Male vs. Female Male vs. Female Depression:  Depression:  

Why Men "Act Out" and Why Men "Act Out" and Women "Act In."Women "Act In."

Jed Diamond, Ph.D., LCSWJed Diamond, Ph.D., LCSW

Kaiser Permanente San Kaiser Permanente San Jose Jose

October 27-28, 2010October 27-28, 2010

“Women seek help—men die.” This conclusion was drawn from a study of suicide

prevention by Angst & Ernst (1990). They found that 75% of those who sought professional help in an institution for suicide prevention were female. Conversely 75% of those who committed suicide in the same year were male.

Since depression is a significant risk factor for suicide and men receive less treatment for depression than do women, it is vitally important that we have a better understanding of the way depression manifests itself in males.

Estimated Annual Suicide Rate per

100,000 by Age and Gender Age Range Men Women Male : Female

15-19 18.5 3.7 6.08

20-24 27.2 4.0 7.35

25-64 25.6 6.1 4.20

65-85 49.4 5.1 9.68

85+ 75.0 5.0 15.00

Reported in Sam V. Cochran and Fredric E. Rabinowitz. Men and Depression: Clinical and Empirical Perspectives. San Diego,

California: Academic Press, 2000, 141.

My Own Journey With My Own Journey With DepressionDepression

On the day after my 5th birthday my On the day after my 5th birthday my father took an overdose of sleeping father took an overdose of sleeping pills. pills.

Although his suicide attempt wasn’t Although his suicide attempt wasn’t successful, our lives were never the successful, our lives were never the same. same.

Standard Depression Standard Depression QuestionsQuestions

1. I did not feel like eating; my appetite 1. I did not feel like eating; my appetite was poor.was poor.

2. I felt that I could not shake off the 2. I felt that I could not shake off the blues. blues.

3. I felt hopeless about the future. 3. I felt hopeless about the future. 4. I had crying spells. 4. I had crying spells. 5. I talked less than usual. 5. I talked less than usual. 6. I felt sad.6. I felt sad. 7. I felt that people disliked me. 7. I felt that people disliked me.

The Center for Epidemiologic The Center for Epidemiologic Studies Depression Screen Studies Depression Screen

(CES-D 20) (CES-D 20)

Well established assessment Well established assessment instrument for determining whether instrument for determining whether someone is depressed.someone is depressed.

Diamond Male Depression Diamond Male Depression Scale (DMDS)Scale (DMDS)

I developed a 51 question scale, the I developed a 51 question scale, the Diamond Male Depression Scale, Diamond Male Depression Scale, which included atypical symptoms which included atypical symptoms thought to be associated with male-thought to be associated with male-type depression. type depression.

Demographics of Study Demographics of Study PopulationPopulation

323 females and 749 males (1072 total).323 females and 749 males (1072 total).

Age range 18-80, Mean 51, 58% over 50.Age range 18-80, Mean 51, 58% over 50.

76% employed, 64% income > 76% employed, 64% income > $50,000/year.$50,000/year.

48% of the males and 40% of the females 48% of the males and 40% of the females depressed (CES-D 20).depressed (CES-D 20).

53%, 1+ relatives have mood disorder.53%, 1+ relatives have mood disorder.

Factor Analysis of Diamond Male Factor Analysis of Diamond Male Depression Scale (DMDS)Depression Scale (DMDS)

Factor 1: Emotional Acting-In Depression, Factor 1: Emotional Acting-In Depression, Chronbach’s alpha = .93Chronbach’s alpha = .93

Negative, withdrawn, stressed, numb.Negative, withdrawn, stressed, numb.

Factor 2: Emotional Acting-Out Depression,Factor 2: Emotional Acting-Out Depression, Chronbach’s alpha = .89Chronbach’s alpha = .89

Short-fuse, impatient, irritable, angry.Short-fuse, impatient, irritable, angry.

Factor 3: Physical Acting-Out DepressionFactor 3: Physical Acting-Out Depression Chronbach’s alpha = .73Chronbach’s alpha = .73

Alcohol abuse, reckless, explosive, violent.Alcohol abuse, reckless, explosive, violent.

Factor 1: Emotional Factor 1: Emotional Acting-In DepressionActing-In Depression

I feel I’d like to get away from it all.I feel I’d like to get away from it all. I feel like things are stacked against me.I feel like things are stacked against me. People I count on disappoint me.People I count on disappoint me. I feel stressed out.I feel stressed out. I feel emotionally numb and closed down.I feel emotionally numb and closed down. I feel sorry for myself.I feel sorry for myself. I feel burned out. I feel burned out.

