The male mental health crisis has escalated during the pandemic, but teen boys and young men aren’t receiving the diagnoses and care they need to heal. Adolescent girls have higher rates of suicidal thoughts and non-fatal suicide attempts, and are three times as likely to report depression symptoms. But when teen boys or young men make a suicide plan, they often take more deadly measures. A JAMA study tracking youth suicide trends over the last four decades found that teen boys are 3.82 times as likely than girls to die by suicide.
In this Q&A, Kristin Wilson, MA, LPC, CCTP, Newport Healthcare’s Chief Experience Officer, explains why the statistics don’t match with the reality, and describes what can be done—within families, school systems, and societies—to reverse these trends.
Q: Why are the recorded rates of anxiety and depression among males so much lower than among females?
Kristin Wilson: In general, our society allows for girls to talk about being sad without shame or fear of being considered “weak,” but for many teen boys and young men, it is often hard to admit that they’re struggling with their mental health. Of course, there are a variety of cultural influences that are important to consider around the acceptability of emotional expression, but there are many young men who feel conditioned from an early age to stifle their feelings rather than expressing and working to understand them. As much as things have shifted in recent years around social gender norms and the ability to have open conversations about mental health, it’s still really hard for many males to admit they feel depressed. A Plan International USA survey of teen boys aged 14–19 found that about a third of them felt “a lot of pressure” to hide their feelings of sadness or anxiety.
In addition to the stigma held within the social norm narrative, parents, doctors, teachers, and other adults may not recognize the signs and symptoms of depression in males. Adolescent boys may confuse sadness, hopelessness, or fear with anger, resulting in less typical depressive behaviors: Sadness may be expressed as anger, frustration, aggression, or irritability. Teen boys are also more likely to use substances as way to self-medicate, or to engage in high-risk behaviors, become defiant, or withdraw from family and friends. Because these behaviors and their implications on others distract from the real issue, the underlying depression may go unnoticed.
Q: So it’s likely that just as many young men as women are struggling with their mental health, and the statistics don’t accurately reflect that because men tend to underreport their symptoms. What, then, accounts for the fact that the suicide rate among males is so much higher than the rate for women?
KW: With girls, their attempts tend to leave an opening for living. When boys decide that they will make an attempt, it feels much more final to them. They internalize so much, because of their fear of speaking the truth, that it gets to a point where they just can’t hold it anymore, and that feels like the only way out. Then the suicide gesture is the statistic that’s recorded, rather than the feelings leading up to it. Regardless of gender, however, suicidal thoughts and actions are serious crisis moments and need to be addressed by professionals.
Q: What can parents do to support their sons who may be struggling but not talking about what they’re feeling?
KW: It’s essential for families to create a safe, technology free, space for open communication and authentic connection. Make time, every day, for meaningful conversations with your kids. Find a consistent time where the family is together and use this time to talk about school, work, friends, and feelings. In a world where we are all so busy, the old idea of having conversations over a shared mealtime may be impossible, but you can still find meaningful moments to connect. Use your car rides, to or from school, activities, or to the store can be great, nonthreatening times to connect about life.
Ask questions that elicit more than one-word answers, actively listen to what they say, and reinforce the idea that it’s okay not to be okay. It’s about staying in touch with your sons on a daily basis, and creating a solid relationship foundation so that they know you will support, hear, and validate all of their feelings, even when things are tough.
As parents, we know our children best. Changes in baseline patterns of behaviors, like eating, sleeping, mood swings, isolation/withdrawal, changes in grades, or a loss of excitement over things they were once passionate about can all be signs of mental health issues. If you are noticing your son’s patterns of behaviors are changing, and your gut is telling you something is wrong, it’s time to act.
Q: Speaking of phones, what role do screen time and gaming play in male mental health, particularly over the past months when there’s been much less in-person social interaction?
