MHFS national conference 2006 Research and evaluation panel Researching men’s health: What do we think we know and what do we really know? Carol Emslie Gender & health team MRC Social & Public Health Sciences Unit, Glasgow

Research on men: 2 key themes 1) Focus on (social) gender rather than (biological) sex  What it means to be a man in a certain place and time  Masculinity is associated with dominance, aggression, courage, toughness, strength, competitiveness, control, lack of emotion  “The worst insult for a boy is to say that he runs, throws, looks or acts like a girl” (Kilmartin 2005) 2) Multiple masculinities. What it means to be a man varies by:-  Class, wealth & income / ethnicity / religion / sexuality/ employment status / geography etc  And by context

Gaps in our knowledge  Heart disease: associated with men  Depression: associated with women

Coronary heart disease  In 2003, 22% of male deaths and 16% of female deaths in the UK were due to CHD  Evidence that the general population, heart patients and health professionals think CHD is a ‘male’ disease (Arber 2006, Emslie et al 2001, Richards et al 2000)  BUT very little work on how men with CHD experience their illness (as men) (White 1999, Emslie 2005)

Delaying seeking help for CHD symptoms  “I’m a survivor so I tend to close my eyes, grit my teeth, and endure”  “See – the family depends on me. I have to be there”  “You don’t want to be a burden on anybody.. Most men don’t. You think it can’t be that bad”  “If she (wife) hadn’t been there, I would never have gone to the clinic. She forced me”  (Evidence drawn from a number of studies)

Implications of CHD for men’s social relationships  With partners  I don’t like her doing it (gardening), that’s what hurts  I feel sorry for her (wife).. I promised to look after her in my marriage vows and I can’t  With friends  Friends don’t come around here any more. They drink, they smoke, they carry on.. ‘let’s not go see how he is, he can’t do any of them things any more’  I am very lonely and isolated

Depression  Rates of treated depression among women are around twice that for men (4% for men & 8% for women, ISD Scotland 2005) »HOWEVER….  Gender differences are smaller in community surveys  Suicide rates are higher for men than women  “Women seek help – men die” ( Moller-Leimkuhler 2003 )  Very little work on men’s experiences of depression (assumption they are ‘strong, silent and stoic’?)

Talking to men about depression The misery of depression  like being in a glass tube where you could see everybody but you couldn’t reach them  like rotting in the depths of hell The difficulty of articulating their experience  I didn’t want to talk to anybody.. even if I had wanted to I couldn’t have made the effort to actually go out and initiate a contact with.. a health professional.(After being persuaded to see GP).. I couldn’t articulate how I was feeling...Ask me a direct question. “Are you feeling suicidal?” “Yes”.. I could answer..but sort of saying.. “How do you feel?” I wasn’t capable of articulating that.  (Emslie, Ridge, Ziebland & Hunt 2006)

Traditional masculinity – a double edged sword?  Control, strength and anger  I got really, really angry at the depression – ‘you are not going to do this to me. I’m going to pull myself out of this’  I come out very strong…I think it’s through suffering, no pain, no gain.  I must admit a lot of depression is about lack of control of your thoughts. But at least to have control over whether you kill yourself or not.. It’s the last crutch which was holding you up.. It’s the best thing that you feel that you can possibly do at the time

Good to talk?  Therapy is anathema in my family..we’re not from that world.. that kind of class. Blokes kind of like CBT (cognitive behavioural therapy).. it’s not about emoting particularly, though it’s kind of good to sometimes tell someone that something hurts you and to get it out.. I think if you can try and think about it as a practical problem solving thing rather than …emotional masturbation.. then I think that will help.

Conclusions 1) We need scientific evidence about men’s health in order to make informed decisions 2) Sometimes talking directly to men is the best way to get this evidence 3) Our challenge - feeding back our research.  It is easier to communicate a simple message but the reality is often complex (men are not all alike)

References  Arber, S., McKinlay, J., Adams, A et al (2006). Patient characteristics and inequalities in doctors' diagnostic and management strategies relating to CHD: A video-simulation experiment. Social Science & Medicine, 62(1),  Emslie, C., Hunt, K., & Watt, G. (2001). Invisible women? The importance of gender in lay beliefs about heart problems. Sociology of Health and Illness, 23(2),  Emslie, C. (2005). Women, men and coronary heart disease: review of the qualitative literature. Journal of Advanced Nursing, 51(4),  Emslie, C., Ridge, D., Ziebland, S., & Hunt, K. (2006). Men's accounts of depression: Reconstructing or resisting hegemonic masculinity? Social Science & Medicine, 62(9),  Kilmartin, C. (2005). Depression in men: communication, diagnosis and therapy. Journal of Men's Health and Gender, 2(1),  Richards, H., McConnachie, A., Morrison, C. et al (2000). Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain. Journal of Epidemiology and Community Health, 54,  White, A. (1999). 'I feel a fraud': men and their experiences of acute admission following chest pain. Nursing in Critical Care, 4(2),