Men's peer support for mental health challenges: future directions for research and practice.

Peer support has a long history of helping people navigate mental health challenges and is increasingly utilized within men's mental health promotion initiatives. Despite considerable research conceptualizing and evaluating peer support in various contexts, little is known about the gendered dimensions of men's peer support and mutual help for mental health. This article provides an empirically informed commentary on men's peer support and informal help-seeking preferences to make recommendations for future directions for research and practice. Research examining men's peer support is emergent and the available evidence suggests that there is potential to conceptually align with many men's values and preferences for mental health help-seeking. Peer support offers a non-clinical, strength-based adjunct to professional support that may aid men in navigating a range of mental health challenges. Consideration must be given to the influence of gender socialization and men's diverse experiences with developing and maintaining peer relationships. It should not be assumed that authentic and supportive relationships will naturally form when men congregate together. As a growing number of interventions and programs emerge targeted at boys and men, there are important opportunities to leverage these health promotion efforts to encourage and coach men to engage in mutual help. Opportunities for research and practice are discussed to better understand and harness the health-promoting potential of peer support for men's mental health.

Is suicide a mental health, public health or societal problem?

PURPOSE OF REVIEW: Suicide is a complex phenomenon wherein multiple parameters intersect: psychological, medical, moral, religious, social, economic and political. Over the decades, however, it has been increasingly and almost exclusively come to be viewed through a biomedical prism. Colonized thus by health and more specifically mental health professionals, alternative and complimentary approaches have been excluded from the discourse. The review questions many basic premises, which have been taken as given in this context, particularly the '90 percent statistic' derived from methodologically flawed psychological autopsy studies. RECENT FINDINGS: An alternative perspective posits that suicide is a societal problem which has been expropriated by health professionals, with little to show for the efficacy of public health interventions such as national suicide prevention plans, which continue to be ritually rolled out despite a consistent record of repeated failures. This view is supported by macro-level data from studies across national borders. SUMMARY: The current framing of suicide as a public health and mental health problem, amenable to biomedical interventions has stifled seminal discourse on the subject. We need to jettison this tunnel vision and move on to a more inclusive approach.

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma.

Background: Gender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them. Methods: This paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design. Results: Key themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit. Conclusions: While findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who "understand," and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities.

Men's Experiences of Mental Illness Stigma Across the Lifespan: A Scoping Review.

The stigma of men's mental illness has been described as having wide-reaching and profound consequences beyond the condition[s] itself. Stigma negatively impacts men's mental health help-seeking and the use of services amid impeding disclosures, diminishing social connection and amplifying economic hardship. Although men often face barriers to discussing their struggles with, and help-seeking for mental illness challenges, research focused on men's lived experiences of mental illness stigma is, at best, emergent. This scoping review explores men's mental illness related stigmas synthesizing and discussing the findings drawn from 21 published qualitative articles over the last 10 years. Four thematic findings were derived: (a) the weight of societal stigma, (b) stigma in male-dominated environments, (c) inequity driven stigmas, and (d) de-stigmatizing strategies. Despite evidence that stigma is a common experience for men experiencing diverse mental illness challenges, the field remains underdeveloped. Based on the scoping review findings, research gaps and opportunities for advancing the field are discussed.

Occupational exposure to suicide: A review of research on the experiences of mental health professionals and first responders.

Exposure to suicide is a major factor for suicidality. Mental health professionals and first responders are often exposed to suicide while on-duty. The objective of this scoping review is to describe the state of current research on exposure to suicide among mental health professionals and first responders, focusing on the prevalence and impact of exposure to suicide, and to identify current gaps in the literature. We searched MEDLINE, Scopus, PsychNET, and Web of Science and identified 25 eligible papers. Between 31.5-95.0% of professionals had been exposed to suicide. Exposure to suicide had impacts on personal life, professional life, and mental health; and caused emotional distress. There was little research investigating exposure to suicide among police officers, firefighters, and paramedics. More research existed on mental health professionals, but none assessed exposure to suicide as a risk for suicide amongst this group. The review concludes that exposure to suicide is distressing for mental health professionals, and likely to be for first responder however, more research on these groups, especially paramedics, is required.

Young People's Perspectives and Understanding of the Suicide Story in 13 Reasons Why.

