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Table 2 Coding tree

From: Mental health professionals view about the impact of male gender for the treatment of men with depression - a qualitative study

MHPsʼ description of male patientsThe “typical” manBehaviour1119“reserved”
Appearance11“bald head”, “beard”, “rather muscular”
Attributes1825“man of action”
Cultural background99“If someone comes from Turkey or from Afghanistan, then mental illness is very taboo, you can’t have that there.”
Formal education22“But [men who are, M.S.] somehow simply structured, and poorly educated; in the beginning, they tend to only scratch the surface.”
Urban/rural area56“I would guess, until people who live in rural areas can admit to themselves that they are sick, I think this will take much longer. Because everyone knows everyone.”
Age/generation1424“So particularly the older generations, these men are doers. And they do. And they get through it.”
The “non-typical” manBehaviour59“talkative”, “unsure”, “afraid”,“passive”, “shy”
Appearance12“long hair”, “weedy”
Attributes715“softy”, “to be led by one’s head”, “wimp”
Cultural background11“If someone comes from Sweden or Denmark, then it’s a similar context to ours.”
Formal education78“[...] with an academic who’s depressed, he’s got a little more access to his emotional world.”
Urban/rural area11“It is probably easier for people in the city to seek treatment.”
Age/generation811“And the younger they are, the more open they are somehow.”
No gender variation 1426“This is also very dependent on the individual. I think it depends on the make-up of their families.”
MHPsʼ theory of illnessMental illness in media and society 1425“Football coaches also get burnout and depression; football players too. And I believe that society has come to accept that people do not have limitless resilience.”
Normative superstructureChange in society leads to overload45“That this may well cause problems, in modern or postmodern times, to find oneself in a role or in multiple roles, and because of much higher demands and choices, the risk of failure is much greater.”
(successful) employment expected1419“It is simply a reflection of societal attitudes that men are still expected to be employed and to want to be employed, so to speak.”
Depression is related to weakness/failure1014“I’m big, I’m strong, I take care of others. I can do anything, I’m a somebody. I’m not sick. I’m not allowed be sick. I am the strong one.”
Reason / occasion of depressionMissing/poor coping strategies1730“And they just escape, at least that’s my experience, often into drugs or alcohol.”
Personality1018“And these are also more likely men who normally present as strong personalities, and perhaps also with narcissistic elements.”
Socialisation1736“These are often defining childhood experiences; the family situation during childhood and youth, the parents as role models or supporting caregivers.”
Family burden1213“Or that they are overwhelmed by their family situations.”
working conditions3074“A frequent problem tends to be the workplace, with excessive demands in their job and the threat of job loss or being humiliated in the workplace.”
Relationship problems1932“In my experience with men, family problems in particular crop up again and again as well; following separation, and also during a divorce, many men develop a depressive episode.”
Biological factors710“In my opinion, they are either actually genetically determined, i.e. hereditary gene structures.”
Admission into the mental health care systemLate initiation of treatmentCrisis situation3057“And then because of all the overload at work and so on and then, yes, at some point, collapses.”
Burden of dependents610“The burden of the women concerned is already very high. When they send the men to us.”
Suicidality1019“[…] they wait as long as they become suicidal, afterwards they will arrive at the hospital and even that often not voluntary.”
preconditionInsufficient knowledge1020“So I think that very few people say that they have depression, because they have no idea what [that] actually means. So they don’t know what it is.”
Poor self-perception1417“And the man hasn’t even noticed what’s been going wrong all these months and years.”
Do not deal with mental issues1729“And so men go somewhere with their buddies and of course emotions are rarely a topic of conversation.”
Self-attribution of menAccept help is related with weakness2241“And to be able to manage things by yourself, otherwise you’re not a really a grown man.”
Maintain self-worth1117“And this [sense], if they are not needed, because they can’t do it any more, this means they quickly develop the feeling that they are no longer needed and worthless.”
Sense of responsibility1520“[...] In terms of the family situation – have situations begun to develop where they also have obligations, [where] they have to do what is expected, you know?”
Stigma/ predjudices 1021“What would the village say if I was in a madhouse?”
Structural barriersConcern about future career2237“Is he going to lose his position or his leadership position in the company? Because he has this condition, because it’s a condition that doesn’t persist for 2 weeks, but often lasts 10 or 12 weeks, and then they go to rehab and of course they become afraid of loss.”
Knowledge of GPs45“Well, perhaps not all GPs are up to date on depression. And perhaps we have to think about what are, I would say specific, if there are any specific male symptoms that can be indicative of depression.”
Intrinsic motivationTo function66“So, to recover just to be able to function again – that’s the main desire.”
Partner/family77“[…] that you’d say, I want to do that for the sake of my family, or I want to continue to support my children and just want to be healthy for them.”
Pension request68“[…] perhaps even a type of man who accepts this diagnosis very well or even desires it; these are people who are for example in their 50s or early 50s and have difficulties getting back into the job market and want a pension plan.”
External motivationGeneral practitioner79“So, patients are often sent by their GP. Both men and women. GPs are often the first point of contact, […] and many patients first go to their GP as someone they can trust.”
Colleagues & friends22“Then perhaps friends do it, or perhaps colleagues do it, if they react well.”
Family1418“So I guess if there’s a family that works reasonably well, then it’s likely that the partner or perhaps the parents or parents-in-law will say at some point that enough is enough. Now you have to do something about it.”
MHPsʼ views of male patients’ expectationsExpectationsShort treatment duration1218“‘Short and quick’ has been said to me.”
Complete recovery77“So men do expect this kind of complete recovery.”
Medication710“And then it’s just clear, okay, it has to be medication.”
Psychotherapy24“So because with the psychotherapeutic conversations many men somehow… then they would have to actually say something about themselves and so on.”
ApproachesSceptical about treatment67“And then they ask what the point is and say that they think they’re not making any progress.”
Mechanical thinking816“You flip a switch and then you’re fine again.”
Solution-oriented810“They say ‘What should I do? I’ll do it’.”
MHPsʼ mental health treatment aimsPsycho-education 2357“But an explanatory model is therefore very important. So, clarification and an explanatory model: why do I have this and what is it exactly?”
Social environment 33“So then I always try to make contacts.”
Normalisation 1827“So, anything that brings a bit more stability somehow, a bit more insight into the situation as a whole, yes, that it is simply… that it is normal and that it can happen.”
Distance oneself & Self-perception 49“What I think is important is that I need to learn to distance myself if it concerns my health. In which situations am I overwhelmed? Or in which situations do I always continue to function but should start to say, Stop, stop, this far and no further?”