
Background
Help seeking for mental health problems in an adolescent population: the effect of gender
Haavik, L., Joa, I., Hatloy, K., Stain, H. J., & Langeveld, J. (2019) · Journal of Mental Health · doi:10.1080/09638237.2017.1340630 · Cited by 163 · see citing works
“Another Australian study indicated that male adolescents rarely asked for help from their social networks or professionals even when experiencing high levels of distress (Möller-Leimkühler, 2002).”
Background
Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients.
Lizardi, D., & Stanley, B. (2010) · Psychiatric Services · doi:10.1176/ps.2010.61.12.1183 · Cited by 161 · see citing works
Gender differences in public beliefs and attitudes about mental disorder in western countries: A systematic review of population studies
Holzinger, A., Floris, F., Schomerus, G., Carta, M. G., & Angermeyer, M. C. (2011) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796011000552 · Cited by 158 · see citing works
“Some theories also contend that men are not permitted to be expressive in their illness behaviour or postpone seeking help in an effort to conform to a socially prescribed male role where weakness and need for help are not believed to be masculine (Robertson, 1995; Möller-Leimkühler, 2002).”
Background
Sex differences in the human brain: a roadmap for more careful analysis and interpretation of a biological reality
DeCasien, A. R., Guma, E., Liu, S., & Raznahan, A. (2022) · Biology of Sex Differences · doi:10.1186/s13293-022-00448-w · Cited by 149 · see citing works
“For example, reduced helpseeking behavior in men may explain their lower treatment rates for depression [92], and current diagnostic guidelines lead clinicians to under-detect ASD in females [93].”
Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis
Walby, F. A., Myhre, M. Ø., & Kildahl, A. T. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201700475 · Cited by 149 · see citing works
“This finding implies that use of such services is less prevalent among men (61,62).”
Background
Stigma, Pluralistic Ignorance, and Attitudes Toward Seeking Mental Health Services Among Police Officers
Karaffa, K. M., & Koch, J. M. (2016) · Criminal Justice and Behavior · doi:10.1177/0093854815613103 · Cited by 150 · see citing works
Men's help seeking: Examination of differences across community size, education, and income.
Hammer, J. H., Vogel, D. L., & Edwards, S. R. (2012) · Psychology of Men & Masculinity · doi:10.1037/a0026813 · Cited by 149 · see citing works
Men’s Mental Health Services: The Case for a Masculinities Model
Seidler, Z., Rice, S., River, J., Oliffe, J., & Dhillon, H. (2018) · The Journal of Men s Studies · doi:10.1177/1060826517729406 · Cited by 132 · see citing works
“Clearly, when men access services, health care system approaches regularly fail to fully engage them, and the chances are low that these men will attempt to reengage via other services after a negative experience (Calear, Griffiths, & Christensen, 2011; Möller-Leimkühler, 2002).”
Background
Separation as a suicide risk factor
Wyder, M., Ward, P., & Leo, D. D. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.11.007 · Cited by 146 · see citing works
“…et al., 1999); to inhibit emotional expressiveness and choose aggression and risk-taking as responses to stressful events (Grossman and Wood, 1993; Moller-Leimkuhler, 2002a,b); to use avoidant coping strategies (Halstead et al., 1993); and to limit help-seeking behaviour (Barker and Adelman,…”
Background
The Disclosure Experiences of Male Child Sexual Abuse Survivors
Gagnier, C., & Collin-Vézina, D. (2016) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2016.1124308 · Cited by 144 · see citing works
“Simply put, “boys are taught to be stoical and to ignore symptoms (“boys don’t cry”), the threshold for expressing pain and emotional sensitivity (especially related to emotions like weakness, uncertainty, helplessness, and sadness) is heightened and results in emotional restriction” (Möller-Leimkühler, 2002).”
