Depression and Anxiety
BY Frank Spinelli, M D
September 15 2010 2:00 AM ET
Depression affects six million men in the United States. Although it has been noted that men are less likely to be affected by depression than women, studies suggest that men are less inclined to complain about it to their doctors. Several large surveys suggest a higher prevalence of psychiatric disorders among gay men. Conversely, the suicide rates in men are four times higher than in women; however, women attempt it more often.
There is a debate concerning whether gay men on the whole suffer from depression more than their heterosexual counterparts. The fact is that gay teenagers are more likely to suffer from depression due to the stress of “coming out,” while others struggle with discovering their sexuality, knowing that they are “different” from their peers.
Adolescent gay men even have higher rates of suicide. Likewise, many adult gay men struggle with the complex issue of “coming out” and the apprehension over being a societal anomaly. In the HIV community, mental illness is a frequent issue, most often due to the debilitating nature of the disease, but also due to the battle in coming to grips with the diagnosis. Reports suggest that the rates of major depression, bipolar disorder, and obsessive compulsive behavior in HIV- positive patients can be as high as 54 percent. Other studies have shown that untreated depression can even increase the progression to AIDS in this population.
A recent report by the American Journal of Psychiatry found that there were indeed higher rates of depression in gay men than in the general population. As a result, gay men are more likely to engage in high-risk sexual behavior and to abuse alcohol and drugs with more frequency. Inadequate social support, internalized homophobia, shame over not meeting cultural standards, and cultural insensitivity were cited as some of the many reasons that gay men fall prey to depression.
The World Health Organization categorizes depression into typical, mild, moderate, or severe episodes. Patients with depression may suffer from low energy, decreased activity, and depressed mood. Often there is a diminished capacity for enjoyment and interests. Concentration is reduced, and there can be marked lethargy even in performing minimal tasks. Depressed men complain about disturbed sleep patterns in which they either sleep too much or suffer from insomnia. Appetite is usually affected in much the same way, with patients complaining that they eat too much or too little. Usually the depressed male expresses feelings of low self- worth, lack of self- esteem, and diminished self-confidence. Men with prolonged depression describe a sense of utter worthlessness and associated guilt. Moods can vary from one day to the next and are often accompanied by “somatic” complaints, such as body aches and pains. One of the most striking complaints for gay men is a loss of sexual interest and pronounced erectile dysfunction.