The University of Birmingham Do depressed and anxious men do groups?

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University of Birmingham

Do depressed and anxious men do groups? What
works and what are the barriers to help seeking?
Cramer, Helen; Horwood, Jeremy; Payne, Sarah; Araya, Ricardo; Lester, Helen; Salisbury,
Chris
DOI:
10.1017/S1463423613000297
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Cramer, H, Horwood, J, Payne, S, Araya, R, Lester, H & Salisbury, C 2014, 'Do depressed and anxious men do
groups? What works and what are the barriers to help seeking?', Primary Health Care Research &
Development, vol. 15, no. 03, pp. 287-301. https://doi.org/10.1017/S1463423613000297
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PrimaryHealthCareResearch&Development2014;15:287–301 RESEARCH
doi:10.1017/S1463423613000297
Do depressed and anxious men do groups?
What works and what are the barriers
to help seeking?
HelenCramer1,JeremyHorwood1,SarahPayne2,RicardoAraya3,HelenLester4andChrisSalisbury1
1CentreforAcademicPrimaryCare,SchoolofSocialandCommunityMedicine,UniversityofBristol,Bristol,UK
2SchoolforPolicyStudies,UniversityofBristol,Bristol,UK
3CentreforMentalHealth,AddictionandSuicideResearch,SchoolofSocialandCommunityMedicine,
UniversityofBristol,Bristol,UK
4PrimaryCareClinicalSciences,SchoolofHealthandPopulationSciences,UniversityofBirmingham,
Birmingham,UK
Aim:Tomaptheavailabilityandtypesofdepressionandanxietygroups,toexamine
men’s experiences and perception of this support as well as the role of health
professionals in accessing support. Background: The best ways to support men
with depression and anxiety in primary care are not well understood. Group-based
interventionsaresometimesofferedbutitisunknownwhetherthistypeofsupportis
acceptable to men. Methods: Interviews with 17 men experiencing depression or
anxiety.Afurther12interviewswereconductedwithstaffwhoworkedwithdepressed
men(halfofwhomalsoexperienceddepressionoranxietythemselves).Therewere
detailedobservationsoffourmentalhealthgroupsandamappingexerciseofgroups
inasingleEnglishcity(Bristol).Findings:Somemenattendgroupsforsupportwith
depression and anxiety. There was a strong theme of isolated men, some reluctant
to discuss problems with their close family and friends but attending groups. Peer
support,reducedstigmaandopportunitiesforleadershipweresomeoftheidentified
benefits of groups. The different types of groups may relate to different potential
member audiences. For example, unemployed men with greater mental health and
supportneedsattendedaprofessionallyledgroupwhereasmenwithmildermental
healthproblemsattendedpeer-ledgroups.Barrierstohelpseekingwerecommonly
reported, many of which related to cultural norms about how men should behave.
Generalpractitionersplayeda key role in helping men toacknowledge theirexperi-
encesofdepressionandanxiety,listeningandprovidinginformationontherangeof
supportoptions,includinggroups.Menwithdepressionandanxietydogotogroups
and appear to be well supported by them. Groups may potentially be low cost and
offer additional advantages for some men. Health professionals could do more to
identifyandpromotelocalgroups.
Keywords:anxiety;depression;groups;men;primarycare;qualitative
Received9November2012;revised1May2013;accepted26May2013;
firstpublishedonline26June2013
Introduction
Correspondence to: Helen Cramer, Centre for Academic
The assumption that men are less vulnerable to
Primary Care, School of Social and Community Medicine,
depression and anxiety than women is increas-
UniversityofBristol,CanyngeHall,39WhatleyRoad,Bristol
BS82PS,UK.Email:[email protected] ingly being questioned. Men are less likely to be
rCambridgeUniversityPress2013
288 Helen Cramer et al.
diagnosed with depression (Piccinelli and Given the stigma of depression for men, their
Wilkinson, 2000; Van de Velde et al., 2010) and lower rates of help seeking and some evidence
anxiety(Kroenkeetal.,2007;Waltersetal.,2012). that talking in groups about mental health may
Importantly, higher rates of male suicide in expose men to mockery, we sought to explore
most countries (Payne et al., 2008; ONS, 2009) as group support for men in more detail. This
well as much higher rates of drug and alcohol study therefore aimed to establish if men do
abuse(Nolen-Hoeksema,2008;OliffeandPhilips, attendtherapeutic/supportgroupsfordepression,
2008; Ridge et al., 2010) suggest that men may the types of group they attend, the reasons
dealwithmentalhealthissuesanddistressdifferently why they attend them and the advantages and
to women. disadvantages of groups.