Background
Suicide in young men
Pitman, A., Krysinska, K., Osborn, D., & King, M. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60731-4 · Cited by 144 · see citing works
Stigma and the military: Evaluation of a PTSD psychoeducational program
Gould, M., Greenberg, N. L., & Hetherton, J. (2007) · Journal of Traumatic Stress · doi:10.1002/jts.20233 · Cited by 143 · see citing works
“In addition, the sample was mainly comprised of men and research (e.g., Moller-Leimkuhler, 2002) consistently shows gender difference in help-seeking behavior, perhaps because of the social norms of traditional masculinity (e.g., courage, independence, success, and invulnerability).”
Background
Brief report: Need for autonomy and other perceived barriers relating to adolescents’ intentions to seek professional mental health care
Wilson, C. J., & Deane, F. P. (2012) · Journal of Adolescence · doi:10.1016/j.adolescence.2010.06.011 · Cited by 131 · see citing works
“Most studies have found that females are more likely than males to seek professional help (e.g., Garland & Zigler, 1994; Moller-Leimkuhler, 2002).”
Masculinity and race-related factors as barriers to health help-seeking barriers among African-American men
Powell, W., Adams, L. B., Cole-Lewis, Y. C. O., Agyemang, A., & Upton, R. D. (2016) · Behavioral Medicine · doi:10.1080/08964289.2016.1165174 · Cited by 126 · see citing works
Social media behavior, toxic masculinity, and depression.
Parent, M. C., Gobble, T., & Rochlen, A. B. (2018) · Psychology of Men & Masculinity · doi:10.1037/men0000156 · Cited by 134 · see citing works
Examining Sexual Health Differences between Lesbian, Gay, Bisexual, and Heterosexual Adults: The Role of Sociodemographics, Sexual Behavior Characteristics, and Minority Stress
Kuyper, L., & Vanwesenbeeck, I. (2010) · The Journal of Sex Research · doi:10.1080/00224491003654473 · Cited by 134 · see citing works
“The fact that internalized homonegativity was related to sexual health care need among women but not among men could possibly be explained by the fact that women are more likely to seek professional (psychological) help in the first place (eg, Moller-Leimkuhler, 2002 ; Ojeda & Bergstresser, 2008 ; Wang et al, 2007 ).”
Background
New fathers’ perinatal depression and anxiety-treatment options: an integrative review
O’Brien, A. P., McNeil, K. A., Fletcher, R., Conrad, A., Wilson, A. J., Jones, D., & Chan, S. W. (2017) · American Journal of Men's Health · doi:10.1177/1557988316669047 · Cited by 131 · see citing works
The study of men and masculinity as an important multicultural competency consideration
Liu, W. M. (2005) · Journal of Clinical Psychology · doi:10.1002/jclp.20103 · Cited by 127 · see citing works
An empirical test of a mediation model of the impact of the traditional male gender role on suicidal behavior in men
Houle, J., Mishara, B. L., & Chagnon, F. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.07.016 · Cited by 124 · see citing works
Gender Differences in Individuals at High‐Risk of Psychosis: A Comprehensive Literature Review
Barajas, A., Ochoa, S., Obiols, J. E., & Lalucat-Jo, L. (2015) · The Scientific World Journal · doi:10.1155/2015/430735 · Cited by 122 · see citing works
“Finally, it is important to note that more women than men seek help for psychological or medical problems [39].”
Background
A Review of Men's Health and Masculinity
Garfield, C. F., Isacco, A. J., & Rogers, T. E. (2008) · American Journal of Lifestyle Medicine · doi:10.1177/1559827608323213 · Cited by 123 · see citing works
Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany
Maske, U. E., Buttery, A. K., Beesdo-Baum, K., Riedel-Heller, S., Hapke, U., & Busch, M. A. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.006 · Cited by 120 · see citing works
Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICs
Victora, C. G., Hartwig, F. P., Vidaletti, L. P., Martorell, R., Osmond, C., Richter, L., Stein, A. D., Barros, A. J. D., Adair, L. S., Barros, F. C., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02716-1 · Cited by 118 · see citing works
Big boys don’t cry: depression and men
Branney, P., & White, A. (2008) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.106.003467 · Cited by 117 · see citing works
“For example, seeking help might be interpreted as incompetence and dependence (Möller-Leimkühler, 2002), and research has shown that individuals who adhere to the masculine role have negative attitudes towards using counselling services (Good & Wood, 1995).”