Factor 2: Emotional Acting-Factor 2: Emotional Acting-Out DepressionOut Depression

I flare up quickly.I flare up quickly. I have trouble controlling my temper.I have trouble controlling my temper. I am easily annoyed, become grumpy, or I am easily annoyed, become grumpy, or

impatient.impatient. Other people “drive me up the wall.”Other people “drive me up the wall.” When others disagree with me I get very When others disagree with me I get very

upset.upset. It doesn’t take much to set me off.It doesn’t take much to set me off. I have difficulty maintaining self-control.I have difficulty maintaining self-control.

Factor 3: Physical Acting-Factor 3: Physical Acting-Out DepressionOut Depression

I have hit someone when I was provoked.I have hit someone when I was provoked. I work longer hours because going home is stressful.I work longer hours because going home is stressful. I gamble with money I have set aside for other I gamble with money I have set aside for other

things.things. I drive fast or recklessly as a way of letting off I drive fast or recklessly as a way of letting off

steam.steam. If I'm feeling low, I'll use sex as a pick me up.If I'm feeling low, I'll use sex as a pick me up. I have felt I should cut down on my drinking or drug I have felt I should cut down on my drinking or drug

use.use. I get so jealous or possessive I feel like I could I get so jealous or possessive I feel like I could

explode.explode.

DMDS Factors in Depressed and Non-Depressed Men and DMDS Factors in Depressed and Non-Depressed Men and WomenWomen

Predicting Factor 1 Emotional Acting-In Unstandardized Coefficient

P-value

Depressed Men vs. Women 1.15 .208

Non-depressed Men vs. Women .47 .510

Predicting Factor 2 Emotional Acting-Out

Depressed Men vs. Women 1.47 .002

Non-depressed Men vs. Women 1.19 .001

Predicting Factor 3 Physical Acting-Out

Depressed Men vs. Women 1.52 < .001

Non-depressed Men vs. Women .86 .003

Male-Type Depression and Male-Type Depression and AndropauseAndropause

Loss of sexual desire for marital partner.Loss of sexual desire for marital partner. Problems with erections.Problems with erections. Irritability and anger.Irritability and anger. Fatigue and low energy.Fatigue and low energy. Marital and family conflict.Marital and family conflict. Depression.Depression.

Social Context TodaySocial Context Today

End of 150 years of cheap fossil End of 150 years of cheap fossil fuels.fuels.

Global warmingGlobal warming Economic dislocationsEconomic dislocations

Results: Increasing stress, scarcity, Results: Increasing stress, scarcity, aggression and depression.aggression and depression.

Treatment Options for Treatment Options for Men:Men:

1. Exercise1. Exercise

2. Omega-3 fatty acid supplements2. Omega-3 fatty acid supplements

3. Light Exposure3. Light Exposure

4. Anti-Rumination strategies4. Anti-Rumination strategies

5. Social Support5. Social Support

6. Sleep Hygiene6. Sleep Hygiene

7. Energy Psychology7. Energy Psychology

Energy PsychologyEnergy Psychology

Energy Psychology is proving to be the Energy Psychology is proving to be the perfect tool for a great many men. perfect tool for a great many men.

• It is action oriented. It is action oriented. • Talking is not required. Talking is not required. • There are no pills to take. There are no pills to take. • No need to re-live painful experiences No need to re-live painful experiences

from the past. from the past. • Relief is often immediate. Relief is often immediate. • And results are lasting. And results are lasting.

Psychology of the FuturePsychology of the Future

According to Dawson Church, Ph.D., According to Dawson Church, Ph.D., one of the field’s leading one of the field’s leading researchers, “I believe that Energy researchers, “I believe that Energy Psychology has a potential for the Psychology has a potential for the alleviation of human suffering that alleviation of human suffering that rivals any advance in psychology or rivals any advance in psychology or medicine in the last five centuries.” medicine in the last five centuries.”

Energy Psychology at KaiserEnergy Psychology at Kaiser

Randomized Trial of Tapas Acupressure Technique for Weight Loss Maintenance

Charles Elder, M.D., M.P.H.Kaiser Permanente Center for Health

Research, Portland, OR 97227 E-mail: Charles.R.Elder@kp.org

Recommendations for Future Recommendations for Future ResearchResearch

Future research will be needed to validate the Future research will be needed to validate the results of the study and to develop numerical scores for results of the study and to develop numerical scores for evaluating depression and suicide risk using the DMDS. evaluating depression and suicide risk using the DMDS.

It would be helpful to conduct research with a It would be helpful to conduct research with a general population to see if results were consistent in a general population to see if results were consistent in a population representative of the general community. population representative of the general community. Particular attention should be focused on including men Particular attention should be focused on including men and women from different ethnic groups, cultural and women from different ethnic groups, cultural backgrounds, economic levels, and age groups. backgrounds, economic levels, and age groups.

Thank You!Thank You!

If you’d like more information on my If you’d like more information on my work you can contact me:work you can contact me:

E-Mail: E-Mail: Jed@MenAlive.comJed@MenAlive.com

Web: Web: www.MenAlive.comwww.MenAlive.com