Comparedtowomen,menconsistentlydemon-
strate a greater reluctance to seek help for
their health (Galdas et al., 2004; Addis, 2008; Method
Men’s Health Forum, 2008) and especially for
mental health problems such as depression Recruitment, sampling and data collection
(Hunt et al., 1999). Stigma linked to societal
ideals and expectations of men’s behaviour is Mapping group availability
thought to be one of the main reasons that men An initial mapping exercise sought to identify
avoid seeking help for depression. Depression all free or low cost, statutory and voluntary
may challenge masculine ideals of physical and sector groups for men with depression or anxi-
emotional toughness (Emslie et al., 2006). ety in an English city health authority (Bristol
Emotional displays can be seen by men as self Primary Care Trust, September 2010–January
indulgent and are linked to femininity; provid- 2011). Groups were identified by talking to key
ing further motivation to deny and hide mental health community organisations such as
depression (Warren, 1983). One study found MIND and snowballing techniques, as well as
that some older men who did admit to experi- internet searching. This process was carried
encing depression described feeling isolated and out until we had exhausted all lines of enquiry
different (O’Brien et al., 2005). Younger men in and no new groups were being identified. The
the same study who tried to talk about mental mapping exercise aimed to identify as many
health problems were quickly silenced through groups as possible that might be attended by
mockery. Alternatively, activities such as drink- men with depression. From the outset, however,
ing alcohol is a more culturally acceptable way we were interested in the more structured
for men to relieve their stress, especially work- groups for mild to moderate depression or
ing class men (Dolan, 2011). anxiety and less interested in groups for physical
If men do acknowledge and seek help for health problems or addictions. The team wanted
depression and anxiety, general practitioners to explore further the assumption that men
(GP) treatment options are generally limited to would be harder to recruit into more structured
medication and referral to counselling or cogni- groups. Anger groups were actively looked for
tive behavioural therapy (Gilbody et al., 2003; and included (albeit from an adjacent health
McPherson and Armstrong, 2012). Such talking authority), based on the understanding that
therapies are popular (Lam, 2001; van Schaik anger is thought to be a more typical male
et al., 2004) but usually offered on an individual response to depression (Winkler et al., 2006).
basis (Bower and Gilbody, 2005). However, in A template was developed to help gather com-
many areas of the United Kingdom patients are parative details on the aims and structure of
increasingly being offered groups rather than each of the community groups such as where
individual therapy, in an effort to increase access and how frequently the group met, who led the
to care. Group formats can potentially reach group and who could join. In addition to
more patients, more cost-effectively and address examining the types of services available, this
socialisolation(Morrison,2001;Arayaetal.,2006) mapping exercise served as a sampling frame-
although their evidence base is yet to be fully work to select a subsample of groups to observe
established(Cuijpersetal.,2008;Crameretal.,2011). in detail.
PrimaryHealthCareResearch&Development2014;15:287–301
Box 1 Details of the groups identified by the mapping exercise and study involvement
Groupdescription Statedaimsand Structure Funderand Mixedsexor Whocanjoin? Recruitmenttostudy
objectivesofthe host menonly?
group organisation
Professionallyled Toprovidegeneral Weeklydropin.Meetin Statutory Menonly Opentomeninlocal Selectedfor
supportgroup supportandbuild communitykitchenin sector area.ReferralbyGP observation.
confidence healthylivingcentre.Open orotherhealth Observedthisgroup
support.Shareactivities, professionalreferral once.
