Project objectives

Study objectives are to:

• Use qualitative methods to identify and compare different models of group intervention for men with depression including an exploration of the advantages and disadvantages of single sexed and mixed gender intervention groups.
• Explore patients’ views about how men manage their depression, the types of mental health and support services men currently use or might be acceptable to men, and how they communicate mental health problems with health professionals. 
• Detail clinicians’ and other workers experiences of supporting and managing men with depression within primary care and the wider community. 
• Examine if and in what ways the content and delivery of a structured CBT programme designed for women, accessible via primary care, could be appropriately used and modified for male participants. 

Changes to project objectives

Several factors impacted on my ability to spend time on this project and meant that it was not finished at its first intended date.  These factors included a successful project award from the NIHR Research for Patient Benefit award (VICC study) and a personal NIHR post doctoral fellowship award.  Due to these successes I needed to spend a certain amount of time setting up especially the NIHR Research for patient benefit Variation in cardiac care project, and which was not anticipated at the time of the original application.   Aside from these ‘external’ factors there were also been a few delays within the project such as needing to extend the R&D approval from just Bristol PCTs to include South Gloucestershire, delays in agreeing service support costs and a longer run in time for observations of one of the South Gloucestershire depression groups. 

The project is largely finished.  All the data has been collected and most of the analysis done.  Several presentation of the findings have been presented including the more clinically relevant and descriptive findings at SAPC annual Glasgow conference 2012 and more theoretical findings at the European Association of Social Anthropologists in Paris July 2012.  The first paper on the clinical findings was submitted to the journal Primary Health Care Research and Development in November 2012.  Rather frustratingly we are still awaiting for the peer review process to be completed and to hear if the journal is going to  accept the paper.  A second paper on masculinity theory has been drafted.  The analysis is largely complete but the paper needs to be fully written.  It is planned to complete this second paper by June 2013.

Brief summary

Aim

To map the availability and types of depression and anxiety groups, and to examine men’s experiences and perception of this support.

Background

The best ways to support men with depression and anxiety in primary care are not well understood.  Group-based interventions are sometimes offered but it is unknown whether this type of support is acceptable to men. 

Methods

Interviews with 17 men experiencing depression or anxiety.  A further 12 interviews were conducted with staff who worked with depressed men (half of whom also experienced depression or anxiety themselves).  There were detailed observations of four mental health groups and a mapping exercise of groups in a single English city (Bristol). 

Findings

Some men attend groups for support with 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, reduced stigma and opportunities for leadership were some of the identified benefits of groups. The different types of groups may relate to different potential member audiences.  For example, unemployed men with greater mental health and support needs attended a professionally-led group whereas men with milder mental health problems, who were also more likely to be employed and more highly educated, attended peer-led groups. Barriers to help-seeking were commonly reported, many of which related to cultural norms about how men should behave. General Practitioners played a key role in helping men to acknowledge their experiences of depression and anxiety, listening and providing information on the range of support options, including groups. Men with depression and anxiety do go to groups and appear to be well supported by them.  Groups may be low cost and offer additional advantages for some men.  Health professionals could do more to identify and promote local groups.

Plain English summary

Depression in men is a significant and increasing problem.  Previous studies have shown that depression is especially stigmatising for men and that many men do not seek help.  Depression in men is frequently missed by GPs and where it is recognised, GPs may have little to offer patients and access to talking therapies is often difficult.  There is growing research evidence that Cognitive Behavioural Therapy (CBT) is a useful therapeutic approach that can help patients to self manage their depression.  Group CBT can potentially reach more patients, more cost-effectively.  A pilot study of a brief group CBT intervention for women has shown promising results.  Whether this sort of intervention could be run in the same way for men is unclear.  This study proposes to examine the successful elements of existing men’s groups, barriers which stop men attending groups and how an existing model of group CBT therapy could be modified.  This study will give clearer insight into managing depression among men in primary care and if successful, could be taken forward as a nested study within a randomised controlled trial proposed for women.

Dissemination

Published articles

Do depressed and anxious men do groups? What works and what are the barriers to help seeking? Cramer H,Horwood J,PAyne S,Araya R, Lester H, Salisbury C, 

https://www.ncbi.nlm.nih.gov/pubmed/23800394

Public and participant involvement 

The main aim of the data collection would be to elicit the views of men and those who work with men around the acceptability and feasibility of a men’s mental health group.  In addition to this, during the early stages of the research, key people and organisations would be invited to attend an early consultation meeting to give feedback and guidance on the aims of the project and to help with, for example, shaping topic guides for interviews.  These key people would include staff from mental health organisations and men who attend mental health groups (and some may be both service users and staff).  Good contacts already exist with local mental health organisations such as Bristol’s ‘MIND’, as well as service user networks such as ‘Service Users in Research’ (formally SURGE), also the West Hub Mental Health Network and the Avon and Wiltshire Partnership.  A similar group of interested people and organisations would be reconvened towards the end of the study to present the emerging findings and receive feedback.  As well as presenting the findings of the study at conferences such as the Society for Academics in Primary Care the findings would also be disseminated at mental health conferences with strong user presence such as the West Hub Mental Health Network.   

This study will identify obstacles that might hinder men’s access to a group intervention.  The project would help to map current services being offered to men with depression in deprived communities and be able to spot gaps in current services.  It would identify and bring together national examples of effective interventions helping men with depression and draw on national and international literature.  It would highlight gendered issues in communication and further an awareness of how men may present distress and depression, useful for GPs and health professionals. 

Impact

The project has contributed to local policies and practice rather than nation policies so far.  

Early findings were presented at ‘A picture of health?  Men’s Health and Wellbeing Conference in Bristol, March 2011.

A picture of health?Men’s Health and Wellbeing Conference.  Post conference report.  Public Health directorate, NHS Bristol. 2011

From this conference a spin off Men and Boys’ Health and Wellbeing Stakeholder Group in Bristol was set up and of which I have been a regular attender.  The group works to influence and coordinate men’s health and wellbeing services in Bristol. In Jan 2013 I gave a presentation to this group on the later findings.   I also contributed to a GP study day for Bristol GPs in May 2012 based on the findings of the study. 

This project was funded by the National Institute for Health Research School for Primary Care Research (project number 71)

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Primary Care Research, NIHR, NHS or the Department of Health.