BRIEF REPORT Screening for Depression Among Minority Young Males Attending a Family Planning Clinic Ruth S. Buzi and Peggy B. Smith Baylor College of Medicine Maxine L. Weinman University of Houston The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression among 535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. The assessment indicated that 119 (22.2%) males met criteria for depression. The study also examined the associations between depression, sociodemographics, and service requests. Depressed males were more likely than nondepressed males to be Hispanic and to request services related to relationships, feelings, financial resources, physical issues, and well-being. The findings indicated that young males who are affected by depression have unmet needs, but when given an opportunity, are able to express those needs. Because family planning clinics are increasing the number of male clients, they are well positioned to screen them for depression. Keywords: young males, depression, request for services Major Depressive Disorder (MDD) is recognized as one of the most common chronic conditions today. According to the U.S. Department of Health and Human Services (2012), ap- proximately 2 million adolescents, or 8.0% of the population ages 12 to 17, had at least one major depressive episode during 2010. A recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2012) indicates that one in five American adults aged 18 or older, or 45.6 million, people had mental illness in the past year. The rate of mental illness was twice as high among those 18 –25 (29.8%) than among those aged 50 and older (14.3%). Males experience more persistent depressive symptoms and disorders from adolescence into adulthood than females (Dunn & Goodyer, 2006; Colman, Wadsworth, Croudace, & Jones, 2007). Non-Hispanic African American males tend to have the highest rates of MDD at 13.2%, followed by Hispanics or Latinos (12.7%) and then non-Hispanic Whites (8.7%) U.S. Department of Health & Human Services, 2012). Depression among minority adolescents and young adults was found to be related to stress, lack of social resources, and low socioeco- nomic status (Brown, Meadows, & Elder, 2007). Risk factors for African American men’s depression include economic strain, interpersonal conflicts, and racial discrimination (Wat- kins, Green, Rivers, & Rowell, 2006). Hispanic and African American males also display significantly earlier onset of MDD compared with their White counterparts (Riolo, Nguyen, Gre- den, & King, 2005). Despite the fact that males also suffer from depression, they seek mental help from health care professionals less frequently than females, which only further decreases the likelihood of diagnosing their mental health disorders (Addis & Mahalik, 2003; Smith, Braunack-Mayer, & Wittert, 2006). Males often feel pressured to avoid emotional expres ...

1. BRIEF REPORT
Screening for Depression Among Minority Young Males
Attending a
Family Planning Clinic
Ruth S. Buzi and Peggy B. Smith
Baylor College of Medicine
Maxine L. Weinman
University of Houston
The Center for Epidemiologic Studies Depression Scale (CES-
D) was used to assess depression among
535 African American and Hispanic young males ages 14 to 27
attending a family planning clinic. The
assessment indicated that 119 (22.2%) males met criteria for
depression. The study also examined the
associations between depression, sociodemographics, and
service requests. Depressed males were more
likely than nondepressed males to be Hispanic and to request
services related to relationships, feelings,
financial resources, physical issues, and well-being. The
findings indicated that young males who are
affected by depression have unmet needs, but when given an
opportunity, are able to express those needs.
Because family planning clinics are increasing the number of
male clients, they are well positioned to
screen them for depression.
Keywords: young males, depression, request for services

