Given the high rates of depression and anxiety reported by incarcerated men in general, it is important to identify the factors associated with these mental health concerns among this vulnerable population. Relatively little is known about the psychosocial factors that confer risk on depressive and anxiety symptoms among this population. Masculine norms have been implicated in the literature as possible salient factors that affect the mental health of incarcerated men. There have, however, been minimal empirical investigations in this area. This study extends the literature by identifying how distinct masculine norms and reported use of informal support affect the mental health of incarcerated men.
The results of this study begin to underscore how masculinity adds to the discourse on the complexity of the psychology of men in prison (Hsu, 2005
). The findings suggest that incarcerated men who endorsed higher levels of heterosexual presentation and lower emotional control reported more depressive symptoms. These findings are consistent with previous research (Burns & Mahalik, 2006
) and support the masculine dysfunction strain theory (Levant, 1996
), which highlights how the pressure to adhere to masculine norms may create gender strain and take a psychological toll on these men, resulting in increased depressive symptomatology(Syzdek & Addis, 2010
Higher adherence to the masculine norm of heterosexual presentation corresponded with elevated levels of anxiety. These findings are aligned with experimental studies from college samples of men that suggest that men experience heightened feelings of anxiety when their manhood is threatened (Vandellow, Bosson, Cohen, Burnaford, & Weaver, 2008
). That is, men often have to strive to achieve unrealistic notions of “ideal” heterosexual masculinity – which results in the development of a fragile and precarious masculinity (Vandellow et al., 2008
). It is possible that heterosexual posturing may be exacerbated in prison given that this conveys strength, power and “non-femininity” which in turn could be protective in certain situations (Johnson, 1979
). In other words, a heterosexual presentation could be a way of establishing self in the prison hierarchy and reducing challenges while incarcerated, all with negative mental health consequences. In addition, Hsu (2005)
notes that “suppression and rejection of homosexual desires together with the deprivation of heterosexual relationships” (p.13) may result in psychological distress. Embedded in this observation are questions about the role of male-to-male sexual contact on the endorsement of these norms and mental health challenges experienced. This hypothesis is speculative at best; therefore more research is warranted examining the nature of heterosexual presentation, male-to-male sexual contact while incarcerated, and mental health among incarcerated men.
Informal support was a strong determinant of both depressive and anxiety symptoms. Men who reported having less informal support generally had higher levels of depressive and anxiety symptoms. Interestingly, informal support moderated the effects of heterosexual presentation on depressive and anxiety symptoms. Higher use of informal support was protective of psychological distress even when men endorsed high levels of heterosexual presentation. This finding is consistent with literature that highlights the protective effects of informal support (Woodward et al., 2008
). It makes sense that individuals who use informal support systems (such as, friends or resources in the community) might report less psychological symtomatology. That is, by seeking support or having the knowledge that one has resources available may temporarily alleviates men’s heterosexual identity concerns. While using informal support appears to be protective in the community, this option may be a challenge while incarcerated. Although informal support systems may help alleviate distress, men in prison have to balance and negotiate the possible negative ramifications of seeking and using support. One effective strategy could be providing required forums (i.e., informal support groups that are not labeled so) for all the men so individuals will not be singled out. Increasing community involvement strategies where family members and other social supports are encouraged and supported to regularly see the men while they are incarcerated could also be important. This may help to provide a more normalizing experience and lead general acceptance and modeling using support systems among incarcerated populations.
There is practical value in identifying psychosocial factors that increase or protect mental health problems. Most of the rehabilitation programs in the prison systems are focused on substance abuse treatment, and vocational and academic training rather than mental health interventions (Pomeroy et al., 2000
). The current findings underscore the importance of addressing and integrating the mental health needs of incarcerated men. That is, although there are substance abuse treatments in many prisons, these interventions should also address mental health concerns (Grant el al., 2004
). Correctional facilities may consider screening for mental health concerns such as anxiety and depression in this population. Further, group counseling interventions with incarcerated men should carefully incorporate discussions of masculinity, given that it tends not to be explicitly discussed in prisons (Sabo, Kupers & London, 2001
). In these group forums, facilitators can raise awareness of masculine norms by posing questions such as “what did you learn about how men should think, feel, and act?, which of these lessons did you take to heart?, how did they get you into trouble?”, which did you resist?, how did these lessons help you with the challenges you faced?”. Psychoeducational interventions and classes that provide information about multiple topics including healthy masculine scripts that promote health, identifying informal support systems, stress management and substance use, might be a highly effective and cost efficient strategy (Pomeroy et al., 2000
). For example, these interventions could provide the men with mutual support that can mitigate social isolation, as well as teach them healthy active coping strategies to deal with stressors and regulate mood. A preventative framework for providing these interventions, as well as careful labeling of such services, may decrease the potential stigma that may be associated with attending services that are officially for support or treatment, especially for men. In order for these changes to take root, structural changes also need to be initiated within the prisons and jails that support prisoners’ mental health.
This study begins a conversation about the relative value of examining mental health for this group; however the results should be considered in the context of the limitations of the study design. First this study is not representative of all incarcerated men and the design was cross-sectional so causation cannot be assumed. Longitudinal studies could help explicate the specific mechanisms and nature of the relationships. To ease the burden and reduce the structured interview time for the participants, only brief measures were included in the study. This time constraint limited our ability to investigate these constructs (CMNI and BSI) more comprehensively. These observations could have been more instructive with more involved measures of the norms presented. This would have also aided in the analysis of how they operate in the short and longer versions for incarcerated samples. Future studies should consider using full scales of the CMNI or other masculinity(MRNI-49; Berger, Levant, McMillan, Kelleher, & Sellers, 2005
) or gender role conflict measures (GRCS; O’Neil et al., 1986
) with similar populations. Finally, a larger sample would have provided more power to detect small effects.
Despite the limitations, this study advances the literature on the psychosocial factors associated with mental health among this vulnerable and hard to reach population. This study is the first to our knowledge to investigate how informal support moderates the effects of distinct masculine norms on depression and anxiety. These findings are important given that the mental health of incarcerated men is a salient public health problem, with nearly half of all state prisoners in the United States reporting serious mental health challenges. The current findings suggest that the judicial system would benefit from the adaptation of proven mental health programs paired with social support, since this may help reduce the risks of recidivism, homelessness, and substance dependence, along with a host of other risk behaviors (Pomeroy, Kiam, & Green, 2000
; Siennick, 2007