Background
Young adults face major barriers to seeking help from mental health services
Vanheusden, K., Mulder, C. L., van der Ende, J., van Lenthe, F. J., Mackenbach, J. P., & Verhulst, F. C. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2008.05.006 · Cited by 152 · see citing works
Is there evidence for a male depressive syndrome in inpatients with major depression?
Möller-Leimkühler, A. M., Ronald Bottlender, A., Strauß, A., & Rutz, W. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00051-x · Cited by 115 · see citing works
Self-citation
Males’ mental health disadvantage: An estimation of gender-specific changes in service utilisation for mental and substance use disorders in Australia
Harris, M. G., Diminic, S., Reavley, N., Baxter, A., Pirkis, J., & Whiteford, H. A. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415577434 · Cited by 113 · see citing works
“Future consideration could be given to including a policy focus on overcoming male-specific barriers to help-seeking, including traditional constructions of masculinity (Moller-Leimkuhler, 2002), comorbidity and low rates of help seeking for substance use disorders.”
Background
Understanding how men experience, express and cope with mental distress: where next?
Ridge, D., Emslie, C., & White, A. (2010) · Sociology of Health & Illness · doi:10.1111/j.1467-9566.2010.01266.x · Cited by 119 · see citing works
Why do men go to the doctor? Socio-demographic and lifestyle factors associated with healthcare utilisation among a cohort of Australian men
Schlichthorst, M., Sanci, L. A., Pirkis, J., Spittal, M. J., & Hocking, J. S. (2016) · BMC Public Health · doi:10.1186/s12889-016-3706-5 · Cited by 112 · see citing works
“Negative attitudes to help seeking have been discussed as a barrier to help seeking in men [20, 27, 28], particularly in the context of mental health problems [26, 29, 30].”
Background
Depression and anxiety in patients with different rare chronic diseases: A cross-sectional study.
Uhlenbusch, N., Löwe, B., Härter, M., Schramm, C., Weiler-Normann, C., & Depping, M. K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0211343 · Cited by 111 · see citing works
Gender Disparities in the Treatment of Late-Life Depression: Qualitative and Quantitative Findings From the IMPACT Trial
Hinton, L., Zweifach, M., Tang, L., Unützer, J., & Oishi, S. (2006) · American Journal of Geriatric Psychiatry · doi:10.1097/01.jgp.0000219282.32915.a4 · Cited by 108 · see citing works
“Our findings are consistent with prior literature on male psychology that emphasizes that depressed men often express their distress through alternative idioms such as anger, rage, and risky behavior.(15,36) Our qualitative data, based on the perspectives of those who provide care to older depressed men, also suggests…”
Result
Adherence to Depression Treatment in Older Adults: A Narrative Review
Zivin, K., & Kales, H. C. (2008) · Drugs & Aging · doi:10.2165/00002512-200825070-00003 · Cited by 110 · see citing works
Attitudes About Mental Illness and its Treatment: Validation of a Generic Scale for Public Health Surveillance of Mental Illness Associated Stigma
Kobau, R., DiIorio, C. K., Chapman, D., Delvecchio, P., & Members, S. M. I. S. P. (2009) · Community Mental Health Journal · doi:10.1007/s10597-009-9191-x · Cited by 112 · see citing works
“Men’s scores on negative stereotypes and more negative views toward recovery and outcomes may result from traditional masculine social roles ( Moller-Leimkuhler 2002; Tudiver and Talbot 1999).”
Background
Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk
Horwitz, A. G., McGuire, T., Busby, D. R., Eisenberg, D., Zheng, K., Pistorello, J., Albucher, R., Coryell, W., & King, C. A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.115 · Cited by 107 · see citing works
“This is consistent with other studies that have indicated men are less likely to seek help, even when distress levels are similar to women (e.g., Möller-Leimkühler, 2002).”
