Abstract
This study addresses the pronounced mental health disparities faced by African American men, characterized by the heightened severity of mental health conditions and their reluctance to seek mental health treatment. Persistent neglect toward the mental health of African American men perpetuates systemic inequities and heightens the stigma surrounding mental well-being within their communities. This study investigates the interaction of masculinity, distrust in doctors, and parental support on attitudes influencing African American men’s reluctance to seek mental health care. A survey administered to 74 African American men revealed a negative correlation between masculinity and attitudes toward seeking mental health treatment. In contrast, no significant correlations were found between distrust in doctors and parental support on attitudes toward seeking mental health treatment. These findings were analyzed using Pearson’s correlation, underscoring the urgent need to address masculine norms in mental health discourse among African American men. Implications of the findings and future directions for masculinity in African American men are discussed.
Introduction
Men’s mental health has emerged as a critical and under-explored dimension of psychological research. The landscape of men’s mental health is complex and includes a myriad of social, collective, and individual experiences. Depression and suicide are leading causes of death among men, with 6 million affected each year (Chatmon, 2020). Suicide is ranked as the third leading cause of death among African American individuals aged 15 to 19 years, fourth among individuals aged 20 to 29 years, and eighth among individuals aged 30 to 39 years. Notably, African American male adolescents and young adults exhibit the highest rates (Crosby & Molock, 2006). The life expectancy for African American men is 6.2 years less than Europeans (Wade, 2008), and experience earlier onset of disease, more severe diseases, higher rates of complications, and more limited access to health care (Courtenay, 2000a, as cited in Wade, 2008). Moreover, African American men tend to have attitudes and behaviors that jeopardize their health (Wade, 2008). The exploration of African American men’s mental health has become increasingly imperative in understanding the intricate factors that shape their psychological well-being.
African American men’s reluctance to seek mental health treatment has emerged as a critical area of concern marked by the complex factors of masculinity, distrust in doctors, and parental support. While existing literature explores the link between masculinity and men’s engagement in seeking general health treatment, distrust in doctors among African Americans, and parental support toward seeking general health treatment, there is a glaring absence of information and research regarding African American men seeking mental health treatment (Chatmon, 2020). This study will examine the barriers of masculinity, distrust in doctors, and parental support and the impact they have on African American men seeking mental health treatment.
Masculine norms shape the socialization and aspiration of young males (Pollack, 1998), and men belong to a culture where the standards of masculinity are killing them (Chatmon, 2020). Traditional masculinity and toxic masculinity are key factors that influence whether men seek out mental health treatment. Traditional masculine norms are societal norms and behaviors that are associated with men in a given culture, which include strength, independence, self-affirmation, and social dominance (Malonda-Vidal et al., 2021). Toxic masculinity refers to a cultural framework and set of expectations that promote harmful behaviors and attitudes associated with traditional masculinity (Press, 1995a). It involves destructive behaviors such as a lack of empathy, emotional intelligence, aggression, domination, and control (Ingram et al., 2019). By nature, traditional masculine norms are not toxic; they can manifest in positive ways (Di Bianca & Mahalik, 2022). Healthy masculinity involves the acceptance that men can exhibit vulnerability, emotional expression, articulate their feelings without feeling emasculated, engage in open communication, seek professional help, and consider therapy as a viable option. Numerous studies have explored instances where traditional and toxic masculine norms not only fail to encourage men to seek general health treatment but also pose a risk to men’s overall health. Courtenay (2000a) discovered that the more men adhere to the toxic masculinity ideology which reprimands them for showing weakness or seeking help, the more it portends to putting their health at risk. Wade (2008) discovered that men who engage in traditional masculine norms are associated with not seeking health care, preventive care, or following through on chronic illness treatment. Moreover, Chatmon (2020) discovered that beliefs around traditional masculinity were positively associated with challenges in identifying or articulating emotions, further intensifying their internal struggles. This reluctance to seek help may stem from a potential lack of awareness when a problem truly exists, resulting in men being unwilling to ask for help. Kupers (2005) conducted a study looking at how toxic masculinity is a barrier to mental health treatment in prison. The study revealed that men who demonstrated more qualities of toxic masculinity exhibited increased resistance to psychotherapy. In general, factors such as the reluctance to acknowledge vulnerability, the desire to maintain control over one’s physical and emotional well-being, the inclination to project strength, and the aversion to seeking assistance contribute to the underutilization of seeking professional help (Courtenay, 2000a). Existing literature provides evidence supporting the notion that adherence to traditional and toxic masculinity ideologies can dissuade men from seeking not only general health treatment but also mental health treatment.
