Depression in males

Mental disorders pose a huge challenge to national health systems and economies.

Strikingly, the overall rates for women suffering from mental disorders are significantly higher compared to men, at 33 versus 22 percent. In Germany alone, the number of people written off sick due to mental disorders increased by about 50 percent over the period 2000 to 2011, according to national health insurer AOK.

The most common mental illness among people aged 18-65 is depression. In Europe, up to 10 percent of the overall population is directly affected by depression and depression-related problems, according to the European Commission. In Germany, depression hits around four million people, or five percent the population. A third of those afflicted are men.

Male psychology remains shaky terrain, however, when it comes to detecting and curing mental illness. Leading health experts agree that gender-specific behavior still plays a key role when it comes to diagnosing mental illness.

"I think this is still down to stereotypical behavior or role patterns. Even these days it's still more acceptable for women to say they're afraid than men," says Dr. Iris Hauth, president of the German Association for Psychiatry, Psychotherapy. She's also head psychiatrist of Alexianer Sankt Joseph Hospital in Berlin.

"I recently had a patient who said to me: My wife can't take it when I cry," Hauth says. She adds that in many spheres of society, it's still the case that men can't show any weakness, can't cry. "Men in top positions think they can't afford to admit to having psychological issues."

All under control, he says

This casts doubt on the official statistics. Women might be diagnosed more often with psychological issues than men, but that doesn't necessarily mean men are in better mental shape. Far from it. It's a gender paradox that men who are psychologically sick often say they're fine - unlike women, who are more open about their issues. Many men still view mental disorders as a sign of weakness that they need to sort out for themselves.

"That's why men often don't bother consulting a doctor. And if they do go to the doctor, they tend to complain about physical symptoms such as backache, or the like," Hauth says.

This means many men who have developed a mental illness simply don't feature in the statistics, let alone receive treatment - unlike women. And as Iris Hauth explains, there's another reason why the statistic for men need to be taken with a pinch of salt.

"Male depression often has different symptoms than that of women. Women tend to be down, sad, lethargic and withdrawn. Men are often irritable and aggressive, and try to drown their depression with alcohol."

In such cases, general practitioners might fail to diagnose depression, let alone treat it for what it is. However, if these cases were included in the prevalence of male and female depression, it would likely result in a more balanced statistic, say health experts.

The cost of depression

No matter which gender, severe psychological ailments can only be remedied with targeted psychotherapy or medication such as anti-depressants. Studies also highlight regular physical exercise as a good preventive measure. But if depressed men remain untreated and turn to alcohol to drown their sorrows, the results can be dramatic.

An estimated 804,000 suicide deaths occurred worldwide in 2012. In high-income countries, 90 percent can be attributed to mental illness. In Europe, men are almost five times more likely to commit suicide than women - a clear sign that men need to address their fears more openly, Hauth says.

But they need more backing to come out of the psychological closet, and she's convinced a public awareness campaign directed against the stigmatization of mental disorders in men would be a step in the right direction.

"We need to get the message across that men can be sick, too. That mental illness is not a sign of weakness."Such a campaign, she adds, should be accompanied by gender diversification of therapy.

"In psychotherapy, we're still lacking gender-specific approaches. With men, it's more about showing emotion, weakness, the breakdown the superego and lofty ideals. Currently, these specific approaches are not very pronounced in behavioral therapy and psychotherapy."

According to the European Commission, depression results in an overall economic cost of at least one percent of GDP across countries. In Germany, the economic damage is estimated at over 22 billion euros per year. The World Health Organization estimates that depression will become the most common sickness in industrialized countries by 2030, pushing cardiovascular ailments into second place.