Psychotherapists' Endorsement of Traditional Masculinity Ideologies and Their Assessment of Gender Differences in the Treatment of Depressive Disorders

Background: Psychotherapists differ in their treatment success depending on the patient's gender, with men being a challenging patient group for many psychotherapists. On the patient's side, traditional masculinity ideologies (TMI) have been linked to atypical symptom presentation in depression, reduced psychotherapy use, poorer therapy engagement and increased risk for psychotherapy dropout. However, the association between therapists' endorsement of TMI and their assessment of gender differences in the treatment of depressive disorders has never been investigated. Methods: A total of 438 therapists (psychological psychotherapists or psychiatrists) from Switzerland, Germany and Austria completed an online questionnaire about their endorsement of TMI and their perceived differences in psychotherapy success in female and male depression patients. Results: Most therapists reported no difference in their perceived treatment success for depression therapy between men and women (n = 283, 65%). However, the vast majority of the 155 (35%) psychotherapists who reported a difference in treatment success disfavoured men (n = 118, 27%) as compared to women (n = 37, 8%). Psychotherapists who disfavoured men also reported stronger endorsement of TMI as compared to psychotherapists who reported no perceived gender differences in psychotherapy success. Conclusion: Our results reveal a group of psychotherapists (high in TMI) that perceive men with depression as harder to treat than female patients with depression. Previous findings on therapist effects suggest that this bias has a negative impact on psychotherapy outcomes in male patients. Therefore, it is important that clinicians recognise how their endorsement of TMI may bias their assessment, potentially disadvantaging male patients with depression.