509408

research-article2013

QHRXXX10.1177/1049732313509408Qualitative Health ResearchOliffe et al.

Article

Masculinities, Work, and Retirement Among Older Men Who Experience Depression

Qualitative Health Research 23(12) 1626­–1637 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732313509408 qhr.sagepub.com

John L. Oliffe1, Brian Rasmussen1, Joan L. Bottorff1, Mary T. Kelly2, Paul M. Galdas3, Alison Phinney1, and John S. Ogrodniczuk1

Abstract The high incidence of depression among older men has been linked to numerous factors. In this qualitative descriptive study of 30 older, Canadian-based men who experienced depression, we explored the connections between participants’ depression, masculinities, work, and retirement. Our analyses revealed three thematic findings. The recursive relationship between depression and work was reflected in depression impeding and emerging from paid work, whereby men’s careers and work achievements were negatively impacted by depression amid assertions that unfulfilling work could also invoke depression. Lost or unrealized empires highlighted the centrality of wealth accumulation and negative impact of many participants’ unfulfilled paid work aspirations. Retirement as loss and the therapeutic value of work reflected how masculine ideals influenced men to continue working to avoid the losses they associated with retirement. The findings confirm the need to support men’s work-related transitions by affirming a diversity of masculine identities beyond traditional workman/breadwinner roles. Keywords depression; masculinity; men’s health; older people; workplace Depression is a serious mental illness associated with considerable disease burden and reduced quality of life (Alexopoulos, 2005). In terms of gender, men are formally diagnosed with depression at half the rate of women (Government of Canada, 2006), and an array of factors are posited as underpinning this longstanding difference. For example, men’s self-reliance, stoicism, and reticence to seek professional help for depression have been linked to dominant discourses of masculinity as a means to explain why men are less likely than women to identify, acknowledge, and/or report depressive symptoms (Oliffe & Phillips, 2008). Further supporting the need to better understand men’s depression is the suicide rate among men, which is up to eight times higher than that of their women counterparts (Kochanek, Murphy, Anderson, & Scott, 2004). Among men 75 years and older, the prevalence of suicide is especially high (Statistics Canada, 2010). In addition to men’s resistance to help seeking and fragmented pathways to mental health care services (Strike, Rhodes, Bergmans, & Links, 2006), the use of generic depression screening tools have been reported as factors contributing to the underdiagnoses of older men’s depression and their high suicide rates (Rutz, Walinder, von Knorring, Rihmer, & Pihlgren, 1997). Diverse explanations exist about the etiology of older men’s depression. Socioenvironmental theories suggest it

might be a byproduct of bereavement (Bennett, 2007); adversity; and interpersonal difficulty, including the loss of a child, loneliness (Bergdahl, Allard, Alex, Lundman, & Gustafson, 2007), inadequate social networks (Kraaij, Arensman, & Spinhoven, 2002), reduced autonomy (Smith, Braunack-Mayer, & Wittert, 2006), and comorbidities (Alexopoulos, 2002). In this study and article, we used a social constructionist gender framework to describe connections between masculinities, work, and retirement among older men who experienced depression.

Masculinities and Men’s Depression Connell’s (1995) masculinities framework has been adapted by health researchers to describe a plurality of gender performances that are taken up by men who 1

University of British Columbia, Vancouver, British Columbia, Canada Independent Research Consultant, Vancouver, British Columbia, Canada 3 University of York, Heslington, York, United Kingdom 2

Corresponding Author: John L. Oliffe, School of Nursing, University of British Columbia, 302–6190 Agronomy Rd., Vancouver, British Columbia, Canada V6T 1Z3. Email: [email protected]

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1627

Oliffe et al. experience depression. Central to this social constructionist gender work are two principles: (a) patriarchal power and characteristics, including self-reliance and competitiveness, are understood as hegemonic masculine ideals that influence men’s health practices and illness experiences; and (b) a plurality of context-dependent masculine performances are embodied by men in relation to dominant ideals of masculinity. These masculine performances are stratified as complicit, subordinate, and marginalized responses; however, it is important to note that men can move between these masculine identities. Complicit masculinity, for example, sustains hegemony by enacting social practices that approximate or reproduce men’s hegemonic status in the social hierarchy; subordinate forms of masculinity embody practices associated with failed hegemony, for instance, lack of authority, weakness, domesticity, and statuses associated with femininities such as illness and dependency; marginalized masculinities are linked to deprivileged race, class, and ethnic markers and include men who are excluded because of their perceived deviation from standards of White Western idealized masculinity (Connell). Masculinity frameworks can also be used to theorize gender in terms of its intersectionality with other social factors, such as age and ageism (Griffith, 2012). In line with this, Hearn (2010) argued that to fully understand the contradictory means by which men receive status and experience marginalization as a result of aging, masculinities researchers must address the gendering and embodiment of aging. For example, older age might signify men’s accumulation of wealth or power; however, it is inevitably accompanied by a weaker and frailer physical body that relegates older men to a subordinate status in Western cultures (Buchbinder, 2002). For older men who have failed to build material wealth amid experiencing mental health challenges, retirement and the limitations of aging and illness can invoke a variety of additional crisis points. In the empirical masculinities and men’s depression literature, avoidance and escape from mood distress by acting out with substance use or aggressive behaviors has been highlighted (Brownhill, Wilhelm, Barclay, & Schmied, 2005). The inclusion of men-specific depressive symptoms including anger, irritability, and substance overuse have been explained through men’s alignment to masculine ideals, which in turn are undetected using the Diagnostic and Statistical Manual of Mental Disorders criterion (Kilmartin, 2005). Men’s preference for selfmanaging depression has been linked to their desire to embody idealized masculinities amid distancing themselves from “having” a mood disorder or “needing” emotional support—deficits and actions that are typically associated with femininities (Johnson, Oliffe, Kelly,

Galdas, & Ogrodniczuk, 2012; Mőller-Leimkühler, 2002). Emslie, Ridge, Ziebland, and Hunt (2006) also highlighted how most participants in their study incorporated values of hegemonic masculinity in their narratives of recovering (autonomy, re-establishing control in their lives) from depression. A few masculinities studies have included and/or were focused on older men’s mental health. In a mixedmethods study of men aged 55 to 97 years, Tannenbaum and Frank (2011) reported that participants rarely sought help for emotional problems and when professional help was solicited for physical ailments, participants depicted help seeking as a decisive masculine action. McVittie and Willock (2006) found that becoming a patient and relinquishing self-reliance rendered older men (>65 years) subordinate within masculine hierarchies, a transition participants tried to avoid by delaying seeking professional help. Although men’s performances of masculinity and their alignment to masculine ideals shift in different social contexts, how specific masculine performances shape men’s identities in response to aging and life transitions, such as retirement, is poorly understood. Older men can face unique challenges in regard to maintaining or remaking a masculine identity. Indeed, older men tend to be represented as genderless beings in Western societies, in contrast with depictions of manliness that focus on youth, sexual virility, resources, and professional careers (Thompson, 2007). In addition, ageism prevails in industrialized nations whereby dominant cultural practices rarely honor or grant positive status to elders, especially when they are no longer part of the workforce. As a result, the psychological work of constructing positive gender identities in older age and in transitions such as retirement tends to reside with the individual.

