Typical, Atypical and Mixed Depression Presentations in Men; Underlying Psychopathology and Suicidal Risk

Abstract

Despite the higher prevalence of depression in women, men are at significantly increased risk of completed suicide. In light of this paradox, research has sought to improve the identification of this disorder in men. A male-depressive phenotype has been proposed to include a broad range of externalising behaviours such as irritability, aggression and substance misuse. Studies have typically shown, however, that the presence of these symptoms are strongly linked with internalised depressive symptomology. No studies have considered the presence or otherwise of a unique atypical presentation consisting solely of externalising symptoms. Therefore, the current study considered the prevalence of typical, mixed and atypical depressive presentations in a sample of N=1000 Canadian males. The proportions classified into distinct depressive profiles was: typical (8%), mixed (12%) and atypical (11%). All groups had significantly elevated psychopathology (alexithymia, grandiose and vulnerable narcissism, and general psychological distress) relative to notdepressed participants. Furthermore, risk of mental illness and suicidal behaviour was significantly elevated in all depressed groups, with an atypical presentation being 20-times (OR=20.64) more likely to be suffering a moderate mental illness, and almost 5-times (OR=4.80) more likely to exhibit current suicidal behaviour relative to not depressed. These results highlight the clinical importance of considering a range of presentations of depression in men, all of which have increased risk, and demonstrate that men with comorbid externalising symptoms have the highest risk of poor outcomes.