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The Social Nature of Male Suicide: A New Analytic Model
Abstract
Suicide is one of the leading causes of male mortality. In nearly every country in the world, more males than females end their life by suicide. Previous research indicates male-specific risk factors include social factors such as being unmarried, low income, and unemployment. An analytic model of male suicide is developed, proposing that the traditional male gender role creates a culturally-conditioned narrowing of perceived options and cognitive rigidity when under stress that increases male suicide risk. Suicide prevention and intervention require recognition of the role of high traditional masculinity, situating individual explanations within a broader social context. Based on this theory and the few existing empirical studies, testable hypotheses are proposed.
... Another purpose of this article is to address the important issue of men having an increased risk of dying by suicide compared to women. While women have higher rates of suicidal ideation and nonfatal suicidal behavior in most Western countries, more men die by suicide almost all over the world (gender paradox) (Canetto & Sakinofsky, 1998;Coleman & Casey, 2011). Against this backdrop, it is particularly problematic that men are consistently underrepresented in suicide research (Seager et al., 2014). ...
... Culturally shaped norms of masculinity could influence STBs in men in several ways. On the one hand, traditional masculine values, such as being successful and strong, are likely to cause severe distress if these standards are not met (Coleman & Casey, 2011). According to Baumeister's Escape Theory of Suicide (Baumeister, 1990), emotional distress caused by self-perception of failure enhances the risk for STBs, which has already been empirically proven (Chamberlain et al., 2009). ...
... Future studies should investigate for which individuals suicidal ideation and other STBs serve as a strategy for affect-regulation and for which not, and what processes are involved. Theory and previous research suggest a particular importance of gender norms for both the development of STBs (Coleman, 2015(Coleman, , 2020Coleman & Casey, 2011;Griffin et al., 2022) and difficulties with affect regulation (Jakupcak et al., 2003;Levant et al., 2014;Logoz et al., 2023). The role of gender norms like high traditional masculinity should therefore be considered more in the context of affect-regulation and STBs. ...
Introduction
Men have an increased risk to die by suicide compared to women but are underrepresented in suicide research. To improve individual risk prediction for suicide‐related thoughts and behaviors (STBs), risk factors are increasingly being studied at an individual level. The possible affect‐regulatory function of suicidal ideation has hardly been investigated ideographically and has not yet been tested in a male sample.
Methods
We investigated the bidirectional associations between suicidal ideation and negative and positive affect in a sample of n = 21 male inpatients with unipolar depression and a history of suicidal ideation both at the group level and at the individual level. Participants underwent an intensive ecological momentary assessment for 6 days with 10 data points per day.
Results
We found no evidence for an affect‐regulatory function of suicidal ideation at the group level, neither for effects of affect on subsequent suicidal ideation (antecedent affect‐regulatory hypothesis) nor for effects of suicidal ideation on subsequent affect (consequence affect‐regulatory hypothesis). Person‐specific analyses revealed substantial variability in strength and direction of the considered associations, especially for the associations representing the antecedent hypothesis.
Conclusion
The demonstrated between‐person heterogeneity points to the necessity to individualize the investigation of risk factors to enhance prediction and prevention of STBs.
... Estas dos entradas analíticas, tanto de alcance macroestructural como de nivel micro, apuntan hacia la idea de la conexión, ya sea a nivel social o individual. A pesar de las diferencias y de la tensión epistémica entre las explicaciones sociales e individuales del suicidio (Coleman, Kaplan & Casey, 2011), las teorías sociales y psicológicas coinciden en que existe una relación significativa entre la construcción social de la masculinidad hegemónica o tradicional y el suicidio en varones (Coleman, 2015;Coleman et al., 2020;Månsdotter et al., 2009;Pirkis et al., 2017;River, 2014). ...
... La investigación acerca del vínculo entre masculinidades y suicidio ha encontrado relaciones teórico-analíticas predominantes. En el estudio de la cuestión destaca la base económica, el rango etario y la dimensión étnica (Canetto, 2017;Fässberg et al., 2012;Feigelman et al., 2016; REVISTA SUL AMERICANA DE PSICOLOGÍA 11(1), 2023 | | ISSN 2318-650X | Mac An Ghaill & Haywood, 2012), los factores sociales (Coleman et al., 2011) y las dificultades psicológicas (Knizek & Hjelmeland, 2018;Möller-Leimkühler, 2003), entre las cuales resaltan: depresión, abuso de sustancias y desórdenes de personalidad (Coleman et al., 2011); así como características ocupacionales específicas, como trabajar como militar (Braswell & Kushner, 2012;Burns & Mahalik, 2011;Månsdotter et al., 2009) o agricultor (Bryant & Garnham, 2015;Merriott, 2016). Estos elementos comparten un eje transversal: el género como variable sociológica explicativa central. ...
... La investigación acerca del vínculo entre masculinidades y suicidio ha encontrado relaciones teórico-analíticas predominantes. En el estudio de la cuestión destaca la base económica, el rango etario y la dimensión étnica (Canetto, 2017;Fässberg et al., 2012;Feigelman et al., 2016; REVISTA SUL AMERICANA DE PSICOLOGÍA 11(1), 2023 | | ISSN 2318-650X | Mac An Ghaill & Haywood, 2012), los factores sociales (Coleman et al., 2011) y las dificultades psicológicas (Knizek & Hjelmeland, 2018;Möller-Leimkühler, 2003), entre las cuales resaltan: depresión, abuso de sustancias y desórdenes de personalidad (Coleman et al., 2011); así como características ocupacionales específicas, como trabajar como militar (Braswell & Kushner, 2012;Burns & Mahalik, 2011;Månsdotter et al., 2009) o agricultor (Bryant & Garnham, 2015;Merriott, 2016). Estos elementos comparten un eje transversal: el género como variable sociológica explicativa central. ...
Este artículo presenta relaciones analíticas claves para entender el vínculo entre la construcción social de las masculinidades y el suicidio en varones. La metodología empleada consistió en una revisión de la literatura relevante, incluyendo las investigaciones recientes que estudian el suicidio en varones en el contexto de la pandemia covid-19. Los hallazgos principales permiten ubicar un debate epistémico y metodológico en el estudio del suicidio varonil, entre enfoques epidemiológicos-estadísticos y metodologías cualitativas como las autopsias verbales —psicosociales— y sociológicas. Se presentan perspectivas globales de este fenómeno que describen la interacción entre la autoeficacia varonil y el rol de proveeduría económica, los factores de desintegración social y aislamiento relacionados con la edad, y la etnicidad y diversidad sexual en varones. También se describen perspectivas psicológicas sobre el suicidio, tales como el síndrome depresivo masculino y el suicidio como escape. Además, se revisó la literatura existente para Hispanoamérica y Ecuador en particular.
... A large body of evidence links deterioration of men's mental health with social and/or situational stressors, beckoning research aimed at understanding factors affecting men's mental health in ever-shifting COVID-19 contexts. A theoretical understanding of the connection here is offered by Coleman et al. (2011) with reference to male suicide, in their discussion of the "social nature of male suicide." This theory purports that men's mental health is particularly at risk of decline, culminating in suicide, following the experience of circumstances that necessitate major psychosocial transitions which threaten a man's sense of masculine security. ...
... Our finding that the frequency of reported mental health effects of social isolation eclipsed other stressors known to affect men's mental health, such as job loss and relationship strain, is novel given the scarcity of evidence that compares the relative self-reported impact of these stressors. Building on theoretical understanding of the psychosocial and situational determinants of men's mental health (Coleman et al., 2011), our results imply that perhaps the isolation associated with stressors such as job loss or relationship breakdown might be one of the mechanisms underpinning the role of these risk factors in male suicide. While we cannot unequivocally infer the extent to which social isolation occurred alongside job loss, for example, alleviating feelings of isolation is nevertheless crucial in protecting men's mental health. ...
... Results concerning the mental health impact of unemployment-related stressors reinforce earlier research consistently reporting the role of these situational stressors in the proliferation of psychological distress among men, particularly suicidality (Clapperton et al., 2019;Cunningham et al., 2021); summarized in the "social nature of male suicide" theory (Coleman et al., 2011). Unemployment is often framed as a catalyst for distress among men, potentially due to men's tendency to assume the social role of primary provider and/or breadwinner as a result of, at least in part, masculine socialization (Courtenay, 2000;Seidler et al., 2021). ...