Masculinities, Work, Retirement, and Older Men’s Depression Scholars have described diverse connections between men, masculinities, and work among young and midlife career professionals, delineating the centrality of work and/or career to men’s lives and identities. For example, Collinson and Hearn (2005) suggested that organizations are sites for the reproduction of men’s power, whereby performativity around structure, control, decision making, and remuneration reflect, as well as reinforce, masculine ideals. Kilmartin (2007) highlighted how men in the Western world buy into masculine workplace norms by defining themselves according to their jobs and evaluating their worth across the boundaries of public and private, paid and unpaid work. Idealized masculinities can also be taken up and contested by men in the workplace.

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1628

Qualitative Health Research 23(12)

Decision making and strategic planning—key aspects of managerial authority—are activities that define idealized masculinity, and flowing from this control are power relations that routinely exclude and subordinate lesspowerful workers. Hegemonic marketplace masculinities, Kimmel (1994) suggested—typified by aggression, competition, and anxiety among men who focus on outperforming one another at work—can coexist alongside men who resist such masculine ideals. Men’s overrepresentation in dangerous manual and heavy labor industries and downstream outcomes, including workplace injury and death, has also been linked to masculinities, social class, and risk taking (Dolan, 2007, 2011). As men grow older, they are often less able to compete effectively with younger, “hungrier,” and more aggressive male colleagues (Collinson & Hearn, 2005). The transition to retirement can preempt older men’s estrangement from the masculine man-as-breadwinner associations with work and money (Buchbinder, 2002), and cause an identity crisis when work has been a man’s primary source of affirmation and accomplishment (Brown, 2008). Calasanti and King (2005) suggested that men’s immersion in the work arena provides a sense of agency and identity in predicting that older men facing retirement can experience this transition as a threat to masculine ideals. A United Kingdom– based gender comparison study that included 11 men in their 50s found that some participants who “worked to live” ran counter to traditional masculinity, ascribing that real men “live to work” (Emslie & Hunt, 2009). Research addressing older men has also focused on the degree to which retirement and unemployment impact the development of, or risk for, depression. For example, depressed workers are more likely to retire than nondepressed workers (Doshi, Cen, & Polsky, 2008), and men of lower socioeconomic status are at greater risk for hopelessness and depression (Soares, Macassa, Grossi, & Viitasara, 2008). Mutran, Reitzes, and Fernandez (1997) predicted that the greater the intrinsic value of men’s work, the less retirement satisfaction, whereas Butterworth et al. (2006) claimed older retirement age (65 to 74 years) results in a lower prevalence of mental illness among men. In line with this evidence, retrenchment and unemployment are also associated with adverse health outcomes, including men’s depression and suicide (Brand, Levy, & Gallo, 2008; Chan, Yip, Wong, & Chen, 2007). We found only two published studies that included some attention to the connections between masculinities, work, and older men’s depression. Completed by Bennett (2007), a study of 60 older widowers revealed how, amid embodying self-reliance, control, and the strength to cope, distractive strategies (such as immersing themselves in work) were used by men to distance themselves from the grief and depression associated with losing a

partner. Galasinski’s (2008) study of men’s depression drawing on interviews with 27 participants ranging in age from 30 to 60 years concluded that some men were unable to cope with workplace stress, whereas workaholics, after years of working too much, eventually cracked under the pressure. To build on this research and respond to Whorley and Addis’s (2006) call for qualitative research to better understand the impact of masculinity on older men’s health, we focused on describing the connections between masculinities, work, and retirement among older men who experienced depression.

Methods The methodological approach informing our study was interpretive description, a qualitative method drawing on the explicit logic of how knowledge is used in the applied health disciplines (Thorne, 2011). Our approach relied on a knowledge-to-practice orientation whereby we sought knowledge from the perspective of the manner in which it is to be used as a means to garner empirical findings with practice utility (Thorne, 2008). In keeping with this approach, our social constructionist framing was purposely employed to produce knowledge with the aim of understanding older men’s depression and positively influencing their mental health and well-being.

Recruitment A convenience sample of 30 men ranging in age from 55 to 82 years (M = 67.8) participated in the study. They were recruited through brochures posted at community centers and newspaper advertisements describing the study and inviting potential participants to contact the research staff. Included in these recruitment materials and the study consent forms were the title of the study— Depression and Older Men—along with details about participating to assist us to better understand older men’s depression-related experiences. The sample included men who self-identified as having had depression (n = 10) and those who had been formally diagnosed with depression (n = 20). All were English-speaking. Participants lived in Vancouver (n = 17), a city of more than 600,000 in British Columbia, Canada, and Kelowna (n = 13), a regional city in the interior of British Columbia with a population of ~165,000. Although the study was designed to explore the connections between masculinities and older men’s depression, our focus on men’s work was influenced early in data collection by the men’s eagerness to talk about work, retirement, and the connections to their depression. In this respect, the focus on work was inductively derived, and employed (n = 18) and retired (n = 12) men were included to afford participants’ current, prospective, and retrospective accounts about work.

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1629

Oliffe et al. The industry sectors in which the men currently or previously worked were mostly white-collar occupations across various socioeconomic groups. One third of the men reported professional careers; one third worked in skilled trades and service-related sectors; and one third had spent their working lives in administrative, managerial, or sales-based occupations. Four men reported a single, lifelong occupation concluding in retirement: a researcher, a self-employed consultant, a social worker, and a paramedic. At the other extreme, a 62-year-old man currently working in an administrative position stated he had been employed by 31 different companies. According to Canadian social programs, most participants were eligible for the Canadian Old Age Security Pension at age 65 (Statistics Canada, 2009). The Canada Pension Plan, a second source of income for older Canadians based on contributions made during one’s working life, was also available to most men, and a few retirees received additional income from private pension funds.

