The transition from high school to college represents a pivotal developmental period that may result in significant maladjustment for first-year college men. Men may feel pressured to “prove” their masculinity by engaging in traditional masculine behaviors that could be negative for their overall well-being. Although adherence to multidimensional masculine norms has been associated with poorer mental health, no studies have examined the role of masculine norms on prospective depressive symptoms among first-year college men. Examining college men’s adherence to multidimensional masculine norms longitudinally can offer a promising theoretical framework to explain within-group variability in depression symptomatology. The sample included 322 men from the Mid-Atlantic region of the United States. Masculine norms were assessed during the beginning of their first year of college. Depressive symptomatology was assessed 6 months after the first wave of data collection. Masculine norms were positively and negatively related to prospective depression scores, such that men who endorsed the masculine norms of Self-Reliance, Playboy (i.e., desire to have multiple sexual partners), and Violence, had heightened risk, whereas men who endorsed Winning and Power Over Women were less likely to report depressive symptomatology. Distinct masculine norms appear to confer risk for depression while other norms appear to be protective. This study was the first to examine the role of multidimensional masculine norms on prospective depressive symptomatology among college men. The results suggest that practitioners working with men should consider assessing their clients’ adherence to distinct masculine norms and explore how these might be impacting their current mental health.

Although research consistently documents that women are two to four times more likely to be diagnosed with depression than men (Kessler, 2003; Kilmartin, 2005), growing evidence suggests the sex gap in depression rates is narrowing (Borges et al., 2010; Kessler, Chiu, Demler, & Walters, 2005). While men have a comparatively lower prevalence of major depression disorders (Shim, Baltrus, Ye, & Rust, 2011), research suggests that nearly 10%–40% of men experience depression (Bayram & Bilgel, 2008). Given men tend to underreport systems of depression (Magovcevic & Addis, 2008; Sigmon et al., 2005) it is likely that the severity of their distress may be underestimated. This is especially concerning given men are four times more likely to die from suicide attempts (Oquendo et al., 2001). Further, compared to women, men report increased alcohol-related problems (Hasin, Stinson, Ogburn, Grant, 2007) and are more likely to engage in violent behaviors (Courtenay, 2000) as a possible way of coping with negative emotional states (Rice, Fallon, Aucote, & Moller-Leimkuhler, 2013). Despite college men’s susceptibility for risk, nearly 70% of college men experiencing mental health concerns do not seek counseling services (Eisenberg, Hunt, & Speer, 2012). Men may also experience additional barriers to accessing care, including the use of clinical depression diagnostic tools that may not fully capture their symptoms (Rochlen et al., 2010), and under-diagnosis due to clinician bias (Addis, 2008; Nadeau, Balsan, & Rochlen, 2016).

A growing body of literature has documented the public health significance of examining college men’s depression. In particular, scholars in masculinity theory and research have examined the promising role of gender-relevant factors, including distinct masculine norms, and their influence on depression (Gerdes & Levant, 2017; Wong, Ho, Wang, & Miller, 2017). Despite the burgeoning field of research, there has been a surprisingly scant amount of prospective studies in this area (Wong & Horn, 2016; Wong et al., 2017). The paucity of longitudinal research in the area of masculine norms and depression limits the etiological understanding of how gender socialization may underlie or precede the development of depression. Longitudinal studies can provide important information regarding the recognition of risk processes (Rutter & Sroufe, 2000) and, when used to examine risk for depression specifically, can aid in targeted efforts to improve detection and interventions to reduce risk (Bellamy & Hardy, 2015). Additionally, examining depression longitudinally among freshmen, or first-year college men, is critical and timely. Research suggests this subgroup of men may be vulnerable to mental health problems as the transition from high school to college represents a critical and challenging developmental period that may result in significant maladjustment (Jackson & Finney, 2002). The first year of college in particular may be a potentially crucial period for men given the pivotal transitions (e.g., being away from family and forming new social networks) and developmental tasks (e.g., identity formation) that may create strain and confer risk for mental health problems. Accordingly, the purpose of this study was to longitudinally examine the role of masculine norms on prospective depressive symptomatology among an increasingly at-risk group: freshman college men (Dyson & Renk, 2006; Geisner, Mallett, & Kilmer, 2012).