The COVID-19 pandemic has presented a suite of circumstances that will simultaneously affect mental health and mobilize coping strategies in response. Building on a lack of research specifically exploring men's mental health impacts during the COVID-19 pandemic, this study presents the results of a qualitative survey exploring men's self-reported aspects of the pandemic giving rise to mental health challenges, alongside their diverse coping strategies applied during this time. The sample comprised 555 men from North America (age M = 38.8 years; SD = 13.5 years), who participated via an online survey with two open-ended qualitative questions assessing, respectively, the aspects of the pandemic affecting their mental health, and the strategies used to manage these challenges. Free-text responses were coded using inductive content analysis. Results pertaining to the mental health impacts of COVID-19 were categorized into two overarching themes: far-reaching ramifications of COVID-19 encompassing consequences for lifestyle, work, and functioning, alongside novel anxieties related to health risks and daily uncertainty. In addition, coping strategies reported were categorized into two broad themes: efforts to avoid, dull or distract oneself from distress, alongside adapting and doing things differently, which encompassed largely approach-oriented efforts to flexibly ameliorate distress. Results signal the far-reaching impacts of COVID-19, alongside profound flexibility and diverse enactments of resilience among men in adapting to unprecedented challenges. Findings have implications for mental health promotion that should aim to leverage men's adaptive coping to encourage opportunities for social connectedness in response to the mental health impacts of the various psychosocial challenges of the COVID-19 pandemic.
... In understanding male distress presentations, we also need to investigate how it is responded to. Scholars have suggested that societies may be more culturally attuned and receptive to female presentations of despair (Coleman et al., 2011). γ bias, a term operationalized by Seager and Barry (2019), is the hypothesis that our empathy is partly conditioned by cultural norms that may mean we are more sensitive to male behaviors that cause harm than those that harm men, as well as more primed to perceive men as occupying positions of power/privilege than as being disadvantaged. ...
... Given consistently higher suicide rates in men, we urgently need to explore the role of gender, masculine norms, and male socialization in potentially elevating male suicide risk. Previous research has shown that men who strongly endorse traditional masculine values are at higher suicide risk (Coleman, 2015;Coleman et al., 2011), particularly norms relating to selfreliance (Pirkis et al., 2017). Masculine norms were also central to findings in the male suicide qualitative metasynthesis (Bennett et al., 2023). ...
This study uses the Delphi expert consensus method to work with lived-experience experts and establish research priorities to advance our understanding of male suicide risk and recovery. Items for the Delphi were generated via findings from two recent quantitative and qualitative systematic reviews on male suicide, a comprehensive gray literature search, responses to a global survey on male suicide, and feedback from a panel of 10 international academic/clinical male suicide experts. A two-round Delphi study was conducted to gain consensus among 242 lived-experience experts representing 34 countries on 135 potential male suicide research questions. Panelists were asked to rate each item on a 5-point Likert scale from should not be included to essential. Consensus was defined as 80% of respondents scoring an item as “essential” or “important.” After two Delphi rounds, consensus was reached on 87 items. The final questions were then grouped by the author team and expert academic/clinical panel into thematic clusters to create a 22-point agenda of research priorities. Like all methodologies, there are weaknesses to the Delphi method, not least that the experts employed in a Delphi study do not represent all experts on a topic. We note that many items that did not make it to the top of the research agenda related to minority experiences. All the questions prioritized in this agenda can be applied to different demographics. However, minority populations may require tailored Delphi’s using expert panels drawn specifically from those groups. A final agenda of 22 research priorities was developed. Questions related to 10 thematic domains: (a) relationships with others, (b) relationship with self, (c) relationship with emotions, (d) mental health, (e) suicidal behaviors, (f) early-life experiences, (g) structural challenges, (h) cultural challenges, (i) at-risk groups, and (j) support and recovery. The three highest endorsed items related to loneliness and isolation (98%), feelings of failure (97%), and sources of stress and emotional pain (96%) for men who are suicidal.
... are associated with suicidality in men (Canetto & Cleary, 2012), conformity to certain hegemonic or traditional masculine gender role norms is consistently indicated as a factor in many men suffering from suicidality (e.g., Alston, 2012;Cleary, 2012;Coleman, Kaplan, & Casey, 2011;Houle, Mishara, & Chagnon, 2008;M€ oller-Leimk€ uhler, 2003). Research focused on masculinity and men's mental health also increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained (i.e., mediated and/or moderated) by certain psychological processes or health behaviors (Easton, Renner, & O'Leary, 2013;Houle et al., 2008;Wong, Ho, Wang, & Miller, 2017). ...
... For instance, a primary factor that influences self-injurious thoughts and behaviors is the desire to escape from aversive thoughts and/or feelings (Boergers, Spirito, & Donaldson, 1998;Hawton, Cole, O'Grady, & Osborn, 1982). Baumeister's (1990) prominent theory of suicidality includes a focus on how suicide is driven by a desire to escape pain associated with the self and current life problems, and research increasingly indicates that many men report a prominent feature in their experience of suicidality is the desire to alleviate their intense distress and/or unmet expectations of masculinity (e.g., Alston, 2012;Coleman et al., 2011). Because thought suppression is a method of experiential avoidance, thought suppression and suicidal behaviors share a similar function of avoidance or escape from painful thoughts and feelings (Najmi, Wegner, & Nock, 2007). ...
Objective:
In most countries, men are at higher risk than women for suicide death. Research focused on masculinity and men's mental health increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained by certain psychological processes or health behaviors. The objective of this study was to extend this area of research in a national sample of US men (n = 785) by investigating if their adherence to certain hegemonic masculine gender role norms (toughness and self-reliance through mechanical skills) is associated with the suppression of distressing thoughts and if thought suppression then increases their risk for suicidal thoughts and behaviors.
Methods:
Men in the US who have recently experienced a stressful life event completed an anonymous online survey. Structural Equational Modeling (SEM) was used to test for direct and indirect effects (i.e., mediation) between variables.
Results:
Men's engagement in thought suppression mediated the relationship between self-reliance and suicidality. The norm of toughness was both directly related to suicidality and mediated by thought suppression.
Conclusions:
Thought suppression appears to be a process that provides some explanation for the relationships between hegemonic masculine norms and suicidality in men, though this study indicated it may play only a small role. Research continues to build that certain masculine norms, such as self-reliance and toughness, are particularly concerning for men's health.HIGHLIGHTSMen's thought suppression mediates the relationship between self-reliance and suicidalityMen's toughness impacts suicidality both directly and via engagement in thought suppressionThese findings have implications for interventions that help men manage distressing thoughts.
... These factors are seen to contribute to the formation of suicidal ideation and intent. The subsequent transition from this intent to suicidal behaviour is moderated by volitional factors such as capability, impulsivity, devising a plan and access to means [14], factors which are thought to readily explain transitions across the suicide continuum in men [16]. ...
... Regarding relationships, our results align with past studies suggesting that married/partnered men experienced lesser odds of suicidal ideation alone (but was unrelated to suicide planning; [35]). These findings reinforce the theoretical understanding of the 'social nature' of male suicide [16], linking men's psychosocial context (e.g. employment; relationship status) with distinct categories of suicide risk in men. ...
Background
Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men’s self-reported protective strategies when experiencing suicidal thoughts and behaviour.
Methods
A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men’s self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis.
Results
Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting , reflecting men’s intra- and interpersonal management strategies; and sustaining selflessness , where men’s imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans.
Conclusions
Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men’s identification with familial protector and/or provider roles as protective against suicidal action.
... World Health Organisation's (n.d.) recent data on age-standardised suicide rates (per 100,000 population) and the large community-based survey conducted by marks a declining trend of male suicide rates and a sharp decrease of female rates in Bangladesh which marks men as a risky group. Considering the higher rate of male suicide rate globally, the diverse risk factors associated with the male suicidal phenomenon (Coleman et al., 2011) and the increased trend of male suicide in Bangladesh, it is necessary to explore the contextual praxis of suicide and attempted suicide in Bangladesh. From that perspective, we made an attempt to delve into exploring the context of intimate partner relationship in men's suicide and suicide attempts in Bangladesh. ...
... These men encountered serious troubles in their intimate relationship when performing their socially expected, family provider/breadwinner responsibilities which elevated their risk for suicidal behaviour. These cases exemplify an escape from the intolerable view of self and the connected negative effects (Coleman et al., 2011). ...
Suicidal behaviour (e.g., suicide and suicide attempt) is a multifaceted phenomenon which often draws on several social and psychological contexts. This research examines how men’s suicides and attempted suicides are embedded in the contextual praxis of intimate relationships in Bangladesh. Qualitative semi-structured interviews were undertaken with family members, close relatives, and friends of 37 men who died by suicide or attempted suicide. This research’s findings identify five key risk factors associated with men’s suicide and attempted suicide, namely: troubles over the designated family provider’s responsibilities; troubles emanating from second marriage; betrayal of loyalties; complications in non-marital relationships; and feelings of no control over wife. Each theme suggests that men who died by suicide or who attempted suicide found it challenging to balance their culturally expected (hegemonic) masculine image with their intimate relationships. Suicide and attempted suicide surfaced as a consequence of such challenges in their life. Efforts are suggested to lessen the burden on men’s masculine expectations and promote an egalitarian social space in order to reduce suicide risk in men.
