Understanding anxiety in men

Fisher, K., Seidler, Z. E., King, K., Oliffe, J. L., & Rice, S. M. 2021. Men's anxiety: A systematic review. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2021.08.136

Anxiety disorders are the most common form of mental illness in Australians, affecting 3.3 million people annually. The number of Australians who experience depression is fewer than half of that. According to the Australian Bureau of Statistics, 12.4% of males aged 16 years and over experienced anxiety over a period of 12 months during 2020-21, with prevalence highest in young males (21.4% of 16-24-year-olds) and declining with age (to 4.5% in 75-84-year-olds). Anxiety is the second greatest cause of years lived with disability for Australian men, and costs our economy tens of billions of dollars annually.

Despite its greater prevalence, less is known about the effects of anxiety on men than is known about depression.

A recent systematic review of available evidence (“the first synthesis of the literature on men’s anxiety”) suggests that anxiety manifests differently in men than in women. Although the underlying studies vary in the methods used to assess anxiety and were mostly performed using groups of young Caucasian men, the review begins to provide insight into how anxiety is experienced by men.

Young men report more physical symptoms of anxiety (e.g., sweaty hands, tachycardia, dizziness, headache, loss of appetite), and are less likely to experience symptoms of internalised sadness, social disruption and interpersonal distress that are more common in females. Similarly, internalised symptoms of depression are more common for women than men, who are more likely to experience externalising symptoms². Males’ greater experience of somatic symptoms, and feelings of not being in control of their anxiety, echo similar reports from men with depression.

Men with anxiety prefer self-reliance and informal support to formal help-seeking and use problem-based coping strategies (i.e., facing problems and confronting stressful situations rather than avoiding them) to manage their anxiety. This approach seems effective: those who use problem-based coping tend to have less severe anxiety. Even more encouraging is that the review mentions effective interventions for reducing anxiety, based on helping to improve coping skills¹.

The stigma of anxiety – specifically the perception that it reflects weakness – is a barrier to men seeking help. However, stigma may not be attached to help-seeking for severe anxiety, perhaps reflecting an understanding that these symptoms indicate legitimate illness for which assistance is required.

When men seek help for anxiety, they want ‘informal’ services they can access immediately and confidentially, that normalise their anxiety in the context of their health more generally.

The review deliberately examines the role of masculinity in men’s experience of anxiety, and it is complex. Generally, adherence to the masculine norm of toughness (maintaining an air of confidence, determination and self-reliance) is protective against anxiety, whereas restrictive emotionality and overt heterosexual presentation are associated with increased levels of anxiety.

The picture emerges of traditional masculine norms promoting problem-based coping and enabling self-management of anxiety, which may be effective up to a point. If problems cannot be overcome, traditional masculine norms may prevent men seeking help from others. Also, gender role discrepancy is associated with greater social anxiety, and anxiety itself can feel emasculating. Both of these scenarios suggest the prospect of a self-perpetuating cycle of conflict between men’s masculinity and their anxiety.

It is clear that anxiety presents in diverse ways among men but the review by Fisher et al. included “no qualitative investigation into men’s description and perspective of their subjective experiences of anxiety symptoms and coping strategies. In comparison, more than 20 qualitative studies have been undertaken to identify and investigate men’s experiences of depression”. Hence, we know far too little about anxiety in men, which hinders our ability to help them.

Given the high prevalence of anxiety in Australian males, and its extraordinary cost, we need to learn, and do, much more to deal with it.