forexamplecooking.Free initiallytoonetoone Interviewedthe
togroupmembers.Ledby support facilitatorandthree
(paid)men’shealthworker groupmembers
Peer-leddepression Tohelpsupport Twelvestepsmodelloosely Voluntary Mixed Anyonewith Selectedfor
group anyonewithmental followed.Weeklydropin. sector depression.Advertise observation.
distress.Runby Facilitatoralsogroup groupontheinternet Observedoneofthese
usersforusers member.Sixgroupsaround andthroughlocal groupsforthree
thecityholdweeklydrop organisationssuchas sessions.
ins.Smallweeklyfee MIND Interviewedseven
(eg,£1.50)tocover groupmembers,twoof
refreshments whomalsoworkedas
facilitators
P
r D
im Peer-ledsocial Providesupportand Twiceweeklyselfhelp Voluntary Mixed Anyoneexperiencing Selectedfor
o
ary anxietygroup socialopportunities groups.Twogroupsrunning sector socialanxietiesthat observation. d
H insafeenvironment inBristolandamonthly impactonqualityoflife Observedoneofthese ep
ealth wstroumcteunr-eodnldyisgcruosusipo.nSso,msoecial Aindtevrenretitseangdrotuhproounghthe gInroteurpvsieownecde.threegroup ress
C activitiesandpracticepublic localorganisationssuch members,oneofwhom e
ar speakingonceamonth. asMIND workedasafacilitator d
e a
R Smallweeklyfeetocover n
es refreshments d
ea a
rch Professionallyled Theservicesaimto Rollingprogrammeofsix Statutory Mixed AdultslivinginSouth Selectedfor nx
& angermanagement helpyoucopewith toeightweeklongpsycho- sector Gloucestershire observation. io
group yourproblems,to educationalgroups: sufferingfrommildto Observedangergroup u
D s
e begintohelpyou depressionmanagement, moderatesymptomsof twice.
v m
e understandhowyou angermanagement, commonmentalhealth Twicetriedtoarrange
lo e
p feelandtohelpyou assertiveness,anxiety problemssuchas observationof n
m
e startdealingwith management,stress anxiety,stressand depressiongroup,one d
nt theproblemsin management,relaxation depression.Selfreferral memberingroupdidnot o
20 practicalways skillsmindfulliving.Free orreferralbyGP wanttotakepartin gr
14; toattendees studysodidnotobserve. ou
1 Theothergroupwetried p
5: toobservehadnomen s?
2
8 attending.
7
–301 Ifancteilritvaietowredone 289
P 2
r 9
im 0
a Box1Continued
ry H
H
ealth Groupdescription Sogrtbaojteuecpdtivaeimsosfatnhde Structure Fhoorugsnatdneirsaatinodn Mmeixneodnsleyx?or Whocanjoin? Recruitmenttostudy elen
C C
are ra
R Professionallyled Aimedtohelpmale Shortcourserunforfour University Menonly Anymalestudentat Couldnotselectfor m
e e
se depression/anxiety studentsfeelmore weeks–oneoffcoursein funded universityX observationasgroupno r
arc group confident,less 2011.Freetoattendees longerrunning. et
h isolatedand‘find Interviewedone a
& theirvoices’ facilitator l.
D
e
v Professionallyled Psychological Psycho-educationalgroups Statutory Mixed PeopleinBristolwho Approachedforstudy
e
lo depression/anxiety therapyaimedat offourtosixweekly sector areexperiencing inclusionbutmanager
p
m group improvingwell- sessionsonmood depression,anxietyor declined.Reasongiven
en beingandrecovery managementandstress stress.Aninitial thatitwouldbetoo
t
2 forpeople control. assessmentdecides intrusivefor
0
1 experiencinganxiety Cognitivebehavioural whichlevel/typeof participants.
4
; anddepression therapygroupsof12 supportisneeded Interviewedone
1
5 sessions.Freetoattendees (includinggroupsand facilitator/manager
:
2 individualsupport).
