South African men’s experiences of depression and coping strategies

Abstract

Major Depressive Disorder is regarded as a major contributor to the global burden of disease. It is considered as the fourth highest cause of disability across the globe and second highest between the ages of 15 and 44. It is a serious mental health condition that affects individuals’ physical and mental health and is often associated with comorbidities, functional impairment and at times fatal consequences. Men with depression are considered as an at-risk group as research has shown that males are less likely to receive intervention or health care compared to women, due to hegemonic masculine norms. Within the qualitative research community, some efforts have been made to give voice to men’s experiences of depression and help-seeking, as well as the coping strategies that they deploy to manage such symptoms. However, comparatively little to no research has focused on the South African population, and specifically on Black men’s experiences. Similarly, only a few studies have concentrated on the positive, helpful and/or adaptive coping strategies used by men to manage their internal distress. Thus, this study contributed to a growing body of knowledge and filled a gap in current literature.

This research was qualitative in nature and deployed Braun and Clarke’s (2006) six-phase framework for conducting a thematic analysis, in order to analyse the eight individual interviews conducted. The analysis produced various themes and subthemes that elucidated the experiences of masculinity, depression, help-seeking and coping mechanisms among Black men in South Africa. The three overarching themes included: Real men don’t cry; Sadness hurts, but sharing hurts more; and Dark days, take control; all of which were related to several subthemes. The analysis indicated that Black men in South Africa do experience depressed moods and internal distress. However, they may deny such experiences due to their subscription to strength-based masculine ideals. They instead foster a mask of indifference to such pain by denying or supressing their emotions in order to assimilate into masculine norms. This was even more apparent in Black African cultures where hegemonic masculine norms were further entrenched and encouraged. Furthermore, public and self-stigma were commonly cited as a reason why the men in the study felt the need to uphold this image of indifference and keep subscribing to such dogmas.

This translated into the men’s experiences and attitudes towards help-seeking, where they would often reject or be reluctant to disclose their emotional distress to professionals or to those closest to them. This was due to the perception that help-seeking is in line with femininity, which diverts/shifts away from the masculine ideals they sought to uphold. Another aspect introduced was how these concepts intertwined with Black African cultures. Namely, it may be more difficult for Black men in South Africa to openly express their experiences of depression or seek help psychologically, as these are Westernised terms and are uncommon in Black communities. However, a more traditionally accepted help-seeking route was to go to a traditional healer or Sangoma. Considering the men’s overall reluctance to seek help, they engaged in coping strategies in order to manage depressed feelings, as this was more in line with the masculinity expectations of autonomy, unemotionality and problem solving. Negative coping mechanisms were seen as a celebrated and normalized way for men to numb or supress their emotional distress, while still enacting masculinity. Lastly, although positive coping strategies were posited as a way for men to directly engage in distressful emotions, this was more difficult to adopt as they were perceived to be aligned with more feminine traits.

This research created a framework that can be used to conceptualise Black South African men’s experiences of depression, help-seeking and coping strategies. This research is of utmost importance considering that men are noted to be more likely to experience functional impairments or fatal consequences due to their reticence for help-seeking. As such, men and future public health messaging could capitalise on this research in order to improve help-seeking and self-management behaviour amongst this population. This is particularly relevant considering our current context of the COVID-19 global pandemic.

Keywords: Major Depressive Disorder, South African men, help-seeking, coping strategies, and qualitative thematic analysis.