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Stereotypes Contribute to Older Men Seeking, Receiving Depression Care Less Frequently

am examined the data from a large, multisite study of a disease management program for late-life depression in primary care, called IMPACT (Improving Mood: Providing Access to Collaborative Treatment for Depression). The IMPACT participants were 1,800 adults 60 and older with major depression or dysthymic disorder from 18 primary care clinics, affiliated with eight health-care organizations in the United States.

The UC Davis researchers analyzed gender differences in history of depression treatment, as well as referral rates and symptoms. To better understand lower rates of depression treatment and referral to IMPACT of older men, the researchers also conducted qualitative interviews with 30 key individuals connected to IMPACT, including referring physicians, depression care managers and study recruiters, to learn about the challenges in recruiting and treating depressed older men.

Hinton and his team found that, compared with older women, older men were much less likely to be referred to IMPACT, to recognize and describe symptoms of depression, and to have received prior treatment for depression. The interviews identified factors that were important contributors to the gender disparities: the manner in which men experience and express their depression, traditional masculine values, and the stigma of depression.

The IMPACT interviewees reported that older men experience and express their depression in ways that do not fit well with diagnostic criteria, making a diagnosis more difficult. Some of the IMPACT principals speculated that older men “might have more difficulty accessing and recognizing their feelings,” while others believed men were “actively trying to conceal or mask their depression.” For example, one primary care provider, when asked if men present their depression differently from women, said, “They try to hide it, basically, whereas women are more open and they come and talk … because it is their nature for some reas
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