8
7– Peoplealreadyusing
30 secondarymental
1
healthservicesnot
eligible.GPreferral
Peer-leddepression Toprovideasafe Weeklydropinandsupport Voluntary Mixed Anyoneusingorhave Didnotapproachfor
supportgroup placeforpeople group,notstructured.Peer sector usedmentalhealth observation.
using,orwhohave led servicesbutexcluding Interviewedonegroup
used,mentalhealth thosewithsevere member
services mentalhealthillness
Peer-ledmental Toprovideasocial Weeklydropin.Open Voluntary Mixed BlackAfricanor Approachedforstudy
healthgroup spaceformental agendaincludingwatching sector Caribbeanserviceusers inclusionboth
healthserviceusers DVDdiscussions,etc.User andcarers observationand
tointeractandshare run.Ranforlimitedperiod interviewbutfacilitator
commoninterests declined.Noreasons
andexperiences given.Informationfor
mappingexercisewas
provided
Professionallyled Opportunityfor Weeklydropinduring University Mixed Opentoanystudentat Didnotapproachfor
depression/anxiety studentstomeet universitytermtime funded universityXbutaimed observation
supportgroup othersandshare atstudentswhoare
experiences feelingloworanxious
Do depressed and anxious men do groups? 291
Group observations
p The groups selected for observation were pur-
Recruitmenttostudy Didnotapproachforobservation.Interviewedonegroumember Didnotapproachforobservation Didnotapproachforobservation pomasaBtnpofore:dpusxnpircvtaogt1aeurra)lltoryc.ieuchhAdsipeepadalamlslfnttopprhtfursalomecri(rdtstmauisctutreo)ioeep.nbsa-rs(onFee(dpnptorsevrlruypoeari,rsntfmeieeoossnbinssutxoiiootetmhndnaaoa-,ggtxlfrhlaeieymnenesxdldeueoievemdbret,s)(yn;esv,pertaeyvaegrepanirrateog-iatlseuoielornpsod)onssf;,
Whocanjoin? Anyoneusingsecondarymentalhealthservicesand/oranyonehavingbeenprescribeddrugsforemotionalormentaldistress Anyuserorexuserofmentalhealthservices Anyonesufferingfrommentalillnesswholivesorworksinlocalarea avvWstenieneiiomdtshrdthsebeeeiedoasrrt.tlenahbOsikeinygnibfrnwnfoosoigoenerurmrtrtapmeveenearatcdvdtaotoiiikobeaonicnwusnsnoesedsgnrniaovoastbefre-leoordbntecnuhytceeteboiabve(rtsleettdhlewwdfiesomnosergieeroebgnemno(rstostdewbhouaaewonptrraeecswsg)hrrerwoacoitoanracutnldesabpldenpysgc)ttibuthpviaaorroernneetonnhddde-.,
later transcribed. To distinguish between the dif-
r
o
x? ferent types of data collection technique and data
ey
snl recording method the following conventions are
do d d d
xen xe xe xe used: data collected by Interview are [I]; data col-
Mime Mi Mi Mi lectedbyObservationare[O];byaudio-Recording
are [R] and by Notes are [N]. The observations
Funderandhostorganisation Voluntarysector Voluntarysector Voluntarysector ltoroieboossnekeaerrvdacanhtadeitornaf(satHtcei.lwnCitde.a)ert.eeioEnctchhaaisrcrtrasyiceleatde.prpiAsortoulilcvtsa,ilnbgwtryeoarusvapiegwiivnfseetenmraaanblcdye-
the South West 4 committee (10/H0102/47).
rt,
Structure Monthlyinformalsuppoself-advocacyandsocialopportunities Meeteverysixweeks Meettwiceweekly.Informalsocialgroup.Notstructured.Runbyvolunteers Ir(atahneattttp)edFeeirionrnvearddisdtGepeetuneddaPantramltdgitaicreienbooidnptounetaupranmvotlstifheedinwennmeoattspreealtrrnlhesvpsiighesonirwekcooalesnuulntwpdhosietnrobagguiartmtsnohohxueemiadiperdestf;yoGsw;rpP(hoa(bcok)ba)ebrhnoonnaaootuddottt:
depression or anxiety (see also Table 1). In order
Statedaimsandobjectivesofthegroup Topromoteself-advocacy,goodpracticeandmeaningfulserviceuserinvolvement.Actasaninformalnetworkofsupport Campaignandsupportgroupforsecondarymentalhealthserviceuserspastorpresent Selfhelpusersupportgrouptohelppeoplegetoutoftheirhomesandmeetothers tmgimlniormeteoetniumhrtpavfoeotsideieroswtnitn.hwstta.HheetSerroeesvwewcieeoeemwnvoresdepvr,eli,onrtoyaihttbelehlsdweee.aarlaFveisnmecignrtdssreotort,tnwgahpirlecroloersrumeesepiecbroindlneerucvadertitstuotteeioodtinfmntdvitemiwfinontoegert
primary care practices were searched to generate
ed n a list of male patients suffering from depression.
