Newswise — Anxiety, worry and depression are natural responses to the coronavirus pandemic and all of the problems that accompany it. Paul Ingram, an assistant professor of counseling psychology in Texas Tech University’s Department of Psychological Sciences, said the impact on men might be more serious than for women because of how men deal with mental health. 

Social acceptability of depression in men Depression can affect a variety of behaviors and spark many different symptoms. It can affect how often an individual wants to go outside, how long they stay in bed, how they feel physically and mentally, how they think and how they interact with their social network of friends and family. These areas are split into internalized thoughts and feelings and externalized acting-out behaviors. “When we look at the difference between men and women with depression, a lot of it comes down to the social acceptability of the type of symptom,” Ingram said. “There are a lot of stereotypes about how men can share their feelings – and most of those stereotypes are that they aren’t supposed to share their feelings. ‘Boys don’t cry.’ It’s a classic song by The Cure. All the symptoms – such as feeling sad, depressed or guilty – are the types of symptoms that men are not encouraged to share. There are a lot of differences in how men and women express their symptoms.” 

Often, men’s symptoms are external or physical. Ingram said it’s acceptable for men to say they have a headache or they are tired – more acceptable than saying out loud, “I’m sad.” Depressive behaviors in men are often expressed by externalizing those internal symptoms with physical expression.

Drinking is a common, yet problematic, way of externalizing internal feelings because it can become a cyclical avoidance habit. Many individuals turn to drinking for relief from negative feelings, only to discover that the feelings or the problem causing those feelings still exists. 

“Alcohol – or any kind of avoidance – does not make the problem go away,” Ingram said. “Drinking just makes it so that you don’t feel those negative symptoms in the moment. Whenever the problem comes up again, there can be a feeling of guilt or frustration associated with the avoidance that can make you feel more helpless, so you just feel worse.” 

Those external symptoms aren’t necessarily worse in men, but it is more socially acceptable for men to talk about the external symptoms, while it’s more socially acceptable for women to talk about the internal symptoms. “Just because men are reporting these external symptoms, such as headaches or exhaustion, it doesn’t mean they aren’t feeling the sadness or depression,” Ingram said. “Men are experiencing the same emotions as women. Men have emotions and needs and all of those things that have been characterized as feminine. But how men express it is different. Even the insight that men have into those emotions or needs is different. If they haven’t spent their entire life thinking about emotions, they may not realize what sadness is. That sounds kind of strange, but if people have pushed it down and ignored it, it might take them a while to recognize it.” 


Gender socialization and gender expectations

Ingram said public stigma plays a role in how individuals form their perceptions of gender identity. Media, cultural values and gender expectations all contribute, and it starts in infancy. 

“That image is imprinted on people from a very young age, of what a man is and should be,” Ingram said. “Even though infants don’t have the visual acuity to see or appreciate that their room is blue, the gender socialization starts there. The way we as a culture talk about and expect men to experience symptoms of depression starts with telling little boys to toughen up and not to cry. That’s a message that an external expression of an internal feeling is not OK, and that can stay with them until adulthood. What matters at the end of the day for men is how much they’ve internalized those beliefs.” 

Ingram said gender socialization has pros and cons. It can provide a clear path for helping people figure out their identity, but there’s a lot of variability to what people believe about who they are and how they identify themselves throughout their lives. “That can make it difficult,” Ingram said. “Some of the socialization is there for good reasons, but there should be flexibility in how parents expect children to be. When it comes to emotions, across the board, there is no benefit to telling children not to talk about their emotions. It’s not good for anyone.

“Parents are in a unique position to act as a buffer. Kids are going to experience socialization at school and through peers. Parents can buffer some of those values by encouraging children to engage in different types of stereotypical and non-stereotypical gender roles. There’s lots of ways for those opportunities to be utilized. 


Manifestations of depression in men and women

There are lots of different ways depression can manifest in someone. All of them can be tied to negative outcomes. Statistically, women are more likely to attempt suicide, but men are more likely to use lethal means in their attempts. “It’s most likely going to be a man using a gun when attempting suicide,” Ingram said. “Unfortunately, there is a higher lethality with gun use. Women are more likely to engage in different types of less lethal behaviors when they attempt suicide, like overdosing with pills. There’s a higher probability of survival for women.” 

Gender stereotypes can play a role in women’s depression as well. While men have stereotypes about what makes a “man,” which can include not asking for help or expressing anger rather than sadness, women hold the same emotions.  

“You see a lot of the stigma about mental illness existing in this same way surrounding gender or sex regardless of who it starts with because the stereotypes are socially based, and we are all impacted by social values and attitudes,” Ingram said.


The coronavirus pandemic is a worst-case scenario

One of the reasons the pandemic is so challenging, both mentally and emotionally, is because it’s a worst-case scenario. Ingram said the ambiguity of what’s going to happen causes high levels of stress. 

“When we think about COVID-19, it’s the worst challenge,” Ingram said. “It’s uncertain, it’s ambiguous and it’s invisible. It’s not like walking outside, seeing a potential threat, identifying it as a danger and then avoiding it. We don’t know where it is because it’s so small, and we don’t know when it will end or what will happen. There’s no clear trajectory or endpoint. This uncertainty is what makes this so impactful. That’s what causes cortisol levels and stress hormones to go off because our mental health is going down. This is the absolute worst kind of stressor.” 