Method Participants and Procedure Survey data were obtained from a larger data set, which aimed to longitudinally investigate health outcomes and behaviors (e.g., underage drinking) among incoming college freshman between the ages of 18 and 20. Participants were recruited through emailing a random sample of freshman through university listservs, as well as through recruitment fliers. In order to participate in the study, participants had to be freshmen between the ages of 18 and 20 years. Before participating in the study, participants had to click a check-box indicating that they read and agreed to conditions set forth in the informed consent form. Participants were included if they completed both Wave 1 and Wave 2 which results in a sample size of 322 incoming young adult freshman men (age: M = 18, SD = .38) that was drawn from the data set in order to examine the risk and protective factors of substance use among young adults at a large public Mid-Atlantic university. The majority of the sample in the present study identified as White/Caucasian American (184; 57.1%), followed by Chinese American (29; 9%), “Other” (27; 8.2%), African American (24; 7.5%), South Asian American (e.g., Indian, Pakistani; 24; 7.5%), Latino/Hispanic (18; 5.6%), and Korean American (16; 5%). The ethnic and racial distribution was representative of the population demographics of the university. The first wave of data was collected during the beginning of the participants’ Freshman year, and the Wave 2, 6-month follow-up was collected in the Spring semester of their Freshman year. The study was approved by (the University of Maryland’s Institutional Review Board) prior to data collection. Data were collected using Qualtrics, a secure online survey software. Participants were compensated $20 for completing the survey administered during the Fall semester of their freshman year, and $20 for the Spring Freshman year 6-month follow-up survey. Measures Conformity to masculine norms inventory Endorsement of multidimensional masculine norms was measured with the Conformity to Masculine Norms Inventory (CMNI-29; Hsu & Iwamoto, 2014). This measure captures the extent to which an individual endorses specific subsets of masculinity as they pertain to U.S. hegemonic masculinity, and was assessed during Wave 1 (Fall of Freshman year). The CMNI-29 is a brief version of the CMNI-46 (Parent & Moradi, 2009), which is in turn a more parsimonious version of the original 94-item CMNI developed by Mahalik and colleagues (2003). Using the CMNI-46, Hsu and Iwamoto conducted multigroup confirmatory factor analysis (CFA) with a large sample (N = 893) of white and Asian American men. The results suggested the CMNI-46 exhibited poor model fit between the two racial groups. Through exploratory factor analysis and CFA, items with high factor loadings and items that were invariant between the two groups were identified resulting in the CMNI-29. In order to provide conceptual evidence between the CMNI-29 and CMNI-46, correlations between the two versions of the subscales were conducted which resulted in robust correlations (r = .91 to 1.00) suggesting that the CMNI-29 is conceptually similar to the CMNI-46. The CMNI-29 consists of 8 subscales: (1) Winning, or striving to win, (2) Playboy, or desiring to have multiple sexual partners, (3) Self-Reliance, (4) Violence, or being aggressive, (5) Heterosexual Presentation, or striving to display oneself as heterosexual, (6) Risk Taking, (7) emotional control, and (8) Power Over Women, or being dominant over women. Each item is scored on a Likert scale, with the responses ranging from 0 (strongly disagree) to 3 (strongly agree). In the current sample, the internal reliability estimates of this measure ranged from α =.74 to α =.86. Beck Depression Inventory-II The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) is one of the most accepted and widely used instruments for measuring depression (Whisman & Richardson, 2015). The BDI-II has been well-validated with college students, demonstrated good internal consistency estimates (internal consistency estimates over .90; Dozois, Dobson, & Ahnberg, 1998), and is an excellent screener for major depressive disorders (Arnau, Meagher, Norris, & Bramson, 2001). The BDI-II is a 21-item self-report measure of the severity of depression over the past 2 weeks. An overall depression severity score is estimated by summing all of the items (scores range between 0 and 69), with scores of 0–13 indicating minimal depression, 14–19 indicating mild depression, 20–28 indicating moderate depression, and 29 and above indicating severe depression. The internal consistency estimate in the current study was .93. The BDI-II was assessed during Wave 2 of the study (i.e., Spring semester of Freshman year, or 6 months after Wave 1 data were collected). Analytic Plan The distributions of the variables were inspected for outliers and assumptions of normality and the BDI-II depression variable was positively skewed (Skewness = 2.04; Kurtosis = 4.327). Negative binomial (NB) regression was selected as the analytic procedure, given that the depression inventory was over dispersed and highly skewed. The NB accounts for the distribution of the outcome variables and adjusts the bias of the standard errors by including a random component that accounts for dispersion (Lewis, Logan, & Neighbors, 2009). We simultaneously entered all of the variables and reported the incidence rate ratios (IRRs), which are the exponentiated regression coefficients. IRRs are the estimates that are interpreted in NB models (Hilbe, 2011). IRRs are similar to an odds ratio and can be interpreted as a one-unit increase in the predictor representing a one-unit increase in depression scores. For examine if the IRR were 1.25, the interpretation would be for one-unit increase in the predictor variable, the participant is 25% more likely to report a one unit increase depression. The NG regression models were conducted using SPSS 24.

