Why mental health crises look different in men and women

For years, women died of heart attacks and other heart-related events because they simply didn’t recognize what was happening and thus failed to seek help quickly. A lot was known about the symptoms of a heart attack in men. But it turned out that signs in women tend to be vastly different and were often missed.

The same is too often true now when it comes to men struggling with mental health issues.

The traditional list of signs that folks have been coached to look for more often apply to girls and women than to boys and men.

Males and females are apt to respond very differently to severe mental distress, according to Dr. Eric Monson of the Huntsman Mental Health Institute. Because their mental health symptoms are more classic — and women are generally more likely to seek medical care than men anyway — women are more likely to recognize when they’re in mental distress and ask for help.

For women, those signs include feeling more tearful and disinterested in things that are normally enjoyed, including activities with other people, said Monson, who is also a child and adolescent psychiatrist, computational geneticist, assistant professor at the University of Utah and a suicide researcher.

Women are more apt to know when they feel down or anxious, he said.

Men are less likely to recognize their mental health challenges and more apt to brush them off, probably in part because mental health crisis stigma still exists.

Stigma is, in fact, enough of a challenge for both males and females that world-renowned psychiatrist and brain expert author Dr. Daniel Amen has launched a national campaign to reframe the conversation to one of “brain health,” not mental health or illness.

Amen, who founded the Amen Clinics and is the author of a number of books including 2025’s “Change Your Brain, Change Your Pain,” recently told Deseret News that the brain health crisis is getting worse, with one-fourth of Americans on psychiatric medication, the number of youthful suicides growing and anxiety and depression diagnoses on the rise.

But just as women ignored signs of a cardiovascular crisis, men are brushing off their mental health crises in part because they don’t know what those look like.

And the signs with which they are familiar are more common in females than males.

A gender look at symptoms

Irritability can signal that a man is depressed or otherwise struggling with a mental health crisis, Monson said. Men in such crisis “may be really short with people around them. I feel like they’re more on edge. They may feel a drive to lose themselves in their work. That’s a kind of ‘socially acceptable’ way to deal with a mental health crisis, right?”

He said hard work acts to camouflage the problem, because working hard is a desirable trait. It makes employers happy. And others say things like “Wow, you’re doing so good. You’re working so hard.”

“But for the man who’s experiencing this, it could actually be a really significant crisis and they’re not feeling well, but they are trying to do this to escape the sensation, the feelings of this mental health crisis they’re experiencing,” Monson said.

There are other differences between males and females regarding mental health, he said. Among them:

• Men show more externalizing behaviors in a mental health crisis and those behaviors can affect people around them. Meanwhile, women in crisis tend toward more internalizing behavior, like self-critical thinking and suicidal ideation.
• The externalizing behaviors can land men in legal trouble. “They can end up actually being put into jail as kind of a repercussion of their mental health crisis because they’re not having it managed effectively,” Monson said.
• Men are more apt to use substances like alcohol and marijuana to numb negative feelings.
• Women make more attempts to end their lives, but men more often die by suicide.
• A woman’s attempt that wasn’t lethal may get her the help she needs, because the fact she’s in crisis is clear.
• Since a man’s death is often the first recognized sign of his mental health struggle, there’s no way to help him after the fact. “It’s very difficult to catch them, if you will, with the way the system is currently built,” Monson said, sadness evident in his voice.
• It’s extremely common for males and females alike suffering from a significant mental health issue to be less aware of it than those around them are.

What others see

When men misbehave, it’s not typically viewed as proof of a personal crisis, per Monson. A more common response might be to write someone off as irresponsible or mean or whatever negative fits the situation.

During a recent Sutherland Institute event, state Rep. Steve Eliason, R-Sandy, said that across the nation, correctional institutions are “far and away the largest mental health institutions.”

It’s problematic in multiple ways, including a dearth of resources to effectively treat the mental health crisis aspects and the long-term consequences of the stigma that incarceration can place on someone, making it harder to move forward upon release.

In Utah, for instance, Eliason said about a third of inmates have a serious mental illness. “And 98% of inmates will go back into communities that are ill-equipped to deal with their challenges and will then wonder ‘why recidivism and homelessness are so high,” he said.

