Why Men Often Underreport Mental Health Difficulties

Although men and women experience mental health challenges at comparable rates, research consistently shows that men are less likely to report their struggles or seek help. This underreporting has significant implications for clinical practice, research, and community wellness. Understanding the gendered barriers to disclosure helps clinicians design more inclusive interventions and outreach efforts, particularly within expressive and art-based therapies.

Prevalence vs. Reporting: A Discrepancy

Epidemiological data reveal that women are diagnosed with depression and anxiety at nearly twice the rate of men—21.3% of women versus 12.9% of men in the United States report experiencing a major depressive episode during their lifetimes (Swami et al., 2021). Yet men die by suicide three to four times more often than women (American Medical Association [AMA], 2021). This paradox suggests that lower reported prevalence among men reflects under-recognition and under-disclosure rather than true lower incidence.

Contributing Factors

1. Masculine Norms and Stigma

Cultural expectations of masculinity—self-reliance, toughness, and emotional restraint—can discourage men from acknowledging psychological distress. Help-seeking is often perceived as weakness or failure, making disclosure difficult (Addiction Center, 2023; Seidler et al., 2022). Public and self-stigma compound this effect, leading many men to suppress or minimize symptoms (Healthline, 2023).

2. Symptom Expression and Measurement Bias

Standard diagnostic tools frequently emphasize internalized symptoms such as sadness or tearfulness, which may not capture how men manifest distress. Male distress often presents as irritability, anger, substance use, or risk-taking—behaviors easily misinterpreted or pathologized without recognition of their emotional roots (Zaneta et al., 2017). Consequently, men may be under-diagnosed even when suffering is clinically significant.

3. Help-Seeking Behaviors and Service Use

Men are substantially less likely than women to utilize mental health services. In 2021, approximately 40% of men with a mental health condition received treatment, compared to 52% of women (Association of American Medical Colleges [AAMC], 2021). Men also tend to delay seeking help until symptoms reach crisis level, limiting opportunities for early intervention (EBSCO Research Starters, 2024).

4. Externalizing Coping Patterns

Instead of articulating internal distress, some men externalize through aggression, workaholism, or substance misuse, masking underlying anxiety or depression (Zaneta et al., 2017). These behaviors can obscure the presence of mental illness both to the individual and to clinicians, perpetuating the cycle of underreporting.

Implications for Practice and Research

Gender-Sensitive Screening

Clinicians should employ gender-responsive screening tools and explore non-traditional indicators of distress such as irritability, emotional numbing, or fatigue. Research demonstrates that diagnostic gender disparities diminish when male-typical symptoms are incorporated (AMA, 2021).

Art Therapy as a Non-Verbal Pathway

Within art therapy, non-verbal and symbolic modalities—such as symbolic self-portraiture or the Tree Ring Self-Portrait—offer men a less stigmatizing route for emotional expression. Creating art externalizes inner states, allowing clients to explore emotions through metaphor rather than direct verbalization. Such methods align with strengths-based approaches and can reduce the perceived threat to masculine identity.

Reducing Stigma and Increasing Engagement

Reframing help-seeking as a form of resilience and agency rather than weakness improves engagement (SAGE Journals, 2024). Community-based, peer-oriented interventions and group art therapy initiatives can help normalize vulnerability and foster social connection—factors known to improve psychological well-being.

Research Considerations

Researchers should account for male underreporting bias by incorporating mixed-methods designs that include qualitative and behavioral data beyond self-report. Oversampling and inclusion of expressive modalities may yield a more accurate representation of male mental health experiences.

Public Health and Prevention

Because men often avoid preventive mental health services, early outreach through schools, sports teams, workplaces, and creative workshops is vital. Interventions framed around performance, creativity, or stress reduction may resonate more effectively (Public Health Research & Practice, 2024).

Conclusion

Men’s underreporting of mental health issues is not a reflection of lesser suffering but of cultural, diagnostic, and systemic barriers that silence vulnerability. For therapists and researchers—especially within art therapy—this understanding underscores the need for gender-sensitive, non-verbal, and strengths-based approaches that redefine help-seeking as an act of courage. By integrating creative expression with evidence-based clinical practice, we can foster environments where men feel safe to articulate, rather than hide, their distress.

References

Addiction Center. (2023). Men and mental health stigma. Retrieved from https://www.addictioncenter.com/community/men-mental-health-stigma

American Medical Association. (2021). Depression’s problem with men. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/depressions-problem-men/2021-07

Association of American Medical Colleges. (2021). Men and mental health: What are we missing? https://www.aamc.org/news/men-and-mental-health-what-are-we-missing

EBSCO Research Starters. (2024). Gender differences in mental health. https://www.ebsco.com/research-starters/psychology/gender-differences-mental-health

Healthline. (2023). How mental-health stigma affects men. https://www.healthline.com/health-news/how-can-we-reduce-mens-mental-health-stigma

Public Health Research & Practice. (2024). Men’s health priorities and prevention. https://www.phrp.com.au/media/media-releases/mental-health-tops-the-ranking-as-mens-greatest-health-concern

SAGE Journals. (2024). Mental health stigma-reduction interventions among men. https://journals.sagepub.com/doi/10.1177/15579883241299353

Seidler, Z. E., Rice, S., River, J., Oliffe, J. L., & Skehan, J. (2022). Men’s experiences of mental-illness stigma across the lifespan. Frontiers in Psychiatry, 13, 8832600. https://doi.org/10.3389/fpsyt.2022.8832600

Swami, V., Barron, D., & Furnham, A. (2021). Gender differences in self-reporting depressive symptoms: Implications for underreporting in men. Frontiers in Psychiatry, 12, 589687. https://doi.org/10.3389/fpsyt.2021.589687

Zaneta, M., Brown, J., & Nielson, J. (2017). Rethinking men’s depression and diagnostic bias. Psychiatry & Behavioral Sciences, 45(3), 215–229. https://doi.org/10.1016/pbs.2017.03.004