23/147 Men's mental health

Research Question: What interventions are effective in promoting good mental health, or preventing poor mental health, among men?

Increasing rates of mental ill-health are a concern for both men and women. This call for research focuses specifically on the mental health of men. There are a range of societal forces and contributors impacting the mental health of men, and in addition, the issue of help-seeking for male mental health is uniquely complex. For general health issues, reluctance to seek help has typically been viewed as more common in men than women, and indeed men report experiencing unhelpful and sometimes frustrating professional interventions. A suggested solution is to tailor health interventions to make them more ‘male friendly’. Despite considerable research in this area, there remains a small amount of evidence on how to address the challenges associated with supporting and promoting male mental health.

Many researchers posit that the true level of male mental ill-health is higher than suggested by official figures, since men tend to have lower engagement with mental health services. Men may feel pressure to quietly endure their distress, creating the phenomenon of ‘hidden distress’. Research suggests that although men appear less frequently than women in data on mental ill-health, their higher levels of suicide, homelessness, alcohol and substance misuse, aggression, risk-taking, offending, and incarceration may be important indicators of such hidden distress.

Societal norms centred on traditional or ‘hegemonic’ (‘the most honoured way of being a man’) forms of masculinity play a part in explaining why men are less likely or less willing to discuss or seek help for their mental health problems. Despite campaigns to address these issues, men may often feel an expectation to conform to the characteristics of being strong, silent, competitive, and in control, fulfilling the role of breadwinner and protector of others. Research has suggested that men who do not, or who feel they cannot, speak openly about their emotions, tend towards having lower levels of mental health literacy, and reduced ability to recognise their own distress or mental health symptoms for which help could be sought.

Life-course approach

The 2017 UK government report ‘A framework for mental health research’, highlights that mental health research needs to take a life-course approach, with an emphasis on prevention and early intervention at all life stages; we need to understand how and why mental health problems emerge and improve support. Whilst this call for research recognises that men’s mental health is important at all stages of the life-course, researchers will likely need to focus their proposal on a specific stage(s) of the life-course – for example boyhood, adolescence, older youth, working-age, fatherhood, and older-age or retirement – appropriately defined.

Men experience different pressures and concerns at each stage of the life-course, which may affect their mental health in specific ways. Certain issues – such as loneliness or labour market exclusion – may also apply to more than one stage of the life-course, but be experienced differently at each stage.

Observations concerning different life-courses:

• Developing a mental health problem at a younger age can have life-long adverse consequences. Half of all mental health problems are established by the age of 14 years, rising to three-quarters by the age of 24 years, and this may affect subsequent emotional and social development, educational achievement, relationships, and employment opportunities.
• The rate of males aged 16-24 years not in education, employment, or training (NEET) is higher than for females. NEET status can leave young men with a sense of failure, lacking purpose in life, and with poor mental health outcomes.
• A growing public health concern for younger men is violence – both self-harm and violence towards other men and women. Self-damaging behaviours, which can be considered a form of self-harm, include overeating, excessive body building, over-exercising, and binge drinking.
• For working-age men, the importance of employment is underlined by connections between unemployment and mental health problems, including feelings of hopelessness, and suicide. Moderate levels of work strain may have a protective effect against depression for men. However, men are also at higher risk of depression than women when work conditions involve high strain (pressurised roles) and low control (for example in the gig economy or where job stability is lacking).
• Retirement is a major life transition that can threaten maintenance of masculine identities, with the potential for poorer health, decreased mobility, loneliness, and social isolation. Men may find it difficult to develop new friendships in later life, and generally have lower levels of contact with family than women. Social isolation negatively impacts mental health in older adults. Nevertheless, research suggests that ageing in men brings a relaxing of pressure to uphold masculine ideals, and increasing emotional openness among younger cohorts.

Health inequalities 

Men are not, of course, a homogeneous group. Intersectionality incorporating factors such as personality, culture, marital status, age, socioeconomic status, sexual orientation, bereavement, and unique life experiences will influence men’s mental health and engagement with interventions. People from under-served groups may be at greater risk of mental ill-health across all stages of the life-course. Under-served groups might include people from ethnic minority backgrounds, young white males who experienced disadvantage, and groups who are seldom heard.

The Public Health Research (PHR) Programme is predominantly interested in interventions operating at a population or group level rather than at an individual level, and which should address health inequalities and the wider determinants of health.

The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore such inequalities of impact in their study design. The PHR Programme is also interested in evaluations of community-level interventions that seek to improve mental health by acting to increase the degree of choice and agency for the population which is the focus of the research. Of particular importance to the PHR Programme is an understanding of inequalities in impact of policies, access to services, and health inequalities experienced by people from ethnic minority backgrounds in the UK.

Suggested areas of research 

This call for research is focused on public mental health interventions (please note, mental health treatments at the individual level are not in scope) that seek to promote good mental health, and/or prevent poor mental health, among men at various stages of the life course. Suggested areas of research could include, but are not limited to, evaluation of:

• interventions that leverage lifestyle behaviours or lifestyle changes as a means to improve men’s mental health
• community-based interventions
• programmes that take a whole-community approach to men’s mental health. This could include interventions:
  • based in specific settings – such as schools, colleges, universities, workplaces, leisure venues, places of worship, community groups and services, health centres, or criminal justice services
  • that focus on specific population groups, such as men from specific ethnic minority groups, men who identify as LGBTQ+, or men facing different forms of disadvantage
• interventions for which the primary focus of the intervention is not necessarily on improving mental health, but the activity or mechanism might impact mental health (positively or negatively)
• interventions that address the multiple, interacting disadvantages that affect the most marginalised men
• trauma-informed and trauma-specific interventions
• intergenerational interventions
• interventions that take a holistic, person-centred approach
• peer support interventions
• interventions related to social media, or online images, messages, or digital content.

Whilst the scope of this call includes men at any stage of the life-course, applicants will need to focus their research on a specific stage(s) of the life-course.

Terminology 

For conciseness and readability, the term ‘men’ is used throughout this brief. Issues of sex and gender identity – for example, regarding intersex or transgender experience – may be addressed through research proposed in response to this call, provided (as with all proposals) that justification is provided for the focus and where findings will have importance for public health practice.

Study designs

A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of health outcomes, target population group, life-course stage, as well as the rationale for their methodological approach. Researchers are encouraged to consider additional outcome measures, including those relating to the broader determinants of health and health inequalities, which should be specified and justified. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term.

Providing value to the economy and community 

Understanding the value of public health interventions – whether outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.

Researchers are strongly encouraged to ensure that service users, including people with lived experience from the target audience, are involved in the design and planning of the intervention and/or as potential (suitably rewarded) members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences, and they might do this through involving them as costed/rewarded members of the research team.

Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice and ensure their proposed research is complementary.

Further information 

To find out more on how to submit an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information.