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Objective: High conformity to traditional masculinity ideologies (TMI) is associated with lower use of psychotherapy, higher self-stigmatization and poor mental health outcomes amongst men. However, the role of conformity to TMI in relation to psychotherapy dropout is still unclear. Aim: The present study aims to clarify the relationship between conformity to TMI and premature termination of psychotherapy (dropout) in men. Method: Data was used from an anonymous online survey in German-speaking Europe. Participants with previous psychotherapy experience provided information on sociodemographics, mental health, TMI, and their past experiences with psychotherapy. Discontinuation of psychotherapy was assessed by self-report and further differentiated into discontinuation with or without consulting the therapist. Men with an unconsulted therapy ending were defined as psychotherapy dropouts. Conformity to TMI was assessed using the Conformity to Masculine Norms Inventory. Results: Of the 266 men (mean [SD] age, 46.1 [13.6]) with psychotherapy experience, 30.5% (n = 81) reported having discontinued psychotherapy at least once, whereas 17.7% (n = 47) of the total sample reported dropout. These 47 men showed significantly higher conformity to TMI than men who did not report past dropout. The sub-scales of self-reliance and playboy showed the strongest associations with psychotherapy dropout. Conclusions: Dropout from psychotherapy was significantly associated with higher conformity to TMI. Therapists should consider, and where necessary, work to flexibly adapt to TMI which may influence how men engage in mental health care. Such an approach would likely improve men’s ongoing engagement in psychotherapy, promoting opportunities to prevent avoidable psychotherapy dropout for men most at risk of deleterious mental health outcomes.

BACKGROUND: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). AIM: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. METHODS: The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. EXPECTED RESULTS: Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. DISCUSSION: This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control conditio

The COVID-19 pandemic is causing extensive job loss leading to a loss of social status in many men. Endorsement of traditional masculinity ideology may render some men particularly sensitive to status loss and thereby to an increased risk for suicidality. In this anonymous online survey conducted in German-speaking European countries, 490 men completed questionnaires regarding loss of social status due to the COVID-19 pandemic, past-month and lifetime suicide attempt and suicidal ideation. Furthermore, endorsement of traditional masculinity ideology and prototypical and male-typical externalizing depression symptoms were measured. Out of a total of 490 men, 14.7% of men reported experiencing status loss due to the pandemic. These men were more than four times as likely to have attempted suicide in the past month (OR = 4.48, 95% CI [1.72, 11.67]) and more than twice as likely to report suicidal ideation during the past 2 weeks (OR = 2.47, 95% CI [1.42, 4.28]), than men not reporting status loss. Status loss, but not endorsement of traditional masculinity ideology, was associated with suicide outcomes. However, when male-typical externalizing depression symptoms and prototypical depression symptoms were included in the models, they exhibited the only direct associations with suicide outcomes (e.g., for past-month suicide attempt: male-typical externalizing depression symptoms OR = 2.18, 95% CI [1.31, 3.62], prototypical depression symptoms OR = 2.41, 95% CI [1.13, 5.12]). A significant interaction between status loss and endorsement of traditional masculinity ideology further suggests an enhancing moderating effect of traditional masculinity on the relationship between status loss and past-month suicide attempts (OR = 3.27, 95% CI [1.16, 9.27]). Status loss due to the COVID-19 pandemic emerges as risk factor for suicide in men. Men who experience status loss due to the COVID-19 pandemic while concomitantly exhibiting strong endorsement of traditional masculinity ideol