In some men, depression does not show up as sadness first. It can come out as irritability, anger, drinking or risk-taking, signs that standard depression questionnaires rarely ask about, if at all. November is Movember, the men's health campaign run by the Movember foundation, and 19 November is International Men's Day.
- The picture: in France, 12.8% of men had a depressive episode in 2024, and more than half of them received no care at all.
- Lesser-known signs: irritability, anger, alcohol, risk-taking, withdrawal, physical complaints.
- Questionnaires: a low PHQ-9 score does not rule out depression in a man who shows these signs.
- What to do: talk to your doctor. If you have thoughts of suicide, in the US call or text 988, in the UK and Ireland call Samaritans on 116 123, elsewhere your local emergency number.
Less depression recorded, more deaths by suicide
According to the World Health Organization (WHO), 6.2% of adult women and 4.1% of adult men were living with depression in 2023. In France, the 2024 Santé publique France health barometer (34,795 adults aged 18 to 79) found the same gap: 18.2% of women and 12.8% of men had a major depressive episode in the past year.
Men with depression also get less care. In that French survey, 53.9% of them had not seen a professional, had no psychotherapy and took no medication, compared with 37.9% of women. Even during a severe episode, this was true for 41.2% of men. In the United States in 2022, 41.6% of men with a mental illness received treatment, compared with 56.9% of women.
Deaths by suicide, on the other hand, mostly involve men. In France, men accounted for nearly 3 in 4 suicide deaths (8,848 deaths in 2023). From 2011 to 2021, the average French rate was 21.2 per 100,000 for men against 6.5 for women. In England and Wales, it was 17.5 against 5.5 per 100,000 for deaths registered in 2025. Worldwide, the male rate is 2.2 times higher (2021 data).
Suicide has many causes, and these figures do not prove on their own that depression in men is underestimated. But the mismatch has led researchers to ask whether we are looking for the right signs.
What the 2013 JAMA Psychiatry study found
Three US researchers, Martin, Neighbors and Griffith, went back to a large national survey, the National Comorbidity Survey Replication, carried out between 2001 and 2003. Their analysis, published online on 28 August 2013, covers 5,692 adults, including 2,382 men.
They built two scales. The first counts only so-called "male-type" symptoms: irritability, anger attacks or aggression, sleep problems, alcohol or drug abuse, risk-taking, hyperactivity, stress and loss of interest. The second adds classic symptoms such as low mood and tiredness.
- Men reported anger attacks, substance abuse and risk-taking more often than women.
- On the "male-type" scale, 26.3% of men met the criteria, compared with 21.9% of women.
- On the combined scale, the gap disappeared: 30.6% of men and 33.3% of women, a difference that was not statistically significant.
These percentages are not rates of current depression: most questions asked about a person's whole life, others about the past 30 days. It is a secondary analysis, and the authors do not suggest using these scales as they stand. Overworking could not be studied because the numbers would have been too small.
A 2017 meta-analysis (32 studies, 108,260 participants) points the same way: depressed men more often reported alcohol or drug misuse and risk-taking, while depressed women more often reported low mood and changes in appetite or sleep. The differences were small to moderate: these are tendencies, not two different illnesses. See also Circadian Depression: What the New Body-Clock Study Shows.
The lesser-known signs
They come from the studies above and from guidance published by Movember and by France's national suicide prevention line, 3114. What matters is a change from what is usual for that person.
- Irritability and anger: snapping over small things. The WHO itself describes depressed mood as feeling sad, irritable or empty.
- Alcohol or drugs: drinking or using more than before.
- Risk-taking: reckless or impulsive behaviour that is out of character.
- Keeping it all in: no longer talking about feelings, answering "I'm fine" to everything.
- Physical complaints: one of the six dimensions of the MDRS-22 scale, described below.
- Withdrawal: cancelling plans, missing sport, going quiet on messages.
- Sleep and stress: sleeping badly, feeling under constant pressure.
On its own, none of these signs means "depression". The 3114 service points out that it is a build-up of signs, or a sudden change, that should raise concern. Only a professional can sort out what is going on.
One scale was designed around these signs: the Male Depression Risk Scale (MDRS-22), published in 2013 by Simon Rice and colleagues (University of Melbourne). Its 22 questions cover six dimensions: emotional suppression, drug use, alcohol use, anger and aggression, physical symptoms and risk-taking. Later tested with 1,000 Canadian men recruited online, it picked up 84.6% of those who reported a recent suicide attempt, against 53.8% for the PHQ-9 (moderate score or higher). The abstract does not say how many men this involved: it is a signal, not proof.
Why the PHQ-9 can miss it
The PHQ-9 follows the nine DSM-IV criteria for depression: loss of interest, low mood, sleep, tiredness, appetite, feeling bad about yourself, concentration, being slowed down or restless, and thoughts of death. It was validated in 2001 on 6,000 patients, most of them women, and tracked men's health equally well. But none of its questions is about anger, alcohol or risk-taking.
The CES-D has its own biases: among 2,340 older US adults with the same overall level of depression, women were more likely to endorse the question about crying spells.
In practice, a low score should not reassure a man who recognises himself in several of these signs. These self-assessment questionnaires help you take stock; they do not give a diagnosis. If work exhaustion is the main issue, our burnout questionnaire (OLBI) measures something different: exhaustion and disengagement at work.
Why so many men do not seek help
A Canadian survey published in 2020 looked at 117 men with moderate depression symptoms on the PHQ-9: only 8.5% were seeing a professional. The main barriers were attitudes rather than practical obstacles: reluctance to talk about mood with their doctor, a habit of solving problems alone, and uncertainty about what therapy involves. The UK government made a similar point (men can be less likely to seek help) in its Men's Health Strategy for England, launched on 19 November 2025.