... Möller-Leimkühler (2003) elaborated hypotheses about the role of traditional masculinity and stressors such as job or relationship loss and larger social changes. Coleman et al. (2011) theorized that traditional masculinity leads to a rigid coping style that increases the probability of sudden suicidal behavior, particularly under conditions of stress. This pattern was linked to Baumeister's (1990) escape theory of suicide where the suicidal act is in part an effort to escape a painful emotional state with no other perceived acceptable pathway to resolution. ...
... In numerous ways, the findings in this paper are consistent with theoretical models of the role of masculinity socialization in suicide death (Canetto, 1997;Coleman et al, 2011;Möller-Leimkühler, 2003) and qualitative studies of men and suicidality (Oliffe et al., 2012). For example, Canetto's (1997) cultural script theory claims that males aligned with more traditional sex role ideologies stand at a higher risk than other males for taking their lives during their young adult years. ...
Objective
We investigated whether male high school students displaying high traditional masculinity (HTM), defined briefly as overacting male roles, possessed distinctive social origins and adult lifestyle trajectories differentiating them from others.
Method
Based upon four survey waves of the National Longitudinal Study of Adolescent to Adult Health cross‐linked to the National Death Index, we contrasted surveys 1 and 2 respondents reporting HTM, n = 3138, 31%, with the remaining 69% (n = 6849) on various sociodemographic characteristics, problem behaviors, suicides, and other premature mortalities.
Results
High traditional masculinity males showed higher suicide rates, but no other differences in premature mortalities, compared with non‐HTM peers. More likely to be White, younger, less close to their fathers, they were more likely to run away from home, get into fights, act delinquently, and engage in problem drinking and drug use. At survey wave 3, more had been arrested. By wave 4, when approaching their early thirties, HTM males showed higher drug uses, more delinquency, completed less schooling, and were less likely to marry.
Conclusions
These data not only suggest higher suicide risks among this population after high school, but judging from the durability of HTM characteristics, but also they appear at risk of “deaths of despair” during later life.
... Cultural expectations aligned with each gender contribute to these perceptions. Coleman, Kaplan, and Casey (2011) highlight that elevated levels of traditional masculinity, characterized by an emphasis on winning, independence, avoidance of emotion, and a predisposition toward anger and violence, create a cognitive rigidity context associated with a higher risk of suicidal behaviors and death. Positive dimensions of masculinity serve as a protective factor against suicidal ideation and suicide, supporting findings that link traditional masculinity to an increased likelihood of mental health issues (Coleman, 2015). ...
The current research explored the mediating role of self-compassion between suicidal ideation and gender role in adolescents. The term “self-compassion” refers to a relatively new concept in the scientific field of positive psychology, which has demonstrated significant importance for human well-being. In this study, 814 adolescents aged 14-19 years participated. Results indicated that self-compassion levels were higher among boys compared to girls, and also that self-compassion appeared to increase with the adolescents’ age. For boys, self-compassion fully mediated the relationship between masculinity and suicidal ideation, where the direct effect was not significant, but the indirect effect was significant. For girls, self-compassion mediated the relationship between both masculinity and femininity and suicidal ideation, with significant indirect effects. These findings highlight the critical role of self-compassion as a protective factor in the context of counseling psychology, suggesting that incorporating self-compassion into preventive mental health strategies could significantly benefit adolescents facing challenges associated with gender roles and suicidal ideation.
... Furthermore, familial tobacco use, family addiction history, and familial violence showed positive relationships with SI in the adjusted model. Addressing emotional needs relates to the fulfillment that comes from connecting or reconnecting with the individual's family, friends, and the relationships they have with others and with themselves [54,55]. ...
Introduction
Suicidal ideations (SI), also known as suicidal thoughts, refer to impulses, desires, and obsessions related to death. Prevalence of suicidal ideation was 14 percent. The current study assumed that identifying the true predictors of SI would allow for a greater understanding of suicide risk.
Methods
In this cross-sectional population-based study, 17,644 residents aged from 15 to 90 years were selected through a multi-stage sampling method from 22 districts of Tehran. Using hypothesized causal models, the pathways through which various variables influenced the components of SI were identified. Also, the applicability of the compensatory and risk-protective models of resiliency for the prediction of SI was tested by using the interaction multiple regression analyses.
Results
SI was experienced by 13.44% of the study population. SI was more prevalent with individuals between the ages of 15 to 24. There are no differences between men and women when covariate analysis is used. The significant predictions by anxiety and physical activity (moderate) indicate support for the compensatory model for male and female, while the significant prediction by those indicates support for the risk-protective model for females.
Conclusion
PA would both lessen the detrimental impact of anxiety on suicidal thoughts and potentially reduce the probability of SI. It's important to develop and evaluate PA-enhancing treatments, especially for woman who are experiencing anxiety.
... In terms of proximal risk, the model suggests that some male suicides can be driven by an intensification of those feelings, with suicide associated with the killing of a failed, hated, or devalued self. The relationship between low self-esteem and suicide risk has also been previously reported (Chatard et al., 2009;Kõlves et al., 2013), as have feelings of failure -specifically in relation to male suicide (Coleman et al., 2011;Möller-Leimkühler, 2003). Additionally, aversive self-awareness is critical to Baumeister's (1990) "Escape from Self" theory of suicide. ...
This study addresses our limited understanding of male suicide risk psychology. 2763 men participated in a global survey examining associations between suicidal history and measures of emotions, psychological pain, feelings towards self, and in-terpersonal connections. Results from multinomial logistic regression analyses indicated that higher levels of loneliness and mental health diagnosis increased the odds of being in the suicidal ideation group compared to controls. A mental health diagnosis and being non-heterosexual increased the odds of being in the suicide attempt group compared to controls. Higher levels of financial strain, mental health diagnosis, being non-heterosexual, having more restrictive attitudes to emotional expression, and lower levels of mattering to others, increased the odds of suicide attempt group membership compared to suicidal ideation.
... As shown by the findings of the studies, these impositions and normalizations generate resistance towards the idea of asking for help, especially in men. They also generate a reduction of self-esteem within the person and in relation to his future possibilities, accompanied by shame, sadness and loneliness, as well as feelings of guilt and humiliation when he feels that he does not or cannot comply with them [13,16,20,28,29,31] it can also generate a short-term burden when he complies with them, albeit uncritically [28]. ...
Background: Prior studies have consistently shown that at- tempts by males tend to be more lethal, and their suicide rates higher than those of females. Although men are more likely to die by suicide, women are much more likely to attempt suicide. Sui- cide is a gendered problem. As a result, suicide prevention also de- pends on recognising that risk factors for suicide may affect men and women differently.
Objective: Explore the way in which heteronormative gender practices and discourses are related to suicide attempts in Cuba.
Methods: This is a cross-sectional study, conducted between October 5 and November 2, 2017 with 2 males and 2 females in an age range between 46 and 77 years. Two categories were used to design and analyze the in-depth semi-structured interviews: social institutions and social reproduction. The content analysis included the way in which these institutions and forms of social reproduction constitute a risk or protection for suicide attempts.
Results: Heteronormative discourses/practices differentially value physical and moral qualities, attitudes and behaviors of male and female. Within a heteronormative construction of gender in Cuba, some institutions might be a risk for suicide attempts through the frustration of meaning needs, and the normalization of gendered self-demand.
Conclusion: Suicide attempts is a gendered issue. The suicide at- tempt can be both an attempt to die or an expression of context engagement and the desire to live, but in other way.
... As shown by the findings of the studies, these impositions and normalizations generate resistance towards the idea of asking for help, especially in men. They also generate a reduction of self-esteem within the person and in relation to his future possibilities, accompanied by shame, sadness and loneliness, as well as feelings of guilt and humiliation when he feels that he does not or cannot comply with them [13,16,20,28,29,31] it can also generate a short-term burden when he complies with them, albeit uncritically [28]. ...
Background: Prior studies have consistently shown that attempts by males tend to be more lethal, and their suicide rates higher than those of females. Although men are more likely to die by suicide, women are much more likely to attempt suicide. Suicide is a gendered problem. As a result, suicide prevention also depends on recognising that risk factors for suicide may affect men and women differently.
Objective: Explore the way in which heteronormative gender practices and discourses are related to suicide attempts in Cuba.
Methods: This is a cross-sectional study, conducted through in depth semi-structured interviews between October 5 and November 2, 2017 with 2 males and 2 females in an age range between
46 and 77 years.
Results: Heteronormative discourses/practices differentially value physical and moral qualities, attitudes and behaviors of male and female. Within a heteronormative construction of gender, the transition from emotions such as sadness, loneliness, and feelings such as shame and hopelessness towards the suicide attempt occurs through three processes: gender signifiers are imposed and naturalized so that the person is signified as a whole, frustration of ontological or meaning needs, and the feeling of being trapped with little possibility of modifying the experiences.
