Date of Award


Degree Name

Doctor of Philosophy


Interdisciplinary Health Sciences

First Advisor

Kieran Fogarty, Ph.D.

Second Advisor

Rob Lyerla, Ph.D.

Third Advisor

Karen Rentas-Torres, Ph.D.


Depression treatment response, gender socialization, integrated behavioral health, mental health services utilization, primary care setting, stigma


The 2010-2013 National Health Interview Survey showed that nearly 9% of men had daily feelings of anxiety or depression, yet less than 41% sought help for their symptoms (Blumberg et al., 2016). Men are more reluctant than women to seek help (Angst et al., 2002; Brownhill et al., 2005). The failure to seek help among men is associated with multiple factors related to stigma and gender, yet male suicide rates are approximately 3-5 times higher than their female counterparts. However, they have a higher likelihood of seeking help from a medical provider rather than a mental health provider. If men were able to get mental health treatment in a primary care setting in which they already receive physical care, would it improve their use of services and depression treatment response? This study sought to determine whether integrated behavioral health primary care setting improves the utilization and/or treatment participation and outcomes among male patients compared to a non-integrated primary care setting.

The study used secondary data of male patients who received care from 12 clinics of a large healthcare provider organization in the Pacific Northwest. Six clinics were integrated behavioral health primary care practices and the other six were non-integrated primary care practices. A retrospective cross-sectional study was utilized to investigate the influence of integrated behavioral health primary care on two outcomes among men: (a) mental health services utilization and (b) depression treatment response. The investigator developed two models for the two outcomes. The analysis involved a descriptive cross-tabulation analysis followed by a binary logistic regression analysis of both models.

Results of the binomial logistic analysis indicated that the multivariate model predicted mental health services utilization among men at a statistically significant level, χ2(20, N = 648) = 93.398, p < 0.01. Men were 3.437 times (CI = 2.917, 6.748) more likely to use behavioral health services in an integrated care setting as in a non-integrated primary care setting. The results also revealed that Baby Boomers (1955-1964) and older adults were 67.8% (CI = .134, .771) less likely than Generation Z (born 1997-2012) to use mental health services. Generation Z patients included in the study were 18 years or older.

The second model predicting depression treatment response was also statistically significant, χ2(20, N = 648) = 32.134, p = 0.042. Firstly, the integrated behavioral health primary care setting was approximately 68.2% (CI = 1.11, 2.547) more likely than a non-integrated primary care setting to have men respond to depression treatment while adjusting for other variables. Secondly, men who used psychotherapeutic medications were 91.8% (CI = 1.294, 2.842) more likely than those who did not use medication to respond to depression treatment. Thirdly, men who did not disclose their relational supports in this sample were 4.334 times (CI = 1.394, 11.436) more likely to respond to depression treatment as the group that were married or lived with a significant other or domestic partner.

Access Setting

Dissertation-Open Access