Cultural and religious barriers make it harder for patients to be correctly diagnosed, especially given depressed men are less likely to acknowledge feelings of self-loathing and hopelessness.
Men’s health is in crisis around the world. It’s one of the few things men have in common - regardless of their nationality, ethnicity, age, or even whether they have access to healthcare or not.
The best measure of this is life expectancy. Globally, men live four and a half years less than women. And it’s not just the length of their lives that is affected by their gender; it’s also how healthy they are whilst they are alive.
Everything from prostate cancer to eating disorders and male obesity is rising amongst men around the world. However, it’s in the mind, not the body, where men are really struggling. Suicide is still the leading cause of death among young men in many countries around the world.
The crisis in men’s health in general - and mental health in particular - is one of the few constants in the many different environments that I have practised medicine. From London to Lesvos and Birmingham to Baghdad, men have conditioning which worsens their problems, especially when it comes to depression.
Ideals of traditional masculinity - of being stoic or even emotionless - are not going away, particularly in the Global South. But maintaining these norms can amount to self-harm when men are dealing with social upheaval, economic crisis - or worse.
This is decidedly more common in Muslim communities; both in Muslim diasporas in Europe and North America as well as in Muslim-majority countries. Cultural and religious barriers make it harder for patients to be correctly diagnosed, especially given depressed men are less likely to acknowledge feelings of self-loathing and hopelessness.
Instead, their depression symptoms are different; rather than complaining of feeling low, they commonly complain of fatigue, irritability, sleep problems or loss of interest in work and hobbies. They’re also more likely to experience symptoms such as anger, aggression, reckless behaviour and substance abuse. These are all behaviours that are over-represented in male populations, including in the Muslim world. There is an iceberg of depression out there, and healthcare professionals can barely see the tip.
More than ever, it is imperative that health services in Europe create culturally appropriate clinical settings where these invisible patients feel comfortable to seek treatment. This is particularly important in countries like Germany where large refugee communities are likely to be harbouring a plethora of mental health issues, but this evolution is also essential in states like Britain and France who have large native-born Muslim communities.
And the EU must fund and support the rolling out of these services around the world, particularly in places like Turkey, Jordan and Lebanon which now host millions of refugees. The knowledge on how to apply agreed upon medical methods in those challenging environments already exists. I worked on a fellowship in refugee medicine that has since been adopted by the UN to assist with the Rohingya Crisis. But the funding to make that accessible everywhere is still lacking, particularly as institutions such as the UN and WHO are dealing with other challenges.
Until that happens, perhaps a low-cost alternative is to train a wide range of (medical and non-medical) staff to spot the signs of depression in their friends, colleagues or even strangers. I have mentioned some earlier but other signs of depression include things that may at first appear as normal life fluctuations; loss of interest in daily activities, changes in appetite or weight, altered sleep patterns, or even something difficult to pin down like difficulty focussing and concentration problems.
If we can make those small changes, whilst involving community and religious leaders, we can address the existing issues head on and finally dispel the taboos, truly supporting communities with their health needs.
And those needs are shockingly similar amongst men; whether they are bankers in London, refugees in Iraq or anything in between.
Dr Mohammedabbas Khaki was recently voted a top 50 GP Doctor. He is a Senior Associate at the General Medical Council and a Trustee of Who is Hussain, a UK-based charity active in 92 cities across six continents.
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