Anxiety affects one in five Australian men at some point in their lives. But the condition remains highly stigmatised, misunderstood and under-diagnosed.

Men are around half as likely to be diagnosed with an anxiety disorder compared to women. Some feel pressure to be fearless and hide their emotions. Others simply don’t understand or have the language to describe anxiety symptoms.

This has serious consequences. Our latest research shows young men are turning to ambulance services when their symptoms become overwhelming – some even think they’re having a heart attack.

So why do so many men wait until they need to call emergency services, rather than seek support earlier from a GP or psychologist? And what prompts them to call? We reviewed the paramedic notes of 694 men aged 15 to 25 years in Victoria, Australia, to find out.

Young men haven’t seen others asking for help

Boys are raised to value courage, strength and self-assurance, and to suppress vulnerability.

When parents encourage boys to “face their fears”, rather than offering emotional comfort and tenderness, anxiety gets positioned in conflict with masculinity. This leads to a disjuncture between the support young men are met with (and come to expect) from others, and the support they may want or need.

This also means boys grow up believing their male role models – dads, brothers, grandads, coaches – don’t get anxious, deterring boys and men from seeking help. As a result, anxiety goes undiagnosed and opportunities for early intervention are missed.

Recently, we have seen positive shifts challenging restrictive masculine stereotypes. This has improved awareness surrounding men’s depression – opening up conversations, normalising help-seeking and leading to the development of men’s mental health programs and resources.

However, men’s anxiety remains in the shadows. When anxiety is talked about, it’s not with the same weight or concern as depression. This is despite men’s anxiety having harmful health impacts including turning to alcohol and drugs to cope, and increasing the risk of male suicide.

What does anxiety look like?

When men are encouraged to talk about anxiety, they describe various challenges including repetitive worries, feeling out-of-control and intense physical symptoms. This includes a high heart rate, shortness of breath, body pains, tremors and headaches.

Jack Steele, a prominent Australian personality and one half of the Inspired Unemployed, opened up about his anxiety difficulties on The Imperfects Podcast last year saying:

I didn’t know what anxiety was. I thought I was the opposite of anxiety.

The way I explain it, it’s like […] your whole body just shuts down. My throat starts closing up and my whole body just goes numb. […] It feels like you’re just so alone. You feel like no-one can help you.

You genuinely think the world’s ending – like there’s no out.

These physical symptoms are common in men but can be frequently dismissed rather than recognised as anxiety. Our research has found that, when left unaddressed, these symptoms typically worsen and arise in more and more contexts.

Why do anxious men call ambulances?

Our new study investigated the consequences of men’s anxiety going unaddressed.

First, we used data from the National Ambulance Surveillance System to identify and describe the types of anxiety young men experience. We then looked at the characteristics and contexts of young men’s anxiety presentations to ambulance services.

Overwhelmed and lacking support, many young men turn to ambulances in crisis. Anxiety now accounts for 10% of male ambulance attendances for mental health concerns, surpassing depression and psychosis.

While every presentation is different, our study identified three common presentations among young men:

1. Sudden onset of intense bodily symptoms resembling life-threatening physical health conditions such as heart attacks.

Twenty-two-year-old Joshua, for example, whose case files we reviewed as part of our study, was on a tram home from work when he experienced sudden numbness in his hands and feet. A bystander saw he was having muscle spasms in his hands. Joshua was alert but extremely anxious and asked the bystander for help.

2. Severe anxiety triggered or worsened by substance use.

Adam, a 21-year-old man, consumed a substantial amount of diazepam (Valium) while driving home, after having an anxiety attack at work. Adam reached out to paramedics because he was concerned his anxiety symptoms hadn’t dissipated, and was worried he may have taken too much diazepam.

3. Mental health deterioration with self-harm or suicidal thoughts, often tied to situational stressors such as unstable housing, unemployment, financial difficulties and relationship strain.

Leo, aged 25, had been increasingly anxious for the past three days. Leo’s parents called an ambulance after he told them he wanted to kill himself. Leo told paramedics on arrival that he still felt suicidal and had been getting worse over the past three months.

Directing resources where they’re needed

Young men’s anxiety presentations are time- and resource-intensive for paramedics, many of whom feel poorly equipped to respond effectively. After ruling out physical causes, paramedic support is typically limited to reassurance and breathing techniques.

Most young men are then instructed to follow up with GPs, psychologists or other health professionals in the general community.

But taking that next step involves overcoming the stigma associated with help-seeking, the shame of having called an ambulance and deep tensions between anxiety and what it means to be a man.

This means many young men slip through the cracks. And without ongoing mental health support, they face high risks of presenting again to emergency services with increasingly severe mental health symptoms.

