Depressive disorders are identified by the Australian Institute of Health and Welfare as the eighth highest cause of disease burden in Australian men, and the third highest for women, reflecting gender differences in prevalence: 7.8% of men and 12.3% of women in Australia are reported to have depression.
The gender difference in the prevalence of depression might simply be an artefact of the ability of diagnostic instruments to diagnose the disorder.
In much the same way that atypical presentation of women with myocardial infarction leads to underdiagnosis and increased mortality[1], many men have symptoms of depression that might be missed by standard screening tools.
Men are more likely to report symptoms of anger, aggression, irritability, substance use and risk-taking than social withdrawal, sleep problems and complaintiveness.
Male-type symptoms are reported at higher rates by men than women, who state they experience stress, irritability, sleep problems and disinterest at a higher rate than men[2].
Hence, gender differences in the rates of depression disappear when male-type symptoms are considered3.
To facilitate better identification of depression in males, Herreen et al. adapted the Male Depression Risk Scale (MDRS-22) into a short seven-item form and compared its performance to the Patient Health Questionnaire (PHQ-9) and Kessler Psychological Distress Scale (K10)[3].
In this study of 920 Australian men, 10% presented with only male-type symptoms; these men would not be identified using traditional measures of depression.
Combined male-type and traditional symptoms of depression were observed in more than one-third of younger Australian males (18-64 years) and in 13% of older men (>64 years). Both groups of men were at risk of suicide3.
The suicide rate for Australian males is 186 per million population — three times higher than for females (58 per million). This disparity seems incongruous with the knowledge that people with depression are among those most at risk of suicide[4],[5].
A possibility is that depression in men is missed by primary healthcare providers, and hence is untreated and ends in tragedy.
We have long known that many people who die by suicide have contact with a general practitioner in the weeks and months prior to their deaths[6],[7], and there is little gender difference in these presentations.
However, the use of mental health services in the weeks and months prior to suicide (in primary care, outpatient or inpatient settings or hospital admissions) is lower for males than females7,[8], [9].
Herreen et al. propose that the use of the MDRS-7 in primary care settings might facilitate screening, diagnosis and management to reduce the personal and public health burden of male depression3.
They recommend further research, to ensure the MDRS-7 is appropriate for men who are different from the sample used for their study, and they caution that this initial study provides only “preliminary information”.
The MDRS-7 is available here.