2. Major Depressive Disorder (MDD) is recognized as one of
the most common chronic conditions today. According to the
U.S. Department of Health and Human Services (2012), ap-
proximately 2 million adolescents, or 8.0% of the population
ages 12 to 17, had at least one major depressive episode during
2010. A recent report by the Substance Abuse and Mental
Health Services Administration (SAMHSA, 2012) indicates
that one in five American adults aged 18 or older, or 45.6
million, people had mental illness in the past year. The rate of
mental illness was twice as high among those 18 –25 (29.8%)
than among those aged 50 and older (14.3%).
Males experience more persistent depressive symptoms and
disorders from adolescence into adulthood than females (Dunn
& Goodyer, 2006; Colman, Wadsworth, Croudace, & Jones,
2007). Non-Hispanic African American males tend to have the
highest rates of MDD at 13.2%, followed by Hispanics or
Latinos (12.7%) and then non-Hispanic Whites (8.7%) U.S.
Department of Health & Human Services, 2012). Depression
among minority adolescents and young adults was found to be
related to stress, lack of social resources, and low socioeco-
nomic status (Brown, Meadows, & Elder, 2007). Risk factors
for African American men’s depression include economic
strain, interpersonal conflicts, and racial discrimination (Wat-
kins, Green, Rivers, & Rowell, 2006). Hispanic and African
American males also display significantly earlier onset of MDD
compared with their White counterparts (Riolo, Nguyen, Gre-
den, & King, 2005).
Despite the fact that males also suffer from depression, they
seek mental help from health care professionals less frequently
than females, which only further decreases the likelihood of
diagnosing their mental health disorders (Addis & Mahalik,
2003; Smith, Braunack-Mayer, & Wittert, 2006). Males often
feel pressured to avoid emotional expression, conceal weak-

3. nesses and vulnerability, and solve problems without requesting
the help of others (Rochlen, McKelley, & Pituch, 2006). That
pressure to be “masculine” may explain why men more readily
than women express anger and irritability when depressed
(Winkler, Pjrek, & Kasper, 2005).
Previous studies have found a strong association between
somatic symptoms and depression (Saluja et al., 2004; Haug,
Mykletun, & Dahl, 2004). Research also has indicated males
who experience physical symptoms of depression are more
likely to seek medical attention (Ferrin, Gledhill, Kramer, &
Garrada, 2009). The National Institute of Mental Health has
reported males are not always aware of symptoms of depres-
sion, which include physical issues such as headaches, stomach
problems, and chronic pain (Harvard Medical School, 2011).
Family planning clinics provide access to reproductive health
services to males. This can provide an opportunity to assess and
address their mental health needs. However, research on mental
health needs of males in these settings is scant. The purpose of
This article was published Online First February 18, 2013.
Ruth S. Buzi and Peggy B. Smith, Population Program, Baylor
College
of Medicine; Maxine L. Weinman, Graduate College of Social
Work,
University of Houston.
This project was funded in part by the Texas Department of
State Health
Services (TDSHS), the Office of Population Affairs/Office of
Family
Planning (OPA/OFP) Department of Health and Human Service,
and the
McGovern Foundation.

4. Correspondence concerning this article should be addressed to
Ruth S.
Buzi, LCSW, PhD, Associate Professor, Population Program,
Baylor Col-
lege of Medicine, One Baylor Plaza, Houston, TX 77030. E-
mail:
[email protected]
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Psychology of Men & Masculinity © 2013 American
Psychological Association
2014, Vol. 15, No. 1, 116 –119 1524-9220/14/$12.00 DOI:
10.1037/a0031574
116
mailto:[email protected]
http://dx.doi.org/10.1037/a0031574
this study was to assess depression among young males attend-
ing a family planning clinic and whether depression varied by
sociodemographics and service requests. This study can begin
to fill the gaps and provide some useful information for future
studies and interventions targeting this understudied popula-
tion.

9. Method
Participants
The study included a convenience sample of 535 African
American and Hispanic young males who attended a family
planning clinic with designated hours for males ages 13–25.
The sample reflects the profile of clients receiving services at
the clinic. The clinic is located in an inner-city neighborhood in
a large city in the southwest United States. The clinic provides
low-cost to free comprehensive family planning and reproduc-
tive health services to indigent adolescents and young adults
who reside in the inner city. Services provided include repro-
ductive health screening related to puberty development, im-
munization status, abuse history, mental health, substance abuse
history, sexual health risk assessment, screening and treatment
for a sexually transmitted disease (STD), and risk reduction
counseling. Males come to the clinic mainly for STD testing
and treatment. Informed consent was obtained before data col -
lection. Parental consent for clinical services is solicited but not
required from minors serviced at Title X–funded clinics.
The study included 535 African American and Hispanic
young males. Their mean age was 20.07, SD � 2.64, range
14 –27. Three hundred fifty-three (66.0%) were African Amer-
ican, and 182 (34.0%) were Hispanic. The majority, 482
(92.2%), were single. One hundred sixty-five (31.0%) were
fathers. Two hundred forty-three (46.6%) were in school, and
67.2% had graduated high school or were in college. A total of
196 (36.6%) young males were employed, and 124 (23.7%) had
health insurance. Three hundred sixty-one (67.7%) reported
they came for STD testing or treatment, and 247 (46.3%)
reported they came for a check-up.
Procedure

