Men's Mental Health in Idaho: Breaking the Silence on Depression and Anxiety

By Kyle Roth, FNP-BC, APRN, MSN, MHA | Roth Family Medicine and Mental Health | Pocatello, Idaho

The statistics are stark. Men are four times more likely than women to die by suicide. They're significantly less likely to seek mental health treatment. And when they do seek help, they're more likely to present with physical complaints — back pain, fatigue, irritability — than with the emotional symptoms that typically trigger a mental health referral.

In Idaho, these patterns are amplified. Rural and frontier communities have higher rates of suicide than urban areas, and the cultural emphasis on self-reliance and stoicism that characterizes much of Idaho's identity can make it even harder for men to acknowledge and address mental health struggles.

This is a public health crisis hiding in plain sight. And it's one we can do something about.

One of the reasons men's depression goes unrecognized — by clinicians and by men themselves — is that it often doesn't look like the textbook picture of depression. The classic presentation of tearfulness, sadness, and expressed hopelessness is more common in women. Men with depression more often present with:

Irritability and anger. Rather than sadness, depressed men often experience persistent irritability, short temper, and low frustration tolerance. This is frequently dismissed as a personality issue rather than recognized as a symptom of depression.

Physical complaints. Headaches, back pain, digestive problems, and fatigue are common somatic expressions of depression in men. Men are more likely to present to a primary care provider with physical symptoms than to seek mental health care directly.

Risk-taking behavior. Increased risk-taking — reckless driving, substance use, gambling, sexual risk-taking — can be a manifestation of depression in men, reflecting both impaired judgment and a subconscious seeking of stimulation to counter emotional numbness.

Substance use. Men are more likely than women to use alcohol or drugs to self-medicate depression and anxiety. Substance use can mask the underlying mood disorder and complicate both diagnosis and treatment.

Workaholism and withdrawal. Throwing oneself into work to avoid emotional pain, or withdrawing from family and social connections, are common patterns in depressed men.

Aggression and control. In some cases, depression in men manifests as increased need for control, aggression, or domineering behavior — a way of managing internal chaos through external control.

Understanding why men avoid mental health care is essential to addressing the problem:

Cultural messaging about masculinity. From an early age, many men receive the message that emotional vulnerability is weakness — that "real men" handle their problems alone. Seeking help for mental health is perceived as a failure of self-sufficiency.

Stigma. Despite progress in public awareness, mental health stigma remains significant, particularly in rural and conservative communities. Men fear being judged, labeled, or seen as less capable if they acknowledge mental health struggles.

Lack of recognition. Because depression in men often doesn't look like "classic" depression, many men don't recognize what they're experiencing as a mental health condition. They may attribute their symptoms to stress, physical illness, or character flaws.

Practical barriers. Men are less likely to have established relationships with healthcare providers, less likely to have health insurance, and more likely to work in jobs that make it difficult to take time off for appointments.

Previous negative experiences. Men who have sought help in the past and felt dismissed, misunderstood, or given inadequate treatment are less likely to try again.

One factor that's particularly relevant for men's mental health — and often overlooked — is testosterone. Low testosterone (hypogonadism) is associated with depression, fatigue, irritability, reduced motivation, and cognitive changes that closely mirror the symptoms of major depression.

Testosterone levels decline naturally with age (approximately 1–2% per year after age 30), but can also be suppressed by:

• Chronic stress and elevated cortisol
• Obesity and metabolic syndrome
• Sleep apnea
• Certain medications
• Chronic illness

Studies show that men with low testosterone have significantly higher rates of depression, and that testosterone replacement therapy (TRT) can improve mood in men with both low testosterone and depression. For men whose depression has a hormonal component, addressing testosterone levels may be as important as — or more important than — antidepressant medication.

At Roth Family Medicine, we routinely assess testosterone levels in men presenting with depression, fatigue, or mood changes — because treating the hormonal root cause is far more effective than masking symptoms with antidepressants alone.

Idaho consistently ranks among the states with the highest suicide rates in the nation. In recent years, Idaho's suicide rate has been approximately 20–22 per 100,000 — roughly twice the national average. Men account for approximately 75–80% of suicide deaths in Idaho.

Several factors contribute to Idaho's elevated suicide rate:

• Rural geography — limited access to mental health services, longer distances to care
• Cultural factors — emphasis on self-reliance, stigma around help-seeking
• Firearm access — Idaho has high rates of firearm ownership; firearms are the most lethal method of suicide attempt
• Economic stress — agricultural and resource-based economies are subject to significant volatility
• Substance use — Idaho has elevated rates of alcohol use disorder

These are not insurmountable challenges. But they require intentional, culturally competent approaches to mental health care.

Effective mental health treatment for men often requires approaches that align with how men think about problems and solutions:

Problem-focused therapy. Men often respond better to therapy framed around problem-solving and skill-building than to open-ended emotional processing. Cognitive Behavioral Therapy (CBT) — which focuses on identifying and changing unhelpful thought patterns and behaviors — tends to be well-received by men.

Brief, goal-oriented interventions. Men are more likely to engage with treatment that has clear goals and measurable outcomes. Setting specific treatment targets and tracking progress can improve engagement.

Medication management. SSRIs and SNRIs are effective for depression and anxiety in men. For men with low testosterone, TRT can be transformative. For treatment-resistant depression, ketamine therapy and TMS offer powerful options.

Ketamine therapy. Ketamine's rapid onset of action — producing antidepressant effects within hours — can be particularly valuable for men in acute crisis who need rapid relief. Its mechanism (glutamate/NMDA) is entirely different from conventional antidepressants, making it effective for many men who haven't responded to SSRIs.

TMS therapy. TMS is a non-medication, non-invasive treatment that many men find appealing precisely because it doesn't involve "taking a pill for emotions." The clinical, technology-based nature of TMS can reduce the stigma barrier for some men.

Testosterone optimization. For men with low testosterone, TRT can improve mood, energy, motivation, and cognitive function — often dramatically. We offer comprehensive hormonal evaluation and management at Roth Family Medicine.

Lifestyle medicine. Exercise is one of the most evidence-based interventions for depression — with effects comparable to antidepressant medication in mild to moderate depression. Sleep optimization, nutrition, and stress management are also foundational.

If you've made it this far, something in this article resonated with you. Maybe you recognize yourself in the description of how depression looks in men. Maybe you've been struggling and haven't known what to do about it. Maybe you're reading this for someone you care about.

Here's what I want you to know: seeking help is not weakness. It takes more courage to acknowledge a problem and do something about it than to white-knuckle through it alone. The men I see in my practice who are doing the hardest work — confronting their mental health, making changes, getting better — are some of the strongest people I know.

You don't have to be in crisis to deserve care. You don't have to have it all figured out before you make an appointment. You just have to take the first step.

We're here when you're ready.

Kyle Roth, FNP-BC, APRN, MSN, MHA is a board-certified family nurse practitioner at Roth Family Medicine and Mental Health in Pocatello, Idaho, specializing in treatment-resistant depression, ketamine therapy, TMS, hormone optimization, and integrative mental health care. To schedule a consultation, visit ZocDoc or call (208) 904-4705.