Yet depression can be treated, whether it is mild, moderate or severe, the WHO stresses. Your GP or family doctor is a good first contact. Describe what you are going through in concrete words: "I snap over nothing", "I'm drinking more", "I haven't slept properly in weeks". Sleep and stress matter too: see Treating Insomnia to Ease Depression and Chronic Stress and the Brain.
How to talk to a man you are worried about
Movember recommends the ALEC approach, developed by the charity R U OK?:
- Ask: mention what you have noticed, for example "You haven't seemed yourself lately, are you feeling OK?". People often say "I'm fine" when they are not, so do not be afraid to ask twice.
- Listen: without judging and without trying to fix everything.
- Encourage action: talking to people they trust and, if they have felt low for more than two weeks, seeing their doctor.
- Check in: follow up after the conversation.
The NHS suggests open questions and reminds you that you do not need to have the answers: listening and taking it seriously already helps. France's 3114 adds: do not brush it off ("it'll be fine"), never promise to keep it secret, and remember you are a friend, not a therapist. If you are worried, you can ask directly: "Are you thinking about suicide?". Talking about it does not plant the idea, the 3114 service stresses. A 2022 meta-analysis found no harm from asking, although the studies mostly involved research questionnaires and interviews.
If you are going through a hard time
You are not alone, and depression can be treated. In the US, call or text 988. In the UK and Ireland, call Samaritans free on 116 123, day or night. In France, call 3114, free and open 24/7, including if you are worried about someone. Elsewhere, or if someone is in immediate danger, call your local emergency number.
Frequently asked questions
Is depression really less common in men?
WHO estimates put it at 4.1% of adult men against 6.2% of adult women. But in the 2013 study, the gap disappeared when anger, alcohol and risk-taking were counted too. The question is not settled.
Does a low PHQ-9 score mean everything is fine?
Not necessarily: the PHQ-9 asks nothing about anger, alcohol or risk-taking. If you recognise yourself in these signs, talk to your doctor.
What if he refuses to talk?
Stay in touch and ask again later. Helplines such as Samaritans and France's 3114 also support worried friends and family, so you can call for yourself. If he talks about wanting to die and you fear he is in immediate danger, call your local emergency number.
References: Martin LA, Neighbors HW, Griffith DM (2013). The Experience of Symptoms of Depression in Men vs Women: Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 70(10):1100-1106, published online 28 August 2013. doi:10.1001/jamapsychiatry.2013.1985 (secondary analysis of the NCS-R, 2001-2003, 5,692 adults including 2,382 men) | Cavanagh A, Wilson CJ, Kavanagh DJ, Caputi P (2017). Differences in the Expression of Symptoms in Men Versus Women with Depression: A Systematic Review and Meta-analysis. Harvard Review of Psychiatry 25(1):29-38. doi:10.1097/HRP.0000000000000128 (systematic review and meta-analysis, 32 studies, 108,260 participants) | Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM (2013). Development and preliminary validation of the male depression risk scale: furthering the assessment of depression in men. Journal of Affective Disorders 151(3):950-958. doi:10.1016/j.jad.2013.08.013 (online community samples, no diagnostic interview: 386 men, then 499 men and 291 women) | Rice SM, Ogrodniczuk JS, Kealy D, Seidler ZE, Dhillon HM, Oliffe JL (2019). Validity of the Male Depression Risk Scale in a representative Canadian sample: sensitivity and specificity in identifying men with recent suicide attempt. Journal of Mental Health 28(2):132-140. doi:10.1080/09638237.2017.1417565 (online sample of 1,000 Canadian men) | Rice SM, Oliffe JL, Kealy D, Seidler ZE, Ogrodniczuk JS (2020). Men's Help-Seeking for Depression: Attitudinal and Structural Barriers in Symptomatic Men. Journal of Primary Care & Community Health 11:2150132720921686. doi:10.1177/2150132720921686 (cross-sectional online survey, 117 men) | Kroenke K, Spitzer RL, Williams JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x (6,000 primary care and obstetrics-gynaecology patients, 580 re-interviewed) | Cole SR, Kawachi I, Maller SJ, Berkman LF (2000). Test of item-response bias in the CES-D scale: experience from the New Haven EPESE study. Journal of Clinical Epidemiology 53(3):285-289. doi:10.1016/S0895-4356(99)00151-1 (2,340 older adults) | Polihronis C, Cloutier P, Kaur J, Skinner R, Cappelli M (2022). What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal. Archives of Suicide Research 26(2):325-347. doi:10.1080/13811118.2020.1793857 (17 studies rated, 8 meta-analysed) | Leon C, Perrin L, Gillaizeau I, Papadopoulos A (2025). Épisodes dépressifs : prévalence et recours aux soins. Baromètre de Santé publique France, résultats de l'édition 2024 (in French). Santé publique France | Santé publique France: Suicides et tentatives de suicide, données (in French, updated 5 January 2026) | Hazo JB, Aubain L, Cadillac M (2026). Le suicide, trois fois plus fréquent chez les hommes, deux fois plus chez les plus modestes (in French). DREES, Études et résultats no. 1364 | ONS: Suicides in England and Wales: 1981 to 2025 (13 October 2026) | WHO: Depressive disorder (depression) | WHO: Suicide worldwide in 2021: global health estimates (2025) | NIMH: Mental Illness (NSDUH 2022 data) | Department of Health and Social Care: Government unveils England's first ever Men's Health Strategy (November 2025) | Movember: Spot the signs and FAQ | NHS: Help for suicidal thoughts | 3114: Comment reconnaître les signes de détresse and Que dire ? Quoi faire ? (in French) | 988 Suicide & Crisis Lifeline | Samaritans