Conclusion: Suicide attempts is a gendered issue. The suicide attempt can be both an attempt to die or an expression of context engagement and the desire to live, but in other way.
... Other men described a lack of self-esteem as a psychological barrier and appeared to feel unworthy of help. This also aligns with existing evidence that suggests men who are suicidal can experience profound feelings of low self-worth and failure (Cleary, 2017;Coleman et al., 2011;Oliffe et al., 2017). Consequently, some men may believe themselves undeserving of support. ...
Male suicide rates represent a public health crisis. In almost every country, more men die by suicide than women and suicide is a leading cause of death for men in the United States and the United Kingdom. Evidence suggests that men are less likely than women to access professional support for suicidal distress. Ensuring more men access support is a critical component of suicide prevention. This study explores responses from 725 men, worldwide, who have attempted suicide or have had thoughts of suicide in the last year, to an open-text question about the barriers they experience to accessing professional support. Using a thematic analysis, results reveal the multifaceted barriers some men experience regarding a lack of motivation, a lack of psychological capability, and/or a lack of physical/social opportunity to access support. Findings suggest that many men have sought support but had negative experiences and that many others want help but cannot access it. Barriers include prohibitive costs and waiting times; potential costs to identity, autonomy, relationships and future life opportunities; a lack of perceived psychological capability; a lack of belief in the utility of services and a mistrust of mental health professionals. Findings suggest the importance of examining the role of male gender in male help-seeking behaviours. We suggest 23 recommendations for services and public health messaging to increase men's help-seeking behaviours.
... In 2019, males accounted for ~80% of suicide deaths in the U.S.; suicide was the eighth leading cause of death for males aged ≥10 years. 1 Males less often have known mental health conditions (KMHCs) than females who die by suicide. 2,3 Many factors could contribute to this: less help seeking, 4 impulsive reactions to stressors, traditional gender roles, 5 and greater access to highly lethal means. 6 Characteristics of suicides among males with and without KMHCs were compared by age group to inform prevention. ...
Introduction
Suicide among males is a major public health challenge. In 2019, males accounted for nearly 80% of the suicide deaths in the U.S., and suicide was the eighth leading cause of death for males aged ≥10 years. Males who die by suicide are less likely to have known mental health conditions than females; therefore, it is important to identify prevention points outside of mental health systems. The purpose of this analysis was to compare suicide characteristics among males with and without known mental health conditions by age group to inform prevention.
Methods
Suicides among 4 age groups of males were examined using the 3 most recent years of data at the time of the analysis (2016–2018) from the Centers for Disease Control and Prevention's National Violent Death Reporting System. Decedents with and without known mental health conditions were compared within age groups. The analysis was conducted in August 2021.
Results
Most male suicide decedents had no known mental health conditions. More frequently, those without known mental health conditions died by firearm, and many tested positive for alcohol. Adolescents, young adults, and middle-aged males without known mental health conditions more often had relationship problems, arguments, and/or a crisis as a precipitating circumstance than those with known mental health conditions.
Conclusions
Acute stressors more often precipitated suicides of males without known mental health conditions, and they more often involved firearms. These findings underscore the importance of mitigating acute situational stressors that could contribute to emotionally reactive/impulsive suicides. Suicide prevention initiatives targeting males might focus on age-specific precipitating circumstances in addition to standard psychiatric markers.
... Statistical di erences regularly tell us that more men than women die by suicide, whereas more women than men attempt suicide (Callanan & Davis, 2011;Choo et al., 2017). Based on outcome, largely determined by mortality rates, suicide is interpreted as a male phenomenon, where men are seen as completers and women as attempters (Canetto, 1992(Canetto, -1993(Canetto, , 1995(Canetto, , 1997Canetto & Lester, 1998;Coleman & Casey, 2011;Dahlen & Canetto, 2002;Range & Leach, 1998). A range of actions, or self-destructive behaviors, also informs the interpretation of men as completers and women as attempters (Andriessen, 2006;Jaworski, 2014). ...
Suicide is commonly understood as an explicitly individual choice. This understanding has been advanced by an anthropocentric viewpoint in contemporary studies of suicide, which see suicide, unsurprisingly, as a thoroughly human phenomenon, defined by humans and relegated to the human mind, culture, and discourse. The problem with this approach toward understanding suicide is with how agency is interpreted. There is an assumption that the agency of suicide is entirely human because of the individual desire and intention to die, manifested in the act of taking one’s own life. But what if the exercise of human agency depends on something else in the course of materializing the act of suicide? This chapter responds to this problem by analyzing the gendering of suicide in The Virgin Suicides (1993), written by Jeffrey Eugenides. Drawing on the new materialist feminist scholarship, I argue that agency in suicide is more than human, because that which is human depends on nonhuman materiality. I also argue that the feminine, traditionally interpreted as reactive and passive in suicide, is in fact agentic. The chapter begins by discussing the cultural context of interpreting gender, which influences how the suicides of the teenage Lisbon sisters—Cecilia, Bonnie, Therese, Lux, and Mary—are understood. I then analyze the power of the masculine gaze and the way it frames and fails to frame the five suicides. I also analyze the gendering of feminine bodies and sexuality. Finally, I consider the significance of the suburban landscape and mood as key to understanding suicidal agency.
... However, masculine identity is not fixed in time or space and is not necessarily a passive and received identity, but arises from an active construction of social identity. Our findings echo those of Coleman et al. (2011) in that retaining the risky ideals of traditional masculinity may increase the risk of suicide among men who are impeded in their efforts to maintain such ideals. To mitigate this, we argue that dominant forms of masculine identity should be challenged and that the ways in which men are positioned in society should be changed. ...
Drawing on Raewyn Connell’s theoretical notion of hegemonic masculinity, this study examines relations between masculinity and suicide attempts in Bangladesh. In-depth interviews were conducted with 17 men from the Jhenaidah district, who had previously attempted suicide. Participants discussed how “real men” were expected to be primary providers, demonstrate their material power and sexual prowess. However, the men disclosed that they encountered difficulties in achieving these versions of hegemonic masculinity in their real lives. Within this context, suicide attempts operated as a redemptive means to overcome perceived masculine “crises.” These findings demonstrate that suicide is a socially and culturally constituted phenomenon, which should be understood beyond an individualized and mental health framework. Suicide intervention strategies in Bangladesh must include critical analyses of masculinities, as well as measures to change rigid processes of gendered socialization.
... Across the socio-psychological literature, there is a plethora of evidence that associates male suicidal behaviors with triggers such as joblessness, unemployment, failure at work, relationship strains, depression, hopelessness, and substance abuse disorders. In women, the most important triggers are personal problems and complications within interpersonal relationships (Coleman, Kaplan, & Casey 2011;Yang, Lau, Wanget al. 2019;Chodkiewicz & Miniszewska 2016). Men significantly more often than women commit suicide under the influence of alcohol and drugs. ...
The first purpose of this paper is to analyze the direct and indirect, short- and long-term consequences of the COVID-19 pandemic for men. The second purpose is to identify the mechanisms underlying the present and predicted pandemic’s impact on men’s life and health (both somatic and mental). The author interprets the higher men's mortality due to coronavirus rates and the males' suicide rates that heightened from the beginning of the pandemic due to life-style that reflects the toxic masculinity norms. This paper's theoretical framework is determined by the social (cultural) trauma theory and the Critical Studies on Men and Masculinities. The method used for the present study is desk research based on the integrated literature review including the results of empirical research directly or indirectly addressing males’ experience of the COVID-19 pandemic from the years 2019 and 2020, the previous pandemics (SARS in 2002-2004 and Ebola in 2014), other social crises caused by economic and political processes, and research explaining men’s stress-related behaviors.
... These findings are consistent with the ones presented by the Center of Disease Control and Prevention. 7,17 Interestingly, the odds of in-hospital mortality were higher among Caucasians compared with African Americans irrespective of intent, which further confirms the association between race and mortality. The nonsignificant P values obtained on subgroup analysis are most likely due to beta errors secondary to the small number of patients since the confidence intervals were wide. ...
Background
To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States.
Methods
The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs).
Results
The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : 1469-3248 (CI: 5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63).
Discussion
Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.
... men's greater tendency to use more violent and therefore lethal means of suicide (Callanan & Davis, 2012), the discrepancy between men and women in suicide death rates is associated with a range of other factors, notably men's conformity to predominant masculine gender role norms (Burns & Mahalik, 2011;Pirkis, Spittal, Keogh, Mousaferiadis, & Currier, 2017) and men's gender-related attitudes toward suicide death based on those norms (Canetto & Sakinofsky, 1998;Coleman, Kaplan, & Casey, 2011). ...