Data Collection Following university ethics approval and completion of a written consent form, individual in-depth semistructured interviews lasting 60 to 90 minutes were conducted at a location and time of the participants’ choice. Researchers explained that the interview was not intended as a form of therapy, but rather as an opportunity to better understand the men’s depression-related experiences. Participants received a nominal honorarium of $30CDN to acknowledge the time spent and their contribution to the study. Participant demographic data were collected and they completed the 21-item Beck Depression Inventory–2nd Edition (BDI-II) to assess their current level of depression at interview (Beck, Steer, & Brown, 1996; see Table 1). Many men had consulted their doctor (n = 13) and/or a psychiatrist (n = 11), and a few participants (n = 5) had received counseling for depression from a psychologist or counselor. Three female interviewers (a master of science, master of arts, and a bachelor of psychology staff) were provided additional ongoing training from the study’s principal investigator. This included reviewing and discussing interviews to guide the interviewers’ use of probe and loop questions to expand on participant perspectives (Oliffe & Mroz, 2005). Consensus prevails that the gender of the interviewer can influence the interview data (Oliffe, 2010), and although participants had the option of being interviewed by a man, we suspect that being interviewed by a younger woman might have reduced the potential for participants feeling vulnerable or subordinate in talking about their depression. In addition, some participants might have taken on an educator role in describing their depression to relatively young female

Table 1.  Demographic Characteristics of Older Men. Characteristic Age (years), M (range) Marital status:  Married/common-law   Single/never married  Divorced  Separated  Widowed Formally diagnosed with depression BDI score   Minimal depression (0–13)   Mild depression (14–19)   Moderate depression (20–28)   Severe depression (29–63)   Not completed Treated for depression? (Currently or previously)   No current treatment  Medications  CBT/Counseling/Therapy

n (%) 67.8 (55–82)   16 5 4 3 2 20 (66%)   14 (46.7%) 3 (10.0%) 6 (20.0%) 5 (16.7%) 2 (6.6%)   9 (30%) 21 (70%) 11 (36.7%)

Note. BDI = Beck Depression Inventory; CBT = cognitive–behavioral therapy.

health researchers. An interview guide was used and questions about work and retirement were added after the research team reviewed data collected from the first 5 participants. Interviewers provided a printed list of mental health service resources to the participants and had specific guidelines for ceasing interviews and referring the men to mental health care services if they observed any participant distress. Digitally recorded interviews were transcribed verbatim, excluding identifying information, reviewed for accuracy, and labeled with an identifier code.

Analysis The interview data were read for instances wherein participants described their working life, career, and/or retirement-related experiences. From this “parent” code, labeled “employment,” data subsets of “community work,” “expectations of others,” “paid work,” and “money and retirement” were developed. Entire interviews and the coded data were reviewed with the overarching research question in mind: What are the connections between masculinities, work, retirement, and older men’s depression? Using interpretive descriptive methods, recurring, converging, and contradictory patterns were inductively derived, along with illustrative examples from the data (Thorne, 2008). Guided by Morse (1995), data saturation was achieved when no new information was obtained in

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1630

Qualitative Health Research 23(12)

the interviews, and the existing data were sufficient to build comprehensive and convincing findings. From the preliminary categories, themes were identified and labeled and descriptive notes were written to define each of the emergent findings so that relationships between them could be developed. The categories and themes were discussed and refined by members of the research team (including the interviewers) to ensure the rigor and credibility of the analyses. In theorizing the findings, we returned to the relevant empirical work and Connell’s (1995) masculinities framework to conceptually advance and theorize the findings.

Results Depression Impeding and Emerging From Paid Work In retirement, and when entering their later work years, most participants struggled to make sense of their work life, reflecting on the many years they had toiled in a variety of jobs, industries, and organizations. Although men constructed workman ideologies as central to their lives, their narratives also revealed the deeply entwined nature of their depression and paid work. Typically, men’s representations of how depression impeded their job performance were chronicled along with accounts about how work-related issues could invoke depression. Many men constructed their depression as the key factor for failing to realize their work potential or leverage any remaining opportunities to reconcile or rewrite their work history. In response to our opening interview question that invited participants to provide some background about themselves, the men detailed squandered work opportunities, and tended to ruminate about regrets, disappointments, and work-related turmoil. A 68-year-old retired customer service representative lamented his work history, “I don’t know what I would have been, but I had the brains and the opportunity but not the drive,” whereas a 55-year-old retired manager quipped, “I have a lot of brains. Too bad I wasn’t able to develop them into a career of some sort.” Embedded in these men’s narratives of regret were the assertions that depression had stopped them from capitalizing on their intellectual capacity, which in turn diminished their work and career outcomes. A 66-year-old security guard, who in the 1960s worked as a cook, also explained how depression reduced his options for the type of paid work he could comfortably do: “I’ve done a lot of things, but cooking was my main bag, then security. . . . Work gets hard with depression, too. I mean depression causes a lot of pressure on you when you’re working.” Evident here, and in many participant interviews, were examples for how the men’s depression-induced

symptoms—including lethargy—reduced the ability to focus and anxiety limited their work performances and career prospects. Although the men connected their depression and work lives within the interviews, many described how they were unable to openly do this elsewhere. To overcome or minimize the disarray that their depression could produce, men used strategies to pass as being well—both as a form of job protection and a means to avoid the stigma they anticipated would accompany any workplace knowledge of their depression. A 55-year-old bus driver had kept his depression hidden from work colleagues for 15 years. When he became too depressed to work, he claimed physical injury rather than depression to legitimate his sick leave: It was easier to tell them at work that no, I couldn’t drive because I had a sore back because my vertebrae [had been] broken than it was to say, “I feel really shitty today. I want a day off.” It was much easier to say, “My back’s killing me. I’m not coming in.” That’s a physical versus a mental thing.

Evident here are masculine ideals whereby injury and/ or physical pain are accepted as barring particular types of work. Conversely, the validity of depression was suspect, more likely dismissed as a transient mood amenable to self-control and best remedied by manly resilience. Although secret-keeping helped to maintain some men’s work personas, the effort involved in masking depressive symptoms often increased the their workload and fueled their depressive symptoms. In the extreme, strategies failed to such an extent that the visibility and impact of their depression on others rendered the men unemployable, as a 66-year-old ex-military and retired technician explained: They retired me early because of my depression and my posttraumatic stress. I was having trouble with people at work, you know. I started threatening people and I hit a student one time for being lippy. You know I was having anger management problems and the depression where I threatened to shoot everyone in the shop one day.

While learning how depression impeded many men’s ability to perform at work, we also heard much about how work-related issues triggered or exacerbated men’s depression. Participants described how being undervalued or pressured to perform contributed to their workplace resentment. A 62-year-old retired policeman suggested that the traumatic nature of the work, along with lack of recognition and promotion, led to his poor physical health and depression: All through my career no matter how hard I work, you know, I get pushed out of the way or kicked back, and my body

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1631

Oliffe et al. quit. . . . I had more grief at work. I had another boss who was, he actually ended my career. He actually failed me on my performance evaluation and I had to write about a 27- or 28-page appeal, and they brought it up just enough to pass me. which ended my career in terms of promotions. . . . It’s just like there’s no winning . . . you’re dedicated, do the best you can, work hard, get kicked in the teeth.

