Depression is a widespread mental health condition, impacting over 300 million people globally, with a lifetime prevalence exceeding 20% (Tian et al., 2024). There can be notable differences in presentation between men and women, often leading to underreporting or misdiagnosis. Understanding how depression in men can differ from that in women is essential for increasing awareness, ensuring accurate diagnosis, and providing effective treatment. In Singapore, cultural influences may also shape how people perceive depression and mental health in general.
Epidemiological studies indicate that women have a higher prevalence of depressive disorders compared to men, with this disparity emerging during adolescence and continuing into adulthood (Piccinelli & Wilkinson, 2000). This often contributes to men being overlooked in statistics and makes it harder for those with depressive symptoms to be noticed.
Differences in Presentation and Mechanisms
Depression often looks different in men compared to women. Men are more likely to exhibit symptoms such as irritability, anger, aggression, alcohol misuse, and risk-taking behaviours. These symptom presentations often lead to misdiagnosis or underdiagnosis, as they do not align with traditional diagnostic criteria for depression. On the contrary, women are more likely to experience classic symptoms of depression, such as persistent sadness, feelings of worthlessness, and a greater proneness to anxiety and somatic complaints.
The mechanisms underlying gender differences in depression are complex. Research suggests that genetic predispositions influencing susceptibility to depression may vary between men and women, although the neural mechanisms underlying these differences remain unclear (Tian et al., 2024). Hormonal variations, including fluctuations in oestrogen and testosterone, have been linked to mood regulation and stress responses, potentially being an additional contribution to the observed gender differences in depression rates.
Depression in Singapore
In Singapore, there has been an increased awareness of mental health, facilitating more comprehensive studies on the prevalence and impact of depression and other mental health conditions. In 2016, the Second Singapore Mental Health Study (Institute of Mental Health, 2018) was conducted. It revealed that one in seven people had experienced a mental disorder in their lifetime, with major depressive disorder (MDD) being among the most common. In addition, the study showed that the lifetime prevalence of MDD increased from 5.8% in 2010 to 6.3% in 2016. Further analysis revealed that while the prevalence of depression among women remained stable, the lifetime prevalence among men rose from 4.3% to 5.8% (Subramaniam et al., 2020).
Cultural factors, such as societal expectations and the stigma surrounding mental health, may influence how depressive symptoms are expressed and reported among Singaporean men. Traditionally, men are expected to be strong and unaffected, and often being the providers for their families. In this context, there is no room for showing vulnerability. This can result in a reluctance to open up and seek help, potentially exacerbating the condition and its consequences. Moreover, societal norms can further discourage openness. If a man were to reach out to a friend or family member and share his struggles, he might be belittled due to these prevailing norms. Even if that were not the case, the fear of being belittled may still prevent him from opening up.
Improving Early Detection and Intervention
Improving early detection and intervention in Singapore is key to reducing the burden of depression in men, who may be less likely to seek help due to societal norms and stigma. Helpful steps would include:
- Raising awareness: Campaigns aimed at normalising conversations about mental health can help men recognise their symptoms and feel more comfortable seeking support. Public health initiatives, such as NCSS’s Beyond the Label campaign, help address the stigma around mental health.
- Expanding routine check-ups: Including mental health screenings in regular medical check-ups, alongside greater emphasis on this in the workplace, can help identifying early signs of depression and promote referrals for support.
- Training gatekeepers: Educating teachers, managers, healthcare professionals, and community leaders to identify signs of depression in men, such as irritability, withdrawal, or changes in behaviour, can help detect symptoms early and secure early intervention.
- Promoting peer support: Mental health support groups provide a safe space for men to share their experiences without the fear of judgement. Initiatives like these can be particularly effective in reaching those who might otherwise be reluctant to participate in formal therapy. Research indicates that support groups can result in highly positive experiences for men (e.g., Vickery, 2022).
Conclusion
Understanding the gender-specific aspects of depression is important to facilitate better detection and correct diagnosis. For men, recognising the unique ways depression can manifest will lead to earlier detection and prompt intervention, ultimately resulting in significantly better outcomes. In Singapore, addressing the stigma surrounding depression in men within the cultural context will be beneficial.
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References
Institute of Mental Health. (2018). Latest nationwide study shows 1 in 7 people in Singapore has experienced a mental disorder in their lifetime. https://www.imh.com.sg/Newsroom/News-Releases/Documents/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf
Piccinelli, M., & Wilkinson, G. (2000). Gender Differences in Depression: Critical Review. British Journal of Psychiatry, 177(6), 486–492. https://doi.org/10.1192/bjp.177.6.486
Roystonn, K., Koh, Y. S., Shafie, S., Sambasivam, R., Vaingankar, J. A., Chong, S. A., & Subramaniam, M. (2024). Understanding Major Depressive Disorder in Singapore: Insights from the second Singapore Mental Health Study (SMHS 2016). Journal of affective disorders, 364, 295–304. https://doi.org/10.1016/j.jad.2024.08.046
Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, B. Y., Sambasivam, R., … Chong, S. A. (2020). Tracking the Mental Health of a Nation: Prevalence and Correlates of Mental Disorders in the Second Singapore Mental Health Study. Epidemiology and Psychiatric Sciences, 29(29). https://doi.org/10.1017/S2045796019000179
Tian, X., Hu, N., Lu, L., Tan, L., & Li, P. (2024). Gender Differences in Major Depressive Disorder at Different Ages: A REST-Meta-MDD Project-Based Study. BMC Psychiatry, 24(575). https://doi.org/10.1186/s12888-024-06021-6
Vickery, A. (2022). ‘It’s made me feel less isolated because there are other people who are experiencing the same or very similar to you’: Men’s experiences of using mental health support groups. Health & Social care in the Community, 30(6), 2383–2391. https://doi.org/10.1111/hsc.13788