Factors that promote men’s engagement with mental health services and interventions has been a growing area of research in recent years (Affleck et al, 2018). It has been found that even after overcoming barriers to accessing care, approximately one in four men will prematurely drop out of treatment (Swift & Greenberg, 2012). Chock et al (2015) also found that approximately 44,000 UK, Australian and Canadian based men who died by suicide in 2015 engaged with a health service in the week before they died; demonstrating that men recognise that they need help, but this help may not be effectively tailored to their needs. Men’s reluctance to access mental healthcare has also been attributed to structural issues whereby services and interventions are insufficiently sensitive to masculine ideals (Brownhill et al, 2003).

Static risk factors (factors which do not change throughout an individual’s life) are an important area of research to better understand men’s vulnerability to mental illness (Steele et al, 2018). For men, exposure to childhood maltreatment has been found to be a particularly salient risk factor for mental illness in adulthood (Cecil et al, 2017; Gallo et al, 2018). Although, despite being at greater risk of mental illness, research shows that men do not disclose sexual abuse until (on average) 28 years after the event (Easton et al, 2013).

The authors of a new Canadian study (Rice et al, 2020) had two principal aims:

• To statistically validate the Intensions Masculine Values Scale (IMVS) (Oliffe et al, 2019) factor structure using confirmatory factor analysis
• To determine whether masculine values were differentially linked to men’s mental health functioning depending on exposure to childhood maltreatment.

Methods

The sample comprised 530 Canadian men, ranging in age between 19 and 81 years, recruited through an online panel provider. Participants completed an online survey which assessed the following measures:

Intensions Masculine Values Scale (IMVS)

The IMVS (Oliffe et al., 2019) was originally validated as a 12-item self-report inventory of health-related masculine values. Oliffe et al (2019) originally validated the IMVS in a mixed-methods study of young men (mean age 21 years) living in Western Canada. The IMVS assesses two domains of health-related masculine values: i. Open and Selfless, and ii. Healthy and Autonomous. Each domain includes 6 items; for example “A man should make his own decisions” and “A man should care about other people”. Participants responded on a 5-point Likert scale (1= strongly disagree to 5= strongly agree).

Patient Health Questionnaire (PHQ-9)

The PHQ-9 (Kroenke et al., 2001) is amongst the most widely used self-report measures of symptoms of major depression (Choi et al., 2014).

Suicidal Behaviours Questionnaire – Revised (SBQ-R)

The SBQ-R (Osman et al., 2001) is a well validated four-item self-report measure of suicide risk, which assesses past suicide planning, recent ideation, history of verbalisation of suicidality and future likelihood of attempt (e.g., ‘How often have you thought about killing yourself in the past year?’).

Childhood maltreatment

Childhood maltreatment was assessed by five categorical (e.g., yes/no) questions designed for the present study, similar in nature to other single-item childhood maltreatment assessments applied in epidemiological and other research (e.g., Godbout et al., 2009; Green et al., 2012).

Data analysis

Confirmatory factor analysis (CFA) using maximum likelihood estimation was undertaken on the IMVS items. K-means cluster analysis was undertaken to identify cluster groups on the two IMVS subscales. In order to avoid simple high-low groupings, the authors identified a priori ≥ three clusters within the IMVS data. ANOVA and chi-square tests of association were used to evaluate any cluster group differences across demographic variables. Any demographic factors that differed across cluster groups were treated as covariates in subsequent analyses of depression (PHQ-9) and suicide risk (SBQ-R) outcomes. In order to identify IMVS cluster grouping X exposure to childhood maltreatment interactions for the PHQ-9 and SBQ-R, MANCOVA was undertaken, including control variables.

Results

Confirmatory factor analysis validated an abbreviated eight-item, two-factor model of the Intensions Masculine Values Scale (IMVS-8; CFI=.984, TLI=.977, RMSEA=.054, SRMR=.032).

Cluster groups of low (n=57), moderate (n=206) and high (n=267) adherence to health-related masculine values were identified, equivalent on exposure to childhood maltreatment and previous mental health treatment.

A multivariate group X maltreatment interaction was observed (p=.017) whereby males in the low cluster with a maltreatment history endorsed higher mood-related symptomology.

This same pattern was observed in a univariate group maltreatment interaction for suicide risk (p=.006).

Conclusions

The authors concluded that health-related masculine values, such as being healthy and autonomous, were associated with lower depression and suicide risk in men who have a history of childhood maltreatment. Future intervention studies should investigate whether development of health-related masculine values can reduce depression and suicide risk.

The results also support the statistical validity of the two factor Intensions Masculine Values Scale (IMVS-8), particularly in older men.