While noting the significant role mental health crisis can play in landing someone in jail, Monson is careful to note that “that’s not to say that if everybody had great mental health care, that there would be no bad behavior. That would be a very simplistic viewpoint.

“But I do think that if mental health were better recognized in men, it would absolutely help reduce some of those problematic behaviors, especially in those that are more susceptible to alcohol, drug use and things like acting out and getting aggressive with other people.”

He also noted that a plea for more understanding of men’s symptoms in no way pits the sexes against each other. In fact, better understanding of mental illness regardless of the person’s gender would go a long way toward making treatment effective and attainable.

Age makes a difference

Many of the challenges that are different in men and women when it comes to mental health are also different in boys and girls, particularly starting in adolescence.

“I would say there’s a fairly clear distinction between kids before they go through puberty and after,” Monson said.

In younger children, there’s more overlap in symptoms between males and females. But little boys are still more likely to have behavior challenges — behaviors like hyperactivity and impulsivity in classrooms, as well as irritability and acting out. Little girls can show those traits, too, but it’s more common to find the girls more tearful or “more intolerant of some of the environments they’re in and more avoidant,” Monson said.

Often girls are diagnosed with anxiety and mood disorders, while boys are diagnosed with attention deficit/hyperactivity disorder and oppositional defiant disorder, “things like that,” per Monson.

Boys are sometimes just treated like they’re being jerks, when something else entirely is going on. “Especially little boys are more likely to become a ‘problem child’ of a classroom, and I think that does have a really profound impact on their mental health as well,” he said.

Worse, school officials can create an expectation that’s hard for the child to overcome. Something along the lines of “Oh, I had Joey last year. It was awful.”

Said Monson, “I think it usually demonstrates that there’s an underlying issue that’s probably not being managed effectively, and if we could manage it effectively — and sometimes it is truly just ADHD, it’s not necessarily anxiety or depression — but if we were to manage it effectively, that relieves so much of that environmental stress that’s being put on that person, because they’re not getting into trouble so much.

“It can really change their self-perception that they’re not a bad person,” he said.

Changing the script

Monson said careful, well-considered research that includes considering sex differences in how mental health crises may appear is vital.

That’s also vital in suicide prevention.

Alternative ways to connect with men in crisis are important, too, Monson said. He points to the I Love You Bro Project based in Lehi, Utah, which links men to peers in support groups.

“You would think this is such a clear and obvious thing to do, setting up support groups that are run by men to support men,” Monson said. “It’s not a widespread phenomenon. This is something that’s fairly new.”

The I Love You Bro founder, Joe Tuia’ana, also spoke at the Sutherland event, noting the value of having a group of peers who are similar in age and other demographics that makes it feel safer to talk about what’s going on. Having a sponsor willing to walk with you helps, too.

What’s been shown to be less than productive is having a spouse or partner that nags a man to get help. Plenty of research says that doesn’t work for men, though it does usually work for women. A woman told she needs help is much more likely to seek it.

Monson said it may feel to the man like he’s exposing weakness and “they don’t feel good about that.”

Male friends can approach it differently and one of the best approaches might be, “I was thinking of checking this out. Would you go with me and support me?” That can be a soothing way to introduce someone to the process.

That doesn’t mean women can’t help the men in their lives who are in crisis. The key is to listen, Monson said.

“Being able to just listen and be open, try not to push too hard or make a lot of suggestions, but be a space where this man feels safe talking to you about it as much as he’s comfortable doing — that can be very helpful,” he said.

That’s true for both men and women. Monson said someone who wants to help should make himself or herself a safe space, willing to just listen and hear someone out.

Other helps include normalizing talking about issues like suicide and mental health so people are not afraid to discuss their challenges. And reducing stigma is a societal task.

Monson — and many other mental health experts — emphasize that talking about suicide is not going to trigger suicide. That’s old and thoroughly debunked thinking.

Among the good news, health care providers across specialties are getting better at asking about mental health as a routine part of a patient visit, he said. “That’s a good thing.”

“Mental health problems are a real health problem,” Monson said, noting if it was a heart problem or diabetes, no one would say “You just have to stop worrying” or “If you’d just think about things differently.”

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Read more: Rewriting the path to healing: Inside Harper Clinic’s whole-person mental health model