In this scenario, despite his seniority, the man’s 25-year career stalled to the extent that it was essentially over, leading him to subsequently retire, albeit reluctantly. The associated turmoil, he suggested, manifested an array of physical musculoskeletal ailments, and depression emerged soon thereafter. The man’s demanding and challenging work and its effect on his mental health was evident in his summation: “I did some really good police work, put some really bad guys in jail, but I paid a heavy price.” Other men who had endured chronic depression also highlighted the particular nature of their work as the trigger or cause of their illness. A 62-year-old department store worker who, despite his longstanding disquiet with the service industry, was unable to find more meaningful work, said, I was back at a job I hated. I swore when I escaped from the service industry that I wouldn’t go back, but I was back and working at that. I mean I was making an income but I was just not a nice man to be with . . . I mean I just hate my job.

Job losses also featured as a trigger for men’s depression, and the impact of being “let go” or fired resulted in significant distress. A 55-year-old man explained how losing his government job in the 1990s resulted in his lowest moment and a prolonged period of “not wanting to involve myself in anything”: I went through heavy denial, heavy anger, blaming other people. . . . I felt that I was wronged . . . even though I understood that many people got laid off at that time, and I understood that for many people things didn’t work out, but I really took it personally. . . . Major events, job loss are a big deal for me . . . a really, really big deal, really caused some life-changing events.

This man’s account portrayed job loss as fueling anger and hostility, emotions and actions he interpreted retrospectively as flowing toward as well as from his depression. The degree to which depression encumbered men’s work performance or work contributed to their depression varied. Like many older men for whom work is central, losing their job or being forced to retire unexpectedly or early invoked grief, loss, and anger amid derailing work and/or career-based identities (Barnes & Parry, 2004). Similar to Galasinski’s (2008) assertion that work strongly influences men’s masculine identities, work featured in participants’ accounts of what they currently or

previously did; however, it was also the site of much discontent about what they had failed to achieve—a conundrum that rendered many participants even more susceptible to depression.

Lost or Unrealized Empires Many men’s commentaries focused on paid work as the vehicle to achieve financial and material success, and fulfill breadwinner and provider roles for their family. The amount of money earned through work determined the level of success that the men might reasonably claim, and wealth accumulation was a key criterion for assessing their relative worth. Several men described financial hardships that were consequences of life and work circumstances, including failed businesses, unemployment, economic downturn, and poorly compensated jobs and career paths. A compromised financial state could directly contribute to participants’ depression, as a 79-year-old man who had worked in the clothing industry described: “A lot of people have financial worries. . . . I think a lot of men have that problem and that’s what drives them, you know, into depression.” A 58-year-old man who owned two retail franchises explained how his failed business venture left him poor despite years of work, a situation that exacerbated his depressive symptoms: Bill collectors are calling, bankers are calling me, so I had to sell all this off. So after fifteen years of hard work I got a handshake and a loony [slang for a Canadian one-dollar coin]. I was sick over that. I thought I had ulcers and I was passing blood. . . . I was sick, so depression came in. . . . Everything I had, the empire is gone. . . . I was, for two months I was upset and sick, sort of just mentally drained. I had nothing. . . . Starting all over again—that was my first little touch of depression.

This man positioned himself as losing entrepreneurial hegemonic status, perceiving his fall within the gender order in and of itself as the cause of his depression by dislocating his claim on a set of monetary-based masculine ideals. Many men regretted not fulfilling their money-making potential and this was seen by some to have a profound influence on their emotional well-being in their later working years and in retirement. Financial success was the yardstick by which these men judged their life and legacy, and some represented themselves as not “measuring up” financially to other men. In line with Buchbinder’s (2002) assertion that older men’s power is most often expressed through wealth and purchasing power, it was clear that some participants felt subordinated for failing to reach monetary masculine ideals. For instance, a 73-year-old retired divorcee who had limited financial resources pointed out how money dominated discussions

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1632

Qualitative Health Research 23(12)

among the relatively affluent men he golfed with, a situation that resulted in him withdrawing from some conversations: They zero in on money, they like to talk about money. . . . Some of them are very well off, you know, all their life they worked, made a lot of money, this is the conversation. I listen but sometimes you sit and, you know, [think] “I don’t have money. What’s there to talk about?”

Similarly, a 68-year-old single man who had worked for 20 years as a waiter compared himself to wealthy businessmen who made endowments to medical and educational organizations: I’d like to do that, I’d like to build a building, [with] my name on it, but I don’t have the resources, so sometimes I feel a bit set back on that level. How come I can’t get to that stage, that sort of disappoints me.

It is important to recognize that although these participants represented themselves as subordinate in specific contexts (i.e., among wealthy golf club friends or waiting table for successful businessmen), they might also have demonstrated aspects of hegemonic masculinity in other arenas, and/or in comparison to less resourced men (and women; Connell & Messerschmidt, 2005). Nonetheless, men’s self-assessments often signaled their awareness and perhaps preoccupation with failing to measure up to the monetary success of wealthy men. Financial hardship also impacted some men’s intimate relationships. A 75-year-old self-employed man griped about his ex-wife, saying, “She couldn’t or didn’t find a job. I wound up working day and night. . . . I worked long bloody hours.” Amid explaining the eventual demise of the relationship, he confided, “The resentment was growing all this time.” A 66-year-old married cook confirmed, “You get depressed, too, if you don’t have a good partner with you to manage, to manage your household expenses. That gets very depressing.” Evident were men’s expectations that partners should contribute financially toward the family living costs; yet their provider and breadwinner pressures were also apparent. For example, among participants with partners who were making more money than they, the lost breadwinner status was portrayed as particularly challenging. A 55-year-old semiretired married man and former small business owner suggested, “It’s not socially acceptable to not be the main breadwinner.” He further explained that his reduced earning capacity had manifested as resentment toward the world and, in particular, toward people who had better financial prospects: I had this nice salary job with the regular hours from Monday to Friday and weekends off, and it’s gone. And you know,

now I’m running a small business with staff issues and pressure for hours and sweating the income and so on, and it’s just . . . you know, you see people in those situations and I guess part of it’s jealousy and part of it’s missing what I had, and wondering how the hell I ended up where I am. . . . What signal did I miss that I should have bailed out or, you know? Like what have I done wrong here? What have I done to deserve this?

Although financial provision for the family was strongly linked to men’s masculine identities, some poignant counterviews were shared. For example, a few participants highlighted a sense of purpose derived from unpaid work. A 64-year-old man argued that he had not retired because he volunteered his time to do community work: That’s one of my options to retire, but I don’t want to. Then I’ll become a nonproductive member of society. . . . I’ve a lot to contribute to the society yet in which they’ve contributed to me. That’s why I contribute it back to the society by volunteering. I don’t ask for money. What I do, I never ask for money. I go to my community and I say, “Look, can I help you in any other way?”