Results Descriptive Analyses The means, standard deviations, range of scores, reliability estimates and Pearson correlations are reported in Table 1. With respect to the BDI-II scores, 12.4% (40) of the participants reported scoring within the mild to moderate and higher range, of which 6% (19) scored in the moderate or higher range. The results from the correlational analysis suggest that distinct masculine norm dimensions were significantly correlated with depression scores. Specifically, the masculine norms Playboy and Self-Reliance were positively related to depressive symptomatology. Playboy was related to Self-Reliance, Risk-Taking, and Power Over Women. Self-Reliance was positively related to Risk-Taking, Emotional Control, and Power Over Women. Violence was associated with Heterosexual Presentation, Winning, Emotional Control and Power Over Women. Table 1. Correlations, Means, Standard Deviations, and Reliability Coefficients for Depression and Multidimensional Masculine Norms. View larger version Negative Binomial Regression Analysis The negative binomial regression model revealed that the Wave 1 masculine norms Playboy (IRR = 1.06, p < .03), Self-Reliance (IRR = 1.25, p < .001) and Violence (IRR =1.07, p < .01) were positively associated with Wave 2 depression scores 6 months later. That is, individuals who endorsed the masculine norm Playboy (e.g., desire for multiple sexual partners), Self-Reliance (e.g., not seeking or asking for help), and Violence (e.g., engaging in violent behavior) were more likely to report higher depression scores during Wave 2. On the other hand, higher endorsement of the Wave 1 masculine norms Winning (IRR = .94, p < .029) and Power Over Women (IRR = .90, p < .008) decreased the probability of reporting depression during Wave 2. Men who endorsed the norm Winning (e.g., drive to win) and Power Over Women (e.g., men should be superior to women) were less likely to report depressive symptoms (see Table 2). Table 2. Negative Binomial Regression With Wave 2 Beck Depressive Inventory-II as the Criterion and Wave 1 Multidimensional Masculine Norms as the Independent Variables. View larger version

