Most Australian men experienced at least one adverse childhood experience (ACE), and almost half experienced two or more, according to a report released this month by Ten to Men: the Australian longitudinal study on male health by the Australian Institute of Family Studies (AIFS).
The findings show that mental health outcomes for adult men worsen directly as adversity exposure increases.
Aboriginal and Torres Strait Islander men experienced complex (two or more ACE exposure types) at about three times the rate of non-Indigenous men (32% vs 10%). High and multiple ACE exposure was also more prevalent among men living in regional and remote areas than in major cities (15% vs 9%), and men in socioeconomically high‑disadvantage areas were twice as likely to have experienced complex exposures as those in low‑disadvantage areas (14% vs 7%).
Men who had served in the armed forces also experienced a higher level of complex adverse childhood experiences. Multiple exposures were also substantially higher among men with disability compared to those without disability (16% vs 5%).
The researchers say that the association between childhood adversity and adult mental ill-health is causal and direct, and remains when adjusting for a range of socio-economic and demographic factors.
Experiencing just one adverse experience was associated with double the risk of depression.
Ten to Men measured physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, and household dysfunction (for example, exposure to domestic violence) experienced by men, as children.
A baseline report with a view to policy
The researchers say that preventing childhood abuse and adverse experiences needs to be at the core of preventing mental ill health as adults.
Dr Sean Martin is Acting Group Head, Data and Lifecourse Studies at the AIFS, and leads the Ten to Men program.
“Taking our cue from that ACMS report from 2023, we were also interested in having a look — as a starting point — at a representative sample of the levels of exposure to adverse childhood events for men,” said Dr Martin.
“Across the country, emotional abuse and physical abuse are the most commonly reported events. We used a latent class analysis, which groups unobserved relationships within the data. We found three distinct groups: low exposure, moderate exposure, and high exposure.”
“The higher you go in those groups, the more intense your experiences were growing up. There was a proportional increase in risk or severity of your mental health outcomes as an adult.”
The study found that one in six men with a diagnosed mental health condition has never accessed Medicare-recorded care (Lee Charlie/Shutterstock).
Measures designed specifically for men
Dr Martin said understanding how men experience mental ill-health is key.
The study found that one in six men with a diagnosed mental health condition has never accessed Medicare-recorded care, particularly those experiencing financial stress.
“There is this notion out there that men don’t engage with the healthcare system.I think they are, but we as researchers need to get better at identifying how to respond to these issues with the right questions.”
Ten to Men recently started using a measure called the Male Depression Risk Scale. The scale assesses six domains of externalising or atypical depression symptoms, including emotion Suppression, drug use, alcohol use, anger and aggression, somatic symptoms, and risk taking, via self-report, relative to the preceding month, and is adapted for use in primary care.
“In this study we ran, for the first time, a depression measure specifically designed for men, and found some differences in the risk.”
Social support as a protective factor
“We were interested in what we called resilience enhancing factors. Unfortunately, exposure to some degree of maltreatment or adverse experiences in childhood might never reduce completely to zero. So then the issue becomes, what can you do once you have an adolescent child with these experiences?” Dr Martin said.
“One of the things that we found was there’s quite a strong effect amongst men for having a high degree of social connectedness, and a high degree of social support.”
“Amongst those who did have those experiences, they can lessen their risk of developing mental health in adulthood by up to 25 to 30%.
“We need to acknowledge that, in terms of heteronormative relationships, women tend to be doing more than their fair share of the emotional labour. And we don’t want to create a scenario where that creates additional burden for them.”
“My experience is that most of their partners, their loved ones, are very happy to do that work, to support their men in any way that they can. But they may not have been given the right tools.”
“Second to that is encouragement for them to see their GPs. Working with fantastic GPs around the country, they are absolutely up for this, and would benefit from some of the advances in trauma-informed care and other areas.”
Mental health and domestic violence
This time last year, the Ten to Men project released a report showing that around one in three men (35%) reported they had ever used a form of intimate partner violence, as an adult.
The current report is not designed to address this issue.
“No one is suggesting that mental health is the answer for men’s use of domestic violence. That would be a very dangerous message, and would offer less accountability for people who choose to use these sorts of behaviours.”
“But I think there is enough evidence now accumulating that suggests that it may be a part of — and there is a very active debate on how much that is the case — the range of issues that we need to consider, in everyone’s interest, in trying to reduce these horribly high levels [of family violence].”
A social change
“The broader mission structure is to allow men to talk about these issues, and particularly, talk about them with their GPs. I think that men are rising to the challenge a bit, and they are up for a challenge.”
“But I don’t think it just rests with GPs; we also need to be working equally with loved ones, with partners, with friends and family, because the evidence suggests that that’s where men go to first. There’s a broader societal challenge around encouraging men who have experienced these sorts of issues to go out and seek the help that they can.”
If you think you would benefit from some support and would like to talk to a trained professional, call 1800RESPECT (1800 737 732). Aboriginal and Torres Strait Islander readers can also contact 13YARN (13 92 76).
Becca Whitehead is a freelance journalist and health writer. She lives in Naarm and is a regular contributor to the MJA’s InSight+.