The intersection of traditional and toxic masculinity poses a complex and compelling challenge in the landscape of seeking mental health treatment, particularly among African American men (Douglas, 2020). African American men are conditioned to be strong, be the breadwinner, and not show emotions starting in childhood (Douglas, 2020). In African American male communities, Lease et al. (2019) identified a cultural inclination to demonstrate strength and provider roles. As a consequence of these traits, there was a diminished involvement in their health and a tendency to avoid seeking health care. A subsequent study found that adhering to specific traditional masculine traits, such as self-reliance, among African American men was linked to reduced engagement in health-seeking behaviors (Wade, 2008). The existing literature provides evidence that adhering to established norms of masculinity can result in fewer health-promoting behaviors, such as seeking general health treatment among African American males, and an increased likelihood of jeopardizing their health.
The history of slavery and systematic oppression of African Americans has negatively impacted mental well-being and plays a significant role in seeking help. Historical roots deeply anchor African American skepticism toward medical and mental health treatment, dating back to slavery in 1619 (Poussaint & Alexander, 2001). Between 20 to 30 million Africans were captured and forcibly brought into chattel slavery, recognized as one of the most insidious forms of mental and physical torment (Ramos, 2014). This period marked the onset of the cruelest racial oppression endured by African Americans, involving degradation, starvation, whipping, beating, lynching, rape, separation from family, and other atrocities inflicted by the white majority. This systematic abuse aimed to psychologically dehumanize African Americans, strategically diminishing their status to that of an object and stripping away any sense of humanity. This points to intergenerational trauma that has shaped the mental health of African American men. According to Brooks and Hopkins (2017), using data from the Summary Health Statistics 2012 report, “African Americans were less likely than White people to have seen a doctor or other health professional in the past six months” while also examining the attitudes of minority groups in “adverse reactions by White clinicians” which illustrated that the higher the distrust scores, the more negative were attitudes. During the 1800s, Dr. Thomas Hamilton utilized an African American male slave to evaluate the effects of the medication he was developing for heat strokes. Throughout the experiment, the slave fainted and had to be revived to continue the study (Douglas, 2020). In addition, the infamous Tuskegee study involved deceiving 600 African American men, injecting them with syphilis, and falsely promising them free health care, which they never received (Chatmon, 2020). The historical–cultural evidence of distrust suggests that African American men have justified reasons to be distrustful of health systems, causing them to refrain from seeking treatment due to apprehensions about the treatment’s validity.
The first person that a kid turns to during their process of development is their mom or dad. Seeking an outside helping hand, especially in relation to mental health, is largely influenced by parental guidance. Maiuolo et al. (2019) found that parental acknowledgment of mental health plays a crucial role in the process of gaining professional help. Additional research by Mojtabai and Olfson (2008) revealed that parental knowledge of youth self-harm was linked to an increased propensity to receive professional help. These studies suggest that the support provided by parents is a major factor in determining an adolescent’s mental health outcome. Among African Americans, research indicates that African American parents expressed less favorable attitudes compared with European or Hispanic parents (Turner et al., 2015). This variance may stem from generational differences regarding the perceived significance of mental health. Given the historical experiences of African Americans, displaying vulnerability could make them more susceptible to societal targeting. Consequently, seeking help may be accompanied by feelings of shame or guilt, driven by the fear of parental reactions and the prospect of disappointment. Existing literature indicates that the decision to seek mental health treatment is influenced by parental support.
Stigma significantly impacts an individual’s inclination to seek health care (Grady et al., 2019). There is a prevalent stigma surrounding mental health, contributing to a decreased likelihood of individuals seeking mental health treatment. Within the African American community, mental health is deemed a taboo subject. Experiencing a mental health issue is often perceived as a sign of weakness, brokenness, and a lack of strength (Chatmon, 2020). An explanation for this lies in the enduring generations of trauma experienced by African Americans, where mental health issues are regarded as a minor challenge that can be easily addressed. Moreover, African Americans are also striving to protect the positive image of the Black community. African American men nurture a profound appreciation for resilience and strength and experience tension as the cultivated sense of vulnerability conflicts with societal expectations. The apprehension of appearing weak or broken deepens the stigma and fosters defensive posturing and shame associated with seeking mental health treatment.
The objective of this research was to study the relationship between masculinity, distrust of doctors, and the role of parental support in seeking mental health treatment. The hypotheses tested in this study were: masculinity will be negatively correlated with help-seeking attitudes for mental health, distrust in physicians will be negatively correlated with help-seeking attitudes for mental health, and parental support will be positively correlated with help-seeking attitudes for mental health. In addition, this study explored the association of masculinity with internal shame and parental acceptance of seeking mental health treatment.