Result
Suicide Prevention: State of the Art Review
Stone, D. M., & Crosby, A. E. (2014) · American Journal of Lifestyle Medicine · doi:10.1177/1559827614551130 · Cited by 103 · see citing works
Men's views on depression: A systematic review and metasynthesis of qualitative research
Krumm, S., Checchia, C., Koesters, M., Kilian, R., & Becker, T. (2017) · Psychopathology · doi:10.1159/000455256 · Cited by 104 · see citing works
Erectile Dysfunction and Constructs of Masculinity and Quality of Life in the Multinational Men's Attitudes to Life Events and Sexuality (MALES) Study
Sand, M. S., Fisher, W. A., Rosen, R. C., Heiman, J. R., & Ian Eardley, C. (2008) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2007.00720.x · Cited by 105 · see citing works
“Research has also found that men seek psychiatric and counseling services less often than women with comparable emotional problems [17,18], and demonstrate lower rates of help seeking for such diverse conditions as cancer and depression [19, 20 ].”
Background
"Standing Out from the Herd": Men Renegotiating Masculinity in Relation to Their Experience of Illness
O’Brien, R., Hart, G. J., & Hunt, K. (2007) · International Journal of Men s Health · doi:10.3149/jmh.0603.178 · Cited by 103 · see citing works
“However, there are some empirical data indicating that help-seeking with depressive symptoms may present particular difficulties for men because of the challenge this presents to the sense of masculinity (Heifner, 1997; Moller-Leimkuhler, 2002).”
Background
What Interrupts Suicide Attempts in Men: A Qualitative Study
Player, M. J., Proudfoot, J. G., Fogarty, A. S., Whittle, E. L., Spurrier, M., Shand, F., Christensen, H. M., Hadži-Pavlović, D., & Wilhelm, K. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0128180 · Cited by 101 · see citing works
“Furthermore, a positive correlation is observed between higher adherence to masculine norms and a higher likelihood of experiencing depressive episodes [5,6].”
Background
Examining the role of sex in self-injurious thoughts and behaviors
Fox, K. R., Millner, A. J., Mukerji, C. E., & Nock, M. K. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.009 · Cited by 99 · see citing works
“Men are less likely than women to use health care services for routine, yearly visits and preventative services, even controlling for age, and pregnancy-related visits (Garfield, Isacco, & Rogers, 2008) as well as less likely to seek and utilize mental health care services for things like stressful life events, depres…”
Background
Subjective well-being and ‘male depression’ in male adolescents
Leimkühler, A. M., Heller, J., & Paulus, N.-C. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.07.007 · Cited by 100 · see citing works
Who Influence Men to Go to Therapy? Reports from Men Attending Psychological Services
Cusack, J., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2004) · International Journal for the Advancement of Counselling · doi:10.1023/b:adco.0000035530.44111.a8 · Cited by 99 · see citing works
“…file version Nov 28th, 2002 272 Cusack, Deane, Wilson, and Ciarrochi seek help for mental health problems (Mahalik, Good & Englar-Carlson, 2003) a finding that has been identified across a number of cultural groups (e.g., Barry, Doherty, Hope, Sixsmith, & Kelleher, 2000; Moeller-Leimkuehler, 2002).”
Men In and Out of Treatment for Depression: Strategies for Improved Engagement
Seidler, Z. E., Rice, S. M., Oliffe, J. L., Fogarty, A. S., & Dhillon, H. M. (2018) · Australian Psychologist · doi:10.1111/ap.12331 · Cited by 96 · see citing works
Physical activity and depression in men: Increased activity duration and intensity associated with lower likelihood of current depression
Currier, D., Lindner, R., Spittal, M. J., Cvetkovski, S., Pirkis, J., & English, D. R. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.09.061 · Cited by 96 · see citing works
Belief in dealing with depression alone: Results from community surveys of adolescents and adults
Jorm, A. F., Kelly, C., Wright, A., Parslow, R., Harris, M., & McGorry, P. D. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.05.018 · Cited by 95 · see citing works
“This finding is consistent with earlier research showing a lower rate of help-seeking in males for depression (Möller-Leimkühler, 2002), as well as other health problems (Galdas et al.”
