The Impact of Masculinity on Mental Health

Am J Mens Health

. 2020 Feb 21;14(1):1557988320906980. doi: 10.1177/1557988320906980

Dimensions of Masculine Norms, Depression, and Mental Health Service Utilization: Results From a Prospective Cohort Study Among Emerging Adult Men in the United States

Katelyn M Sileo ^1,2,, Trace S Kershaw ^2,3

Study looks at link between masculine norms like “status, toughness and anti-femininity” on depression and mental health services in the NE United States. The study also looks at substance use and hostility as secondary outcome, with depression as a moderator.

• Followed some 119 heterosexual men aged18-25 year for six months.
• At the start, 29-25% met the criteria for depression.
• Greater endorsement of masculine statues associated with less depression at baseline and six months
• Greater masculine toughness associated with more subsdtance use at baseline
• Greater masculine anti femininity associated with greater hostility at baseline and after six months.
• Greater endorsement of status associated with greater mental service utilization, especially for men who weren’t depressed, while “toughness” and “antifeminity was associated with less mental health utilization.
• This study sheds light on the harmful and protective effects of masculine norms on depression, related mental health outcomes, and mental health service utilization, with implications for gender-tailored approaches to engage and retain young men in mental health services.
• In 2017, 7% of adults (17 million people) had at least one major depressive episode. Women are more likely to report depression, but burden more under-reported among men.
• National survey found that 9% of men reported feelings of anxiety and depression, but only one in four of those with symptoms sought treatment.
• Younger men, men of color and low income men even less likely to seek treatment.
• Men report higher rates of anger, aggression, substance use and risk taking.
• Suicide among men is nearly four time higher than among women and remains the second leading cause of death for males aged 10-34.
• “ The socialization of men to be strong, resilient, independent, and emotionally inexpressive and to avoid weakness and femininity contributes to the masking of depressive symptoms among men as well as men’s delay in or avoidance of treatment seeking”
• “dysfunction strain paradigm” suggests that the pressure men feel to be masculine leads to psychological problems
• Studies show link” Men’s socialization to be mentally and physically strong (i.e., toughness) is generally thought to contribute to men’s tendency to hide depressive symptoms and avoid mental health services (Smith et al., 2018). It is possible that socialization to be tough could build resilience and protect against depression. between masculine norms and depression, anxiety, hostile behaviors and other mental health outcomes.
• Different masculine qualities had different effects on mental health in one meta-analysis. “Primacy of work” attitudes seemed to have little impact. But “self-reliance, playboy, violence, and power over women” attitudes linked to depression. “winning” and “status” had a positive connection to healthy behaviors and treatment seeking.
• Study concluded some masculine attitudes increase risk while others are protective.
• “status” associated with less depression, more treatment seeking
• “toughness” associated with substance use and avoidance of treatment.
• Anti-femininity assocaited with more hostility, less treatment – but not with more depression.
• “including the healthy aspects of masculine status in outreach and counseling may motivate emerging adult men to engage in mental health and preventative services—that is, emphasizing the importance of good mental health for success in men’s goals related to work and family.”

Brown University School of Public Health

Men, Masculinity and mental health

Carl Dimitri summarizing studies by Samantha Rosenthal

https://sph.brown.edu/news/2025-07-24/men-masculinity

• In 2022, 36% of people aged 18-25 experienced mental illness – and 12% suffered “serious mental illness.” – especially young men
• Rosenthal in Rhode Island Medical Journal studied “restrictive masculinity norms” which are expectations yoiung men should be tough, dominant, self-reliant and willing to take risk – which not showing sadness, fear or vulnerability.
• World health organization has identified “harmful masculinity” as a serious public health concern that discouraging treatment but is linked to violence, inequality and mental health struggles.
• Men face elevated risk of heart disease and stroke, have shorter lifespans and more likely to skip care for physical and mental problems.
• men who feel supported by restrictive masculinity norms are more likely to engage in reckless driving and unsafe sex, and are more likely to become addicted to gambling and pornography.
• 2022 Rhode Island Survey found 15% of young men had pornography addiction, compared to 3% of females. Pornography addiction linked to higher rate of suicide.
• Gambling addiction affects 12% of young men and almost no women.
• Men accounted for 75% of suicides – with a rate three times higher than women.
• ““This highlights some of the pressures on men to suppress their emotions because that’s what society tells them—to rely solely on themselves to try to cope and deal with these issues,” she said. “Then they often isolate and it’s because there’s shame around having these feelings or feeling this bad, or not even feeling like they can build relationships where emotions can be shared.”
• Rosenthal recommended sending trusted advocates into schools to talk about pornography, gambling and substance use.