KW: We see a lot of isolation and addiction that occur as part of gaming and other online activities. Kids will withdraw into their rooms or the basement to play, and be there for hours. They might say they’re gaming with somebody else who’s also online, but that connection is a lot different from being in a room interacting with peers. Online connections within the context of competition don’t always have the same benefits as face-to-face human connections.
Often parents feel they have no control over screen time, and that’s been especially true during the pandemic. For many families, all the rules went out the window because everyone was just trying to survive. Many kids were home during the day while parents were working, which created a loss of boundaries and structure. Parents may need to pause and consciously reestablish limits around screen time and gaming, and also build in time together as a family, particularly as we head back into the school year with so many additional stressors and moving parts.
Q: What can schools do to help reverse the mental health trends among males?
KW: In the United States, we’ve done a good job implementing home medical surveys to assess for fevers and other COVID symptoms before going into school buildings, but we’re not asking questions about COVID’s impact on baseline mental health. With everything that has been happening over the last two years, our world is suffering from collective trauma. COVID and the quarantine guidelines are impacting all of us to a different extent, but we are all being impacted.
In a recent 4H–Harris Poll survey on the impact of the pandemic on youth mental health, seven out of 10 teens reported increased depression, anxiety, and stress, and 79 percent said they wished there were safe spaces in school to talk about mental health. Teens know they are feeling differently and want to talk about it—they just don’t know where to go. It’s important that schools are creating emotional check-ins so they know what’s happening with their students, and their staff, and work toward creating trauma-sensitive environments. More staff education is needed on collective trauma and trauma responses, especially those that are being normalized right now, like substance abuse, disordered eating, and difficulty concentrating.
Building in key protective factors can help school communities enhance resilience and insulate against trauma—things like emphasizing authentic relationships, creating safe spaces to talk about mental health, implementing mentorship programs, and providing education on coping strategies. By cross-training school professionals, and providing mental health education to all staff in the building, schools can become more aware of how the pandemic is impacting their community and gain resources to support those who are struggling.
Q: Once teen boys and young men do get into treatment, which approaches tend to be most effective for them?
KW: There are numerous approaches that can be effective in creating sustainable healing. The American Psychological Association’s guidelines for psychological practice with boys and mennotes that for male adolescents, shorter sessions, informal settings outside the office (such as outdoor activities), and group therapy may be more supportive and effective than traditional psychotherapy.
Engaging boys and young men on a physical and creative level in a clinical setting can be powerful and can feel less threatening versus talk therapies. Adventure therapy allows for a reconnection to the world, a grounding in nature, and a somatic experience. Music therapy is another modality that can be very powerful—writing lyrics to songs or playing a musical instrument allows for connection to self and others. As a clinician, it’s about finding ways for them to feel comfortable in their bodies, so that self-expression can happen.
Science may also help provide insight into the most effective ways to support male mental health. For example, there appears to be a neurobiological foundation for the differences in how males and females respond to the chronic stress associated with mental health issues. Studies done by researchers at Virginia Commonwealth University have found that mitochondria in male and female mice react differently to stress, producing different impacts on the brain.
Q: As a larger society, how can we work toward supporting teen boys and young men to feel safe talking about mental health and to get the care they need?
KW: We all need to work together to destigmatize mental health issues and create safe spaces for those conversations to happen—both nationally, through digital platforms, and within families and communities. We need to reinforce the understanding that, regardless of gender, it’s okay not to be okay, and that asking for help is not a sign of weakness but rather a sign of strength.
Kristin Wilson, MA, LPC, CCTP, has been working in the treatment field since 1997. During the past 20 years, her leadership roles have included clinical supervisor, executive director, and clinical outreach representative, as well as senior regional director of marketing for a major behavioral health network. Kristin is a licensed clinician who has worked in a variety of mental health treatment settings, including inpatient, residential, and outpatient levels of care for chemical dependence, process addictions, and eating disorders. She holds a Master’s degree in psychology and Creative Arts Therapies, and is a Certified Clinical Trauma Professional and certified yoga teacher.