Retirement may be dangerous to your health—especially if you’re a man.
A growing body of research has found that retirement significantly increases the risk of clinical depression and even suicide among men.
As an advisor working with retirees, you may be a witness—and sometimes an unwitting accessory—to lives whose joy is sapped by depression. If these afflicted clients are men, you will probably have to take the lead in encouraging them to seek help because they won't volunteer that they need it.
There are an estimated 11 million depressed men in America at any given time, according to psychotherapist Terrence Real, LICSW, author of “I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression.” That's about 9% of the adult male population. “But we have to take that number with a huge grain of salt,” Real added, “because so many men don't come forward. They are just not built to talk about these sorts of issues.”
The most typical cause of depression in older men is loss, according to Alan Berman, Ph.D., ABPP, who is executive director of the American Association of Suicidology in Washington, D.C. He explained that men who have attached their sense of identity and value to their work can become depressed in retirement if they can't successfully transfer that attachment to new interests. Other losses—the death of a spouse or peers, loss of work relationships, moving away from lifelong attachment to home and friends—often lead to loneliness and sadness. A man confronting a serious illness or signs of mental decline may become depressed by the prospect of dependency.
When this kind of crisis hits a man, not only does the masculine agenda he's lived by his whole life fail him, but he often has no network of support to lean on. As Real pointed out, “Many men on the road to success have worked very hard, sometimes at the expense of their family, friends, recreation, health. So when the man turns to these relationships, he may be troubled, or he simply may not have the richness of social connection.” Apathy or negativity can become chronic or turn into an ever-deepening spiral.
Why Men Tend to Hide Depression
“A man is about as likely to ask for help for depression as to ask for directions, and for much the same reason,” said Real, who struggled with his own depression issues. “It's part of the male code, part of masculine culture.”
The essence of traditional masculinity, he suggested, is invulnerability. The more vulnerable you are, the less manly you are.
“This sets up what I call compound shame,” he said. “Men get ashamed about feeling ashamed, about feeling depressed. A depressed man is not only ‘weak enough’ to be overwhelmed, which is unmanly, but he's overwhelmed by his own feelings. So there's the double stigma of having an emotional disorder and being weak.” By contrast, a depressed woman has to deal with the stigma of having a disorder, but it's not considered unwomanly.
As a result, many men hide depression from their family members and others. “This is a great tragedy because depression is one of psychiatry's success stories,” Real said. “Studies show that 90% of people who get help with depression through therapy and often medication report substantial relief. But fewer than three out of five depressed people get help.” Tellingly, only about 20% of therapy clients are men.
Clues to Depression
Some of the classic signs of depression are feeling blue, losing one's sense of pleasure and joy in life, changes in sleeping or eating habits (too much or too little) and fatigue. Men may also express depression through signs that aren't as common among women, such as increased drinking, a marked increase in irritability and aggression, or what Real calls “radical isolation”: a significant withdrawal from other people and life.
Depression may also manifest itself in changes in a client's personality, personal hygiene and ability to make financial decisions, in sexual dysfunction and sometimes in memory problems. Women tend to be more outwardly emotional, while men tend to internalize their feelings.
Ken Donaldson, a licensed mental health counselor in Seminole, Fla., who is a certified relationship coach, warned that while symptoms like memory loss, confusion, social withdrawal, loss of appetite, weight loss, sleeping disturbances and bothersome aches and pains could be due to depression, they may have another physical cause.
“A number of things can mimic depression as a man gets older,” he said. “It could be the beginning of dementia or Alzheimer's; it could be many things.” In particular, he pointed out, men go through hormonal changes as part of andropause. When testosterone levels drop, the symptoms can resemble depression, but treatment for depression won't produce the desired improvement in mood. Donaldson advised that men who feel depressed should ask their general practitioner for a check of their testosterone levels. “Sometimes taking prescribed testosterone can raise the levels and remove the symptoms,” he observed.
Berman's experience in the suicide prevention field prompts him to broaden the symptomology for older men with depression. They may also show evidence of a “depletion syndrome,” he said: lack of interest in previously enjoyed activities, self-medication with alcohol, hopelessness and thoughts of death. In concert with signs of increased anxiety such as agitation, fidgetiness or insomnia, depletion symptoms are of particular concern since they are associated with increased risk for suicide.
What to Do If You’re Concerned
“The first thing advisors need to do is to stop colluding with the shame around depression,” Real said firmly. “We get afraid to confront a depressed man. We’re afraid we’re going to make him even more fragile, or that he’ll blow up.” He urged that advisors imagine themselves dealing with a depressed friend or relative. Wouldn't it be a great service to open up the conversation?
“So first of all, be his friend—a sympathetic listener,” Real said. “If the issues are serious enough, there's no shame in suggesting the possibility of talking to a professional therapist, counselor or pastoral advisor.”
“If they come in with feelings of hopelessness or suicidal ideation, even if it's really vague, you don't want to waste any time before you take action,” emphasized mental health counselor Donaldson. “If they’re married, get the spouse involved. Sometimes she will be in denial too, and other times she won't know what to do. If there's no spouse, call in one of the adult children for more feedback and help.”
This is a good reason, he believes, for advisors to build relationships with one or more of their clients’ adult children. “Not every advisor is open to this, and not every elderly client wants it to happen,” he said. “But where it's possible, I would contact an adult child and make the request.”
Getting a Troubled Client to Open Up
When a male client is worried that admitting to depression will make him seem unmanly, how can an advisor get him to open up about what's going on?