Result
Hippocampal volume in first episode and recurrent depression
Kronmüller, K., Schröder, J., Köhler, S., Götz, B., Victor, D., Unger, J., Giesel, F., Magnotta, V. A., Mundt, C., Essig, M., et al. (2009) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2008.08.001 · Cited by 92 · see citing works
“Depressive men, especially in their first episode, seek medical treatment at a later point in time than depressive women do (Piccinelli and Wilkinson, 2000; Möller-Leimkühler, 2002).”
Background
Being men with eating disorders: Perspectives of male eating disorder service-users
Robinson, K. J., Mountford, V. A., & Sperlinger, D. J. (2012) · Journal of Health Psychology · doi:10.1177/1359105312440298 · Cited by 94 · see citing works
“Previous research (Moller-Leimkuhler, 2002) has shown that men are less likely than women to seek help for emotional problems more generally, and this may also have contributed to participants’ difficulties admitting the ED.”
Method
Europe's men need their own health strategy
White, A., McKee, M., Richardson, N., Visser, R. D., Madsen, S. A., Sousa, B. C. D., Hogston, R., Zatonski, W., & Makara, P. (2011) · BMJ · doi:10.1136/bmj.d7397 · Cited by 87 · see citing works
“Men are less likely to contact health services because of mental health problems, 27 potentially placing them at risk of deterioration and suicide.”
Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda
Umubyeyi, A., Mogren, I., Ntaganira, J., & Krantz, G. (2016) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1130-2 · Cited by 91 · see citing works
“in which ‘‘real men’’ are considered to be physically fit, careless of their health and self-sufficient [36] while young women are more likely to make use of the most trusted people in their social environment to find help, support and advice for mental health problems [37].”
Background
Racial discrimination and depressive symptoms among African-American men: The mediating and moderating roles of masculine self-reliance and John Henryism.
Matthews, D. D., Hammond, W. P., Nuru-Jeter, A., Cole-Lewis, Y., & Melvin, T. (2013) · Psychology of Men & Masculinity · doi:10.1037/a0028436 · Cited by 112 · see citing works
“However, as the gender gap in the prevalence of depression is narrowing over time (Addis, 2008; Kessler, Chiu, Demler, & Walters, 2005; Möller-Leimkühler, 2002; Oliffe & Phillips, 2008; Stoolmiller, Kim, & Capaldi, 2005), researchers are paying increasing attention to depression among men.”
Background
Critical Issues in Men’s Mental Health
Bilsker, D., Fogarty, A. S., & Wakefield, M. A. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743718766052 · Cited by 90 · see citing works
Occupational risk of affective and stress-related disorders in the Danish workforce
Wieclaw, J., Agerbo, E., Mortensen, P. B., & Bonde, J. P. (2005) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.917 · Cited by 90 · see citing works
“This finding may explain why women are more often diagnosed, but not necessarily more affected by depressive and stress-related disorders (49, 50).”
Background
A comparison of the medical lethality of suicide attempts in bipolar and major depressive disorders
Zalsman, G., Braun, M., Arendt, M. C. B. B., Grunebaum, M. F., Sher, L., Burke, A. K., Brent, D. A., Chaudhury, S. R., Mann, J. J., & Oquendo, M. A. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00381.x · Cited by 89 · see citing works
Men managing cancer: a gender analysis
Wenger, L. M., & Oliffe, J. L. (2013) · Sociology of Health & Illness · doi:10.1111/1467-9566.12045 · Cited by 88 · see citing works
Sex Differences in Consequences of Musculoskeletal Pain
Wijnhoven, H. A. H., de Vet, H. C. W., & Picavet, H. S. J. (2007) · Spine · doi:10.1097/brs.0b013e31805931fd · Cited by 87 · see citing works
“Finally, perhaps different role expectations for the sexes may explain sex differences in healthcare use: help seeking may be more socially acceptable for women than for men.(20) Unlike healthcare use, no sex differences were found for work disability (ever in life) or work leave due to any MP in the currently working…”
Background
Men’s Likely Responses to Clinical Depression: What Are They and Do Masculinity Norms Predict Them?
