Association Between Psychotherapy Use, Sexual Orientation, and Traditional Masculinity Among Psychologically Distressed Men

Public Significance Statement Heterosexual-identified men are less likely to use psychotherapy as compared to non-heterosexual-identified men. While higher prototypical depression symptoms increase the likelihood for psychotherapy use, strong endorsement of TMI and high externalizing depression symptoms reduce the likelihood for psychotherapy use. Health care policies should specifically target heterosexual-identified men with high TMI and externalizing symptoms to increase psychotherapy uptake among men who experience psychological distress. Heterosexual-identified men, as compared to non-heterosexual-identified men, are less likely to seek out psychotherapy when experiencing psychological distress. Stronger endorsement of traditional masculinity ideologies (TMI) has been reported to be associated with reduced psychotherapy use among men. However, the relationship between psychotherapy use, TMI, and sexual orientation needs to be explored. A total of 728 psychologically distressed men (59.9% heterosexual-identified, 40.1% non-heterosexual-identified) from German-speaking parts of Europe completed an online questionnaire asking about current psychotherapy use, endorsement of TMI, experienced gender role conflict (GRC), prototypical depression symptoms, and externalizing depression symptoms. In total 34.5% (n = 251) of the men were currently using psychotherapy, of which 47.4% (n = 119) identified as heterosexual and 52.6% (n = 132) as non-heterosexual. Heterosexual-identified men used psychotherapy less than non-heterosexual-identified men, while exhibiting lower prototypical depression symptoms but comparable externalizing depression symptoms. Additionally, heterosexual-identified men exhibited higher endorsement of TMI across all domains and experienced more masculine GRC, especially in the domains Success Concerns and Restricted Affection. Endorsement of TMI was associated with increased externalizing depression symptoms only among heterosexual-identified men. Logistic regression analyses showed stronger endorsement of TMI, increased externalizing depression symptoms, and identifying as heterosexual to be associated with reduced psychotherapy use. Men identifying as heterosexual with strong endorsement of TMI, and high externalizing depression symptoms have a reduced likelihood to use psychotherapy. Thus, challenging TMI and advocating for alternative masculinities that include health promoting behavior can especially help heterosexual-identified men with strong TMI.