title: Role of the gender-linked norm of toughness in the decision to engage in treatment for depression.
abstract: OBJECTIVE
  Given their prevalence and persuasive power in our culture, gender norms--commonly described as socially reinforced, learned expectations of what it means to be a man or a woman--likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment ("wait-and-see" approach).
  
  
  METHODS
  Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression. Participants who reported ever having been diagnosed as having a depressive disorder on the BRFSS were oversampled threefold. Analyses were conducted using linear and logistic regressions.
  
  
  RESULTS
  Men and women who scored higher on toughness had a greater preference for the wait-and-see approach (OR=1.14, p<.01). Women were less likely to prefer the wait-and-see approach (OR=.58, p<.04) and scored lower on toughness (B=-.70, p<.01). Men's greater levels of toughness partially mediated the sex difference in treatment preferences (OR=.91, p<.03).
  
  
  CONCLUSIONS
  Men's greater adherence to the toughness norm explained part of the sex difference observed in treatment-seeking preferences, but toughness undermined women's treatment seeking as well. Findings could be used to inform novel public health communications intended to attract both men and women to psychiatric services.
authors: Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA. rolough8@naz.edu
authors: Ryan E
authors: RE
authors: O'Loughlin
authors: Paul R
authors: PR
authors: Duberstein
authors: Peter J
authors: PJ
authors: Veazie
authors: Robert A
authors: RA
authors: Bell
authors: Aaron B
authors: AB
authors: Rochlen
authors: Erik
authors: E
authors: Fernandez y Garcia
authors: Richard L
authors: RL
authors: Kravitz
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D002140:California; D003657:Decision Making; D003863:Depression / Q000628:therapy*; D005260:Female; D005783:Gender Identity; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*