Box1Continu Groupdescriptio Peer-ledmentalhealthsupportgroup Peer-ledmentalhealthcampaigngroup Peer-ledmentalhealthwalkinggroup Tiqsmrneeuhcarceevleluseiitlcdviiesoeipntsdna.gw.ntAiTaaeishsnrtteetucoshdptaaeyaaslctknkioiedinenfndgft11osba02rimb8ynopvaGluioetttiPtseotidsuetnirsvafseoenardwonrifednleermtseteptaereosvnrenistsensacewstlreseohnoeuetwunattoeilnturtoohegtf
PrimaryHealthCareResearch&Development2014;15:287–301
292 Helen Cramer et al.
Table 1 Overview of participant numbers and depression. Some of these staff were facilitating
recruitmentmethod some of the 12 groups identified and included in
the mapping exercise (see Box 1), while other
Datacollectionmethod Details n
staff who were interviewed ran groups which
Interviewswithmenwith Attendeesofgroups 9 wereconsideredoutsidetheremitofthemapping
depressionandanxiety Medicalnotessearch 5 exercise (eg, they ran men’s groups in secondary
Mediaadvert 3 care or with specific target populations such as
Total 17
men living in hostel accommodation). All inter-
Interviewswithstaff Facilitatorsofgroups 12a
Total 12 views were semi-structured, used a topic guide
Observations Groupsobserved 4 and were conducted at locations convenient to
Groupattendees 30b interviewees such as community health centres.
All interviews with staff (S) and participants (P)
aOutofatotalof12staffinterviewed,sixofthese
were audio-recorded and transcribed.
weremenwhoalsotalkedabouttheirownfeelingsof
anxietyordepressionandwhohadallattendedgroup
servicesasgroupmembers.Allintervieweeshavebeen
countedonlyonceandaredescribedeitheras‘staff’ Data analysis
or‘menwithdepressionandanxiety’eventhoughthe Thematic analysis using the constant compar-
boundarybetweenstaffandnon-staffinthisstudyis
ison technique was used to scrutinise both the
fairlyfluid.
bIncludesmenwhowerealsointerviewedindividually. group observations and interviews (Strauss and
Corbin,1998).Thesoftware‘ATLAS.ti’aideddata
management. An initial coding framework was
these 12 responders (n55) were purposefully developed from observation and interview tran-
selected according to the type of support they scripts. This frameworkwas added to, refinedand
used (eg, group support or individual therapy) to codesbuiltintobroadercategoriesandthemes.In
maximise representation of different types of order to ensure robust analysis another member
supportusedinthesample.Asecondaryselection oftheteam(J.H.)concurrentlyandindependently
criteria of ethnicity was used to increase ethnic coded a portion of the transcripts. H.C. led the
diversity in the sample. The third recruitment analysis and discussed the preliminary coding
strategy, which aimed to recruit men who neither framework and themes with S.P. and J.H. initially
accessed groups nor spoke with their GP about and then with the wider authorship group.
depression and anxiety, was to place adverts in
local papers and community newsletters.