For this participant, his desire to keep busy and contribute to society far outweighed any financial incentive or need to work for a wage. Several men shared similar views and, by distilling work as reward enough (rather than relying on paid work to affirm the worth or true value of their labor), they broke with masculine “salaryman” ideals. Yet, these men also aligned to masculine ideals in detailing their capacity to work amid implicit assurances that their existing financial resources would sustain them.

Retirement as Loss and the Therapeutic Value of Work Many men for whom retirement loomed did not anticipate that transition as an opportunity. Instead, a sense of unfinished business, loss of routine in their life, and the erosion of important purpose were detailed as key challenges. The routines and structure of work in men’s lives helped them manage their depression by providing them “something to do,” a reason for getting out of bed in the morning. For a 55-year-old man, casual work as a bus driver was therapeutic in that it provided him structure: I’ve been fairly stable over the last couple of years with my job and doing what I wanted to, but it’s [the work] on a dayto-day basis. They give me my work for tomorrow and so I have three or four or five things on my “to do” list. . . . I know when I’m supposed to get up, I know what I’m supposed to do. I know where I’m supposed to go and then I have three or four charters . . . at the end of the day, then

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1633

Oliffe et al. I put the bus away and I’m done. . . . It seems when I have structure, it helps me work through the depression a lot better.

Without the structure afforded by his job, the participant lacked the motivation to get up in the morning and on weekends; he quite literally slept away the time. He went on to explain that he had experienced layoffs in the past, reflecting on how losing his job had each time “put him in a hole.” With this comment, he was not referring to his financial losses, but rather a lost sense of who he was as a man when unemployed, suggesting, “I’m not what I was and I’m not what I’m going to be; I’m somebody else.” Given these past experiences of being unemployed, he worried about retirement, suggesting, “I don’t know what’s going to happen if I have to retire. I really like being somebody . . . whatever that somebody is.” In addition to routine, the nature of some men’s work allowed, and perhaps demanded, they adopt a nondepressive persona. For example, a 58-year-old car salesman explained: You’ve got to be pumped. When you walk out of that door, you’re on stage. It’s the toughest job I’ve ever done because you’ve got to be out there, meeting people, you’ve got to be a psychologist. . . . I’ve got to be bubbly and happy, otherwise I won’t sell a car, right?—so I have to turn that on.

This participant constructed what Hearn (1999) referred to as public performances of masculinity, whereby his work persona emerged in stark contrast to the depressive symptoms he privately harbored. For some men, including a 61-year-old single company director, work also reduced the social isolation invoked by depression, affording connectedness with others: “I mean, my boss here was very understanding [about my depression], and I knew that I’d force myself to come to work because I knew if I didn’t I’d just stay in bed with the covers over my head.” When men’s identity remained tightly bound to their work life, retirement posed a threat and tested their capacity to manage their depression. Accordingly, some men refused to acknowledge that they were retired. An 82-year-old widower who worked as a part-time consultant stated, “I haven’t worked for a long time, but I’ve never said I’ve retired. Well, I used to consult all the time. If the phone rings it might be somebody.” Similarly, a 62-year-old retired police officer described his continued need to garner achievements: It’s like I need to keep proving to myself that I can do stuff, so whenever I commit to something I say it has to be on my terms, so it has to be when I’m able to do it but I’ll do it. I need to keep having accomplishments. . . . So now I do the wood-turning events . . . If I didn’t, if I didn’t do anything, I’d really be in trouble.

Although not prepared to engage professional medical help, he positioned these activities as therapy in that they provided a sense of purpose that bolstered his self-esteem. When some men had difficulty finding meaningful activity in retirement, their depression became more challenging. At one extreme, a few participants linked retirement to suicidal thoughts. A 66-year-old locksmith predicted that his life was not worth living as a retired person: If life is not enjoyable and your life’s work is more or less done, why go on with something that you don’t enjoy? . . . I don’t want to do that kind of thing [suicide], yet from a personal standpoint I think about it a lot.

Many men wanted to talk about their experiences of, and thoughts in and around, depression, but felt this was not something that retired or older men could do with one another. A 66-year-old retiree described how he no longer enjoyed social outings, preferring to be alone: “If I go for a couple of beers, I’d rather go sit in the corner and wail. Before, I used to be among the crowd having a good time, but not now.” A 75-year-old retired man admitted that he was perfectly able to talk about sports and cars and other “guy stuff,” but recognized that “guys aren’t interested in talking about depression,” inferring that this was something best kept to himself. A 56-year-old retired man reflected on why talking about feelings was taboo for men: “Boy, if you go to the bar and [start] talking about how you’re a bit down, you’re alone pretty quickly. . . . Boys aren’t supposed to be crying and boys aren’t supposed to be having problems.” With retirement beckoning or already in place, many men’s purpose, social connections, and purchase on paid work as the indicator of a life well lived became increasingly fragile.

Discussion and Conclusion Our novel study integrated somewhat estranged topics— masculinities, work, and retirement among older men who experienced depression—and offers important understandings about a vulnerable subgroup of men. In turn, the usefulness of Connell’s (1995) masculinities framework in health research is affirmed and, more specifically, its robustness for distilling empirical insights to guide gender-sensitive supports for older men who experience depression. The plurality of Connell’s masculinities framework is perhaps most visible through the dynamic interactions between men’s masculine workman identities, their internalized ideals, and both the perceived and real demands of the social world. Building on this, it is important to note that participants had the capacity to inhabit complicit, marginalized, and subordinate masculinities rather than neatly fitting into one category as a byproduct of being an older working or retired man who experienced depression.

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1634

Qualitative Health Research 23(12)

