Men's Views on Depression: A Systematic Review and Metasynthesis of Qualitative Research.

BACKGROUND: According to the concept of "male depression," depression among men might be underdiagnosed and undertreated because of gender differences in symptoms and coping. There is evidence that men experience atypical depressive symptoms including irritability, aggression, substance abuse, and increased risk behavior. To date, a substantial number of qualitative studies on men's views on depression has been conducted in the last few decades. METHODS: Based on a systematic review and metasynthesis of qualitative studies on men's subjective perspectives on depression, we aim at a comprehensive understanding of men's subjective views on depression with a specific focus on masculinity constructions. RESULTS: Based on 34 studies assessed as appropriate for the study, 2 overarching subthemes could be identified: normative expectations regarding masculinity ideals and men's subjective perspectives of depression as "weakness." Men's strategies include denial of "weakness" and "closing up." Further themes include suicide, masculinity ideals as a healthy resource, and alternative masculinities. DISCUSSION/CONCLUSIONS: Traditional masculinity values might serve as barriers but also as facilitators to adaptive coping strategies in depressed men. More research is needed to study the dimensions and role of alternative masculinities in the context of depression.

The attitudes of mental health professionals towards patients' desire for children.

BACKGROUND: When a patient with a serious mental illness expresses a desire for children, mental health professionals are faced with an ethical dilemma. To date, little research has been conducted into their strategies for dealing with these issues. METHODS: Seven focus groups with a total of 49 participants from all professional groups active in mental health (nurses, psychologists, social workers and psychiatrists) were conducted in a 330-bed psychiatric hospital. Group discussions were transcribed verbatim and analysed by the documentary method described by Bohnsack. RESULTS: Mental health professionals did not feel that their patients' desire for children was as important in daily practice as were parenting issues. When discussing the desire for children on the part of patients, the following themes emerged: "the patient's own decision", "neutrality", "the patient's well-being", "issues affecting the children of mentally ill parents" and "appropriate parenthood". In order to cope with what they perceived as conflicting norms, mental health professionals developed the following (discursive) strategies: "subordination of child welfare", "de-professionalisation", "giving rational advice" and "resignation". CONCLUSIONS: The theme of "reproductive autonomy" dominated mental health professionals' discourse on the desire for children among psychiatric patients. "Reproductive autonomy" stood in conflict with another important theme (patient's children). Treating reproductive issues as taboo is the result of the gap between MHPs' perceptions of (conflicting) norms when dealing with a patient's desire for children and the limited opportunities to cope with them appropriately.In order to support both patients with a desire for children and mental health professionals who are charged with providing counselling for such patients, there is a need to encourage ethical reflection and to focus on clinical recommendations in this important area.

Mental health nurses' and psychiatrists' views on addressing parenthood issues among service users.

Mental health professionals (MHPs) are in a central position to provide support for mental health service users (MHSUs) in regard to parental needs, from preconception to caring for children. This study aims to examine whether mental health nurses and psychiatrists regard the issue of having children and being a parent as relevant to be considered in a clinical setting, how they describe the MHPs' roles and responsibilities in this regard, and to what extent they feel willing and able to fulfil these demands. A qualitative approach was undertaken by conducting four focus groups with 30 MHPs (15 nurses and 15 psychiatrists) within an inpatient mental health service in south Germany. We found that MHPs generally acknowledged the importance of parenting issues for psychiatric treatment. However, they assessed the talks between MHPs and MHSUs about parenting as less relevant in routine practice; the issue of the desire for children in particular was seen as generally not important. Addressing parenthood issues was restricted to mainly two areas: clarifying children's situations during inpatient treatment and considering medication issues among (potentially) pregnant service users. MHPs' focus on the adult service user, privacy, and historical issues were the main arguments against addressing parenthood issues.

[Adult Victimization of Mental Health Service Users - A Review of Prevalences, Risk Factors, and Disclosure]. / Viktimisierung im Erwachsenenalter von Personen mit Psychiatrieerfahrung.

BACKGROUND: Although adult victimization among psychiatric patients is frequent, the subject is neglected within the mental health service literature in Germany. METHODS: Systematic review on adult victimization prevalences, introduction of risk factors and discussion against theoretical concepts and findings on disclosure of victimization. RESULTS: International studies consistently indicate high adult victimization risks compared to general population. Risk factors include psychopathology, substance abuse, (former) experiences of violence, and a lack of social integration. Disclosure of victimization is hindered by several barriers. CONCLUSIONS: Preventive and interventive measures should be provided at individual, service, and societal level. More research is needed regarding prevalences for German user populations, disclosure within (mental) health services, and situational, interactive and sociocultural factors of victimization.

[Dealing with Parenthood among Mental Health Service Users During Inpatient Treatment: Mental Health Professionals' Perspectives to Barriers and Facilitators]. / Umgang mit Elternschaft psychiatrischer Patienten in der stationären Behandlung: Möglichkeiten und Grenzen aus subjektiver Sicht psychiatrischer Fachkräfte.

Study aims To gain insight into mental health professionals' subjective perceptions of parenthood among psychiatric patients during inpatient treatment. Methods 31 problem-centered semi-structured interviews with psychiatric professionals were conducted and analyzed by content analysis methods. Results From participants' perspectives, parenthood issues are mainly relevant during hospital admission when child care has to be secured. Participants reported the following barriers: sickness aspects, fears of patients, lack of time and professional knowledge on parenthood issues in clinical care. Discussion Structural barriers which hinder consideration of parenthood issues beyond hospital admission should be reduced.

[Mental Health Professionals' Perspectives Towards Desire for Children and Family Planning Among Psychiatric Patients - Results of a Qualitative Study]. / Kinderwunsch und Familienplanung psychiatrischer PatientInnen aus Sicht der Fachkräfte ­ Ergebnisse einer qualitativen Studie.

Study aims: Analysis of mental health professionals' attitudes to reproductive issues among psychiatric patients. Method: 31 problem-centered semi-structured interviews with psychiatric professionals were conducted and analyzed by content analysis methods. Results: Outside of psychotherapeutic treatment the desire for children is generally assessed as less important in the context of mental health care, it is often limited to effective birth control with regard to drug treatment. Mental health professionals perceive moral concerns, lack of expertise among professionals and individual doubts as barriers when dealing with reproductive issues. Discussion: In order to meet psychiatric patients' reproductive needs, perceptions of barriers among mental health professionals in dealing with reproductive issues should be reflected and discussed. Recommendations could support professionals and help ensure adequate support for psychiatric patients.