10. Participants were recruited to the study during their visit to
the family planning clinic on male designated days. Recruit-
ment to the study took place only on the designated days for
males. Males who came on other days were not recruited to the
study. The sample reflects approximately 61% of the males seen
during the study period at the clinics. A clinic staff member
explained that the purpose of the study was to better understand
the needs of young males who access family planning services.
Informed consent was obtained before data were collected. To
protect participants’ confidentiality, they completed the ques-
tionnaires in a private room. The staff member was also avail -
able to clarify answers to any questions. The Institutional
Review Board of the affiliated institution approved the study.
Measures
Depression. Depression was measured using the Center for
Epidemiologic Studies Depression Scale (CES-D) (Radloff,
1977).
The CES-D consisted of 20 questions pertaining to depressive
symptoms, prefaced with “How often have you felt this way
during
the past week?” Respondents were asked to rate items such as
depressed mood, feelings of worthlessness, feelings of hopeless -
ness, loss of appetite, poor concentration, and sleep disturbance.
Possible scores ranged from 0 to 60, with higher scores
indicating
more severe depressive symptoms. A score of 16 or higher indi-
cated a depressive disorder. In cases with unanswered items, the
Radloff scoring procedure was used to rescore each case to
match
the standard CES-D score. Participants who had more than one
missing score on any of the 20 items were excluded from the
analysis.

11. Sociodemographic characteristics. The measures for so-
ciodemographic characteristics included age, ethnicity, school
sta-
tus, owning health insurance, marital status, fatherhood status,
and
employment status.
Service Requests
Males were given a list of 20 services and asked if they wanted
to know more about any of these areas. The list included
services
to assist with health screenings, relationships, anger
management,
eating well and exercising, employment, and education.
Results
Sociodemographic Characteristics
Of the 535 young males who participated in the study, 119
(22.2%) met criteria for a depressive disorder. Chi -square anal-
yses were conducted to compare the depressed and nonde-
pressed males based on sociodemograp hic characteristics. The
results indicated Hispanic males were more depressed than
African American males (28.6% vs. 19.0%, �2 � 6.38, df � 1,
n � 535, p � .011). No other sociodemographic characteristics
distinguished depressed and nondepressed males (see Table 1).
Ethnic differences were also examined with regard to sociode-
mographic characteristics. Employment was the only demo-
graphic characteristic that was statistically significant. Hispan-
ics were more likely to be employed than African Americans
(42.9% vs. 33.4%, �2 � 4.59, df � 1, n � 535, p � .032).
Request for Services

12. Of the 20 services, 10 showed significant statistical differ -
ences between depressed and nondepressed males. Depressed
males requested services related to STD prevention, getting
along with family and partners, getting a job, working out,
eating well, being depressed/feeling down, testicular cancer,
college applications/loans, vasectomies, and emergency contra-
ception (see Table 2).
Discussion
This study assessed depression and the associations between
depression, sociodemographics, and service requests among
young minority males attending a family planning clinic. A
little over 20% of the men in this sample met criteria for
depression. Depression was higher among Hispanic males than
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117DEPRESSION AMONG MINORITY YOUNG MALES
African American males. This finding is inconsistent with other
studies that have shown higher rates of depression among
African American males than Hispanic males. Risk factors for
depression among Hispanics include ethnic Microaggressions, a