For many men, work presented a double-edged sword. For some, work provided an opportunity to manage their depression. To this extent, it served as a defense against depressive anxieties, mobilizing action to ward off feelings of loss, regret, and failure. Indeed, some men expressed awareness that work could be therapeutic, and continuing to work presented an opportunity to master life’s tasks and perhaps achieve elusive idealized goals, or at the very least to present a nondepressed persona. Work also provided a vital opportunity to embody an idealized masculine identity in reaping tangible benefits of monetary success. Conversely, work, which carried a lion’s share of the burden to sustain masculine ideals, posed innumerable challenges and threats to men’s self-esteem. Measuring up to masculine ideals meant, for these men, that it was necessary to achieve a good measure of success in their work life. Nonetheless, many men experienced job loss, periods of unemployment, missed opportunities, and oppressive work environments. Consequently, work failed to provide the necessary means to realize a vital sense of their masculinity. In addition, it was also the case that some men seemed to rely solely on work to uphold their masculine identity. Among retired men, an important workman identity could be lost in this regard and, coupled with a work history rife with regrets, the conditions were set for depressive symptoms to take hold. Despite mass social change in recent decades, hegemonic masculinity has proved remarkably stable. Although media representations of what it means to be a man espouse diversity unforeseen in previous eras, there persists the notion that “real” men still align with a masculinity defined by qualities that include the display of strength, stoicism, instrumentality, and the capacity to produce material wealth (Connell, 1995). Indeed, this sample of men expressed alignment to somewhat traditional masculine ideals and manly virtues. Many participants attempted to keep their depression hidden from colleagues, friends, and perhaps even themselves. Such determined efforts reflected an attempt to avoid the stigma of depression in the external world and their own internalized shame stemming from the meaning of having a mental illness (Riska, 2009). Of course, the masking and self-deception of the depressive symptoms exerted its own toll. Synnott’s (2009) assertion that the costs men pay for being men are also evident in our findings, in that participants’ failed aspirations for fulfilling breadwinner and family protector ideals were deeply intertwined with their depression. Work provided the men in this study with a place to perform and reinforce masculine workman ideals; similar findings about the role of work in men’s lives have been reported in other research (Barnes & Parry, 2004; Collinson & Hearn, 2005; Kilmartin, 2007). Yet evident also were significant losses and the subordination that

could accompany men’s underachievement in the workplace. Hearn (1999) has argued that social expectations need to be relaxed with respect to the fulfillment of the breadwinner role if men are to achieve a healthy negotiation of work and family life. Men’s ability to reconstruct or change their gendered identities is critical for the transition to successful retirement. This transition can be smoother for men who are willing to adopt egalitarian gender roles, whereas difficulties are more likely encountered by men focused on maintaining traditional manly connections to paid work (Barnes & Parry). The social affirmation of alternate avenues for expressing masculinity could potentially ease the burden on men for high career achievement, validating what might constitute work–life balance for some men. Idealized masculine activities might be expanded to include involvement in volunteer community ventures, the development of meaningful hobbies, and attending to the relational needs of the family. The negotiation of this shift for some men might mean redefining, or at least expanding, their own sense of what it means to be a man—particularly at this later stage in life. Empirical research attests to the necessity for older men with strong career identities to forge alternate identities by maintaining good social networks and engaging enjoyable activities in their community (Barnes & Parry, 2004). It is important to note that some community-based initiatives, including the Australian men’s sheds (Golding, Brown, Foley, Harvey, & Gleeson, 2007) and the United Kingdom’s “men in sheds” programs (Williamson, 2010), have attracted older men to workshop-type spaces in community settings to provide regular activity-based opportunities by groups deliberately and mainly comprising men. Many of the attendees are older men experiencing illness (including depression) and life changes—including retirement, unemployment, isolation, and separation—who report camaraderie and a sense of belonging as key benefits of their participation in the groups (Golding et al.). Creating such spaces for men might offer a smoother transition from work to retirement, meeting both relational needs and enhancing subjective well-being. Our study’s limitations provide some direction for further investigations. The cross-sectional study design did not afford insights about changes (or the processes that underpin change) across men’s lives. Conducting life-course and longitudinal studies to distil how particular transitions (e.g., fatherhood, middle age, disability) impact men’s work and depression would provide more evidence on which to consider the findings drawn from this study. Of benefit also will be analyses stratified by social class and socioeconomic status as a means to highlight differences, diversity, and patterns within and across subgroups of men (Danielsson & Johansson, 2005; Emslie, Hunt, & O’Brien, 2004). Couple dyad samples (heterosexual, gay, bisexual) could also afford

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1635

Oliffe et al. gender relations analyses to describe how masculinities and/or femininities shape the work and retirement experiences of men who have depression (Oliffe, Kelly, Bottorff, Johnson, & Wong, 2011). In conclusion, it seems especially relevant to describe linkages between masculinities, work, retirement, and depression as the global economic downturn continues to rupture many men’s work (de Guerre, Galea-Davis, & de Guerre, 2011) and salaryman identities (Iida & Morris, 2008). The 2008 recession shed 5.5 million jobs in the United States, 80% of which were lost by men, and by 2010, only 39% of older workers 55 to 64 years and 23% of workers over 65 years were reemployed (U.S. Bureau of Labor Statistics, 2011). Since 2009, job losses have continued to occur at levels unprecedented in decades, and older workers face higher risks for unemployment in these volatile, uncertain economic conditions (Mandal, Ayyagari, & Gallo, 2011). Similarly, in Canada (Uppal, 2010) and the United Kingdom (Dini, 2009; Macnicol, 2008), the recession has caused the majority of job losses in the manufacturing, construction, natural resources, and transportation industries—sectors traditionally dominated by men. These trends suggest that many older men are especially vulnerable to system-related changes in the workforce, the vast majority of which will likely dislocate traditional links between masculinities and work. For men who manage to maintain employment, many work within a climate of uncertainty and job insecurity, situations that can negatively impact mental health (Mandal et al., 2011). In addition, these unprecedented changes to paid work are occurring amid older men’s high suicide rates (Statistics Canada, 2010; U.S. Census Bureau, 2010), an outcome that can emerge from men’s depression. Overall, our findings confirm the need to track how older men’s depression might be contingent on their construction of masculine identities in response and adaption to the broad employment and social changes that will continue to restructure industrialized nations. Acknowledgments Special thanks to the men who took the time to participate in this study. Thanks also to Joanne Carey, Melanie Phillips, and Kristy Hoyak for their data collection and project management, and Christina Han, Estephanie Sta. Maria, and Tina Thornton for their feedback and editorial assistance in finalizing this article.

Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:

This research and article were made possible by the Social Sciences and Health Research Council (SSHRC) (Grant# 11R28234 [SSHRC: 410-2008-1544]). Career support for the first author was provided by a Michael Smith Foundation for Health Research scholar award.

