The Mental Health Troubles of Middle-Aged Men

There are many psychiatric subspecialties focused on specific age categories. These include child psychiatry, youth mental health, and geriatric psychiatry. But there is no subspecialty known as "mid-life mental health" or "middle-aged psychiatry."

This is concerning, as statistics indicate that this can be an especially vulnerable period. For example, suicides in Western countries are particularly pronounced in the 40-60 age group, with especially high rates in middle-aged men.

Evidence suggests that the experience of sudden life events that often occur in the middle years of life, including job loss and divorce, can particularly damage men’s mental health. (For more, see my new book Men’s Issues and Men’s Mental Health.)

Unemployment and Job Loss

The postwar years have seen massive socio-economic changes across the Western world, mainly in the form of a transition from an industrial economy to a knowledge economy. This shift has led to a major decline in industries such as manufacturing that once gave secure and meaningful employment to blue-collar and less-educated men, who have subsequently experienced high rates of unemployment and job loss.

Such unemployment can have severe financial consequences, and in worst-case scenarios can lead to severe debt, bankruptcy, and foreclosure. Several studies show that these factors increase the risk of midlife male depression and middle-aged male suicide.

Some research indicates that job loss and unemployment tend to have a more negative effect on men than women. Indeed, one seminal study of over 1,000 opposite-sex dizygotic twin pairs examined sex differences in pathways to depression, finding that past-year stressful life events related to financial, employment, and legal issues were strong risk factors for male depression, but not for female depression.

This greater impact on men has been related to several factors by a variety of different studies. First, men still tend to be the primary family breadwinner, and their income is often essential to support a household. The loss of this income can have a devastating impact on a family's quality of life.

Second, men tend to derive more purpose and meaning from their work than women, meaning that the loss of a job can create a painful vacuum. Third, unemployed men are often stereotyped and stigmatized by wider society, which can negatively affect social inclusion and self-esteem.

Educational Attainment and Midlife Mental Health

Evidence suggests that middle-aged people with low educational attainment are more vulnerable to poor mental health than those with higher educational attainment. Indeed, one U.S. study found that suicide rates among the middle-aged were 2.4 times greater among those with a high school diploma or less, compared to those with a college degree.

Another study examined over 440,000 suicides in the U.S. and found that adults who possessed a college degree had the lowest suicide rates, while those with just a high-school diploma had the highest rates. Other research indicates that people with just a high-school education have higher rates of adult depression and anxiety compared to those with a graduate or professional degree. This is consistent with other studies which have found that high-school dropouts had higher rates of adult depression than high-school graduates.

Importantly, mounting evidence suggests that low educational attainment is much more common among males than females, with research indicating that males are more likely to fail exams and drop out of high school, and less likely to attend university and obtain a bachelor’s degree. Such educational underachievement in young males is widely unrecognized and has not been a policy priority, despite its negative impact on society.

Marital Status and Divorce

Divorce and separation are common occurrences in the middle years of life. Much research indicates that this can have a negative impact on mental health. For example, a large-scale U.S. study found that unmarried men aged 40-60 were 3.5 times more likely to die by suicide compared to married men of the same age, with markedly higher rates for unmarried men compared to unmarried women.

Of note, several elements of the research literature indicate that the psychosocial experience of divorce can be particularly painful for men, acting as an acute stressor with chronic consequences. For example, one study found that men experience a much greater loss of social support after divorce compared to women, mainly because women tend to maintain stronger links with friends and family throughout marriage than men.

All of this can leave divorced and separated men lonely and isolated precisely when they need social support the most. Indeed, fathers are typically separated from their children after a divorce, with over 80% of custodial parents in the U.S. and Canada being mothers. This separation from children can create a particularly painful void for the affected men, which can breed shame, guilt, grief, a sense of failure, and psychological distress.

Conclusion

For many people, the middle years are a time to enjoy the fruits of their education and labour among family and friends. But for others, it can be a time of severe financial strain, loneliness, and existential despair. As such, concerted action is necessary to address these issues.

• First, the provision of appropriate education, training, retraining, and vocational opportunities in the middle years should be considered an essential component of an integrated mental health policy.
• Second, there is a need for specific and tailored gender-sensitive supports and services to help vulnerable middle-aged people undergoing unwanted life transitions such as job loss and divorce.
• Third, there is a need for more focused mental health research on midlife mental health and evaluation of promising programs, with specific attention paid to gender differentials.

As yet, there is no subspecialty known as "middle-aged mental health," let alone a focus on gender differentials. This has to change.

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