Ingram said with the pandemic, there is a new baseline of stress when people wake up because there are added challenges to deal with. During lockdown, that challenge could have been whether or not there was enough food. The pandemic has caused people to worry about things they’ve never had to worry about before. When basic needs aren’t resolved, everything else becomes secondary, and the uncertainty is making it worse. 

“People have been successful evolutionarily because of the way our minds are able to make shortcuts and connect ideas,” Ingram said. “We’re very good at coming up with heuristics to help us problem-solve and select what we need to pay attention to and what we don’t. We have never dealt effectively with ambiguity, so creating wide-reaching situations brings out the worst in us and in our ability to plan and problem-solve. This is true of both men and women.”


Mental health affects physical health

During the months when lockdowns were in place, drinking rates skyrocketed. Ingram said this isn’t surprising, since drinking is one way people try to avoid their feelings.

“When it comes to men, we know they are more likely to try and repress feelings anyway,” Ingram said, “because ‘You shouldn’t have feeling as a man.’ That’s the social messaging. Drinking is an obvious avoidance strategy – we see it in movies and media all the time. We see men drinking a lot more because it pushes down their feelings. The more men buy into the stereotypical gender roles, the more likely they are to use that avoidant coping strategy. I’d expect them to drink more. There’s some serious health implications as well, not just mental health issues.” 

When the body undergoes a stress reaction, it goes into fight or flight mode, regardless of the type of stressor. Increased arousal results in raised heart rate and increased blood flood. The human body isn’t meant to endure prolonged elevations of those experiences. The longer they experience a stressor, the more negative the long-term impacts are on the body.  

“Men face the additional burden on their health, particularly their cardiovascular health, of carrying more muscle mass and having specific hormones that tax the heart even more,” Ingram said. “The long-term impacts of stress are likely to be fairly substantial for men. This may be part of the reason we see discrepancies in terms of who is dying from COVID-19. 

“Men are more likely to die from the disease. There may be other factors as well, but certainly the physical way in which men experience stress is part of it. Higher tendencies toward negative views about seeking help just means there is one less tool men are likely to utilize to help combat this risk factor, unfortunately.”


The effect of unemployment

Unemployment, or the risk of unemployment, also plays a big role in men’s mental health. The relationship between employment and depression is double-sided. Unemployment makes it more likely for men to develop depression, especially if they adhere to perceived gender roles, and it can make depression worse. “Some research over the last few months is showing that this exact pattern is happening now just as it has at other times when individuals faced economic hardships,” Ingram said. “This is true of both men and women, of course. The key here is the degree to which individuals identify as the breadwinner, a role men frequently hold for themselves when they have more traditional views of gender.” An unprecedented number of people have filed for unemployment in 2020, and for some men, being a provider is a key component to their identity. When it’s suddenly ripped away, it can be challenging. “Women have similar challenges as well – there’s something called the second shift, where working women spend all day at work and then come home,” Ingram said. “If their household adheres to traditional gender roles, they have this second job of cooking, cleaning and child care. Some of these gender roles can set extreme limitations on men and women and how they can approach their life. Flexibility is key.”


Getting help  

Coping strategies for dealing with mental health vary from avoidance strategies to self-help strategies. Some individuals find that reading books is helpful. Others find solace in talking to friends. “Help doesn’t always have to involve a professional,” Ingram said. “It depends entirely on the attitudes and beliefs a person has about mental health. If you have a belief that your mental health will not get better when you talk to a therapist, you’re not going to go. If men are avoiding problems and aren’t able to talk about them with their friends, they definitely won’t talk about them with a therapist. There are a thousand right ways to engage in healthy coping – exercise, diet, therapy, socializing with positive peer influences, incorporating enjoyable activities and hobbies into the day, getting good sleep. There are lots of different things you can do. Depending on the person, the exact things may vary, but the more you do of any of them the better of you are. “In general, psychological health is about being flexible and not prescriptive. When we adhere to stereotypical gender roles and stereotypes in an inflexible way, that hurts us. It’s going to be different for everyone. I can’t tell you what the correct answer is for being you any more than you can tell me the correct answer for being me.”


How to think about the pandemic

Another helpful way individuals can cope with the pandemic is by reframing how they think about it. Considering it a traumatic event can have diminishing returns, because it’s difficult to shift from that way of thinking. 

“If we say it’s traumatic, then we’re not going to want to shift away and make it an unfortunate thing that we overcame – the focus will be on how traumatic it was, not that you made it through the event,” Ingram said. “I think the best way to frame it is that it’s unprecedented in modern times. It’s difficult. We have to take one day at a time and focus on how we are doing and remember that when you experience extreme stress, it’s OK if you don’t do well.”

Ingram said it’s important to keep in mind that, even though there’s been a lot of messaging to continue as if nothing has changed, everything has changed. “There are all sorts of challenges we’ve never had before,” Ingram said. “If you have kids, you’re now in charge of teaching them and doing your job. If you have animals, you’re going to be taking care of them and interacting with them and dealing with one additional thing. There’s no separation from work. These are difficult challenges, and acknowledging that right now is very important.”