Gender norms and the mental health of boys and young men

Simon Rice^a,d simon.rice@orygen.org.au ∙ John Oliffe^e,h ∙ Zac Seidler^a,d ∙ Rohan Borschmann^b,f,i,j ∙ Jane Pirkis^c ∙ Nicola Reavley^c ∙ et al. 

Lancet, August 2021

Women’s health movement in the past half century has made gains, but there’s been no corresponding men’s health movement, examining gender expectations and impacts.

• Masculine norms are thought to confer power and status to boys and men and so haven’t shifted much.
• However, masculine norms also carry risks for poor mental health, including a 400% higher risk of suicide. Males fare poorly on substance abuse, risk taking injury, conduct problems, violence, aggression and incarceration.
• Gender norms drive men to present as strong, competitive, in control, unburdened by vulnerability and prize toughness, anger, hostility and emotional control. Shame becomes a barrier to dealing with sadness, anxiety and fear.
• Marketing makes this worse by adopting masculine images in promoting gambling, alcohol and tobacco use.
• “A pernicious accentuation of peer norms⁶is perpetuating outdated stereotypes of what it is to be a man. “
• “Schools have great scope to shape the culture of male peer groups. Older male students can buddy with younger students, or young facilitators can run school-based workshops promoting positive male identities, perhaps re-establishing a rite of passage to maturity, largely absent from contemporary society.”
• Phrases like “toxic masculinity” only makes it worse by attaching shame to “masculine” qualities.
• “Changes in attitude and behavior can be reinforced by honoring and leveraging the bravery and courage (positive masculine norms) of those boys and young men who reject harmful norms and challenge and change stereotypes such as that men don’t cry and that boys will be boys in public and private arenas..”

American Psychological Assocation podcast

with Ronald Levant, University of Akron, Harvard – author of 19 booksa dn 250 peer-reviewed journal articles.

Episode 162

https://www.apa.org/news/podcasts/speaking-of-psychology/masculinity-mental-health

• Men less likely to have close friendships
• Less likely to get treatment for mental health issues
• Die on average five years sooner than women
• 6 times more likely than women to commit suicide.
• Men commit 90% of homicides – and make up 77% of homicide victims.
• “masculinity” defined as cultural norms for how boys/men should behave.
• Male role norms include:
  • Avoiding all things feminine
  • Restricting expression of emotions – especially vulnerabilities
  • Self reliance
  • Toughness
  • Dominance
  • Placing importance on sex
  • Disdain for sexual minority men – including gay and bisexual.
• Paradox – men commit most violence, but most men aren’t violent. So which men are most likely to engage in violence?
  • Men who score very higher on masculinity – hyper masculinity scores.
  • Men who feel ashamed for violating masculine norms (although most men define themselves in other ways and don’t give masculine norms much thought)
  • Things that many men are most ashamed of are violating masculine norms – cried too much as a child, had a crush on another boy, backed down from a fight, too close to my mother.
• Levant and others have studied school shooter cases as well as murder suicide cases and found anecdotally that in most cases masculinity issues came up for the male shooters. This included diaries and newspaper profiles mentioning threatened masculinity issues like being bullied, can’t attract women and other examples.
• Surveys suggest most men feel it’s their job to make a “man” out of their sons. Moreover, elementary school boys vicious in using ridicule and bullying to enforce masculinity stereotypes.
• Levant notes some improvements, with millennials less disdainful for sexual minority men and fathers participating more in child rearing.
• Male infants more likely to cry up to the age of one, but by age two girls more verbally and physically expressive than boys. Once they start school, boys lose their facial expressivity – likely due to reactions from other boys.