Major depressive disorder (MDD) is a leading cause of disability worldwide.1 Depression is associated with high rates of medical and psychiatric comorbidity,2 poor physical health and functioning,3 and increased risk of suicide.4 Lifetime prevalence estimates of MDD range from 14% to 17% in the United States (U.S.).5,6 African Americans, compared with White Americans, have slightly lower prevalence estimates of lifetime MDD. However, African Americans have depressive episodes that are more disabling, more persistent, and more resistant to treatment relative to their White counterparts.7
There are consistent gender differences in the prevalence and treatment of MDD. Women are twice as likely to be diagnosed with depression compared with men.5,6 Paradoxically, men in the U.S. are up to four times more likely than women to commit suicide.8–10 Men, regardless of their race/ethnicity, have lower rates of mental health service utilization for a myriad of stressful life events compared with women.11,12 Traditional masculinity norms contribute to men’s under-utilization of health care services.13 Men are encouraged to “tough out” illness for as long as possible.14 [p. 155] Seeking mental health treatment is perceived by many men to conflict with traditional gender norms.15
In light of this gender paradox,16 the National Institute of Mental Health launched a nationwide public education campaign, Real Men Real Depression, in April 2003.17 This initiative was the first large-scale community mental health campaign in the U.S. that specifically sought to raise awareness about depression among men.18,19 Despite increased outreach over the last decade, depressed African American men are significantly less likely to seek help compared with depressed White men.20 Woodward et al.21 recently examined national treatment rates of African American men with a lifetime mood, anxiety, or substance use disorder. Just 14% of men received care from professional mental health services compared with 29% who did not seek any help.21 The paucity of studies focused on this population is a serious public health concern, as evidenced by the rise in completed suicides among young African American men since the 1980s.