“This takes delicacy,” Real answered. “It's a combination of being diplomatic, yet specific.” He suggested starting a conversation with something like “Bill, you’ve told me in our last few meetings that you’ve been feeling really unhappy.” Or, “You’ve said you’re feeling really stressed out, and you just don't seem to be your old self.” Add any other specifics that you’ve heard or observed. Then you might say, “I’m wondering if you might be struggling with some kind of depression.”
In his work with financial advisors, Donaldson has also had experience with this thorny issue. He pointed out that because clients respect their advisor's concern for their financial security, an advisor can lead with “I’m concerned that some of the changes I’ve been noticing might affect your financial security.”
But then what? Donaldson said, “The question is how can you, without being a therapist, deal more effectively with the emotional issues of your clients. I refer to this as ‘How do you give them a gentle kick in the butt?’ One of the ways you can do this is to say to a client, ‘I would like your permission to give you a gentle kick in the butt.’ Most people will be a little stunned by that, but their curiosity will most likely result in their opening the door for you.”
You can then mention some of your observations and suggest tactfully, “I’m a little concerned that there might be some depression there.” This message may well meet resistance, Donaldson said, so even if you think there's a lot of depression, try to minimize it when you first mention it. Often the client's wife is there and can confirm the symptoms. (See sidebar, page 32.)
Watching for Suicide Risk
Older men's risk of suicide is highest at two points, Donaldson said: early in retirement and after the loss of a spouse.
While it's wise to be especially alert for indicative behavior at these times, don't beat yourself up if you miss early warning signs. Studies indicate that even many trained professionals miss suicide risks.
“Let yourself off the hook about this issue,” Real urged. “It's not your job to evaluate suicide risk.”
“Advisors can only do so much,” Donaldson agreed. “The key is don't ignore the obvious, even if it's only a gut feeling. Anything you notice that's different from the client's usual affect should be mentioned and addressed, gently and sensitively.”
Statistically, men commit suicide at four times the rate women do. The older they get, the higher their suicide rate. Between 65 and 85, the rate actually doubles. (See sidebar, page 36.)
According to Jim McCabe, Ph.D., president of Eldercare Resources, a firm providing geriatric care services in Los Altos, Calif., white males over 74 have the highest suicide risk of any demographic group. “The reason is that they’re more serious about suicide than any other age group,” McCabe said. “They have the means available to do it. And many of them are isolated, so it's difficult to intercede.”
“If you’re concerned about a client,” Berman advised, “it's essential to help him seek help, first for an evaluation and treatment, and second for an assessment of suicide risk. Psychotherapy and medication, in combination, can be quite prophylactic in older age groups.” Because getting older men to seek and accept help may not be easy, he recommended that an advisor solicit their support system, if possible, in order to help them get assistance and adhere to treatment regimens. More information and resources are available online at www.Suicidology.org.
What Else Can You Do?
As Donaldson pointed out, you’re not a trained therapist. Other than possibly getting your client to listen to your concerns, what can you do? Some suggestions:
Provide information about depression. This could be as simple as sharing an article about the symptoms of depression with the client. Donaldson suggested two websites: the National Institute of Mental Health (www.nimh.nih.gov) and the National Alliance on Mental Illness (www.nami.org).
“So many men are in denial—conscious or unconscious—about the fact that they’re depressed,” he reiterated. “Sharing a brochure or a printout can underline your serious concern about the possibility of depression. NIMH has free brochures that they can send you. It's a good idea to have them in your office.”
Ask a counselor or therapist for advice. It's great for advisors to have some mental health professionals in their network whom they can contact for advice and guidance. “There are a lot of financial advisors who are teaming with mental health professionals and seeing clients conjointly, and I think it provides a much more holistic approach,” Donaldson commented.
Involve a professional who specializes in issues affecting older people. “My experience is that most advisors don't want to touch the issue of depression or suicide risk with a 10-foot pole,” said McCabe, a charter member of the National Association of Geriatric Care Managers. “In those cases, it can be useful to involve someone like me. We’re trained to guide the conversation in a way that will provide clues about whether clients are experiencing some high degree of stress.”
When McCabe is invited to sit at the table with older clients or their adult children, he opens the conversation to broader issues like their health history and the nature of their living environment. For example, is the home an appropriate place for Dad to live? If the older person will need to move somewhere against his wishes, it can create a level of stress that needs to be resolved. Another touchy issue is transportation. “One of the biggest hits for an older guy is when he has to quit driving,” McCabe said.
Share a list of trusted resources. “The amount of available community resources for help with this has increased significantly,” McCabe observed. “There are more and more mental health services aimed at older adults. Physicians are better trained to look for psychiatric issues in their geriatric patients.”
Also, he noted, there are more sources like his practice to advise planners. Eldercare Resources can connect advisors with support in such areas as health care, housing and transportation, as well as community services (because, he noted, isolation is one of the reasons men get depressed). It's smart to maintain a list of similar resources in your locale.
Your Opportunity to Make a Difference
The most important step in recognizing and helping clients with depression is obvious: Make a habit of talking with them about more than money. Ask how they feel about their life and their current choices. (For sample questions, see sidebar, page 34.)
In our view, an advisor's job is to inform and educate clients, and to refer them to specialists when they need help that's out of the ordinary. The depth of their relationship with you will dramatically affect the likelihood that they will listen, consider your advice and follow through. You’ll probably have to be proactive, since older men are generally more private and unwilling to reach out for support.
Looking into the future, McCabe suggested that advisors will increasingly work with retired boomer men who are more willing to talk about their feelings and get help than their older counterparts. That's a wonderful prospect.
In the meantime, if financial advisors and mental health professionals work together, their collaborative efforts can provide much more satisfying outcomes for this group of despondent clients. By showing that you care about their well-being, you may be able to help them transition into a happier, more fulfilling Third Age.