Background: The Netflix drama 13 Reasons Why (13RW) focusing on the suicide of an adolescent girl became a global phenomenon. It was accompanied by intense public debate about the risks of exposing youth to fictional portrayals of adolescent suicide. Aims: To explore adolescents' subjective perspectives and understanding of 13RW focusing on the portrayal of adolescent suicide. Method: We applied a thematic analysis to qualitative data from interviews with 25 New Zealand adolescents eliciting views on the show's portrayal of adolescent suicide. Results: Four themes were developed from the analysis: entertaining but not realistic; the unexpected shock factor; jumbled messages; and superficial conversations. Conclusion: This study contributes a youth perspective which has been missing from the debate on 13RW. This research highlights the way that youth, when given the opportunity, articulated a nuanced understanding of the representation of adolescent suicide in 13RW, viewing it as entertainment rather than a realistic depiction that added little in terms of suicide awareness and generated minimal opportunities for in-depth discussion.

Suicide and self-harm content on Instagram: A systematic scoping review.

Given concerns about suicide or self-harm content on Instagram, we conducted a systematic scoping review of peer-reviewed English language primary studies published between 2010-2019. Only ten studies had been published. Looking into purposive samples of Instagram posts tagged with self-harm related hashtags, studies report finding self-harm or suicide content in between 9-66% of their studied posts. Studies assessing Instagram's efforts to tackle such content found they had not been very effective. Despite heterogeneity in study aims, use of terminology, samples, methods of analysis, and study outcomes, we aggregated and distinguished 'content studies' and 'user studies'. Most studies showed concern for self-harm risk, but only one examined the relationship between self-harm posts and actual self-harm behaviours offline. It found such content had negative emotional effects on some users and reported preliminary evidence of potential harmful effects in relation to self-harm related behaviours offline, although causal effects cannot be claimed. At the same time, some benefits for those who engage with self-harm content online have been suggested. More research directly interviewing Instagram users to understand this phenomenon from their perspective is required. Finally, some ethical issues are discussed.

Masculinity, Social Connectedness, and Mental Health: Men's Diverse Patterns of Practice.

Men's mental health has remained undertheorized, particularly in terms of the gendered nature of men's social relations. While the importance of social connections and strong supportive networks for improving mental health and well-being is well documented, we know little about men's social support networks or how men go about seeking or mobilizing social support. An in-depth understanding of the gendered nature of men's social connections and the ways in which the interplay between masculinity and men's social connections can impact men's mental health is needed. Fifteen life history interviews were undertaken with men in the community. A theoretical framework of gender relations was used to analyze the men's interviews. The findings provide rich insights into men's diverse patterns of practice in regards to seeking or mobilizing social support. While some men differentiated between their social connections with men and women, others experienced difficulties in mobilizing support from existing connections. Some men maintained a desire to be independent, rejecting the need for social support, whereas others established support networks from which they could actively seek support. Overall, the findings suggest that patterns of social connectedness among men are diverse, challenging the social science literature that frames all men's social relationships as being largely instrumental, and men as less able and less interested than women in building emotional and supportive relationships with others. The implications of these findings for promoting men's social connectedness and mental health are discussed.

Do changes in social and economic factors lead to changes in drinking behavior in young adults? Findings from three waves of a population based panel study.

BACKGROUND: Social and economic measures in early childhood or adolescence appear to be associated with drinking behavior in young adulthood. Yet, there has been little investigation to what extent drinking behavior of young adults changes within young adulthood when they experience changes in social and economic measures in this significant period of their life. METHODS: The impact of changes in living arrangement, education/employment, income, and deprivation on changes in average weekly alcohol units of consumption and frequency of hazardous drinking sessions per month in young adults was investigated. In total, 1,260 respondents of the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE) aged 18-24 years at baseline were included. RESULTS: Young adults who moved from a family household into a single household experienced an increase of 2.32 (95% CI 1.02 to 3.63) standard drinks per week, whereas those young adults who became parents experienced a reduction in both average weekly units of alcohol (ß = -3.84, 95% CI -5.44 to -2.23) and in the frequency of hazardous drinking sessions per month (ß = -1.17, 95% CI -1.76 to -0.57). A one unit increase in individual deprivation in young adulthood was associated with a 0.48 (95% CI 0.10 to 0.86) unit increase in average alcohol consumption and a modest increase in the frequency of hazardous drinking sessions (ß = 0.25, 95% CI 0.11 to 0.39). CONCLUSIONS: This analysis suggests that changes in living arrangement and individual deprivation are associated with changes in young adult's drinking behaviors. Alcohol harm-minimization interventions therefore need to take into account the social and economic context of young people's lives to be effective.