Implications The study has a number of important implications for future research and clinical practice. Many clinicians may underestimate or minimize the severity of depression symptoms for college-aged men. The findings suggest that college-aged men do experience depression and the significant relationships between initial conformity to distinct masculine norms and prospective depressive symptomatology confirm the importance of longitudinally investigating the role of masculine gender role socialization on the onset and development of depression symptoms. That is, it is possible the more that men adhere to distinct masculine norms, the more likely they will report future depressive symptomatology (Wong et al., 2017). Moreover, examination of both the protective and risk factors associated with masculine norm conformity on men’s prospective depressive symptoms can add more nuance and complexity to the current state of research on men’s depression. Given that masculine norms differentially predicted depressive symptoms, it may be especially critical to understand how particular typologies of masculinities impact men’s well-being. For instance, some studies suggest that subgroups of men (e.g., “detached risk-takers” or “misogynist” typologies) who endorse more rigid traditional masculine ideologies have higher psychological distress and are more likely to report committing sexual assault (Casey et al., 2016; Wong, Owen, & Shea, 2012). Understanding how various clusters of masculine norms interact, such as Self-Reliance, Playboy, and Violence, may provide more insight into mechanisms that predict risk. Since some masculine norms were maladaptive while others were protective, clinicians may consider exploring the potential consequences for ascribing to masculine norms with their clients. The results provide additional support that clinicians should refrain from assuming that adherence to masculine norms is inherently dysfunctional (Mahalik et al., 2005; Wong et al., 2012). Rather, clinicians can help their male clients develop more flexible beliefs about what it means to be a man and explore how these beliefs connect to other salient identities (e.g., race) and contextual factors (e.g., family, work). Lastly, clinicians can identify sources of strength and resiliency and introduce more active coping styles, such as seeking instrumental support and planning, to facilitate help seeking and alleviate depression (Dyson & Renk, 2006).

Limitations While there are a number of strengths of the study, there are some notable limitations. Although the study was longitudinal, Wave 1 levels of depression was not controlled for, thus future studies should include a baseline assessment of depression, not only to control for baseline depression during Wave 1, but perhaps to also better explore how depressive symptoms may increase or decrease as a result of masculine norm conformity. Related, it would be interesting to prospectively examine the degree to which distinct masculine norm conformity changes over time. Another limitation includes the fact that the majority of the sample reported relatively low levels of depression scores, potentially hindering a more thorough detection of correlational effects between masculine norms and depression. On a related note, there is emerging evidence that men might exhibit depressive symptomatology differently than women (Magovcevic & Addis, 2008; Nadeau et al., 2016; Rice et al., 2013), and thus future studies should use multiple measures of depression, as well as male-specific measures of depression, to ensure a more inclusive assessment of depression among male samples. Other measures of depressive symptoms including the Center for Epidemiologic Studies Depression Scale (CES-D) should be considered give this assessment is more sensitive to more mild forms of depression (dysthymia; Wilcox, Field, Prodromidis, & Scafidi, 1998). The sample was collected from one university, which limits the generalizability of the results. More research is needed to better understand the role of toxic masculinity on depression among non-college young adult men. While the racial makeup of the sample was representative of the demographic makeup of the university, the sample was predominantly White which restricts the generalizability of the findings. In addition, while the masculine norm measure used is one that has been validated among White and Asian ethnic groups (Hsu & Iwamoto, 2014), it may not fully capture the experience of masculinity for all men (Gonzales-Forteza, Torre, Vavio, Peralta, & Wagner, 2015). Furthermore, men of different ethnic groups may express or understand depressive symptoms differently. Thus, there is a need to continue to better understand both masculinity and race in influencing prospective depression among young adult men.

Conclusion In conclusion, the study advances gender and psychological science by identifying the distinct role of masculine norms and prospective depressive symptoms among a vulnerable group of young adult men. Multidimensional masculine norms appear to play an important role in understanding men’s mental health. Specifically, distinct masculine norms appear to confer risk, for depression while other norms appear to be protective. Accordingly, clinicians working with male clients should assess their client’s adherence to distinct masculine norms and explore how this might be impacting their current mental health problems.

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. ORCID iD

Derek K. Iwamoto https://orcid.org/0000-0002-8587-9389