DOING WHAT COMES NATURALLY: POSITIVE SELF-HELP STRATEGIES USED BY MEN TO PREVENT DEPRESSION AND SUICIDE FINAL REPORT This research project was funded by beyondblue with donations from The Movember Foundation. ACKNOWLEDGMENTS We would like to acknowledge the contributions of the project’s research partners and advisory committee: Chief Investigators: Research Team: Mensheds Australia: Judy Proudfoot Andrea Fogarty Roy Powell Helen Christensen Erin Whittle Alex Petridis Dusan Hadzi-Pavlovic Michael Player Kay Wilhelm Alexis Whitton We would like to thank Mensheds Australia and the Mankind Project for their assistance with the study at numerous locations. We would also like to thank the following individuals for their contributions to the success of the project: Cesar Anonuevo, Liesbeth Geerligs, Matthew Johnstone, Gayle McNaught, Isabel McTigue, Sally Nathan, Jacinto Santamaria and Siena Tugendrajch. This research project was funded by beyondblue with donations from The Movember Foundation. TABLE OF CONTENTS ACKNOWLEDGMENTS ....................................................................................................................... 1 MAIN MESSAGES ............................................................................................................................... 5 EXECUTIVE SUMMARY ....................................................................................................................... 6 CONTEXT ........................................................................................................................................... 9 INTRODUCTION ............................................................................................................................. 9 OVERVIEW OF THE PROJECT ........................................................................................................ 10 APPROACH ...................................................................................................................................... 11 PART ONE: FOCUS GROUPS AND INTERVIEWS ............................................................................. 11 STUDY DESIGN ......................................................................................................................... 11 RECRUITMENT & ELIGIBILITY .................................................................................................... 11 PROCEDURES ........................................................................................................................... 11 RISK MANAGEMENT ................................................................................................................ 12 DATA ANALYSIS........................................................................................................................ 12 PART TWO: ONLINE SURVEY ........................................................................................................ 12 SURVEY DESIGN ....................................................................................................................... 12 RECRUITMENT & ELIGIBILITY .................................................................................................... 14 RISK MANAGEMENT ................................................................................................................ 14 DATA ANALYSIS........................................................................................................................ 15 PART THREE: ONLINE TOOL DESIGN, DEVELOPMENT AND TESTING ............................................. 15 THE MYCOMPASS PROGRAM ................................................................................................... 15 MODULE DEVELOPMENT ......................................................................................................... 16 PILOT STUDY DESIGN ............................................................................................................... 17 RECRUITMENT AND ELIGIBILITY ............................................................................................... 17 RISK MANAGEMENT ................................................................................................................ 17 DATA ANALYSIS........................................................................................................................ 18 RESULTS .......................................................................................................................................... 19 PART ONE: FOCUS GROUPS AND INTERVIEWS ............................................................................. 19 DEMOGRAPHIC AND CLINICAL PROFILE.................................................................................... 19 Theme 1: A range of positive strategies on standby ................................................................. 21 Theme 2: Recurrent ideas about ‘manliness’ ............................................................................ 22 Theme 3: Silence around suicide .............................................................................................. 23 Theme 4: Advice for others ...................................................................................................... 23 PART TWO: QUANTITATIVE INVESTIGATION – ONLINE SURVEY .................................................... 25 DEMOGRAPHIC AND CLINICAL PROFILE.................................................................................... 25 __________________________________________________________________________________________ ’Doing What Comes Naturally’ Final Report Page 3 of 55 USE PREVENTION AND MANAGEMENT STRATEGIES ................................................................. 28 PART THREE: ONLINE TOOL DESIGN, DEVELOPMENT AND TESTING ............................................. 40 SCREENING .............................................................................................................................. 40 DEMOGRAPHIC AND CLINICAL PROFILE.................................................................................... 40 USE OF MYCOMPASS ............................................................................................................... 40 CONCLUSION ................................................................................................................................... 45 THE MEN ..................................................................................................................................... 45 KEY POINTS .................................................................................................................................. 45 IMPLICATIONS ............................................................................................................................. 48 IMPLICATIONS FOR CLINICAL PRACTICE AND PUBLIC HEALTH .................................................. 48 IMPLICATIONS FOR FUTURE RESEARCH .................................................................................... 50 REFERENCES .................................................................................................................................... 52 APPENDICES .................................................................................................................................... 55 APPENDIX 1: INTERVIEW/FOCUS GROUP QUESTIONS SCHEDULE ................................................. 55 __________________________________________________________________________________________ ’Doing What Comes Naturally’ Final Report Page 4 of 55 MAIN MESSAGES Men were recruited to a multi-phase research project investigating their use of positive coping strategies to prevent and manage the development of feeling flat, down, or depressed. Men from around Australia participated, and in total 770 men were recruited across three phases of research. The main messages arising from the study are as follows: Men use a broad range of positive coping strategies and appear to have several on stand-by to use as necessary. Men actively engage with their mental health, through monitoring symptoms, engaging in activities to keep themselves feeling good, acknowledging signs of feeling down, proactively responding to problems with the potential to worsen their mood, and through making conscious choices about when to take action. Men make clear distinctions between prevention and management when it comes to their mental health. Good prevention is multifaceted, personal and characterised by having a routine which incorporates keeping busy, social connections, acceptance of a range of feelings, maintenance of physical health and regular engagement with enjoyable activities. Good management builds on prevention by acknowledging changes in mood and deploying additional resources to solve or mitigate problems that can impact negatively on mood. This includes taking time out when needed, talking to others and finding ways to take a new perspective on problems. The positive coping strategies used by men varied according to general health, severity of depression, history of depression, and psychological resilience. In general, those in poorer health or with lower psychological resilience used fewer strategies. The men who participated in the study were particularly open to using many different strategies (e.g. having a mentor, practicing meditation, etc.) and advocated the importance of challenging traditional notions of ‘masculinity’ to achieve good mental health (e.g. talking to others about feeling down or needing help). Men reported