Men’s high suicide death rates are likely associated with a range of factors, notably men’s conformity to predominant masculine gender role norms and men’s gender-related attitudes toward suicide death based on those norms. The purpose of this study was to investigate how two models integrating men’s conformity to hegemonic masculine gender role norms, perceived burdensomeness, and thwarted belongingness predict the existence and severity of suicidal ideation in a sample of men at high risk for suicide, homeless men. The study results indicated that multiple norms were predictive of the existence or severity of suicidal ideation while perceived burdensomeness predicted both suicide ideation and the severity of ideation.
... While this high frequency of suicide in men is certainly impacted by men's greater tendency to use more violent and therefore lethal means of suicide, this discrepancy none defined may also be due to difficulties recognizing depressive symptoms, primarily in men that adhere to hegemonic masculine gender role norms (Coleman, Kaplan, & Casey, 2011;Magovcevic & Addis, 2008). Furthermore, men who are already at risk for suicide because of factors associated with gender and depression are further vulnerable when they become homeless, as homeless men are more likely to report a range of other experiences that place them at increased suicide risk, such as substance use problems, mental illness, a history of domestic violence, and past victimization (Allgood & Warren, 2003;Stein & Gelberg, 1995;Toro et al., 1995). ...
Objectives:
Men's suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation.
Methods:
Homeless men (n = 94) completed questionnaires at a resource center in the Rocky Mountain West US.
Results:
Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men's suicidal ideation.
Conclusion:
An externalizing-internalizing model of predicting suicide in men and men's adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.
... Globally, men end their life at 3.3 times the rate of women (WHO, 2016). One potential contributor to the elevated male suicide rate is traditional masculinity (TM), a set of social norms that includes an emphasis on competition, strength, emotion avoidance, and the acceptability of anger and violence (Coleman, Kaplan, & Casey, 2011). Previous research found high TM men over 4.5 times more likely to make a suicide attempt in a large sample of young adults (Coleman, 2015a) and that TM was a risk factor for suicidal behavior in a large mixed gender sample of young adults (Coleman, 2015b). ...
Prior research demonstrates that traditional masculinity (TM) is related to suicidal ideation and attempts, but the relationship of TM to suicide death is untested. The current study validates a proxy rated measure of TM to use in case-control research of suicide death in a sample of 110 older adults. The Male Role Norms Inventory-Proxy (MRNI-P) items produced a strong single-factor solution and good reliability ( = 0.75). As predicted, mean MRNI-P did not differ from self-rated MRNI. Convergent validity tests found moderate correlations for MRNI-P to self-rated MRNI (r = .41, p < .05) and to femininity ideology (r = .29, p < .05). A non-significant trend level association was observed with masculine occupation (r = .20, p < .10), and no association with substance abuse. Amongst males, self-rated MRNI had a non-significant trend level association with suicidal ideation (r = .41, p < .10). Compared to self-rated MRNI, correlations of MRNI-P to the convergent validity variables were modestly attenuated. This attenuation of correlations for a complex proxy-rated construct should be taken into account in planning sample size in studies using the MRNI-P. Other limitations include sampling only older adults and from one city in the US. The MRNI-P is a key methodological tool for testing the relationship of TM to suicide death.
... Taken together, findings across these studies suggest that persons who have high levels of personal need for structure might be at risk of suicide because they lack creative solutions in relation to mortality concerns, and have little tolerance for uncertainty, and have convergent thinking styles that are rigid (Coleman, Kaplan, & Casey, 2011). It is reasonable to suspect that rigid thinking styles and a lack of tolerance for ambiguity might be prevalent among offenders who recidivate, such as those with substance use disorders. ...
Suicide attempts were examined in relation to sociodemographic (age, gender, ethnicity), psychopathological (prior psychiatric hospitalizations, physical and sexual abuse histories), and cognitive (personal need for structure) variables among a sample of ex-offenders with substance use disorders (N = 270). Hierarchical logistic regression was conducted to determine whether personal need for structure would significantly predict whether participants reported past suicide attempts beyond sociodemographic and psychopathological predictors. Personal need for structure and prior psychiatric hospitalizations were the only significant predictors, with higher values of these predictors increasing the likelihood of suicide attempts. Findings are consistent with a cognitive model for understanding suicide behavior, suggesting that persons with a high need for cognitive structures operate with persistent and rigid thought processes that contribute to their risk of suicide.
© The Author(s) 2015.
... Addressing physical needs includes promoting a healthy lifestyle (Nock et al., 2013) and generating interest in previously enjoyable hobbies or pastimes (Parker et al., 2009;Rubenowitz, Waern, Wilhelmson & Allebeck, 2001) as a means of consolidating internal coping strategies (Stanley, Brown, Karlin, Kemp & VonBergen, 2008). Addressing emotional needs relates to the fulfilment that comes from connecting or reconnecting with the individual's family (Coleman, Kaplan & Casey, 2011;Kidd et al., 2006), friends (Johnson et al., 2011;Kleiman & Liu, 2013) and the relationships they have with others and with themselves (Arensman et al., 2013;Fergusson, Beautrais & Horwood, 2003). Aspirational needs are addressed last and encourage the client to progress from viewing their lives from a purely individual level to viewing their lives as contributing to society in terms of spiritual (Spoerri, Zwahlen, Bopp, Gutzwiller & Egger, 2010), altruistic (Patel, 2010;Szreter & Woolcock, 2004) or self-improvement (Granello & Granello, 2007;Mann, Hosman, Schaalma & de Vries, 2004) activities. ...
Background
The important message of engendering hope in clients with suicidal ideation has frequently been obscured by the prevalence of a negative risk factors perspective and by a general lack of empirical support for intervention models based on developing protective factors.AimThis research aimed to explore recovery from suicidal ideation in the six months following engagement in a protective factors-based therapeutic intervention.Method
Recovery was ascertained by the change in levels of positive and negative outlook, as measured by the PHQ-9, the single-item self-esteem indicator, and the positive and negative suicide ideation inventory. This involved administering a questionnaire to clients pre-therapy (n = 376) and again to the same clients one month (n = 147), three months (n = 130) and six months (n = 107) post-therapy. All participants were over 18 years old and presented to a suicide intervention charity for therapy due to suicidal ideation.FindingsResults showed an overall significant effect for engaging in therapy. Comparisons revealed statistically significant decreases in levels of negative outlook and increases in positive outlook, with the largest differences observed in pre-therapy and six-month post-therapy comparisons.ImplicationsResults provide support for the efficacy of intervention models that develop a client's protective factors and for the ability of a client to recover from suicidal ideation. Findings may also encourage therapists to reconsider reliance on the traditional negative model of suicide intervention and to explore intervention methods that enhance clients’ protective factors in line with the positive psychology perspective.
... This is difficult to ascertain however, given that disparate statistics, research and literatures on suicide present only a fragmented picture, in relation to intersections between age, gender and occupation. The rural studies literature reveals that farmers are disproportionately at risk of suicide (Page and Fragar 2002;Judd et al. 2006a;Guiney 2012), the literature on older people and suicide reveals that this age group has the highest suicide rate (Harwood and Jacoby 2000;Conwell 2001;O'Connell et al. 2004;Haag Granello and Granello 2007;Fung and Chan 2011;Manthorpe and Iliffe 2011;Kaplan et al. 2012) and the literature on gender and suicide reveals that in general the rate of suicide for men greatly exceeds that of women (Canetto and Lester 1998;Ní Laoire 2001;Rutz and Rihmer 2007;Synnott 2009;Coleman et al. 2011;Canetto and Cleary 2012). Reading across these disparate literatures suggests that being male, older and a farmer may constitute an amalgamation of high risk for suicide. ...
The literature on suicide reveals an academic praxis that largely overlooks the group potentially at highest risk of suicide, namely older male farmers. Within the broader literature on suicide, a small and constrained body of articles has provided empirical evidence and review of the individual risk factors for older male suicides. The rural studies literature on suicide has predominantly focused on the risk factors of suicide for farmers and rural youth and the ways in which masculinities are implicated in suicide. This article engages with these literatures for what they might reveal about the suicides of older male farmers but also critiques their limitations and makes suggestions about potentially revealing avenues for empirical investigation. It argues that the suicides of older male farmers, both real and within discourse, raise complex questions concerning reasons for suicide, embedded within subjective, social and cultural contexts. Examination of cultures of farming masculinity, rural cultures of ageing and the ways in which old age and suicide are problematised may therefore provide critical insights into the suicides of older farming men.
... Interestingly, the benefit of mindfulness was not restricted to years of experience and was found even following a six-week intervention. Individuals suffering from depression and particularly those at suicidal risk tend to exhibit a narrowing of perceived options and difficulty in considering alternatives, a tendency which may prove fatal [64]. A similar narrowing of thought and difficulty in considering alternatives often occurs in instances of alcohol use and abuse. ...
