Behind the mask of men’s mental health
By: Dr. James Aw, Chief Medical Officer, OMERS
June 23, 2025
What do men worry about? It’s an important question to ask, particularly during Men’s Health Month. In my medical practice, men easily express their concerns about energy, sleep (insomnia and apnea), sexual health, obesity and aches and pains, in addition to medical conditions like heart disease, lower urinary tract disease (prostate, bladder), diabetes and cancer. However - I usually must prompt them about stress and mental health. How’s the emotional health going?
Once I open the door to discuss mental health, many men volunteer that they are stressed out, worrying about family, relationships, work, life transitions (purpose in life) and financial health. Men who are unmarried, single, divorced or widowed are at increased risk of mental health disorders and suicide. Divorce tends to affect men worse than women and may be linked to the sudden loss of social support, emotional connections and child custody battles. First-time fathers can experience postpartum paternal depression, which affects around 10% of men as early as the first trimester and is highest in the three-to-six month post-partum period. Work stressors like high job demands, low job control, job insecurity, effort-reward imbalance, workplace bullying and low social support have been associated with increased depression, anxiety and suicidal ideation in men.
Symptoms of depression and anxiety may be different in men than women. Men may present more with externalizing (“acting out”) symptoms like anger, irritability and risk-taking activities (poor impulse control). Researchers have coined the phrases “male depressive syndrome” and “masked depression.” Substance use disorders (alcohol, drugs) and suicide (~ 75% in men, particularly middle aged and older) are more common in men with mental health disorders.
Men don’t tend to visit the doctor for mental health concerns and are generally reluctant to seek help. They may not be willing to share their feelings and instead suffer in silence. Some of this may be related to society’s past norms of masculinity and stigma around not expressing vulnerability. Groups at high risk for underdiagnosis/undertreated mental health include younger males (prone to substance use disorders), indigenous and ethnic minorities, particularly Black, Asian and Latino (cultural stigma, language barriers, mistrust and lower rates of self-recognition), men with a history of trauma (post-traumatic stress disorder, childhood abuse/neglect) and social isolation. Sexual minority men (gay, bisexual, queer) are also at a higher risk for depression and suicide when dealing with family acceptance, social belonging, stigma and victimization.
So, what can men do?
Mental, physical and social wellbeing are all interconnected. Mental health begins with self-compassion, breaking down stigma, building social support networks, recognizing symptoms and accessing care when you need it. There are male-specific screening tools for depression and psychological distress such as the Male Depression Risk Scale (MDRS-22, MDRS-7) and the Distress Thermometer (National Comprehensive Cancer Network). Brain health is optimized with healthy daily habits that manage modifiable risk factors such as high blood pressure, diabetes, obesity, high cholesterol, physical inactivity, poor diet, smoking, excessive alcohol, social isolation, sleep and hearing loss. These are all good reasons for men to focus on a healthy lifestyle and visit their doctor regularly for wellbeing check-ins to review their risk factors!
It is important to reduce the barriers to men seeking help. New trends in men’s mental health care include social interventions through peer-led, men-only support groups and male-tailored psychotherapy that address traditional masculinity ideologies and break through stigmas. Digital/telemental health and activity-based therapy sessions like walk-and-talk therapy, movement-based counselling and outdoor therapies are helpful for men who are uncomfortable with typical in-clinic settings. Evidence-based treatments provided by a mental health professional may include cognitive behavioural therapy (CBT) and/or medication. Early interventions can make a big difference, but it’s never too late to reach out for help.
In summary, mental health in men has unique features. Early recognition of signs and symptoms should warrant reaching out for help. Developing a strong social support system is essential for mental health and resilience. Fortunately, a healthy lifestyle (exercise, sleep, nutrition, stress management) with biometric monitoring (blood pressure, glucose, cholesterol) are good for the body, brain and ultimately one’s mental health. Men—it’s time to lift the mask on mental health. There are lots of options for help and it’s never too late to start!
For those who want to read more!
Gender differences in depression | The British Journal of Psychiatry | Cambridge Core
University of British Columbia Men’s Health Research Program
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