Mental illness is common, complex, and costly. The World Health Organization (WHO) points out that one in every eight people in the world live with a mental disorder.1 Anxiety and depressive disorders are recognisably the most common conditions, notwithstanding cultural variations in descriptive terminology across communities, societies, and countries. Overall, mental illness is very common, with almost one billion people affected directly and many others impacted indirectly: family, friends, colleagues, and wider communities.2
Like women, men can be affected by a broad range of mental illnesses including mood disorders, anxiety disorders, schizophrenia, substance misuse, attentiondeficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and various other conditions.3 In 2023, the US National Institute of Mental Health noted that “certain symptoms may be more common in men than women, and the course of illness can be affected by a person’s sex. Researchers are only now beginning to tease apart the various biological and psychosocial factors that may impact mental health. Men are less likely to have received mental health treatment than women in the past year”.4
This article looks at two key themes in this area: mental health promotion for men and the increasing evidence that supports mindfulness-based interventions for various mental illness and psychological problems, especially depression.
Mental Health Promotion for Men
It is often said that “men don’t talk” and this is a reason why men are reluctant to seek help for mental health problems. The situation is, however, significantly more complex than that. Recent research paints a more detailed, useful picture about why men tend not to access care when it is needed, and how this might be addressed.
In 2022, a focus group study in Sydney looked at five groups of men and two groups of stakeholders who had frontline experience working with men (e.g., men’s groups, health clubs, mental health advocates), in order to explore “challenges and opportunities for men’s mental health promotion”.5 Following analysis of the focus groups, these researchers identified a “need to provide better direction for gender-sensitised approaches to community-based mental health promotion for men. Especially evident was the influence of gender roles, relations and identities as well as the importance of framing conversations in ways that resonate with potential end users”.
In other words, mental health promotion strategies for men need to be tailored to men’s emotional habits, communication styles, and behaviour patterns. The researchers in Sydney concluded that “strategies are needed that address, or at least consider, men’s restrictive emotionality and emotional awareness, the interiority of mental health, and stigmatisation of mental health promotion and practices. Highlighted throughout, from both men and stakeholders, was the significance of advancing men’s mental health and wellbeing by anchoring mental health promotion to acceptable locations, contexts and behaviours”.
But how can this be put into practice? Any comments about “men” and “women” are always generalisations, and there will inevitably be many exceptions. But this kind of research strongly indicates a need to consider common male behaviours when designing mental health interventions. This should be entirely possible owing to increased research into a broad range of treatments for mental illness, many of which can be readily adapted to the needs of specific groups, such as men. Mindfulness-based approaches are a good example of how this can be achieved.
Mindfulness for Men
Despite the fact that “mindfulness” has become a buzzword in psychotherapy and popular culture in many countries, the practice still holds substantial value, especially when it is practiced with trained teachers or in supervised groups. Recent years have seen growing interest in mindfulness and meditation retreats which are focused on men’s mental health and men’s psychological wellbeing, so mindfulness merits particular attention as an increasingly accepted way of maintaining mental health for men. Mindfulness means paying attention to the present moment, as simply and directly as possible. It involves developing a careful, curious awareness of the sensations, thoughts, and emotions that are present, but trying not to change or judge them. It involves staying focussed on the present moment as much as possible, and when the mind wanders, gently re-directing it back to direct sensations: the feeling of your feet on the floor, the texture of a book in your hands. Mindfulness is both simple and challenging at the same time.
The idea of mindfulness is rooted in Buddhist and early Hindu psychology and forms a key part of meditative practices in both of these spiritual traditions, among others. Over recent decades, mindfulness has also become part of psychotherapeutic approaches to a range of mental illnesses and psychological symptoms in both women and men. More specifically, there is now convincing evidence that particular courses of mindfulness based therapies provided over an eight-week period help to prevent relapse of depression in many people.6 Data to support this approach have accumulated rapidly and steadily in recent years, and merit attention.
In 2021, one “systematic review and network meta-analysis” of “mindfulness-based cognitive therapy [MBCT] for prevention and time to depressive relapse” found 23 relevant publications of which 17 were randomised controlled trials.7 The results clearly supported the effectiveness of MBCT compared to treatment as usual (TAU).
According to the authors, “MBCT is more effective than TAU in the long-term in preventing relapse of depression and has statistically significant advantages over TAU and placebo for time to relapse of depression. No statistically significant differences were observed between MBCT and active treatment strategies for rate of relapse or time to relapse of depression”.
Learning the skills of mindfulness and how to apply them is clearly a powerful way to help prevent relapse of depression for many people, albeit that this practice does not appeal to everyone. Some people prefer approaches that are based primarily on other forms of psychotherapy or medication, so it is important to understand the patient’s views about mindfulness before, during, and after treatment.