Materials and Method
Design
This correlational study was approved by the Institutional Review Board (IRB) at High Point University. All participants provided written consent. The study was conducted in accordance with the declaration of Helsinki.
Sample
Men were eligible to participate if they self-identified as African American, were 18 years of age or older, and were able to read English. Seventy-four participants were recruited.
Procedure and Measures
Participants were solicited through friends, family, classmates, and social media. Once prospective participants were identified, they received a link to access the online information that described the study’s purpose and procedures. Online consent was obtained and eligibility questions were answered. The survey included: (a) The Attitudes Toward Seeking Professional Help Scale, (b) The Attitudes Toward Mental Health Problems Scale, (c) The Group-Based Medical Mistrust Scale, (d) The Masculinity Contingency Scale, (e) The Subjective Masculine Norms Questionnaire and Scale, (f) The Perceived Parental Support of Autonomy Measure, (g) The Perceived Parental Emotional Support Measure, and (h) The Parental Acceptance and Support Scale. The demographics included questions about participants’ race, gender, and age.
The Attitudes Toward Seeking Professional Help Scale (Fischer & Turner, 1970) is a questionnaire that contains 29 statements that measure personal attitudes toward seeking professional help. A sample item would be “Although there are clinics for people with mental troubles, I would not have much faith in them.” The Attitudes Toward Seeking Professional Help Scale is measured on a 4-point continuum (0 = Strongly disagree to 3 = Strongly agree) and was a valuable tool because the convergent validity and internal consistency were good (α = .86).
The Attitudes Toward Mental Health Problems Scale (Gilbert et al., 2007) is a questionnaire that contains 35 statements that measure attitudes toward mental health problems. A sample item would be “My community sees mental health problems as a personal weakness.” The Attitudes Toward Mental Health Problems Scale is measured on a 4-point Likert-type scale (0 = Do not agree at all to 3 = Completely agree) where higher scores indicate negative attitudes toward mental health problems. The scale is a good one to use because the face validity and internal reliability were good (α = .86 and .97).
The Group-Based Medical Mistrust Scale (Thompson et al., 2004) is a questionnaire that contains 12 statements that measure medical mistrust. This study used this scale and made slight modifications to the statements. A sample item would be “On a scale of 1-10, how much do you find doctors trustworthy?.” Modifications were made to provide a quantifiable measure of overall trust in doctors, which is central to understanding the reluctance of African American men seeking mental health treatment. The Group Based Medical Mistrust Scale is measured on a 5-point Likert-type scale (1 = Strongly disagree to 5 = Strongly agree) where higher scores indicate more medical mistrust. The scale is a good one because the convergent validity and split-half reliability were good (α = .80) however, due to the measure being modified, there is no evidence of validity.
The Masculinity Contingency Scale (Burkley et al., 2016) is a questionnaire that contains 10 statements that measure masculinity. A sample item would be “I can’t respect myself if I don’t live up to what it means to be a “real man.” The Masculinity Contingency Scale is measured on a 7-point Likert-type scale (1 = Strongly disagree to 7 = Strongly agree) where higher scores indicate higher masculinity. The scale is a good one because the convergent validity and test-retest reliability were good (α = .91, .92, .93).
The Subjective Masculine Norms Questionnaire and Scale (Wong et al., 2020) is a questionnaire that contains six statements about social norms. This study used this scale and made slight modifications to the social norms. A sample item would be “I think that men should be the breadwinner.” Modifications were made to gauge the extent to which traditional masculine norms can be a determinant in an African American man’s willingness to seek mental health treatment. The Subjective Masculine Norms Questionnaire and Scale is measured on a 6-point Likert-type scale (1 = Strongly disagree to 6 = Strongly agree) where higher scores indicate higher social norms being followed. The scale is a good one because the construct validity and test-retest reliability were good (K = .85) however, due to the measure being modified, there is no evidence of validity.
The Perceived Parental Support of Autonomy Measure (Katz et al., 2018) is a questionnaire that contains 12 statements about perceived parental support. This study used this scale and made slight modifications to the statements. A sample item would be “In the process of deciding to seek mental health treatment, my parents encouraged me to talk about what I think and feel regarding options about seeking mental health support.” Modifications were made to directly evaluate how parental support influences the participants’ autonomy to make decisions about their mental health. The Perceived Parental Support of Autonomy Measure is measured on a 5-point Likert-type scale (1 = Not at all to 5 = Very much) where higher scores indicate higher perceived parental support. The scale is a good one because the internal consistency is α = .80 and with the patterns reported through the correlations, it would support that they are measuring parental support of autonomy however, due to the measure being modified, there is no evidence of validity.