17. form of everyday, interpersonal discrimination that can increase
feelings of depression and sickness (Huynh, 2012). Findings
indicated depressed males were more likely to express interest
in services. These service requests related to relationships,
feelings, financial resources, physical issues, and well -being.
Interest in physical issues was consistent with interest indicated
in previous studies. These studies found that African American
individuals focus more on somatic and physical symptoms to
express depression (Kennard et al., 2006).
Although the young males in the study did not attend the
family planning clinic for mental health services, when given
the opportunity, they acknowledged issues related to depres-
sion. Data suggest that minorities with depression are more
likely to seek care for mental health problems from primary
care providers rather than from mental health specialists (Na-
tional Prevention Council, 2011). As young males are now
included in family planning clinics, screening them for depres-
sion may be an important aspect of comprehensive health
assessments. Although these clinics cannot provide continuous
mental health care, they can screen and link males with the
appropriate care.
This study had limitations related to its cross-sectional design
and reliance on one self-reported instrument. The study also did
not inquire about accessing mental health services. However,
the findings of the initial assessment suggested that because
males have limited access to health care services, they need to
be screened for depression in settings they frequent. Addition-
ally, young males may be more receptive to acknowledging
mental health issues in family planning clinics because these
clinics may be perceived as less stigmatizing than mental health
Table 1
Socio-Demographic by Depression

18. Non- depressed Depressed
Characteristic n % n % �2 p value
Ethnicity
African American 286 81.0 67 19.0 6.38 .011
Hispanic 130 71.4 52 28.6
In School
Yes 194 47.8 49 42.2 1.11 .29
No 212 52.2 67 57.8
Health insurance
Yes 96 23.7 28 23.5 .002 .969
No 309 76.3 91 76.5
Marital status
Single 375 92.4 107 91.5 .104 .747
Married 31 7.6 10 8.5
Fatherhood
Yes 125 30.3 40 33.6 .484 .487
No 288 69.7 79 66.4
Employed
Yes 153 36.8 43 36.1 .017 .898
No 263 63.2 76 63.9
t-test
Age 20.08
SD � 2.67
119 20.03
SD � 2.64

19. 416 t � .188
df � 533
.85
Table 2
Interest in Services by Depression
Non-depressed Depressed
Topic of interest n % n % �2 p value
STD prevention 156 37.5% 58 48.7% 4.87 .027
Getting along with your partner 39 9.4% 22 18.5% 7.60 .006
Getting a job 101 24.3% 43 36.1% 6.61 .010
Working out/eating well 80 19.2% 33 27.7% 4.01 .045
Depression/feeling down 21 5.0% 26 21.8% 32.59 .000
Testicular cancer 29 7.0% 22 18.5% 14.23 .000
College applications/loans 41 9.9% 20 16.8% 4.42 .035
Getting along with your family 19 4.6% 13 10.9% 6.65 .010
Vasectomies 11 2.6% 10 8.4% 8.13 .004
Emergency contraception for girlfriend/wife 12 12.9% 9 7.6%
5.37 .020
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24. 118 BUZI, SMITH, AND WEINMAN
settings. To further our understanding of the extent and nature
of depression among young males, more studies will be re-
quired. Multiple approaches may contribute to a better under -
standing of cultural and developmental aspects related to mental
health care issues among young males. Focus groups with
young minority males attending family planning clinics have
shown to contribute to an in-depth understanding of unmet
needs, challenges and barriers related to their physical and
mental well-being (Buzi & Smith, in press).
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119DEPRESSION AMONG MINORITY YOUNG MALES
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http://dx.doi.org/10.1159/000086321Screening for Depression
Among Minority Young Males Attending a Family Planning
ClinicMethodParticipantsProcedureMeasuresDepressionSociode
mographic characteristicsService
RequestsResultsSociodemographic CharacteristicsRequest for
ServicesDiscussionReferences