Table 2 Coding tree
Theme | Code | Subcode | Quantity | Examples | |
|---|---|---|---|---|---|
Person | Quote | ||||
MHPsʼ description of male patients | The “typical” man | Behaviour | 11 | 19 | “reserved” |
Appearance | 1 | 1 | “bald head”, “beard”, “rather muscular” | ||
Attributes | 18 | 25 | “man of action” | ||
Cultural background | 9 | 9 | “If someone comes from Turkey or from Afghanistan, then mental illness is very taboo, you can’t have that there.” | ||
Formal education | 2 | 2 | “But [men who are, M.S.] somehow simply structured, and poorly educated; in the beginning, they tend to only scratch the surface.” | ||
Urban/rural area | 5 | 6 | “I would guess, until people who live in rural areas can admit to themselves that they are sick, I think this will take much longer. Because everyone knows everyone.” | ||
Age/generation | 14 | 24 | “So particularly the older generations, these men are doers. And they do. And they get through it.” | ||
The “non-typical” man | Behaviour | 5 | 9 | “talkative”, “unsure”, “afraid”,“passive”, “shy” | |
Appearance | 1 | 2 | “long hair”, “weedy” | ||
Attributes | 7 | 15 | “softy”, “to be led by one’s head”, “wimp” | ||
Cultural background | 1 | 1 | “If someone comes from Sweden or Denmark, then it’s a similar context to ours.” | ||
Formal education | 7 | 8 | “[...] with an academic who’s depressed, he’s got a little more access to his emotional world.” | ||
Urban/rural area | 1 | 1 | “It is probably easier for people in the city to seek treatment.” | ||
Age/generation | 8 | 11 | “And the younger they are, the more open they are somehow.” | ||
No gender variation | 14 | 26 | “This is also very dependent on the individual. I think it depends on the make-up of their families.” | ||
MHPsʼ theory of illness | Mental illness in media and society | 14 | 25 | “Football coaches also get burnout and depression; football players too. And I believe that society has come to accept that people do not have limitless resilience.” | |
Normative superstructure | Change in society leads to overload | 4 | 5 | “That this may well cause problems, in modern or postmodern times, to find oneself in a role or in multiple roles, and because of much higher demands and choices, the risk of failure is much greater.” | |
(successful) employment expected | 14 | 19 | “It is simply a reflection of societal attitudes that men are still expected to be employed and to want to be employed, so to speak.” | ||
Depression is related to weakness/failure | 10 | 14 | “I’m big, I’m strong, I take care of others. I can do anything, I’m a somebody. I’m not sick. I’m not allowed be sick. I am the strong one.” | ||
Reason / occasion of depression | Missing/poor coping strategies | 17 | 30 | “And they just escape, at least that’s my experience, often into drugs or alcohol.” | |
Personality | 10 | 18 | “And these are also more likely men who normally present as strong personalities, and perhaps also with narcissistic elements.” | ||
Socialisation | 17 | 36 | “These are often defining childhood experiences; the family situation during childhood and youth, the parents as role models or supporting caregivers.” | ||
Family burden | 12 | 13 | “Or that they are overwhelmed by their family situations.” | ||
working conditions | 30 | 74 | “A frequent problem tends to be the workplace, with excessive demands in their job and the threat of job loss or being humiliated in the workplace.” | ||
Relationship problems | 19 | 32 | “In my experience with men, family problems in particular crop up again and again as well; following separation, and also during a divorce, many men develop a depressive episode.” | ||
Biological factors | 7 | 10 | “In my opinion, they are either actually genetically determined, i.e. hereditary gene structures.” | ||
Admission into the mental health care system | Late initiation of treatment | Crisis situation | 30 | 57 | “And then because of all the overload at work and so on and then, yes, at some point, collapses.” |
Burden of dependents | 6 | 10 | “The burden of the women concerned is already very high. When they send the men to us.” | ||
Suicidality | 10 | 19 | “[…] they wait as long as they become suicidal, afterwards they will arrive at the hospital and even that often not voluntary.” | ||
