Endorsement of Traditional Masculinity Ideologies is Associated With Differences in Psychotherapy Use Among Heterosexual-Identified but not Non-Heterosexual-Identified Men

Background: Heterosexual-identified men, as compared to non-heterosexual-identifiedmen, are less likely to seek out psychotherapy when experiencing psychological distress. Stronger endorsement of traditional masculinity ideologies (TMI) has been reported to be associated with reduced psychotherapy use among men. However, the relationship between psychotherapy use, TMI, and sexual identity needs to be explored.Methods: A total of 728 psychologically distressed men (59.9% heterosexual-identified, 40.1% non-heterosexual-identified) from German-speaking parts of Europe completed an online questionnaire asking about current psychotherapy use, endorsement of TMI, experienced gender role conflict, depression symptoms, and externalizing depression symptoms.Results: In total 34.5% (N = 251) of the men were currently using psychotherapy, of which 47.4% (N = 119) identified as heterosexual and 52.6% (N = 132) as non-heterosexual. Heterosexual-identified men used psychotherapy significantly less than gay- and bisexual- identified men, while showing comparable psychological distress. Additionally, heterosexual-identified men exhibited higher endorsement of TMI across all domains and experienced more masculine gender role conflict, especially in the domains Success, Power, Competition and Restrictive Affectionate Behavior Between Men. In heterosexual- but not non-heterosexual-identified men, stronger endorsement of TMI was associated with reduced psychotherapy use.Conclusion: Higher endorsement of TMI is linked to reduced psychotherapy use among psychologically distressed heterosexual-identified men. Thus, challenging TMI and advocating for alternative masculinities that include health promoting behavior can especially help heterosexual-identified men.