References Alexopoulos, G. S. (2002). Assessment of late life depression. Biological Psychiatry, 52, 164–174. doi:10.1016/S00063223(02)01381-1 Alexopoulos, G. S. (2005). Depression in the elderly. Lancet, 365, 1961–1970. doi:10.1016/S0140-6736(05)66665-2 Barnes, H., & Parry, J. (2004). Renegotiating identity and relationships: Men and women’s adjustments to retirement. Ageing & Society, 24, 213–233. doi:10.1017/ S0144686X0300148X Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. Bennett, K. M. (2007). “No sissy stuff”: Towards a theory of masculinity and emotional expression in older widowed men. Journal of Aging Studies, 21, 347–356. doi:10.1016/j. jaging.2007.05.002 Bergdahl, E., Allard, P., Alex, L., Lundman, B., & Gustafson, Y. (2007). Gender differences in depression among the very old. International Psychogeriatrics, 19, 1125–1140. doi:10.1017/S1041610207005662 Brand, J. E., Levy, B. R., & Gallo, W. T. (2008). Effects of layoffs and plant closings on subsequent depression among older workers. Research on Aging, 30, 701–721. doi:10.1177/0164027508322574 Brown, A. (2008). Health after the workplace—Is retirement a health hazard for men? Journal of Men’s Health, 5, 108–109. doi:10.1016/j.jomh.2008.03.003 Brownhill, S., Wilhelm, K., Barclay, L., & Schmied, V. (2005). “Big build”: Hidden depression in men. Australian and New Zealand Journal of Psychiatry, 39, 921–931. doi:10.1111/ j.1440-1614.2005.01665.x Buchbinder, D. (2002). Unruly age: Representing the aging male body. In S. Pearce & V. Muller (Eds.), Manning the next millennium: Studies in masculinities (pp. 11–28). Perth, Western Australia, Australia: Black Swan Press. Butterworth, P., Gill, S. C., Rodgers, B., Anstey, K. J., Villamil, E., & Melzer, D. (2006). Retirement and mental health: Analysis of the Australian national survey of mental health and well-being. Social Science & Medicine, 62, 1179– 1191. doi:10.1016/j.socscimed.2005.07.013 Calasanti, T., & King, N. (2005). Firming the floppy penis: Age, class, and gender relations in the lives of old men. Men and Masculinities, 8, 3–23. doi:10.1177/1097184X04268799 Chan, W. S. C., Yip, P. S. F., Wong, P. W. C., & Chen, E. Y. H. (2007). Suicide and unemployment: What are the missing links? Archives of Suicide Research, 11, 327–335. doi:10.1080/13811110701541905 Collinson, D. L., & Hearn, J. (2005). Men and masculinities in work, organizations and management. In M. Kimmel, J. Hearn, & R. W. Connell (Eds.), Handbook of studies on men and masculinities (pp. 289–310). Thousand Oaks, CA: Sage.

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1636

Qualitative Health Research 23(12)

Connell, R., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19, 829–859. doi:10.1177/0891243205278639 Connell, R. W. (1995). Masculinities. Berkeley: University of California Press. Danielsson, U., & Johansson, E. E. (2005). Beyond weeping and crying: A gender analysis of expressions of depression. Scandinavian Journal of Primary Health Care, 23, 171–177. doi:10.1080/02813430510031315 de Guerre, M., & Galea-Davis, S. (Producers), de Guerre, M. (Director). (2011). End of men [Motion picture]. Canada: Canadian Broadcasting Corporation. Dini, E. (2009). Older workers in the UK: Variations in economic activity status by socio-demographic characteristics, household and caring commitments. Population Trends, 137, 11–24. doi:10.1057/pt.2009.30 Dolan, A. (2007). “Good luck to them if they can get it”: Exploring working class men’s understanding and experiences of income inequality and material standards. Sociology of Health and Illness, 29, 711–729. doi:10.1111/ j.1467-9566.2007.01012.x Dolan, A. (2011). “You can’t ask for a Dubonnet and lemonade!” Working class masculinity and men’s health practices. Sociology of Health and Illness, 33, 586–601. doi:10.1111/j.1467-9566.2010.01300.x Doshi, J. A., Cen, L., & Polsky, D. (2008). Depression and retirement in late middle-aged US workers. Health Services Research, 43, 693–713. doi:10.1111/j.14756773.2007.00782.x Emslie, C., & Hunt, K. (2009). “Live to work” or “work to live”? A qualitative study of gender and work–life balance among men and women in mid-life. Gender, Work and Organization, 16, 151–172. doi:10.1111/j.14680432.2008.00434.x Emslie, C., Hunt, K., & O’Brien, R. (2004). Masculinities in older men: A qualitative study in the West of Scotland. Journal of Men’s Studies, 12, 207–226. doi:10.3149/ jms.1203.207 Emslie, C., Ridge, D., Ziebland, S., & Hunt, K. (2006). Men’s accounts of depression: Reconstructing or resisting hegemonic masculinity? Social Science & Medicine, 62, 2246–2257. doi:10.1016/j.socscimed.2005.10.017 Galasinski, D. (2008). Men’s discourses of depression. Basingstoke, United Kingdom: Palgrave Macmillan. doi:10.1057/9780230227620 Golding, B., Brown, M., Foley, A., Harvey, J., & Gleeson, L. (2007). Men’s sheds in Australia: Learning through community contexts. Report for the National Centre for Vocational Education Research. Retrieved from www. ncver.edu.au/publications/1780.html Government of Canada. (2006). The human face of mental health and mental illness in Canada. Cat. No. HP519/2006E. Retrieved from www.phac-aspc.gc.ca/publicat/ human-humain06/pdf/human_face_e.pdf Griffith, D. M. (2012). An intersectional approach to men’s health. Journal of Men’s Health, 9, 106–112. Hearn, J. (1999). Crisis in masculinity or a new agenda for men? In S. Walby (Ed.), New agendas for women (pp. 148–168). London, United Kingdom: Macmillan.

Hearn, J. (2010). Reflecting on men and social policy: Contemporary critical debates and implications for social policy. Critical Social Policy, 30, 165–188. doi:10.1177/0261018309358288 Iida, T., & Morris, J. (2008). Farewell to the salaryman? The changing roles and work of middle managers in Japan. International Journal of Human Resource Management, 19, 1072–1087. doi:10.1080/09585190802051378 Johnson, J. L., Oliffe, J. L., Kelly, M. T., Galdas, P., & Ogrodniczuk, J. S. (2012). Men’s discourses of help-seeking in the context of men’s depression. Sociology of Health and Illness, 34, 345–361. doi:10.1111/j.1467-9566.2011.01372.x Kilmartin, C. (2005). Depression in men: Communication, diagnosis and therapy. Journal of Men’s Health and Gender, 2, 95–99. doi:10.1016/j.jmhg.2004.10.010 Kilmartin, C. T. (2007). The masculine self (3rd ed.). Cornwall, NY: Sloan. Kimmel, M. (1994). Masculinities as homophobia: Fear, shame and silence in the construction of gender identity. In H. Brod & M. Kaufman (Eds.), Theorizing masculinities (pp. 119–141). Thousand Oaks, CA: Sage. doi:10.4135/9781452243627.n7 Kochanek, K. D., Murphy, S. L., Anderson, R. N., & Scott, C. (2004). Deaths: Final data for 2002. National Vital Statistics Report, 53, 1–115. Retrieved from www.ncbi.nlm.nih.gov/ pubmed/15587328 Kraaij, V., Arensman, E., & Spinhoven, P. (2002). Negative life events and depression in elderly persons: A metaanalysis. Journal of Gerontology, 57B, 87–94. doi:10.1093/ geronb/57.1.P87 Macnicol, J. (2008). Older men and work in the twentyfirst century: What can the history of retirement tell us? Journal of Social Policy, 37, 579–595. doi:10.1017/ S0047279408002225 Mandal, B., Ayyagari, P., & Gallo, W. T. (2011). Job loss and depression: The role of subjective expectations. Social Science & Medicine, 72(4), 576–583. doi:10.1016/j.socscimed.2010.11.014 McVittie, C., & Willock, J. (2006). “You can’t fight windmills”: How older men do health, ill health and masculinities. Qualitative Health Research, 16, 788–801. doi:10.1177/1049732306288453 Mőller-Leimkühler, A. M. (2002). Barriers to help-seeking by men: A review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71, 1–9. doi:10.1016/S0165-0327(01)00379-2 Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5, 147–149. doi:10.1177/ 104973239500500201 Mutran, E. J., Reitzes, D. C., & Fernandez, M. E. (1997). Factors that influence attitudes toward retirement. Research on Aging, 19, 251–273. doi:10.1177/0164027597193001 Oliffe, J. L. (2010). Bugging the cone of silence with men’s health interviews. In B. Gough & S. Robertson (Eds.), Men, masculinities and health: Critical perspectives (pp. 67–89). London, United Kingdom: Palgrave. Oliffe, J. L., Kelly, M. T., Bottorff, J. L, Johnson, J. L., & Wong, S. T. (2011). “He’s more typically female because he’s not afraid to cry”: Connecting heterosexual gender relations

