Men’s engagement with mental health treatment: towards inclusive interventions in low-income contexts

Men are less likely to hold favorable attitudes towards seeking care, and less likely to use formal assistance for psychological problems. A negative relationship has been observed between endorsement of masculine norms, and both the likelihood of favorable help-seeking attitudes and presenting for therapy. There is little research on men’s mental health, and how to address poor engagement with mental health. There has been still less focus on addressing men’s mental health needs in low- and middle-income countries (LMICs). Chapter One is an overview of issues related to mental health treatment in the developing world, with specific attention to men’s lack of engagement in services. Chapter Two provides a brief literature review of background information pertinent to the three specific research aims. In Chapter Three, we used qualitative methods to identify thematic content related to mental health care initiation among men living in Yangon, Myanmar. We conducted thematic analysis of interviews to identify patterns in participant-described barriers that prevent mental health service use among male former political prisoners. Honesty and morality, self-reliance, and leadership were critical features of Burmese masculinity. Chapter Four utilized a pooled, multi-country dataset from five randomized controlled trials among trauma-affected adults in five LMICs – the Democratic Republic of Congo, Iraqi Kurdistan, the Thailand-Burma Border, Southern Iraq, and Colombia. We explored the moderating effect of gender on the relationship between individual-level characteristics and completion, and found significant moderation based on gender and depression scores, such that men with higher depression scores were significantly less likely to complete treatment than men with lower scores. Chapter Five examines person- and counselor-level factors related to treatment completion among men in the same pooled dataset, with specific attention to the role of depression in men’s attrition. We examined individual characteristics alongside broader clinical features (e.g. counselor age), along with additional models to explore the contextual effect of depression among counselor’s caseloads. Men were ~70% more likely to drop out of a given intervention for a one-point increase on their mean depression rating. There were no significant effects for context, or counselor level covariates. Lastly, Chapter Six discusses these findings in context, as well as broader implications for research and practice. The findings presented here serve as an exploration of the potentially modifiable factors that may better engage men in mental health services