precondition | Insufficient knowledge | 10 | 20 | “So I think that very few people say that they have depression, because they have no idea what [that] actually means. So they don’t know what it is.” | |
Poor self-perception | 14 | 17 | “And the man hasn’t even noticed what’s been going wrong all these months and years.” | ||
Do not deal with mental issues | 17 | 29 | “And so men go somewhere with their buddies and of course emotions are rarely a topic of conversation.” | ||
Self-attribution of men | Accept help is related with weakness | 22 | 41 | “And to be able to manage things by yourself, otherwise you’re not a really a grown man.” | |
Maintain self-worth | 11 | 17 | “And this [sense], if they are not needed, because they can’t do it any more, this means they quickly develop the feeling that they are no longer needed and worthless.” | ||
Sense of responsibility | 15 | 20 | “[...] In terms of the family situation – have situations begun to develop where they also have obligations, [where] they have to do what is expected, you know?” | ||
Stigma/ predjudices | 10 | 21 | “What would the village say if I was in a madhouse?” | ||
Structural barriers | Concern about future career | 22 | 37 | “Is he going to lose his position or his leadership position in the company? Because he has this condition, because it’s a condition that doesn’t persist for 2 weeks, but often lasts 10 or 12 weeks, and then they go to rehab and of course they become afraid of loss.” | |
Knowledge of GPs | 4 | 5 | “Well, perhaps not all GPs are up to date on depression. And perhaps we have to think about what are, I would say specific, if there are any specific male symptoms that can be indicative of depression.” | ||
Intrinsic motivation | To function | 6 | 6 | “So, to recover just to be able to function again – that’s the main desire.” | |
Partner/family | 7 | 7 | “[…] that you’d say, I want to do that for the sake of my family, or I want to continue to support my children and just want to be healthy for them.” | ||
Pension request | 6 | 8 | “[…] perhaps even a type of man who accepts this diagnosis very well or even desires it; these are people who are for example in their 50s or early 50s and have difficulties getting back into the job market and want a pension plan.” | ||
External motivation | General practitioner | 7 | 9 | “So, patients are often sent by their GP. Both men and women. GPs are often the first point of contact, […] and many patients first go to their GP as someone they can trust.” | |
Colleagues & friends | 2 | 2 | “Then perhaps friends do it, or perhaps colleagues do it, if they react well.” | ||
Family | 14 | 18 | “So I guess if there’s a family that works reasonably well, then it’s likely that the partner or perhaps the parents or parents-in-law will say at some point that enough is enough. Now you have to do something about it.” | ||
MHPsʼ views of male patients’ expectations | Expectations | Short treatment duration | 12 | 18 | “‘Short and quick’ has been said to me.” |
Complete recovery | 7 | 7 | “So men do expect this kind of complete recovery.” | ||
Medication | 7 | 10 | “And then it’s just clear, okay, it has to be medication.” | ||
Psychotherapy | 2 | 4 | “So because with the psychotherapeutic conversations many men somehow… then they would have to actually say something about themselves and so on.” | ||
Approaches | Sceptical about treatment | 6 | 7 | “And then they ask what the point is and say that they think they’re not making any progress.” | |
Mechanical thinking | 8 | 16 | “You flip a switch and then you’re fine again.” | ||
Solution-oriented | 8 | 10 | “They say ‘What should I do? I’ll do it’.” | ||
MHPsʼ mental health treatment aims | Psycho-education | 23 | 57 | “But an explanatory model is therefore very important. So, clarification and an explanatory model: why do I have this and what is it exactly?” | |
Social environment | 3 | 3 | “So then I always try to make contacts.” | ||
Normalisation | 18 | 27 | “So, anything that brings a bit more stability somehow, a bit more insight into the situation as a whole, yes, that it is simply… that it is normal and that it can happen.” | ||
Distance oneself & Self-perception | 4 | 9 | “What I think is important is that I need to learn to distance myself if it concerns my health. In which situations am I overwhelmed? Or in which situations do I always continue to function but should start to say, Stop, stop, this far and no further?” | ||