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015

1637

Oliffe et al. and men’s depression. Social Science & Medicine, 73, 775–782. doi:10.1016/j.socscimed.2011.06.034 Oliffe, J. L., & Mroz, L. (2005). Men interviewing men about health and illness: Ten lessons learned. Journal of Men’s Health and Gender, 2, 257–260. doi:10.1016/j. jmhg.2005.03.007 Oliffe, J. L., & Phillips, M. J. (2008). Men, depression and masculinities: A review and recommendations. Journal of Men’s Health, 5, 194–202. doi:10.1016/j.jomh.2008.03.016 Riska, E. (2009). Men’s mental health. In A. Broom & P. Tovey (Eds.), Men’s health: Body, identity and social context (pp. 145–162). Chichester, United Kingdom: Wiley-Blackwell. Rutz, W., Walinder, J., von Knorring, L., Rihmer, Z., & Pihlgren, H., (1997). Prevention of depression and suicide by education and medication: Impact on male suicidality: An update from the Gotland Study. International Journal of Psychiatry in Clinical Practice, 1, 39–46. doi:10.3109/13651509709069204 Smith, J. A., Braunack-Mayer, A., & Wittert, G. A. (2006). What do we know about men’s help-seeking and health service use? Medical Journal of Australia, 184, 81–83. Retrieved from https://www.mja.com.au/journal/2006/184/2/whatdo-we-know-about-men-s-help-seeking-and-healthservice-use Soares, J. J. F., Macassa, G., Grossi, G., & Viitasara, E. (2008). Psychosocial correlates of hopelessness among men. Cognitive Behaviour Therapy, 37, 50–61. doi:10.1080/16506070701628016 Statistics Canada. (2009). Financial security—Retirement income. Retrieved from www4.hrsdc.gc.ca/[email protected]?iid=27 Statistics Canada. (2010). Suicides and suicide rate, by sex and by age group. Retrieved from www40.statcan.ca/l01/cst01/ hlth66e-eng.htm Strike, C., Rhodes, A. E., Bergmans, Y., & Links, P. (2006). Fragmented pathways to care: The experiences of suicidal men. Crisis, 27, 31–38. doi:10.1027/0227-5910.27.1.31 Synnott, A. (2009). Re-thinking men, heroes, villains and victims. Surrey, United Kingdom: Ashgate. Tannenbaum, C., & Frank, B. (2011). Masculinity and health in late life men. American Journal of Men’s Health, 5, 243–254. doi:10.1177/1557988310384609 Thompson, E. (2007). Older men as invisible men in contemporary society. In B. A. Arrighi (Ed.), Understanding inequality: The intersection of race/ethnicity, class, and gender (pp. 289–296). Lanham, MD: Rowman & Littlefield. Thorne, S. (2008). Interpretive description. Walnut Creek, CA: Left Coast Press.

Thorne, S. (2011). Toward methodological emancipation in applied health research. Qualitative Health Research, 21, 443–453. doi:10.1177/1049732310392595 U.S. Bureau of Labor Statistics. (2011). Occupational employment and wages—May 2011. Retrieved from www.bls. gov/oes/current/oes_nat.htm U.S. Census Bureau. (2010). Death rates for suicide, by selected characteristics [Data file]. Retrieved from www.census. gov/compendia/statab/2010/tables/10s0122.xls Uppal, S. (2010 July). Labour market activity among seniors. Perspectives on Labour and Income, 11(7), Statistics Canada Catalogue no. 75–001-XIE. Retrieved from www. statcan.gc.ca/pub/75-001-x/2010107/pdf/11296-eng.pdf Whorley, M. S. R., & Addis, M. E. (2006). Ten years of psychological research on men and masculinity in the United States: Dominant methodological trends. Sex Roles, 55, 649–658. doi:10.1007/s11199-006-9120-1 Williamson, T. (2010). Grumpy old men? Older men’s mental health and emotional well-being. In D. Conrad, & A. White (Eds.), Promoting men’s mental health (pp. 111–124). Abingdon, United Kingdom: Radcliffe.

Author Biographies John L. Oliffe, PhD, RN, is an associate professor and associate director–research at the School of Nursing, University of British Columbia, in Vancouver, British Columbia, Canada. Brian Rasmussen, PhD, RSW, is an associate professor in the School of Social Work at the University of British Columbia in Vancouver, British Columbia, Canada. Joan L. Bottorff, PhD, RN, is a professor in the School of Nursing at the University of British Columbia in Okanagan, British Columbia, Canada, and director of the Institute for Healthy Living and Chronic Disease Prevention. Mary T. Kelly, MA, is an independent research consultant in Vancouver, British Columbia, Canada. Paul M. Galdas, PhD, RN, is a senior lecturer at the Department of Health Sciences, University of York, in Heslington, York, United Kingdom. Alison Phinney, PhD, RN, is an associate professor at the University of British Columbia School of Nursing in Vancouver, British Columbia, Canada. John S. Ogrodniczuk, PhD, is an associate professor and director of the Psychotherapy Program in the Department of Psychiatry, University of British Columbia, in Vancouver, British Columbia, Canada.

Downloaded from qhr.sagepub.com at NANYANG TECH UNIV LIBRARY on May 22, 2015