Do changes in socioeconomic factors lead to changes in mental health? Findings from three waves of a population based panel study.

BACKGROUND: There has been little investigation of changes in socioeconomic measures and mental health (MH)/illness over time within individuals using methods that control for time-invariant unobserved confounders. We investigate whether changes in multiple socioeconomic measures are associated with self-reported MH using fixed effects methods to control for unobserved time-invariant confounding. METHODS: Data from three waves of a panel study with information on MH, psychological distress, labour force status, household income, area and individual deprivation. Fixed effects regression modelling was used to explore whether changes in socioeconomic exposures were associated with changes in MH. We also compared increases and decreases in exposure with changes in MH using first difference models. RESULTS: Respondents who moved into inactive labour force status experienced a 1.34 unit (95% CI -1.85 to -0.82) decline in SF-36 MH score and a 0.50 unit (95% CI 0.34 to 0.67) increase in psychological distress score. An increase in individual deprivation was associated with a 1.47 unit (95% CI -1.67 to -1.28) decline in MH score and a 0.57 unit (95% CI 0.51 to 0.63) increase in psychological distress. Increasing and decreasing levels of individual deprivation were associated with significant changes in both outcomes. CONCLUSIONS: This paper suggests that moving from employment to inactivity and changes in levels of individual deprivation may be more important for short-term MH outcomes than changes in household income or area deprivation. Providing short-term social and economic support for those experiencing financial/material hardship should be considered in interventions to reduce inequalities in MH.

Does transition into parenthood lead to changes in mental health? Findings from three waves of a population based panel study.

BACKGROUND: Longitudinal studies specifically looking at the transition into parenthood and changes in mental health in the general population are scarce. This study aimed to investigate the impact of transition into parenthood on mental health and psychological distress using longitudinal survey data. METHODS: The analysis used three waves from the longitudinal Survey of Family, Income and Employment. Parenthood was classified as first time parent (first and only child <12 months at interview date), subsequent parent (child <12 months and other children in the family), existing parent (no children <12 months but other existing children in the family) and not a parent. We used fixed effects generalised linear modelling, controlling for all time-invariant and time-varying sources of confounding in a sample of 6670 adults within families. RESULTS: After adjusting for confounding from time-varying partner status, area deprivation, labour force status and household income, those who became first time parents reported an increase in mental health (ß 1.22, 95% CI -0.06 to 2.50; mean=83.8, SD=14.1) and a decrease in psychological distress (ß -0.70 95% CI -1.10 to -0.29; mean=13.4, SD=5.0). Subsequent parents reported a decrease in psychological distress (ß -0.60 95% CI -0.95 to -0.24). CONCLUSIONS: Our findings suggest that a transition into parenthood for the first time leads to changes in mental health and psychological distress. Understanding the relationship between becoming a parent and mental health outcomes is important given that parental mental health is integral to effective parenting.

Differential loss of participants does not necessarily cause selection bias.

BACKGROUND: Most research is affected by differential participation, where individuals who do not participate have different characteristics to those who do. This is often assumed to induce selection bias. However, selection bias only occurs if the exposure-outcome association differs for participants compared to non-participants. We empirically demonstrate that selection bias does not necessarily occur when participation varies in a study. METHODS: We used data from three waves of the longitudinal Survey of Family, Income and Employment (SoFIE). We examined baseline associations of labour market activity and education with self-rated health using logistic regression in five participation samples: A) the original sample at year one (n=22,260); B) those remaining in the sample (n=18,360); C) those (at year 3) consenting to data linkage (n=14,350); D) drop outs over three years (n=3,895); and E) those who dropped out or did not consent (n=7,905). RESULTS: Loss to follow-up was more likely among lower socioeconomic groups and those with poorer health. However, for labour market activity and education, the odds of reporting fair/poor health were similar across all samples. Comparisons of the mutually exclusive samples (C and E) showed no difference in the odds ratios after adjustment for sociodemographic (participation) variables. Thus, there was little evidence of selection bias. CONCLUSIONS: Differential loss to follow-up (drop out) need not lead to selection bias in the association between exposure (labour market activity and education) and outcome (self-rated health).

Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

BACKGROUND: Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood. METHODS: Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation. RESULTS: Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects. CONCLUSIONS: This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.