To address this, we need to:

• ramp up conversations about men’s anxiety and take their experiences seriously
• develop an awareness campaign about men’s anxiety. Awareness campaigns have successfully dismantled stigma and shed light on men’s depression and suicide
• improve diagnosis of men’s anxiety disorders by up-skilling and training clinicians to detect anxiety and the unique and distinct constellations of symptoms in men
• create accessible pathways to early support through digital psychological education resources, focused on improving awareness and literacy surrounding men’s anxiety experiences.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Krista Fisher, Research Fellow, Centre for Youth Mental Health, The University of Melbourne; Dan Lubman, Executive Clinical Director, Turning Point & Director of Monash Addiction Research Centre, Monash University; Simon Rice, Associate Professor & Clinical Psychologist, Mental Health in Elite Sports, The University of Melbourne, and Zac Seidler, Associate Professor, Centre for Youth Mental Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More than 7 million people in Australia were born overseas. Some 5.8 million people report speaking a language other than English at home.

But how well are we looking after culturally and linguistically diverse (CALD) Australians?

In countries around the world, evidence suggests people from CALD backgrounds are at increased risk of harm as a result of the health care they receive when compared to the general population. Common problems include a higher risk of contracting a hospital-acquired infection or medication errors.

People receiving cancer care are at particularly high risk of harm associated with their health care.

In a recent study, we found CALD cancer patients in Australia had roughly a one-in-three risk of something going wrong during their cancer care. This is unacceptably high.

We reviewed medical records

We worked with four cancer services (two in New South Wales and two in Victoria) that provide care to high proportions of people from CALD backgrounds. These four cancer services offer a combination of care to patients in hospitals, clinics and in their homes.

We analysed de-identified medical records of people from CALD backgrounds who received care at any of the four cancer services during 2018. To identify CALD patients, we used information from their medical records including “country of birth”, “preferred language”, “language spoken at home” and “interpreter required”.

We reviewed a total of 628 medical records of CALD cancer patients. We found roughly one in three medical records (212 out of 628) had at least one patient safety event recorded. We defined a patient safety event as any event that could have or did result in harm to the patient as a result of the health care they receive. We also found 44 patient records had three or more safety events recorded over a 12-month period.

Medication-related safety events were common, such as the wrong medication type or dose being given to a patient. Sometimes the patients themselves took the wrong type or dose of a medication or stopped medication all together. We also observed a variety of other patient safety events such as falls, pressure ulcers and infections after surgery.

The number of incidents could even be higher than what we observed. We know from other research that not all patient safety events are documented.

We didn’t have a control group, which is the main limitation of our study. In other words, we didn’t examine medical records of patients from non-CALD backgrounds to compare how common patient safety events were between groups.

But looking at other data suggests the rate of incidents is much higher in CALD patients.

Studies over many years indicate around one in ten patients admitted to hospital experience a safety event.

One study from Norway found cancer patients have a 39% greater risk of experiencing adverse events in hospital when compared to other patients (24.2% compared to 17.4%).

Why is the risk of incidents so high for CALD patients?

We identified miscommunication as a key factor that put cancer patients from CALD backgrounds at risk.

For example, we observed from one patient’s notes that the patient didn’t take their medication because they were confused by the instructions given by different clinicians. This confusion might have stemmed from language barriers or health literacy issues.

In some medical records, we also saw interpreter requirements were unmet. For example, at the time of admission, assessment for language needs noted an interpreter was not required. However, later notes mentioned the patient had poor English or needed an interpreter.

Also, with the limited availability of interpreters, they’re often reserved for specialist appointments, and not used for “routine” tasks, such as during chemotherapy treatment. This may result in side effects from cancer medications not being properly identified and responded to, potentially leading to patient harm.

What can we do to improve things?

To make care safer, patients, their families and the clinicians who care for them should come together so that any solutions developed are practical, relevant, and informed by their combined experiences.

As an example, we developed a tool with consumers from CALD backgrounds and their clinicians that seeks to ensure that when patient medications are changed, there is common understanding between the clinician and the patient of their medication and care instructions. This includes recognising the side effects of the medications and who to contact if they have concerns.

This tool uses images and simple language to support common understanding of medication and care instructions. It takes into account specific cultural expectations and is available in different languages. It’s currently being evaluated in two cancer clinics.

To make cancer care safer for patients from CALD backgrounds, health systems and services will need to support and invest in strategies that are specifically targeted towards people from these backgrounds. This will ensure more equitable health solutions that improve the health of all Australians.

Ashfaq Chauhan, Research Fellow, Australian Institute of Health Innovation, Macquarie University; Melvin Chin, Senior Lecturer, School of Clinical Medicine, UNSW Sydney; Meron Pitcher, Honorary, Medicine, Dentistry and Health Sciences, The University of Melbourne, and Reema Harrison, Professor, Australian Institute of Health Innovation, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.