Mahalik, J. R., & Rochlen, A. B. (2006) · Sex Roles · doi:10.1007/s11199-006-9121-0 · Cited by 90 · see citing works
“Despite these alarming rates of suicide, men tend to avoid seeking help for depression compared to women (Kessler, Brown, & Boman, 1981; Moller-Leimkuhler, 2002; Padesky & Hammen, 1981; Rickwood & Braithwaite, 1994 ;W eissman & Klerman, 1977).”
Background
Mental health stigma and professional help-seeking behaviors among Asian American and Asian international students
Maeshima, L. S., & Parent, M. C. (2020) · Journal of American College Health · doi:10.1080/07448481.2020.1819820 · Cited by 86 · see citing works
“Across myriad studies, men have lower rates of mental health help-seeking behaviors in comparison to women.(22,23) A possible explanation for this difference is gender role socialization.”
Background
Marital Processes around Depression: A Gendered and Relational Perspective
Thomeer, M. B., Umberson, D., & Pudrovska, T. (2013) · Society and Mental Health · doi:10.1177/2156869313487224 · Cited by 85 · see citing works
Depression underdiagnosis: Prevalence and associated factors. A population-based study
Faisal‐Cury, A., Ziebold, C., Rodrigues, D. M. D. O., & Matijasevich, A. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.04.025 · Cited by 86 · see citing works
Help‐Seeking in the Norwegian Police Service
Berg, A. M., Hem, E., Lau, B., & Ekeberg, Ø. (2006) · Journal of Occupational Health · doi:10.1539/joh.48.145 · Cited by 85 · see citing works
Prenatal parental depression and preterm birth: a national cohort study
Liu, C., Cnattingius, S., Bergström, M., Östberg, V., & Hjern, A. (2016) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13891 · Cited by 84 · see citing works
Gender differences in general and specialty outpatient mental health service use for depression
Gagné, S., Vasiliadis, H., & Préville, M. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-135 · Cited by 84 · see citing works
Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals.
Amminger, G., Leicester, S., Yung, A., Phillips, L., Berger, G., Francey, S., Yuen, H. P., & Mcgorry, P. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2006.02.018 · Cited by 90 · see citing works
“However, the relatively high proportion of females among UHR individuals, as compared to first episode samples, may also be explained by the notion that more females than males seek help for psychological or medical problems (Moller-Leimkuhler, 2002).”
Background
Attitudes Toward Seeking Professional Help for an Eating Disorder: The Role of Stigma and Anticipated Outcomes
Hackler, A. H., Vogel, D. L., & Wade, N. G. (2010) · Journal of Counseling & Development · doi:10.1002/j.1556-6678.2010.tb00042.x · Cited by 82 · see citing works
The Psychology of White Nationalism: Ambivalence Towards a Changing America
Reyna, C., Bellovary, A. K., & Harris, K. (2022) · Social Issues and Policy Review · doi:10.1111/sipr.12081 · Cited by 79 · see citing works
Depression and anxiety in the reindeer-herding Sami population of Sweden
Kaiser, N., Sjölander, P., Liljegren, A. E., Jacobsson, L. H., & Renberg, E. S. (2010) · International Journal of Circumpolar Health · doi:10.3402/ijch.v69i4.17674 · Cited by 78 · see citing works
“studies have pointed out that traditional male gender roles may explain the reluctance of men to seek help, arguing that norms of traditional masculinity inhibit emotional expressiveness (26) and also account for the greater occurrence of undetected depression among men than women (27).”
Background
Help Seeking Experiences of Survivors of Intimate Partner Violence in Canada: the Role of Gender, Violence Severity, and Social Belonging
Barrett, B. J., Peirone, A., & Cheung, C. H. (2019) · Journal of Family Violence · doi:10.1007/s10896-019-00086-8 · Cited by 81 · see citing works
“2018) and adulthood (Moller-Leimkuhler 2002), with females requesting help more readily than males.”