The Perceived Parental Emotional Support Measure (Scholte, 1999) is a questionnaire that contains four statements about perceived parental emotional support. This study used this scale and made slight modifications to the statements. A sample item would be “I talk to my father/mother about personal matters.” Modifications were made to determine how personal communication and emotional closeness between participants and their parents shape their choices regarding seeking mental health treatment. The Perceived Parental Emotional Support Measure is measured on a 3-point Likert-type scale (1 = Almost never to 3 = Almost always) where higher scores indicate higher parental emotional support. The scale is a good one because internal consistency was good (α = .74) however, due to the measure being modified, there is no evidence of validity.
The Parental Acceptance and Support Scale (Rabiner et al., 1993) is a self-report questionnaire that contains 15 statements about parental acceptance and support. This study used this scale and made slight modifications to the statements. A sample item would be “My parents helped me do the right things in my life.” Modifications were made to assess the degree of how familial relationships and parental acceptance impact help-seeking behaviors. The Parental Acceptance and Support Scale is measured on a 5-point Likert-type scale (1 = Not at all to 5 = Very true) where higher scores indicate higher parental acceptance and support. The scale is a good one because the internal consistency was good (α = .88) however, due to the measure being modified, there is no evidence of validity.
Results
We screened 74 individuals, 68 (91.9%) were eligible for participation, and of those (8.1%) did not consent. Participants’ mean age was 46.09 (SD = 18.51). Pearson’s correlations were run to examine the relationship between masculinity, distrust in doctors, and parental support on seeking mental health treatment in African American men. There was a significant negative correlation between masculinity and attitudes around seeking mental health treatment, r(63) = −.50, p < .000. There was no significant correlation between distrust in doctors and attitudes around seeking mental health treatment, r(65) = −.13, p = .294. There was no significant correlation between parental support and attitudes around seeking mental health treatment, r(62) = .06, p = .608. In addition to these hypotheses, the study also investigated the relationship between internal shame and masculinity, along with parental acceptance and attitudes around African American men seeking mental health treatment. There was a significant positive correlation between masculinity and internal shame, r(66) = .509, p < .001. Furthermore, there was a significant positive correlation between parental acceptance and attitudes around seeking mental health treatment, r(58) = .355, p = .006.
Discussion
This study aimed to examine the correlation between masculinity, distrust in doctors, and parental support for seeking mental health treatment. The hypotheses examined in this study were as follows: masculinity would be negatively correlated with attitudes toward seeking mental health treatment, distrust in doctors would be negatively correlated with attitudes toward seeking mental health treatment, and parental support would be positively correlated with attitudes toward seeking mental health treatment. In addition, the study explored the relationship between masculinity and internal shame as well as parental acceptance toward seeking mental health treatment. This study indicated that masculinity correlated with lower attitudes toward seeking mental health treatment. The current results align with the existing literature from Kupers (2005) where he discovered that men exhibiting traits of toxic masculinity are more resistant to engaging in psychotherapy. Furthermore, this implies that masculinity influences the likelihood of African American men seeking mental health treatment. It could be suggested that African American men are inclined toward adhering to the expectations of masculinity within their societies and families, thus at times sacrificing their mental health.
Some African American men find it important to follow generational, familial, and societal masculinity patterns that have an impact on their mental well-being due to societal or cultural aspects. Throughout history, there has been no emphasis placed on mental health, especially within the African American communities. African American males are the most affected by systemic problems of racism, discrimination, school-to-prison pipeline, and many other forms of systemic racism that contribute to adverse mental health outcomes. This has led to perpetuated ignorance and misunderstanding of emotional well-being. In addition, limitations have been placed by our society upon how men should deal with their emotions. This could prevent them from talking about such issues based on vulnerability and weakness being shown; thus, silence becomes habitual as far as mental health in African American men.
No correlation was found between distrust of doctors and attitudes toward seeking mental health treatment, which is inconsistent with existing literature. Research indicates that African American men have valid reasons for being distrustful of the medical system due to the trauma they have experienced with doctors. Brooks and Hopkins (2017) discovered that African Americans had lower rates of doctor visits compared with Caucasians, which was attributed to their distrust and negative perceptions of Caucasian clinicians. Thus, the results imply that African American men’s reluctance to seek mental health treatment may be influenced by their distrust of Caucasian doctors. One hypothesis is that African American men might not avoid clinicians based on racial fears, but rather due to a personal apprehension toward all doctors. In addition, this might be attributed to the lower frequency of African American men seeking medical attention or a lack of awareness regarding the importance of non-urgent medical care. The medical system may have seen improvements in clinicians because they are becoming more culturally aware, allowing for improvement in trust for African American men.