What Is It About Mindfulness That Helps?
In 2022, one “systematic review and meta-ethnographic synthesis” of MBCT in major depression sought to “systematically review and synthesize the experiences of participants with depression taking part in MBCT”.8 These researchers identified 21 qualitative studies of fair quality on this theme. They found that, “across 21 studies of participants with current or previous depression who had participated in MBCT, three overarching themes were developed: ‘Becoming skilled and taking action’, ‘Acceptance’ and ‘Ambivalence and Variability’.” The researchers also noted that “participants became skilled through engagement in mindfulness practices, reporting increased awareness, perspective and agency over their experiences. Participants developed acceptance towards their experiences, self and others”. Despite plentiful evidence to support various mindfulness-based interventions in both men and women, mindfulness has become a victim of its own popularity. Too often, caricatured versions of mindfulness are presented as quick solutions to complex problems, or easy ways to sidestep challenging inter-personal issues that need to be addressed.9 These misrepresentations are disappointing. Mindfulness is a very useful tool but is not the answer to everything. While more research is needed in certain areas, various levels of evidence now support mindfulness-based psychological therapies for some people with mild and moderate depression, anxiety disorders, self-harming behaviour, substance misuse, obsessive-compulsive disorder, and eating disorders.2 These conditions often prove difficult to treat in practice, so any new therapies which are supported by evidence are welcome.
There is also evidence that mindfulness can help to promote holistic health in chronic medical illness, deepen psychological care during cancer treatment, and assist in terminal care settings, with particular evidence of benefit in depression, pain conditions, smoking, and addictive disorders.10 Finally, for some people without psychological problems or mental illness, mindfulness can offer a powerful way to improve general wellbeing. For men, the evidence supporting mindfulness offers a valuable reason to consider this approach to promoting mental wellness and addressing psychological problems. The benefits can be subtle but profound, provided mindfulness is practiced with diligence, care, and commitment. Mindfulness is not the answer to everything for men, but it often helps.
Written by Professor Brendan Kelly, Brendan Kelly is Professor of Psychiatry at Trinity College Dublin and author of “Resilience: Lessons from Sir William Wilde on Life after Covid” (Eastwood Books, 2023).
Sources and Further Reading
- World Health Organization. Mental Disorders. Geneva: World Health Organization, 2022. (https:// www.who.int/news-room/factsheets/detail/mental-disorders).
- Kelly BD. Mental Health in Ireland: The Complete Guide for Patients, Families, Health Care Professionals and Everyone Who Wants to Be Well. Dublin: The Liffey Press, 2017.
- Castle D, Coghill D (editors). Comprehensive Men’s Mental Health. Cambridge: Cambridge University Press, 2021.
- 4National Institute of Mental Health. Men and Mental Health. Bethesda, MD: National Institute of Mental Health, 2023 (https://www. nimh.nih.gov/health/topics/menand-mental-health).
- Sharp P, Bottorff JL, Rice S, Oliffe JL, Schulenkorf N, Impellizzeri F, Caperchione CM. ‘People say men don’t talk, well that’s bullshit’: a focus group study exploring challenges and opportunities for men’s mental health promotion. PLoS One 2022; 17: e0261997 (https://doi. org/10.1371/journal.pone.0261997) (Link to licence: https:// creativecommons.org/licenses/ by/4.0/).
- Segal Z, Williams M, Teasdale J. Mindfulness-Based Cognitive Therapy for Depression (Second Edition). New York and London: The Guilford Press, 2018.
- McCartney M, Nevitt S, Lloyd A, Hill R, White R, Duarte R. Mindfulness-based cognitive therapy for prevention and time to depressive relapse: systematic review and network meta-analysis. Acta Psychiatrica Scandinavica 2021; 143: 6-21 (https://doi. org/10.1111/acps.13242) (Link to licence: https://creativecommons. org/licenses/by/4.0/).
- Williams K, Hartley S, Langer S, Manandhar-Richardson M, Sinha M, Taylor P. A systematic review and meta-ethnographic synthesis of mindfulness-based cognitive therapy for people with major depression. Clinical Psychology and Psychotherapy 2022; 29: 1494-1514 (https://doi. org/10.1002/cpp.2773) (https:// creativecommons.org/licenses/ by/4.0/).
- Purser RE. McMindfulness: How Mindfulness Became the New Capitalist Spirituality. London: Repeater Books, 2019.
- Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, Simpson TL. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clinical Psychology Review 2018; 59: 52-60 (https:// doi.org/10.1016/j.cpr.2017.10.011).
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