Wherepossible,participantswithdepressionor Results
anxietyinvitedforgroupobservationorinterview
completed a demographic questionnaire and an Types of groups available to depressed and
assessment of depression, the Patient Health anxious men
Questionnaire (PHQ-9). The PHQ-9 was used The mapping exercise identified 12 groups that
becauseitisshortandprovidedsomecomparison men with depression or anxiety could potentially
and continuity with a previous study on groups attend(seeBox1).Someofthegroupsfolloweda
and depressed women (see Cramer et al., 2011). particular structure or therapeutic model while
Although the PHQ-9 is generally well validated many provided more informal support. Some
and commonly used in primary care (Wittkampf groupsranonaregularbasisthroughouttheyear,
et al., 2007) some critics point to a gender bias in while others ran for shorter periods. Most groups
diagnosticcriteriaand screeningtools(Courtenay, wereeitherfree toattendeesoraskedforasmall
2000; Addis, 2008) and which would include the contributory fee to cover refreshment costs. The
PHQ-9, and omitting anger as a key dimension is groups that ran in the statutory sector were all
one example (Winkler et al., 2006). professionally led and tended to be accessed
Staff who facilitated groups from each of the through GPreferral.Mostgroupshadsomeform
groups observed were interviewed. In addition oftargetpopulationorrestrictedmembershipbut
interviews were conducted with a range of staff, very few groups were only open to men. Further
allofwhomrangroupsforpeoplewithanxietyor details of the four groups that were observed can
PrimaryHealthCareResearch&Development2014;15:287–301
Box 2 Details of the groups observed and group attendees
Peer-leddepressiongroup Peer-ledsocialanxiety Professionallyledsupport Professionallyledanger
group group managementcourse
Attendancecriteria Opentomenandwomen Opentomenandwomen Opentomenonly Opentomenandwomen
Structure Structuredgroupbasedon Fairlystructuredgroup Unstructuredmen’sspace Structuredcoursebased
turntakingforhalfthe basedarounddifferent withactivitiesregularly aroundwrittenmaterial.
session.Alsofollowa weeklytopics(eg, available(eg,cooking 1.5hlong,onceaweekfor
12stepsmodel,1.5hlong, symptoms,relationships, sessions,guestspeakers, sixweeks,evenings.GPor
onceaweek,daytime workplaceissues,public Wiifit,craftprojectsor selfreferral
speaking).1.5hlong,once outings).Venue:
aweek,evening.Monthly communitykitchen.Food
socialsinpub.Womenonly provided(eg,pizzas,fruit).
grouponceamonth 1.5hlong,onceaweek,day
time
Facilitator Malefacilitatorin60swith Malefacilitatorinhis30s Aprofessionalmalemental Twoprofessionalfemale
experienceofdepression withexperienceofsocial healthworkerinhis40s trainersintheir40–50s
anxiety whosawmostmenona
one-to-onebasisbefore
theyattendedthegroup.
P
rim Referralforone-to-one D
a fromGPorother o
ry communityworker d
H ep
ealth Typicalsession Ngrootuicpersualensd.Trewmelivnedestreopfsto Rnoetmiciensd,estrruocfttuhreedrumleest,hod Isntrfuocrtmuraeldansedssloioonsse.lyMen Ftoapciiclitbaatoserdstuaslikngthoronuagha ress
Ca recoveryreadaloud. forintroducingeach arrive,chatting,teasand writtenhand-out(eg, ed
re Individualturnstakento membertothegroup.Small foodlaidout.Cooking unhelpfulthinkingpatterns, a
R talkendingturnwith groupdiscussiononthe sessionandcraftprojects expressingangersafely). n
e d
sear pdeisrcsuosnsaiolngoraelle.vSaenctontodhalf wgreoeukp’siftoappicuobrlicinspwehaoklieng sotnarttheedb.aSlocmoney,msoenmesmdooktehe Atottsehnadreeetsoonomtuecnhcopuerrasgoendal an
ch mentalhealthissues.Brief session.Closingfeedback. Wiifit informationduringthe x
& groupfeedbackand Extensivewritten coursebuttoseek iou
D serenityprayerread informationandsupport individualcounselling s
e
ve alsoprovidedoravailable forthis m
lop onthegroups’website en
m
en Numberandgenderof Week1:5men;0women, Week1:8men;2women Week1:6men;0women. Week1:3men;0women, do
t
2 attendeesonweek(s) Week2:3men;0women, (asthesewerepeer-led (plusadditionalmale Week2:3men;0women, g
01 observed Week3:7men;1woman. groupsattendeenumbers facilitator) Week3:3men;0women. ro
4; (asthesewerepeer-led includesmalefacilitator/ (plustwoadditionalfemale u
1 p
5: groupsattendeenumbers groupmember) facilitators) s?