Two experiments examined the relation between mindfulness practice and cognitive rigidity by using a variation of the Einstellung water jar task. Participants were required to use three hypothetical jars to obtain a specific amount of water. Initial problems were solvable by the same complex formula, but in later problems ("critical" or "trap" problems) solving was possible by an additional much simpler formula. A rigidity score was compiled through perseverance of the complex formula. In Experiment 1, experienced mindfulness meditators received significantly lower rigidity scores than non-meditators who had registered for their first meditation retreat. Similar results were obtained in randomized controlled Experiment 2 comparing non-meditators who underwent an eight meeting mindfulness program with a waiting list group. The authors conclude that mindfulness meditation reduces cognitive rigidity via the tendency to be "blinded" by experience. Results are discussed in light of the benefits of mindfulness practice regarding a reduced tendency to overlook novel and adaptive ways of responding due to past experience, both in and out of the clinical setting.
This review explored how currently and/or formerly suicidal men perceived masculinities to contribute to, and/or protect against, their suicidal thoughts and/or behaviors and help-seeking. Nine databases were searched using predefined search terms (e.g., masculin*, man, men, boy, suicid*, qualitative), supplemented by searches of key journals, reference and citation lists, and Google Scholar. Twenty-five English-language articles containing qualitative data were obtained. Studies were conducted in Australia, Bangladesh, Canada, Ghana, Ireland, Norway, Pakistan, South Africa, and the United Kingdom. The articles were appraised for quality and thematically synthesized, resulting in three themes. The findings suggest multifaceted roles of masculinities in influencing suicidal ideation, intent, attempts, and help-seeking. Men linked failure to attain socially powerful positions of provision and status to experiencing suicidal thoughts and behaviors. Viewing suicide as courageous and decisive, thus adhering to masculine expectations, appeared contributory to suicidal behaviors. Men described potential protective factors against suicidal behaviors, including perceived masculine expectations to protect and provide for their families, a view of suicide as cowardly and therefore un-masculine, and drawing upon “positive” masculine norms to facilitate help-seeking for suicidal ideation and distress. There was, however, substantial evidence of men describing not seeking help for suicidal ideation and distress due to adhering to “traditional” masculine norms. Clinical implications and future research directions for incorporating masculinities into male suicide prevention theory and practice are discussed, emphasizing the importance of further research into the experiences of higher risk groups of men and of men with diverse and intersecting identities.
Suicide is a global public health burden, causing around 700,000 deaths annually along with many more non-fatal suicidal behaviours (World Health Organization, 2021). This is translated into the global age-standardised suicide rate at 9.0 per 100,000 population for 2019 (World Health Organization, 2021). Importantly, suicide is gendered. Despite women exhibiting a greater prevalence of suicidal ideation and behaviour, men are more likely than women to die by suicide (Canetto & Sakinofsky, 1998; Beautrais, 2002; Canetto & Cleary, 2012; see also Milner et al., 2020). Globally, the age-standardised suicide rate was 1.8 times higher in men than in women. At the time of writing, the imbalance between male and female suicide rates is higher in high-income countries and is close to 3, while the ratio is more equal in low- and middle-income countries. The only countries where the suicide rate is currently estimated to be higher in women than in men are Bangladesh, China, Lesotho, Morocco, and Myanmar (World Health Organization, 2021; see also: Canetto & Chen, 2020).
Suicide is a gendered phenomenon, where male deaths outnumber those of women virtually everywhere in the world. Quantitative work has dominated suicide research producing important insights but only a limited understanding of why more men die by suicide. We conducted a qualitative metasynthesis and systematic review of 20 years of narratives both from men who are suicidal and from people who are bereaved by male suicide to identify putative risk and recovery factors. We identified 78 studies that encapsulated insights from over 1,695 people. Using Thomas and Harden’s Thematic Synthesis Method, our analysis is built on 1,333 basic codes, 24 descriptive themes, and four analytical themes. We noted an association between cultural norms of masculinity and suicide risk in 96% of studies. Norms relating to male emotional suppression, failing to meet standards of male success, and the devaluing of men’s interpersonal needs appeared to be associated with dysregulated psychological pain and suicide risk. Although masculinity is not pathological, we speculate that the interaction and accumulation of cultural harms to men’s emotions, self, and interpersonal connections may potentially distinguish men who are suicidal from men who are not. Supporting men to understand and regulate emotions and suicidal pain, expanding possibilities for masculine identity, and building meaningful interpersonal connections were reported as helping support recovery from suicidal crises. Though our sample was predominantly White, cisgendered, and English speaking, and the underlying research designs prevent strong causal inferences, we discuss possible implications of these findings for male suicide intervention and suggestions for future research.
Las estadísticas globales muestran la tendencia de que los intentos de suicidio de las personas del sexo masculino son más letales, mientras son las personas del sexo femenino quienes más lo intentan. Las razones no han sido bien comprendidas del todo, en parte porque el enfoque predominante de investigación ha priorizado la estadística descriptiva y la identificación de lo que consideran "factores de riesgo". Como resultado, no se ha comprendido la relación entre intentos de suicidio y lo que significa vivir un sexo socioculturalmente. Por este motivo, el presente trabajo intenta explicar cuáles son las instituciones sociales que participan de la construcción social de la feminidad y la masculinidad en Cuba, y cómo sus discursos/prácticas se relacionan con los intentos de suicidio. Los resultados muestran cómo los discursos/prácticas tradicionales de género impactan de modo diferencial en personas del sexo masculino y personas del sexo femenino. En ambos casos se evidencias rupturas de lazos familias, el sufrimiento de expectativas autoimpuestas, así como de diferentes formas de violencia. El tránsito de sentimientos como la tristeza, la frustración y la soledad al intento de suicidio se produce como resultado de tres procesos fundamentales. El estudio también muestra procesos protectores de la salud mental en el contexto sociocultural cubano. Finalmente, el intento de suicidio se significa tanto como un intento por morir, como una expresión de la voluntad de vivir.
There is a continuity between sex and gender. Not only does one have sex, but institutionalized social discourses and practices construct one's own identity. In this way, social constructions of gender mediate how we think, feel, and act. In this context, the present study aims to understand the relationship between experiences of masculinity and femininity and suicide attempts in Cuba to prevent suicide from a gender perspective. The phenomenological method was used through the in-depth semi-structured interview with four people, two males and two females. The results show that traditional constructions of gender have a bidirectional relationship with suicide attempts. These are normalized through social institutions such as the family and the community and exert a psychological pressure that affects both women and men through the differential significance of bodies and moral qualities. These pressures generate feelings of shame and loneliness and lead the person to attempt suicide when they frustrate the satisfaction of needs for meaning. Protective processes against suicide attempts were also found in the Cuban context.
Émile Durkheim’s Le Suicide (1897/2005) paved the way for the development of the sociology of suicide. However, Durkheim’s positivistic approach in studying suicide was trenchantly challenged by, amongst others, Jack Douglas, who, in Social Meanings of Suicide (1968), advocated extricating the social meanings of suicide from the interpretive tradition of social research. Drawing on Douglas’ approach to the sociology of suicide, this paper reports and reflects on part of a study conducted across several rural areas of Jhenaidah, an area in Bangladesh highly affected by suicide, with 17 males who have attempted suicide. The responses of the participants were interpreted with a view to understanding the social meanings associated with their suicide attempts. Although there was a diversity of individual experiences among the participants with regard to suicide attempts, the paper synthesises these and reflects on three themes which most closely represent the commonalities of experience of the 17 men, namely: (i) inability to provide; (ii) intimate relationship stress; and (iii) loss of social status. In conclusion, the paper contributes to understanding suicide attempts by men as social meaningfully events, delineating the roles and complexities associated with constructions of masculine identities.
Z Salgınlar içinde doğdukları toplumların sosyal, ekonomik, politik ve psikolojik yapısında çeşitli değişimler yaratır. Covid-19 salgınının sosyal boyutunun önemli bir bileşeni olarak cinsiyet, krizin sosyal etkilerini büyük oranda şekillendirmiştir. Hastalığın ve ölümlerin görülme sıklığından, sağlık çalışanlarının ve diğer ön saflarda çalışanların cinsiyetine, ev içinde işlerin dağılımından, ev içi şiddet oranlarına kadar bu etkinin sonuçlarınca belirlenmektedir. Covid-19 salgının cinsiyet boyutunu ve toplumsal cinsiyete etkilerini incelemek sosyal bilimcilerin önünde önemli bir araştırma alanı olarak durmaktadır. Bu çalışma erkeklik rollerinde bir kriz ve değişim fırsatı olarak salgın sürecinde evde olmanın ve evden çalışma deneyiminin erkekler üzerinde yarattığı değişimi anlamayı amaçlamaktadır. Nitel bir araştırma olarak tasarlanan çalışmada farklı şehirlerde yaşayan, farklı eğitim, yaş ve sosyo-ekonomik statülerde bulunan, kartopu örneklem ile seçilen ve salgın sürecinde farklı sürelerle evde olmayı/evden çalışmayı deneyimlemiş 20 erkek katılımcı ile derinlemesine görüşmeler yapılmış ve veriler betimsel analiz kullanılarak analiz edilmiştir. Görüşülen erkekler bu süreçte ev işlerine ve çocuk bakımına daha çok katıldıklarını, ev içinde cinsiyete dayalı iş bölümü ve rol dağılımında değişimler yaşadıklarını ifade etmişlerdir. Bu değişimin boyutunu egemen erkeklik değerlerinde bir dönüşüm olarak nitelemek için çok erken olsa bile; Covid-19 salgını sonrası evden ve esnek çalışmanın hem erkekler hem de kadınlar için kalıcılaşacağını, evin bir çalışma mekânı olarak yeni konumunu ve bu durumun bir "kriz" ve bir değişim fırsatı olarak erkeklik hallerinde yaratacağı kırılmayı anlamanın önemli olduğu düşünülmektedir.
