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The Scope of the Problem
It is estimated that around 50 percent of suicides, or attempted suicides, occur during a period of depression. Although most attempts at suicide occur in people under the age of 35 a further spike in rates of depression occurs in the elderly. The warning signs of depression in older men are frequently overlooked despite the fact that many reach out for help in the very week they take their own lives.
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Spotting the Signs
The symptoms of depression are no different in men than they are in women but there is an increasing realization that men may express depression in different ways, or hide it altogether. Older men present a particular problem in that most are of a generation where terms such as stress and depression simply don’t factor into their consciousness. Older men especially are more strongly socialized into what it means to be a man. The resulting focus on independence, strong-mindedness and independence are issues that may block depression being acknowledged or spotted by others.
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For many older men the cause of depression may be cumulative. From a position of being the primary wage earner, perhaps with associated status and influence, the decline towards depression may start as early as retirement. The change from work to retirement can be dramatic. Income is often reduced and social events associated with work either gradually diminish or stop entirely. Age is commonly associated with health problems and mobility issues and as people age they gradually watch friends and former colleagues die. Any or all of these factors can contribute to depression.
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Clues to Depression
Many older men have no real concept of what it means to be depressed. There are however physical, emotional and behavioral clues to their state of mind. Complaints about aches, pains, stomach upsets, backache, etc are often associated with depression. Unfortunately these same symptoms are associated with conditions frequently encountered by people as they age. Effectively these physical symptoms may mask the psychological symptoms unless the doctor regards these as clues to depression and specifically probes for more information. Emotional symptoms will be no different to those commonly associated with depression. Sadness, irritability, pessimism, problems with concentration and thoughts of death or suicide are some of the more common symptoms.
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The Behavior of Depressed Men
Although there is a degree of overlap in the behavior of men and women who are depressed it remains the case that men are far less likely to seek help from a doctor. In some cases it appears men do recognize their symptoms as depression but, for various reasons, choose not to act. They may, for example, regard depression as something that really only affects women. They may fear the stigma associated with the condition. They may not regard depression as a proper illness and avoid seeing the doctor because of this. Subsequently, men may engage in avoidance tactics such as drinking alcohol. They may stop exercising, socializing, and eating properly.
Depression in older men is neither natural nor inevitable. The denial of depression and reluctance to seek help can make spotting the warning signs of depression in older men a difficult task. However, by stepping back and looking at the bigger picture of isolation, loneliness, illness or other problems associated with age, the signs are there to alert people to dig a little deeper.
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Hammen, C & Watkins, E (2008) Depression (2nd Ed) Psychology Press.
National Alliance on Mental Illness (NAMI) Depression in Older Persons Fact Sheet. http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515
Penninx, B (et al) (1999) Minor and Major Depression and the Risk of Death in Older Persons. Arch Gen Psychiatry.56:889-895.