28 includesmalefacilitator/
7– groupmember) 2
301 93
294 Helen Cramer et al.
be found in Box 2. From the demographic data
n. and depression scores from attendees as well as
Professionallyledangermanagementcourse 20–40sagegroup 8,0,12 16,16,18 Allemployed ndicatesseveredepressiodoaninterviewdidthis.) ofthesefourquestions. dpatFmmaghpteeooeitentpslremasdseeneiieerablbdarexdlleieldaenalrdmytgsdtaootpehwbtomplhasseidredeetu,ehiersfstpvltfhsotaearibhewootreiaefhneopetnsirnsegettsshhesesticroaceeno-horrnlfoavgerasaeesodtlchlrtslpyh.-iegporloereoluooefaBlpsoiduvlmyuuigpnllrmiresangoatcgeaugivoaornrepionygn-nnsouetsgier,snpdmar,alesaasya,tlatlgthylhsieygetoohrymohwaunaunaeagvlaylnpddhesl.
rt 20idto 12 had high depression scores and some had more
suppo overagree oreof saenrdioaudsdmicetinotnaslhsueachlthasissaulceoshsoulcihsma.sschizophrenia
Professionallyledgroup 18–50sagegroup c20,23,10 15,16,18 Allunemployed everedepression,hosepeoplewho apossibletopsc mcdviniiateetHtyewna,rattvavdhwilieaiinshwttghapeaawfdlpeotiasehtutthraragdbsrgrtlowiaarsuofwhifptueshswpdfsahumvor(tathnehirelnu5eanrb3rwlogae0nirnttohagtouhtetpemedsnoaee(dnbnpnedsrieee5nrsstvs)1ayi,a2optsi)nieinonatngenoolarderf-l
osyt of anxiety (n517), see also Table 1. From this data
tnl ut set three key themes emerged: isolation and the
eo o
Peer-ledsocialanxietygroup 20–50sagegroup b3,9 21,23 Ofthoseasked,bothemployed on,15–19indicatesmoderatpressionscoreasgenerallynotanxiety.ofthePHQ-9butscored10owteachesadulteducation. ssaqblwIiotsnuykreocFdaeerilaetneaaatetetlthtfgltilefbyeaioionneelnkrrmgdsndoeeaeealfdelfienonbostdrt,oinosilfoiefataotnlhsyathfy.tees,erwgdTaarbseihcloosortlteohluecitnlhaipsaaapgsosstlora;econnmbptidafhsereelieannsfonacsoeivr;ttitrfiioaticraaltnbgaaulscaooclceplotirescinuoef.soogldsfnglningsrtsaoorwgiondouefdeausprrugpessagrpsotorpimoafouorunnpeerpdsst--
Peer-leddepressiongroup 40–70sagegroup 1,3,6,6,8 d16,17,19,21,21 Rangeofemployed,inpart-timeeducationandretired mayindicatesmilddepressieesofgroupsfilledinadeenttoolwasfordepressioncompletedfourquestionsmberleftschoolat16,hen thinImIksognlairwokkttwaehePosatfft1htros8eissoetorucn[ucmosIdgt,ioRsaaag.klin,lniiynanaegsggdpp,eeesdtaoohctptm3e.l5iUeery,,onoasnitonvet[e-eIgtnro]ossdiuiteItnapyelgjpkuasoasttootstmte,esIcienatognwddnrw-aoinoadntuenhsncpclie’tay]st,:
Box2Continued Agesofattendees Depressionscores(PHQ-9)aofattendees Ageattendeesleftfulltimeeducation Employmentstatusofattendees aPHQ-9scores:Upto14(PleasenotenotallattendbPleasenotetheassessmcThisgroupmemberonlydAlthoughonegroupme asMpaq[arAoueescsisnonttuhedec’Slesir]taaPiisonlpis2ofngodltoitahm[fhmprIteee,oteuRidnmlogci,srbhnsioryoidftuaanuiarpfc.yabyfiioltocwiwiutuouaoalnttrtlodslkroglyswiendfteweae’ttprni[eneerdl]hgelvaosoetsvfabhniiteotnveettnsevinnotnoogsuddilurtvseeoctleeashyuhdcdipiyrndtosia’kbss]fseda
PrimaryHealthCareResearch&Development2014;15:287–301
Do depressed and anxious men do groups? 295
relationship breakdown. Groups were not neces- wasagoodyearbeforeIwas[]shespoketo
sarily the first choice in an immediate crisis, mymotheraboutit,shespoketoherGP,her
but more of an on-going social option. While friends [ ] I’m completely the polar opposite
relationship breakdown is not uniquely experi- of my sister [ ] I didn’t want to burden them
enced by men, what the accounts revealed was a [friends or family] I didn’t want cos you