Z Salgınlar içinde doğdukları toplumların sosyal, ekonomik, politik ve psikolojik yapısında çeşitli değişimler yaratır. Covid-19 salgınının sosyal boyutunun önemli bir bileşeni olarak cinsiyet, krizin sosyal etkilerini büyük oranda şekillendirmiştir. Hastalığın ve ölümlerin görülme sıklığından, sağlık çalışanlarının ve diğer ön saflarda çalışanların cinsiyetine, ev içinde işlerin dağılımından, ev içi şiddet oranlarına kadar bu etkinin sonuçlarınca belirlenmektedir. Covid-19 salgının cinsiyet boyutunu ve toplumsal cinsiyete etkilerini incelemek sosyal bilimcilerin önünde önemli bir araştırma alanı olarak durmaktadır. Bu çalışma erkeklik rollerinde bir kriz ve değişim fırsatı olarak salgın sürecinde evde olmanın ve evden çalışma deneyiminin erkekler üzerinde yarattığı değişimi anlamayı amaçlamaktadır. Nitel bir araştırma olarak tasarlanan çalışmada farklı şehirlerde yaşayan, farklı eğitim, yaş ve sosyo-ekonomik statülerde bulunan, kartopu örneklem ile seçilen ve salgın sürecinde farklı sürelerle evde olmayı/evden çalışmayı deneyimlemiş 20 erkek katılımcı ile derinlemesine görüşmeler yapılmış ve veriler betimsel analiz kullanılarak analiz edilmiştir. Görüşülen erkekler bu süreçte ev işlerine ve çocuk bakımına daha çok katıldıklarını, ev içinde cinsiyete dayalı iş bölümü ve rol dağılımında değişimler yaşadıklarını ifade etmişlerdir. Bu değişimin boyutunu egemen erkeklik değerlerinde bir dönüşüm olarak nitelemek için çok erken olsa bile; Covid-19 salgını sonrası evden ve esnek çalışmanın hem erkekler hem de kadınlar için kalıcılaşacağını, evin bir çalışma mekânı olarak yeni konumunu ve bu durumun bir "kriz" ve bir değişim fırsatı olarak erkeklik hallerinde yaratacağı kırılmayı anlamanın önemli olduğu düşünülmektedir.
The COVID-19 pandemic has had detrimental effects on mental health, including a predicted increase in suicidality, making suicide prevention a high priority. The rate of men's suicide in the United States is significantly higher than that of women's suicide. This case study considers the role of primary care advanced practice nurses in addressing the risks of suicide in their practice with male patients. It is argued that a gender-sensitive approach is necessary to be effective in male suicide prevention efforts.
This chapter analyses masculinity ‘in crisis’, an idea which has shaped, and been shaped by, men’s movements. Recurring crisis-of-masculinity narratives throughout history are discussed, suggesting that ‘crisis’ is internal to masculinity. Contemporary men-in-crisis debates are also reviewed, especially regarding men and work, and male suicide. A distinction is made between ‘conservative’ and ‘progressive’ crisis narratives. Conservative narratives reassert traditional masculinity, presenting women’s equality/feminism as provoking crisis. Progressive accounts, in contrast, highlight traditional masculinity’s harmful effects for both women and men, and recommend reimagining masculinity. These perspectives are illustrated through analysis of recent (non-academic) constructions of crisis. Both narratives reinforce harmful, essentialist, binary notions of gender. The language of crisis is argued to be problematic, reifying gender and erroneously positioning men as ‘the new gender victims’.
Issue addressed
Men dominate the suicide statistics and are less likely than women to seek help for emotional problems, and this has been linked to aspects of stoic masculinity. Promoting help‐seeking and challenging stoic thinking may help to address this problem, but it is unclear what works in engaging men in these topics.
Methods
We developed a multimedia intervention called Man Up – including a documentary and digital campaign. We tested promotional materials and the website by interviewing 17 men from different ages and backgrounds about their perceptions and asked them whether the materials generated interest in the topics of the documentary.
Results
Participants preferred visual materials that were relatable to them and included active and direct language. This helped them to understand and identify with the messages being imparted. Participants had mixed views on talking about masculinity and the use of the term “man up”, with some expressing interest and others being deterred by it. Sharing content about mental health and suicide was seen by some as a risk to personal reputation and their relationships with others.
Conclusions
Our findings informed the design of targeted materials for the national Man Up campaign and website which were then used in a multi‐level national health promotion intervention in Australia.
So what?
Our study provided valuable insights beyond Man Up for those seeking to design and deliver health promotion interventions targeting Australian men and engage in sensitive and stigmatised male health issues. Using active and empowering language was especially important when addressing men which contrasts with many promotional materials currently available.
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This aarticle analyzes the trend, the impact, and the socioeconomic factors associated with suicide mortality in Colombia between 2000 and 2013, according to gender, age groups, and strata of the unsatisfied basic needs index (AVP). We calculated the standardized mortality, lost years of life (AVP), and carried out a negative binomial multiple regression analysis. Mortality from suicides decreased in Colombia between 2000 and 2013. The middle-income stratum INB had the highest mortality from suicides; the very low income stratum showed the greatest decrease; and the very high income stratum had the lowest mortality. Income inequality was positively associated with the risk of dying from suicide, just as the unemployment rate and poverty are negatively related to suicide mortality. In addition to individual risk factors for suicide, socioeconomic conditions in the environment should be considered risk factors for suicide in Colombia.
Background and Purpose: Suicide is a major public health problem in all societies, and this phenomenon is rooted in complex behavioral, biological, social and psychological issues, and information in this area can be very effective in preventing. The purpose of this study is to look at empirical theories and research related to the causes of suicide and prevention strategies. method: For this study the theoretical foundations and retaining the existing research literature on the subject was discussed. Results: Research on suicide has increased in recent years and researchers have used different theoretical models, including socio-cultural, psychological views. Most of the recent research framework developed empirically that the researchers of the causes and risk factors (such as families of disrupted and inefficient, unemployment, frequency of self-injurious behavior, living alone, mental illness, homosexuality and transsexual, physical illness, effort prior to suicide, bereaved and the loss of individual, substance abuse, ideation and suicidal thoughts and planning for it) and prevention strategies (such as the ministers of health, accountability family, job, employment, family support, healthy lifestyle, marital status, physical health, the Positive relationships and social support) in suicidal behavior are revealed. Conclusion: Suicide can be prevented and in order to do this, a better understanding of the causes and risk factors of suicide has to be achieved with respect to genetic, environmental, psychological and social variables, and considering the above mentioned, it developed and implemented specific interventions and interventions. Prevention of suicide is not exclusively a mental health issue, it is a health issue that must be worked on and coordinated at all levels by different groups.
While research has increasingly identified risk factors and protective factors, there has been little research into the impact and predictability of these before and after engaging in a therapeutic intervention. This research addressed this by inviting clients attending a suicide intervention charity to complete questionnaires pre- and post-therapy. Items from the Positive and Negative Suicide Inventory were administered by a therapist before therapy had begun, and by an independent researcher one month after therapy had been completed (n = 147). Lower levels of Negative Suicidal Ideation (desire to die) and higher levels of Positive Suicidal Ideation (desire to live) were reported post-therapy. Analysis on protective factors identified three significant differences pre-therapy. The greatest predictor of positive ideation was more frequent physical activity. There were no differences post-therapy. For risk factors, there were five significant differences pre-therapy, with having a plan to die by suicide the greatest predictor of suicidal ideation. Post-therapy there were difference for gender and age. The risk factors that best predicted suicidal ideation pre-therapy were not significant post-therapy, suggesting that risk factors may be moderated by therapeutic intervention. The presence of age and gender as continued risk factors raised questions over the permanence and classification of risk factors, and the potential ability of different intervention approaches to effectively reduce the impact of these factors. This study appears to be the first to explore the presence and persistence of risk and protective factors before and after a therapeutic intervention, and provides a foundation for future research in this area.
