The Long-Term Impact of Addressing Gender Norms for Men With MS

June 18, 2020

In Part 2 of this interview, Bryan Davis, PsyD, MS, clinical health psychology fellow at Cleveland Clinic’s Mellen Center for MS, details the impact that conversations about masculinity norms in MS can have on future trials and care.

Bryan Davis, PsyD, MS

This is the second of a 2-part interview. To read Part 1, click here.

Although discussions around gender norms between patients and clinicians have become more commonplace, they are still not included as part of standard care for men with multiple sclerosis (MS). The movement toward erasing stigmas around mental health have helped shine a light on this topic, but substantial work remains.

Bryan Davis, PsyD, MS, clinical health psychology fellow at the Mellen Center for MS Treatment and Research at Cleveland Clinic, feels that more transparent conversations between men with MS and their clinicians regarding gender norms and expectations can help ensure improved clinical care outcomes.

Davis shared his preliminary research with NeurologyLive, which confirmed some of the hypotheses that were presumed about masculinity norms in MS. He discussed why this research can bring about positive long-term change in how clinicians care for men with MS.

NeurologyLive: What do you foresee as the long-term impact of these conversations becoming more commonplace between male patients and their providers?

Bryan Davis, PsyD, MS: In terms of accessibility and help seeking, we’re creating a new environment that's a supportive and safe and that feels a little bit more comfortable. I think in the future this will be helpful but we’re really just scratching the surface with this right now. When I first started doing this research, I had to dial it back just a bit because this was really just the start of these sort of studies. We had to create a plan and identify certain gender norms.

We’re also giving credit to which gender norms are actually helpful in terms of treatment adherence and health promotion, compared to those that are trickier and have a conflicted relationship. What does this look like with different generations of men? Older men compared to younger men? What does this look like with different races of men? These are all really good questions. And again, with just scratching the surface and can really identify a lot of these variables. Informing ourselves and informing our providers will ultimately help us know how to be there for men dealing with this disease.

Is there anything about the study and your approach to this research that makes it unique?

With doing this research, it’s been really eye opening. MS is very subjective and complex, so you’re looking at a lot of different experiences from men who it looks different from a lot of them. I really don’t want to focus this as a, “here’s what we do for men because this all looks the same,” but more of as a nuanced relationship as we look at the disease. Looking at this style of research really pulls at that to where, we can really get a lot of good information to use. My data was relatively quantitative, which is important, but taking that data and contextualizing is something I want to keep doing from the clinical psychology side. That’s what we want to do right? We take the information, contextualize it, pull it apart, and think about how we can apply it. When I was pulling information results, I was thinking of my patients and saying to myself, “I’ve seen this.” Bridging that quantitative data with presentation and then thinking about what interventions can be helpful I think is really important.

What were some of your preliminary findings?

In terms of traditional masculinity adherence, or high scores on the CMNI-46. What we found was positive relationships, higher levels of disability status in risky heath behaviors. When we’re seeing increased masculinity scores, we’re seeing increased levels of risky health behaviors. When I think about that, that’s like men, doing behaviors that go against what they should be doing.

For example, getting up and going for a drive even though they’re really fatigued or lifting this heavy object even though they’re having numbness in their legs. It’s things like that that can conflict their traditional masculinity adherence. Also, with higher levels there, we see lower levels of physical health scores, health promotion, or seeking social support. Those are all very important factors. Some of those are very important coping skills in terms of health promotion. We begin to see increased masculinity adherence with lower health promotion, what we found with health promotion, is that we have an increase of seeking social support, an increase in planful problem solving. Essentially thinking things all the way through, as well as positive reappraisal. Health promotion is a big deal, and we’re seeing high traditional masculinity scores, especially in the form of emotional control. When we see that, we’re seeing lower levels of health promotion. When we’re thinking of health promotion, we’re thinking social support, planful problem solving, and positive reappraisal. Specific coping skills such as confrontative coping, the aggressive, hostile, risk-taking type of coping, is related to risky health behaviors. How they are coping can determine positive or negative results in terms of what that looks like.

Overall, a college degree and getting a higher education degree led to better physical and mental health. In terms of good mental health too, we saw positive results in people in a relationship or married. These are good factors to look at and determine when we meet a man. We can have a better understanding of what might be a positive and what might be a red flag. We can conceptualize and navigate what’s best for them. There’s definitely an interaction with traditional masculinity adherence playing a role with health promotion, support seeking, planful problem solving, positive reappraisal. This is what we have so far, and I plan to write this up and publish to share with a lot of people.

Transcript edited for clarity. For more coverage of CMSC 2020, click here.

REFERENCE

Davis B. The conformity of masculine norms and the effects on coping, health behaviors, and quality of life in men with multiple sclerosis. Int J MS Care. 2020;22(Suppl 2). PSF10.