Background
Investigating the impact of masculinity on the relationship between anxiety specific mental health literacy and mental health help-seeking in adolescent males
Clark, L. H., Hudson, J. L., Rapee, R. M., & Grasby, K. L. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102292 · Cited by 78 · see citing works
Latino Immigrant Men's Perceptions of Depression and Attitudes Toward Help Seeking
Cabassa, L. J. (2007) · Hispanic Journal of Behavioral Sciences · doi:10.1177/0739986307307157 · Cited by 77 · see citing works
“For some, the abuse of alcohol or drugs is used as a coping mechanism to self-medicate depressive symptoms and can distort the clinical picture making it harder for clinicians to recognize depression as a separate illness (Cochran & Rabinowitz, 2000; Möller-Leimkühler, 2002).”
Background
Masculinities, Work, and Retirement Among Older Men Who Experience Depression
Oliffe, J. L., Rasmussen, B., Bottorff, J. L., Kelly, M. T., Galdas, P., Phinney, A., & Ogrodniczuk, J. S. (2013) · Qualitative Health Research · doi:10.1177/1049732313509408 · Cited by 80 · see citing works
“Men’s preference for selfmanaging depression has been linked to their desire to embody idealized masculinities amid distancing themselves from “having” a mood disorder or “needing” emotional support—deficits and actions that are typically associated with femininities (Johnson, Oliffe, Kelly, Galdas, & Ogrodniczuk, 201…”
BackgroundInfluential
“I Don’t Need Help”: Gender Differences in how Gender Stereotypes Predict Help-Seeking
Juvrud, J., & Rennels, J. L. (2016) · Sex Roles · doi:10.1007/s11199-016-0653-7 · Cited by 76 · see citing works
“…help-seeking behaviors significantly more than did male participants during the puzzle tasks, χ2(1, N = 560) = 30.03, p < .001, r = .23, replicating findings from previous help-seeking research (Ashton and Fuehrer 1993; Benenson and Koulnazarian 2008; Johnson 1988; Moller-Leimkuhler 2002).”
ResultInfluential

The role of masculinity in men's help-seeking for depression: A systematic review
Seidler, Z. E., Dawes, A. J., Rice, S. M., Oliffe, J. L., & Dhillon, H. M. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.09.002 · Cited by 1,093 · see citing works
Männer und Depression: geschlechtsspezifisches Hilfesuchverhalten
Möller-Leimkühler, A. M. (2000) · Fortschritte der Neurologie · Psychiatrie · doi:10.1055/s-2000-10030 · Cited by 35 · see citing works
Self-citation
Fördernde und hemmende Faktoren der Inanspruchnahme psychotherapeutisch-psychiatrischer Leistungen durch Männer mit Depressionen – Eine qualitative Interviewstudie
Stahl, H., Alferink, J., & Kühme, B. (2025) · PPmP. Psychotherapie, Psychosomatik, medizinische Psychologie · doi:10.1055/a-2842-9225 · Cited by 1 · see citing works
Why Don’t Men Seek Help for Depression? \nThe Impact of Masculinity on Symptom Perception
Howells, L. (2010) · UEA Digital Repository (University of East Anglia)
Barriers to Help-Seeking in Men for Mental Health Issues: The Impact of Gender Role Socialization and Masculinity Ideologies
Frederick, L. (2020) · National University System Repository (National University System) · Cited by 1 · see citing works

Authors: Möller-Leimkühler, A. M.
Affiliations: Ludwig-Maximilians-Universität München (DE)
Corresponding author: Möller-Leimkühler, Anne Maria
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2002-09
Volume: 71
Issue: 1-3
Pages: 1-9
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/s0165-0327(01)00379-2
OpenAlex: W1988759229
Cited by: 851
References: 63
Citations by year: 2026: 21 · 2025: 29 · 2024: 51 · 2023: 30 · 2022: 53 · 2021: 50 · 2020: 47 · 2019: 42 · 2018: 46 · 2017: 49 · 2016: 36 · 2015: 59 · 2014: 40 · 2013: 35 · 2012: 46
FWCI: 6.16
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Gender Studies › Gender Roles and Identity Studies
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: help-seeking, men, depression, masculinity, traditional masculinity, emotional expressiveness, barriers to treatment, gender differences, depressive symptoms, symptom perception, social norms
MeSH terms: Adult, Cultural Characteristics, Depression, Gender Identity, Humans, Male, Social Conditions, Health Behavior

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Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression

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