Strengths and limitations

Strengths

• The present study contributes to the existing literature by identifying health-related masculine values associated with lower depression and suicide risk among men with a history of childhood maltreatment
• The IMVS was originally validated in young men (aged 21-24) (Oliffe et al, 2019). The mean age of the current study is 47.91 (SD=14.51) which supports the validity of its use in older males. Although further validation is required in more diverse populations.

Limitations

• The study employs a cross-sectional design which assesses health-related masculine values at a specific point in time. More research is needed to investigate whether it is applicable to suicide risk over time
• Suicidal behaviours were assessed using the SBQ-R (Osman et al, 2001) which relies on self-report of suicide risk. The participants may not feel comfortable disclosing their past suicidal thoughts or behaviours
• The cluster grouping analysis is dependent on the specific data that is analysed. Other samples may result in different low, moderate and high IMVS-8 responses
• Participation in this study is dependent on having internet access, which may exclude certain populations such as remote communities, homeless men and elderly men.

Implications for practice

Men in the low masculine health-related values cluster, who also reported childhood maltreatment exposure, were in the clinical range for both depression and suicide risk, which is indicative of a particular group that would benefit from a mental health intervention.

This also indicates that supporting opportunities for the development of health-related masculine values in men with static risk factors (such as childhood maltreatment), and report low IMVS-8 scores, could be a significant part of recovery.

Interventions for men could also be broader than traditional medical approaches, such as Men’s Sheds, which provide a location for men to foster social connectedness and meaningful relationships as well as foster positive male identities (Anstiss et al., 2018; Moylan et al., 2015).

Statement of interests

No conflicts of interest.

Links

Primary paper

Rice, S. M., Kealy, D., Ogrodniczuk, J. S., Black, N., Seidler, Z. E., & Oliffe, J. L. (2020). Health-related masculine values, depression and suicide risk in men: associations among men with a history of childhood maltreatment. Journal of Mental Health, 1-8.

Other references

Affleck, W., Carmichael, V., & Whitley, R. (2018). Men’s mental health: Social determinants and implications for services. The Canadian Journal of Psychiatry, 63(9), 581-589.

Anstiss, D., Hodgetts, D., & Stolte, O. (2018). Men’s re-placement: Social practices in a Men’s Shed. Health & place, 51, 217-223.

Brownhill, S., Wilhelm, K., Eliovson, G., & Waterhouse, M. (2003). ‘For men only’. A mental health prompt list in primary care. Australian family physician, 32(6), 443-450.

Cecil, C. A., Viding, E., Fearon, P., Glaser, D., & McCrory, E. J. (2017). Disentangling the mental health impact of childhood abuse and neglect. Child abuse & neglect, 63, 106-119.

Chock, M. M., Bommersbach, T. J., Geske, J. L., & Bostwick, J. M. (2015, November). Patterns of health care usage in the year before suicide: a population-based case-control study. In Mayo Clinic Proceedings (Vol. 90, No. 11, pp. 1475-1481). Elsevier.

Choi, S. W., Schalet, B., Cook, K. F., & Cella, D. (2014). Establishing a common metric for depressive symptoms: linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychological assessment, 26(2), 513.

Easton, S. D. (2013). Disclosure of child sexual abuse among adult male survivors. Clinical Social Work Journal, 41(4), 344-355.

Gallo, E. A. G., Munhoz, T. N., de Mola, C. L., & Murray, J. (2018). Gender differences in the effects of childhood maltreatment on adult depression and anxiety: a systematic review and meta-analysis. Child abuse & neglect, 79, 107-114.

Godbout, N., Sabourin, S., & Lussier, Y. (2009). Child sexual abuse and adult romantic adjustment: Comparison of single-and multiple-indicator measures. Journal of interpersonal violence, 24(4), 693-705.

Green Jr, H. D., Tucker, J. S., Wenzel, S. L., Golinelli, D., Kennedy, D. P., Ryan, G. W., & Zhou, A. J. (2012). Association of childhood abuse with homeless women’s social networks. Child Abuse & Neglect, 36(1), 21-31.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613.

Moylan, M. M., Carey, L. B., Blackburn, R., Hayes, R., & Robinson, P. (2015). The Men’s Shed: Providing biopsychosocial and spiritual support. Journal of religion and health, 54(1), 221-234.

Oliffe, J. L., Rice, S., Kelly, M. T., Ogrodniczuk, J. S., Broom, A., Robertson, S., & Black, N. (2019). A mixed-methods study of the health-related masculine values among young Canadian men. Psychology of Men & Masculinity.

Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment, 8(4), 443-454.

Steele, I. H., Thrower, N., Noroian, P., & Saleh, F. M. (2018). Understanding suicide across the lifespan: a United States perspective of suicide risk factors, assessment & management. Journal of forensic sciences, 63(1), 162-171.

Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of consulting and clinical psychology, 80(4), 547.

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