Men and depression: battling stigma through public education

National Institute of Mental Health (NIMH) officials estimate that more than 345 million people have encountered information about men and depression through its media campaign "Real Men. Real Depression." To reduce stigma and educate men and those close to them about the symptoms of and treatments for depression, the campaign uses testimonials of men who have battled the disease, including one from a New York City firefighter who became depressed after 9/11.

"Real Men. Real Depression."--NIMH's ongoing attempt to address the fact that depression affects 6 million American men annually--was launched in 2003 and uses television spots, videos, print ads, posters, pamphlets, PowerPoint presentations and fact sheets to create awareness, says campaign manager Daisy Whittemore. To date, the agency has aired campaign public service announcements on 119 television stations and 874 radio stations and published ads in magazines and newspapers. The campaign has already spurred media coverage of men and depression by such print publications as Time, Sports Illustrated and The Washington Post and such TV networks as CNN and ABC, Whittemore says. Also, about 420 local organizations, including the University of Michigan and Caterpillar Inc., have used the materials to augment or create their own depression prevention initiatives for men.

"We've found this is a really good tool for increasing awareness among both men and therapists of the deadly repercussions of depression," says University of Iowa psychologist Sam Cochran, PhD, who studies depression in men. "These are well-done materials because they are constructing their message around the obstacles that men really face in getting help."

In fact, the materials were developed with those obstacles, like the stigma attached to having an emotional problem or asking for help, in mind, Whittemore says. Beyond that, the program gives all people, not just men, information on how to recognize depression in friends and family members--and offers men and the people who care about them a way to take the next step of seeking help: It includes a contact phone number and e-mail on all of its materials. Since the 2003 launch, NIMH has received about 4,800 campaign-related calls and e-mails.

In the trenches

Other avenues for men seeking help have come out of the local organizations that use the "Real Men. Real Depression." materials. For example, the volunteers and staff of the Mental Health Association of Illinois Valley go to community venues, like homeless shelters, to give short presentations about depression, hand out the NIMH pamphlets and explain how to get help.

In venues ranging from Salvation Army soup kitchens to Urban League meetings to the University of Illinois College of Medicine student gatherings, men are interested in the stories featured in pamphlets and videos, says Katie Jones, executive director of the Mental Health Association of Illinois Valley.

"This population, they really like the graphics; they like that it's multimedia," Jones says. "They don't like when I stand up there and give a speech; they want the materials that relate to them--and not just for themselves, but for men they know, to help them get off the hook of depression."

In evaluations of the presentations, Jones finds that about 93 percent of men say they have a better understanding of depression and how it manifests in men after viewing the NIMH materials.

One of the men featured in the materials, New York City firefighter Jimmy Brown, says he has run into a lot of positive reactions, especially to the first-hand accounts of depression among the police and firefighters he works with in a peer support group.

"Especially with the men I've worked with, those who are in professions that tend to be macho, it's the stigma attached to admitting you have any kind of problems that gets in the way of beating depression," Brown says. "But when you see a real person up there, and you know it's a real person who has the same kind of thing I have, it creates an opening for them, and they know they're not alone and can go out and get help."

Brown gives the example of one fellow firefighter who benefited from seeing a "Real Men. Real Depression." video featuring Brown's personal story of overcoming depression.

"One fireman came up to me and said he'd been feeling real bad for a while and after seeing the piece it occurred to him to talk to his doctor," Brown says. "The doctor sent him to a psychologist who diagnosed him with depression. The long-story-short is he was diagnosed, treated and is feeling a lot better. That I've helped that one person by creating the connection between feeling bad and being depressed, that's what I did this for, and if there's anyone else we've helped, that's gravy."

Building bridges

To have that kind of impact with a broad range of men, the campaign includes the personal stories of men from many different ethnic and professional backgrounds.

Japanese-American attorney Bill Maruyama, another of the men featured in the campaign, says mental illnesses are not usually discussed within Asian families, in part, because of pressure to not bring shame onto a family. Because of this "code of silence," a lot of Asian people may think depression is not an issue within the community and that it's an illness Asian people do not experience, he says.

"The fact is there are Asian people who do get depressed, and the campaign makes that clear," Maruyama says. "Just by saying that, I think there has been an incredible impact. It's hard enough to get people to admit to their families that they have depression, so to publicize this on a broad scale is a big deal."

Indeed, organizers took pains to ask the men portrayed in the campaign broad and culturally sensitive questions, says Rodolfo Palma-Luliòn, a Latino portrayed in the campaign who was a student when the campaign began and now runs a student community outreach program at the University of Michigan.

"They asked how my family had dealt with my depression, which is an important question, especially with Latino men," Palma-Luliòn says. "We have a very organized family structure, lots of family involvement, especially in decision-making. Of course a family would be involved in the decision to seek treatment for depression, so it's important that family reactions be addressed in the campaign."

Checking outcomes

Empirical research addressing the perceptions and impact of the campaign is just beginning, but early results indicate that there might indeed be a lot of people among those "macho" populations helped by the "Real Men. Real Depression." materials, says psychologist Aaron Rochlen, PhD, of the University of Texas at Austin.

In a study of 209 male college students, to be published later this year in the APA journal Psychology of Men and Masculinity, Rochlen and his research partners found that among the men who expressed a negative attitude toward help-seeking and had high levels of gender-role conflict--feelings that men should behave differently than women--the "Real Men. Real Depression." materials were slightly preferred to gender-neutral materials. Among the general group of men, no preference was expressed.

Rochlen says that finding demonstrates a remarkable quality of the campaign: It is tailored to the target audience of men resistant to mental health services.

"This is an example of psychology meeting marketing, of psychology taking on a business perspective and thinking hard about who its target audience is," Rochlen says. "It's clearly tailored to the specific audience that research has shown needs some direct, targeted and specific attention. We have to tell these guys that you're not weak or feminine if you admit to needing help, and that you can become a better man if you're willing to take a look at your emotions and your feelings."