Dr. Barker did identify some differences. Mexican American men linked these losses with impacts on the family more than white non-Hispanic men did. “Mexican men's concerns about the family versus [white non-Hispanic] men's more individualized issues are definitely consistent with a large and diverse literature on these population groups,” she said.
Lack of productivity was linked to an inability to provide for or take care of family members. White non-Hispanic men, however, were more likely to directly link it to physical disability that affected them as individuals.
Ester Carolina Apesoa-Varano, Ph.D., of the University of California, Davis, addressed family issues that emerged from the interviews.
Families play a dual role, both facilitating and serving as barriers to the treatment of depression. Drawing from the participants' accounts, she observed men often perceive a lack of support for their depression.
“Families tend to normalize depression as a part of aging,” she said. That can inhibit care seeking. They also can stigmatize depression, making men less willing to disclose their feelings and less likely to seek formal care, she added.
Conversely, families facilitate care by being involved in daily support and helping the men cope, and by being engaged in illness management such as helping with driving and medications.
Finally, they are often present during the office visits. Generally, having family present during a medical visit is considered a “good thing,” but their presence in clinical encounters “is a trickier situation,” she said, because although it can sometimes facilitate care, it can also be a hindrance. Again, issues of masculinity come into play. Men talk about not wanting to be a burden, so the family's presence might inhibit full disclosure of their feelings and experiences.
Clinicians should actively elicit information about the family and then decide how best to include them. If appropriate, they should provide opportunities for the family to participate in treatment. But this might not always be appropriate. Providers need to tailor their treatment and approach based on what they know of the family's role, she said.
More research is needed to understand the role of the family, Dr. Apesoa-Varano said.
Disclosures: None of the presenters disclosed any conflicts. MeHAS is funded by the National Institute for Mental Health.