RESUMO
OBJECTIVES: To identify viewpoints among men with depression about depression and its treatment, consider how these might influence help-seeking behaviour, and generate ideas for interventions and future research. DESIGN: Q methodology. METHODS: Twenty-nine men with depression completed a Q sort by ranking a set of statements about depression and help-seeking according to their relative agreement with each statement. Factor analysis was used to identify viewpoints relating to male understandings of depression and help-seeking, which were interpreted in the context of participant characteristics and additional information from post-sorting interviews. RESULTS: A two-factor solution accounting for 45% of the total variance was considered the best fit for the data. The 2 factors were: (1) Help is available if you can get to the point of asking for it (34% of the variance) and (2) depression should be dealt with in private; help-seeking makes you vulnerable (11% of the variance). Participants who were significantly associated with both factors described a sense of shame, relating to their own or others' views that being depressed and help-seeking are in conflict with socially constructed 'masculine' values, such as strength and self-sufficiency. In the viewpoint represented by Factor 1, however, the benefits of help-seeking outweigh the negatives. In contrast, the viewpoint represented in Factor 2 holds that depression should remain a private struggle and that help-seeking is too risky a move to make. CONCLUSIONS: In order to access treatment, men must first recognize depression, then overcome considerable perceived and internalized stigma to ask for help. Improving public knowledge about the nature of depression; positive messages about the act of help-seeking, types of treatment available, and effectiveness of treatments; and work to overcome the challenges posed by long waiting times and other service constraints may increase rates of help-seeking, and represent areas for future research. PRACTITIONER POINTS: Interventions to improve recognition of depression symptoms, particularly in the absence of recent negative life events or suicidal ideation, might help to improve help-seeking rates among men. Media campaigns should consider focusing on the positive elements of help-seeking and potential for recovery, and the impact of such campaigns should be evaluated. Improving public knowledge of the types of non-medical intervention that are available for depression may help to increase help-seeking rates. Clinical services and commissioners should be aware of the impact of long waiting times and strict discharge policies on service users, especially those who have difficulty asking for help.