By Rob Meadows
If we are to begin to understand men’s mental health more fully, we need to move away from the idea that all men are the same. Different groups of men are at risk of different mental health problems at different points in the life-course. Older men, for example, are at greater risk of isolation, bereavement and loss (Meadows and Davidson 2006; Davidson and Meadows 2010). This loss, which can include loss of income and status, can make older men more vulnerable to mental ill health. Other vulnerable groups of men include men from Black, Asian and Minority Ethnic (BAME) communities and men in the criminal justice system. With respect to men in the criminal justice system, it is estimated that at least 10% of prisoners have an acute psychotic disorder on entry to prison, with a further 61% reporting a personality disorder (Stewart, 2008). For others, the experience of prison itself can lead to the development of mental problems including depression and anxiety (Joint Committee on Human Rights, 2004), with as many as 90% of prisoners reporting mental health problems prior to release (Singleton et al., 1998; Department of Health, 2001). We could go on.
But at the same time as recognising that men are different we need to keep an eye on shared factors; such as masculinities, power and structural dynamics. Put another way, we need to consider fixed types and fluidities and this poses significant methodological problems. In 2011 White and Richardson called for a ‘gendered epidemiology’, arguing that “a key factor in advancing our understanding of men’s health is in the development of gendered epidemiology, such that we begin to unravel how men’s health practices can be mechanisms for ‘doing gender’, thereby legitimating exploration of the man’s perspective” (2011: 407). For me (and others) such a gendered epidemiology needs to employ longitudinal data and allow for the discussion of:
- Age/biography/life course effects – As Public Health England identify, the life course perspective investigates both accumulated risk across the life course as well as how different stages can create or exacerbate health issues.
- Cohort effects – Suggesting a strong cohort effect (where generations differ from one another), a Samaritans (2012) report states: “Men currently in their mid-years are the ‘buffer’ generation – caught between the traditional silent, strong, austere masculinity of their fathers and the more progressive, open and individualistic generation of their sons. They do not know which of these ways of life and masculine cultures to follow”
- Period effects – Periods of austerity and recession are also likely to widen social inequalities in mental health and hit vulnerable groups the hardest. Men, in particular, are at increased risk of mental health problems and premature death due to suicide and alcohol related problems (Wahlbeck and McDaid 2012).
I am not sure how far we have travelled towards this gendered epidemiology or indeed whether we are even still talking about it. Hopefully we can use the upcoming mental health awareness week and men’s health week to reflect on both substantive and methodological issues. And if anyone is interested in operationalising ‘recovery’ in mental health, do come along to Surrey in July
- Davidson, K. and Meadows, R. (2010) Older men’s health: the role of marital status and masculinities in B. Gough and S. Robertson, (eds) Men, Masculinities and Health: Critical Perspectives. London, Palgrave.
- Department of Health, (2001) Changing the outlook. London: Department of Health & HM Prison Service.
- Joint Committee on Human Rights (2004) Joint deaths in custody: Third report of session 2004-05. London: House of Lords / House of Commons Joint Committee on Human Rights.
- Meadows, R and Davidson, K (2006) Maintaining Manliness in later life: Hegemonic masculinities and emphasized femininities in T. Calasanti and K. Slevin (eds) Age Matters: Realigning Feminist Thinking, London, Routledge, pages 295-312
- Samaritans (2012) Men and Suicide: why it’s a social issue. Stirling http://www.samaritans.org/sites/default/files/kcfinder/files/Samaritans_Men_and_Suicide_Report_web.pdf
- Singleton, N., Meltzer, H. and Gatward, R. (1998) Psychiatric morbidity among prisoners in England and Wales. London: Office for National Statistics.
- Stewart, D. (2008) The problems and needs of newly sentenced prisoners: results from a national survey. Ministry of Justice
- Wahlbeck, K. and McDaid, D. (2012). Actions to alleviate the mental health impact of the economic crisis. World Psychiatry, 11(3), 139-145.
- White, A. and N. Richardson. “Gendered epidemiology: making men’s health visible in epidemiological research.” Public Health7 (2011): 407-410.
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