The EBN blog this week is by Nathaniel Smith, (n.smith3@hull.ac.uk) Lecturer in Nursing, in the Faculty of Health Sciences at the University of Hull, UK. 

Men and mental distress: 

Men’s presentation to healthcare services for their mental health is complex, and worthy of further attention. Mental health distress is a common experience, but it is acknowledged that men in distress can present differently to women¹. Whilst women may communicate their distress through tearfulness or talking about feelings, men are less likely to express emotions overall². Further, there are risky behaviours arising from men’s mental health distress, such as where men’s depression is related to alcohol use, increased working hours, and lower contacts with health services³.  

Underpinning all of this, are strong social expectations around men’s mental health and roles as partners and workers, leading many men to avoid showing their distress and seeking help. Given that three quarters of suicide deaths are in men, with rates increasing and highest rates being in the 45-64 years age group, men’s mental health is a growing priority⁴. This means that nurses, who encounter men in many settings, need to be aware of how men may express their mental distress and access services in their practice area.  

Men’s mental distress and primary care: 

Primary care settings, such as GP surgeries, urgent care centres and walk in services, are the first point of call for most patients. This is relevant to men who are experiencing mental distress as they do not always verbalise this, nor seek help through these services. This is a challenge, because whilst National Institute for Health and Care Excellence [NICE] guidelines for depression⁵ are available to support primary care staff with clinical decision making, the guidance regarding general mental distress is more limited. This leaves a gap in knowledge around supporting men more generally. Some men can find it difficult to effectively communicate their mental distress, the limited or constrained time available in a typical primary care encounter may leave little time to empower men to effectively communicate their mental distress. 

Stigma and a lack of help-seeking: 

When men do present to primary care with mental distress, there is a perceived stigma around seeking support, and men displaying negative views of self rather than an expression of current emotional wellbeing is common. Fear of intimacy is one predictor of men’s attitudes to help seeking⁶. There has been some improvement in the past 10 years, however men are still less likely than women to seek support for their mental wellbeing⁷, meaning their presentation to services can be delayed or limited. Offering men alternatives such as Men’s mental health support groups provide an opportunity for men to speak with other men about their difficulties.   

Providing the opportunity to talk and provide support: 

Ensuring that men are providing with opportunities to talk to a health professional about their mental health is key. Men report finding it easier to speak about their anxieties with women, but some will also speak with other men when they perceive the environment as safe⁸. As such, there is an opportunity for all nurses to engage with men, regardless of gender. 

Ultimately, nurses work in and across a range of clinical settings and services and need to support the creation of an environment where men feel safe to talk more openly about their mental health.  This must involve being aware of the hidden presentation of male distress and how men’s role expectations hinder their help-seeking. Nurses should actively reduce stigma by encouraging open discussion, signposting to relevant services, and offering reassurance and validation of men’s mental distress.  

Acknowledgement: Thanks to Caroline Davenport, Lecturer in Nursing, University of Hull, for support in the preparing of this blog.  

References: 

1. Patrick S, Robertson S. Mental health and wellbeing: focus on men’s health. Br J Nurs. 2016;25(21):1163–9. 
2. Cai A, Lou Y, Long Q, Yuan J. The sex differences in regulating unpleasant emotion by expressive suppression: extraversion matters. Front Psychol. 2016;7:1011. 
3. Von Zimmermann C, Hübner M, Mühle C, et al. Masculine depression and its problem behaviors: use alcohol and drugs, work hard, and avoid psychiatry! Eur Arch Psychiatry Clin Neurosci. 2024;274:321–33. 
4. Office for National Statistics. Suicides in England and Wales: 2023 registrations [Internet]. 2024 [cited 2025 April 9]. Available from: Suicides in England and Wales – Office for National Statistics 
5. National Institute Health and Care Excellence. Depression in adults: treatment and management NG222 [Internet]. 2022 [cited 2025 April 9]. Available from: https://www.nice.org.uk/guidance/ng222  
6. Sullivan L, Camic PM, Brown JS. Masculinity, alexithymia, and fear of intimacy as predictors of UK men’s attitudes towards seeking professional psychological help. Br J Health Psychol. 2015;20(1):194–211. 
7. UK Parliament. Men’s health. 2023.    
8. Gough B, Robertson S, Luck H. Engendered expressions of anxiety: men’s emotional communications with women and other men. Front Sociol. 2021;6.