This study found no association between parental support and perceptions of seeking mental health treatment, contrary to existing literature. Maiuolo et al. (2019) found that adolescents experiencing mental health problems demonstrate greater reluctance to seek help when parental support is unavailable. Similarly, Turner et al. (2015) found decreased mental health support for African American parents compared with Caucasian or Hispanic parents. These results underscore the pivotal role of parental support not only in a child’s mental well-being but also in their inclination toward seeking mental health treatment. It can be hypothesized that African American men may not need affirmation from their parents because they rely more on affirmation from themselves, social media, and friends. African American men may rely more on validation from themselves, social media, and friends due to various cultural and societal factors. Historically, African American men have faced systemic oppression and marginalization, which can lead to feelings of invisibility, inferiority, and a lack of recognition in broader society. Given the historical and ongoing challenges faced by African American men, seeking validation from friends and peers within their social circles can offer a sense of belonging and support in navigating life’s complexities. Social media platforms provide African American men with opportunities to share their experiences and support from friends who can understand their unique challenges of mental health as African American males. African American men’s reliance on self-validation, social media, and friends may be due to a need for recognition, affirmation, and solidarity within their communities and social groups, especially in life in the face of societal marginalization and systematic barriers.
Although two of the three hypotheses were not supported in this study, other significant associations were found: masculinity showed a positive relationship with internalized shame, and parental acceptance showed a positive relationship with attitudes toward seeking mental health treatment. One possible hypothesis is that increased parental acceptance of mental health challenges among African American men may bolster their confidence in seeking mental health treatment. In addition, there could be shame associated with experiencing mental health problems. Addressing the shame associated with experiencing mental health problems among African American men may lead to improved comfortability with seeking mental health help or therapy and accessing resources that support mental health. By acknowledging and destigmatizing mental health challenges within the community, African American men can feel empowered to seek assistance without fear of judgment or stigma. When the social story moves toward a story of acceptance and understanding, African American men may feel less isolated and more encouraged to prioritize their psychological well-being. Open conversations about mental health may create a supportive environment in which individuals feel welcome to seek help, thereby reducing reluctance to access mental health resources. When African American men see others in their community openly discussing their mental health and seeking treatment, it legitimizes the process and encourages them to prioritize their mental health. Targeted interventions that focus on promoting self-compassion and self-acceptance can help individuals overcome feelings of shame and encourage them to engage in therapeutic interventions aimed at improving mental health outcomes. In addition, parental acceptance of mental health issues within the African American community can play a crucial role in fostering confidence among individuals to seek treatment. When parents demonstrate understanding and support regarding mental health struggles, it creates a safe and validating environment for their children to express their emotions and seek help without fear of judgment or rejection. This familial acceptance can greatly contribute to breaking down barriers to seeking mental health treatment and promoting overall mental wellness within the community.
This study has several strengths, including its focus on African American men - an often underrepresented group in mental health research. By examining the impact of masculinity on mental health treatment-seeking behaviors, the study addresses a critical gap in the literature. However, the study has some limitations. The broad age range of participants (18 to 85 years) could introduce variability that may confound the results, as attitudes towards mental health treatment may differ across generations. Additionally, another potential limitation was the specificity of the population; by only studying African American men, extrapolation to other races can be more difficult. Futhermore, the study’s cross-sectional design limits the ability to establish causality between the variables examined. Moreover, the limited two-week data collection period restricted the number of participants, and with more time, a larger sample of African American men could have participated in the study. Despite these limitations, the findings offer important contributions to understanding the barriers African American face in seeking mental health treatment.
Future research should aim to include diverse ethnicities of male gender, allowing for more comprehensive studies of mental health-seeking patterns. Larger sample sizes should be considered to provide researchers with more robust data (Table 1). Moreover, the relationship between internal shame and masculinity should be further examined to strengthen the understanding of how masculine values influence African American male mental health care. In addition, research efforts should consider socioeconomic factors, such as income, to develop a more comprehensive understanding of its impact on mental health and care-seeking behavior.
Description of Participants
Conclusion
This study provides valuable insights into the intersection of how masculinity, distrust in doctors, and parental support shape African American men’s view on getting mental health treatment. By deepening our understanding of these complexities, this study contributes to the ongoing effort to address mental health disparities and improve access to care for African American men.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
