Psychosocial well-being is important to men, and many conditions or situations can disrupt the sense of well-being. Among the more common factors that can have a negative effect on well-being for both sexes are everyday stressors (positive as well as negative), personal conflicts, traumatic events, and depression. In general, men lack the social support and interpersonal relationships that help women to cope with stresses [1]. Because of this, men differ in their ability to handle stress, with many men resorting to anger, violence, and substance misuse to deal with stress or depression [2,3]. As a result, stress/anger, substance misuse, and depression are among the psychosocial conditions with the most serious health implications for men. Most men will not seek help for psychosocial disorders and may not recognize the symptoms of depression [3,4,5]. Thus, it is important for healthcare providers to address psychosocial well-being and potential threats to well-being as part of routine health evaluations of men.

Safety is also of concern, as anger has been associated with an increased incidence of injuries and violence. In one study, higher levels of anger (at a given moment) were associated with an increased risk of injury, especially in men [10]. In that study, nearly 32% of individuals who had been injured reported having some degree of irritability before the injury.

As noted, substance misuse is higher among men than among women in all age categories, and men are more likely to have psychosocial problems related to the misuse [2,11]. Although the rate of alcohol misuse is highest among younger men, men older than 65 years of age are of special concern because they are much more likely than women to be "problem" drinkers and to misuse a wide range of illicit as well as prescription drugs [11]. As the general population ages, the misuse of illicit drugs is expected to increase [18]. Adding to this problem is the low rate of screening for alcohol misuse in the older population and the secrecy of many men about drug use [18,19].

Additional concerns are the use of anabolic steroids among adolescents and young adult men and the use of methamphetamine among MSM. Use of anabolic steroids begins during the teenage years in approximately 25% of cases, and about 10% of all users are teenagers [20]. The prevalence of methamphetamine use among MSM is approximately 10% to 20%, a rate that is 10 times higher than that in the general population [21].

Several professional organizations, including the USPSTF, recommend screening and behavioral counseling intervention to reduce alcohol misuse [22]. However, reported rates of screening have been low [23]. Several screening instruments have been developed, and they vary in the number of questions, the populations for which they are best suited, and their usefulness in specific situations; no one tool is perfect [24,25,26,27]. The CAGE questionnaire, which includes four questions, is best for detecting alcohol dependency and is easy and quick to perform [24,25]. However, the test may not detect low, but risky, levels of drinking [11,28]. The Alcohol Use Disorders Identification Test (AUDIT) is the most accurate for detecting problem drinking [23,26].

Despite the lower rates of depression in men compared with women, the rate of completed suicide is nearly four times higher for men (25.8 vs. 7.1 per 100,000) [35]. Suicide is a leading cause of death for men in many age groups and across all racial/ethnic populations, except for the Black population [35]. There is some evidence that loneliness, while experienced by both men and women with depression, may be a stronger predictor of suicidal ideation among younger men than other demographic groups [36]. Researchers have hypothesized that feeling understood and loneliness likely function as serial mediators rather than as parallel mediators. In essence, the positive effect of disclosure of distress and feeling understood on depression and suicidality scores may be explained through loneliness measures [37].

Many patient-related factors in the underdiagnosis of depression are primarily related to gender issues, including [2,3,33,38,42,43]:

Because men are less likely to express their emotions, they may recognize and discuss only the physical symptoms of depression, making diagnosis a challenge [3,5,42]. A carefully taken history can elicit information about risk factors, which include a family history of depression, the use of some medications (beta blockers, histamine H2-receptor antagonists, benzodiazepines, and methyldopa), chronic illness or other comorbidity, lack of social support, recent life stressor, and single marital status [11,44]. Substance misuse frequently occurs concomitantly with depression, more often in men than women, but the direction of the causal relationship is not clear [3,44].

Many of the symptoms of depression reported by women are the same for men: depressed mood, changes in appetite and sleep habits, problems with concentration, and an inability to find pleasure in once pleasurable activities [3]. It has been proposed that the symptoms of depression in men represent a male depressive syndrome, characterized by such symptoms as irritability, acting-out, aggression, low tolerance of stress, low impulse control, tendency to blame others, and a greater willingness to take risk [2,3,38,42]. Men with depression may thus present with a very different symptom profile [33].

The treatment approach will depend on the severity of symptoms and the patient's preference. In general, a combination of psychotherapy and pharmacologic management provides the best results for most men [33,44]. Potential psychotherapy approaches include cognitive behavior therapy and interpersonal psychotherapy [3,11,33]. First-line pharmacologic treatment involves the use of selective serotonin reuptake inhibitors, such as paroxetine, sertraline, and fluoxetine [11]. This treatment approach has efficacy rates of 30% to 70% [33]. Clinicians should emphasize the importance of taking the medication as prescribed, as it may be two to four weeks before a benefit is evident [33]. Depression that is associated with chronic illness is often seen as an inevitable consequence of the disease, but the depression should be treated. Frequently, the treatment improves the overall outcome [44].