particular pattern of isolation, responses and know I don’t wanna drag everyone down
coping. For example, one man talked about how with my problems so, I don’t wanna sit there
hetriedtoconnectwithpeoplethroughhiswork, and be the miserable one. [ ]
recognition of his own dependence on female
Interviewer: Mhm and you didn’t have any
partners for support and his suicide attempt:
friends that you could talk about that sort of
I’ve had [ ] shops for the last 35 years y [ ] personal stuff at the time?
Thatwasthekindofawaytotrackpeoplein
so that I had a source of human contact, Participant:No,Ihavesomeamazinglygood
because I tend to isolate quite a lot. y [ ] friends but I just didn’t want to. [ ] I don’t
peoplethatI’vemetaswellasmyselfwhoare talk about it with my friends nowy[ ]
verycutoffandverylonely,andiftheygoto They’re aware of what happened but we
their GPand have a little five minute chat, it don’t talk about it.
might be a lifeline for themy [ ] And when P24 [I,R, aged 44, had attended a
the break up took place, because I was so cognitive behavioural therapy group
dependent you know, in relationships I kind and counselling]
ofgo,Iliketokindofclosemyeyesanddive
iny [ ] I took an overdose. Socio-economicdatagivencontinuesthetheme
of depressed, lonely, isolated men. For example,
P6 [I,R, aged 77, attendee at peer-led
intheoverallsampleofmeninthestudy (groups
depression group and peer-led anxiety
attendees and non groups attendees) and where
group]
we had data, only seven men out of 32 respon-
Anotherthemeontheattractionsofgroupswas dents reported living with partners/wives. One
the importance of support outside family or man who did not attend any groups seemed to
friends. Some men emphasised the difficulties of live a particularly lonely, unconnected existence.
explaining or discussing personal feelings with He was unemployed and described a life with
family members: virtually no ties or support:
I definitely think it helps you manage your Interviewer: What about [ ] your support
ownmentalhealth,whetheritwouldstopyou networks? Have you got some good friends
getting down into a huge depression I don’t or family around?
know but in terms of like just sharing with
Participant: Absolute zero, absolute zeroy
people on a weekly basis [with people] who
Igotfamily[]Iwasbroughtupinachildren’s
sayaren’tmembersofyourfamilyandaren’t
homey[family members] certainly wouldn’t
close friends and cos it’s entirely in con-
listen. [ ] I see a mate now and again [ ]
fidenceIjustthinkthatcanbeyouknowsort
Ievensaidtomy,wellkindofanex-girlfriend,
of quite healthy.
I phone her and that’s all I do, I don’t see her,
P7 [I,R, aged 45 attendee at peer-led
‘I can’t support you, I can’t support myself [ ]
depression group]
there’s nothing there for us to be together’y
One man contrasted his own delay and reluc- evenwhenIwasinthechildren’shome[]the
tanceintalkingtohisfamilyandfriendswiththat peoplethatlookafteryou,that’salltheydo[]
of his sister: and then you leave and then ‘bye bye’ you
don’t see them again.
Participant: Oh her and mum talk about it P29[I,R,aged54,didnotattendgroups
[depression] all the time. [ ] my sister was or counselling and was not registered
actually receiving medication for I think it with a GP]
PrimaryHealthCareResearch&Development2014;15:287–301