Objectives: Traditional masculinity is hypothesized to be associated with suicidal ideation, and traditional masculinity is predicted to interact with stressors, intensifying suicidal ideation. Methods: Cross-sectional and prospective data from a study of 2431 young adults was analyzed using hierarchical regression main effects and interaction models. Results: Traditional masculinity was associated with suicidal ideation, second only in strength to depression, including when controlling for other risk factors. Prospective effects were substantially weaker. There was mixed evidence for traditional masculinity by stress interactions. Conclusion: The results provide preliminary support for the role of traditional masculinity in suicidal ideation, but the relationship should be tested in studies of suicide attempts and mortality. Implications for prevention and intervention are explored.
Drawing on constructs of masculinity as it relates to both gun ownership and men's health, we use a rich data set, the New Jersey Violent Death Reporting System as well as hospital discharge data, to analyze 3,413 completed male suicides between the years of 2003 and 2009. We test the hypotheses that the use of firearms is more common when physical health problems are cited as suicide circumstances, and that suicide decedents who use firearms have poorer physical health than those who used other methods. Results show that firearms are disproportionately used in male suicides when physical health is listed as a circumstance. Additionally, among suicide decedents with a hospitalization during the 3 years prior to death, those who used firearms were in poorer health than those who used other methods. These findings have implications for prevention efforts, because restricting access to lethal means is an important aspect of suicide prevention.
In the present study, the researchers examined factors related to depression, hopelessness, and suicidality in gay, lesbian, and bisexual adolescents, compared with demographically similar heterosexual adolescents. Sexual minority adolescents reported greater depression, hopelessness, and past and present suicidality than did heterosexual adolescents. However, when controlling for other psychosocial predictors of present distress, significant differences between the 2 samples disappeared. For past suicidality scores, the effects of sexual orientation were reduced, but still significant, when accounting for the other predictor variables. These results suggest that environmental factors associated with sexual orientation, which can be targeted and changed through prevention and intervention efforts, play a major role in predicting distress in this population.
Suicide is analyzed in terms of motivations to escape from aversive self-awareness. The causal chain begins with events that fall severely short of standards and expectations. These failures are attributed internally, which makes self-awareness painful. Awareness of the self's inadequacies generates negative affect, and the individual therefore desires to escape from self-awareness and the associated affect. The person tries to achieve a state of cognitive deconstruction (constricted temporal focus, concrete thinking, immediate or proximal goals, cognitive rigidity, and rejection of meaning), which helps prevent meaningful self-awareness and emotion. The deconstructed state brings irrationality and disinhibition, making drastic measures seem acceptable. Suicide can be seen as an ultimate step in the effort to escape from self and world.
Boys are in a crisis--boys in treatment and boys next door. Practitioners need to know more about research that helps to elucidate this crisis of boyhood as well as new clinical insights, derived from a modern rethinking of boyhood. The results of the Listening to Boys' Voices project (see W. S. Pollack, 1999) are reviewed as a springboard for pragmatic suggestions for changes in clinical attitudes toward, and treatment of, boys and young men. Practitioners are also urged to help society stem the tide of pain that today's boys must face in the midst of changing attitudes toward the normative journey toward masculinity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In developed Western societies, it is well known that more men than women commit suicide each year, whereas women are more likely to be involved in suicide attempts. Despite these differences, public policies in the West have tended to treat gender as a descriptive, rather than causal, factor in suicidal behaviours. However, differences between socially constructed masculinities and femininities may impact on suicide-related behaviours and help explain gender differences in both behaviours and outcome. This literature review considers suicide through the lens of gender, drawing on a social constructionist perspective to explain differences between women and men in suicidal behaviour. In particular it focuses on individual and life history factors, social and community variables and living and working conditions. It will be argued that suicide-related behaviours, like health-behaviours more generally, are influenced by (and influence) demonstrations of masculinities and femininities. Finally, it will explore how a gendered view of suicidal behaviour will be of potential benefit to public health policies aimed at reducing gender differences in suicidal behaviour.
The new psychology of men has emerged over the past 15 years within the larger fields of men's studies and gender studies. Informed by the academic breakthroughs of feminist scholarship, the new psychology of men examines masculinity not as a normative referent, but rather as a problematic construct. In so doing, it provides a framework for a psychological approach to men and masculinity that questions traditional norms of the male role and views some male problems as unfortunate byproducts of the male gender role socialization process. This article introduces this new field, covering the gender role strain paradigm, masculinity ideology, and the 3 varieties of male gender role strain—discrepancy-strain, dysfunction-strain, and trauma-strain. Implications for practice are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychologists increasingly recognize depression as a serious, albeit often undiagnosed, condition in men. In fact, undiagnosed and untreated depression in men may be one reason why many more men than women commit suicide. However, because of cultural conditioning that discourages expression of depressed mood in men, assessment as well as treatment of depression in men are sometimes difficult. Use of gender-sensitive assessment strategies and interventions will assure that more men will be identified and treated for depression. This article integrates scientific findings related to depression in men with specific gender-sensitive assessment and psychotherapeutic intervention strategies designed to enhance psychologists' skills in working with this significant problem in men. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychologists will be better prepared to intervene effectively with male clients if they can assess how their male clients' experiences as men in society have contributed to their presenting problems. In this article, the author reviews how masculine gender role strain contributes to men's cognitive distortions and leads to, for example, aggressiveness, an overemphasis on achievement, and relational and emotional disconnection. Eight areas of salient gender role messages for men are examined to facilitate clinicians' assessments of men's gender related cognitive distortions. In the final section of the article, issues salient to treating men who endorse these gender related cognitive distortions are discussed. By focusing on the influence of men's gender role socialization on presenting problems, it is hoped that clinicians may be empathic to the social context that contributes to men's cognitive distortions and clinicians can reduce the effects of gender role strain in male clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the United States, gender differences in suicidal behavior rates emerge during adolescence, when females are more likely to engage in suicidal behavior, but are less likely to die as a result of a suicidal act than males. These gender patterns of suicidal behavior are common but not universal, suggesting cultural influences. This article reviews the highlights of the research on cultural meanings of gender and suicidal behavior. Studies suggest that U.S. adolescents perceive nonfatal suicidal behavior as more “feminine” and less potent than killing oneself. Persons who are suicidal in response to a relationship problem are considered more “feminine” than persons who become suicidal in response to an achievement failure. Males are more critical and avoidant of suicidal persons than females, especially when the suicidal person is a male. These beliefs may play a role in decisions about suicidal behavior (what kinds of suicidal behavior are chosen, and under what conditions). Cultural narratives of gender and suicidal behavior may be particularly influential for adolescents because adolescents are in the process of defining their identity, and often take cultural messages about “appropriate” gender behavior more seriously and more literally than adults. The implications of the findings from the research on cultural meanings of gender and suicidal behavior for prevention programs are outlined.
Aboriginal populations worldwide face increasing rates of suicide. Despite this recurring observation, little research has emerged from Aboriginal settings.
This paper describes the psychosocial and behavioral characteristics of 30 consecutive adult suicides from four First-Nations communities in Quebec, Canada.
Psychological autopsies guided by the LEDS with family members of the deceased.
Suicide among this group is overrepresented by young single men. Alcohol intoxication at the time of death was reported for 22 cases in association with rapid acting out after the precipitating event for 20. All but two cases had a history of alcohol abuse, and drug use was also present in 23 cases. In 16 cases there had been a previous suicide attempt, 14 of which occurred during the previous year. The main socio-demographic characteristics of the communities were overcrowded living arrangements and no job status (90%). Seven cases were incarcerated or locked up at the time of death. Clustering of suicide was observed within seven nuclear families including 16 suicides.
This study shows that Aboriginal suicide is the result of a complex interweaving of individual, familial, and socio-historical variables. The impact of contemporary social stressors on individual well-being must be addressed to prevent suicide in this community.
The topic of suicide has long been an important socioeconomic issue studied in many countries. Suicides inject an atmosphere of unrest into society, and media attention furthers that social uneasiness. From the viewpoint of economics and management, suicide is a waste of human resource: it decreases the labor force in society and deteriorates human capital. This paper provides a series of analyses of suicide rate based on theoretical reasoning and empirical approaches. Aggregate data from G7 countries are obtained and stacked into panel data for analysis. Data are collected for different age groups. Even though suicide issues have been extensively discussed in the past, newly developed econometric tools are applied to her. Beyond previously recognized relationships between economic factors and suicide rates findings include that unemployment strikes men more than women in terms of psychological pressure: for middle age or older women, unemployment may even be positive for the entire family; and female labor force participation exerts pressure on male counterparts and increases its suicide rate. As a result, a low income family with an unemployed man and an employed woman is at high risk for adult male suicide.
Being male constitutes a risk factor for early death, and this may be connected to concepts of masculinity. The objective of the present study was to investigate the association between masculinity rank during late adolescence and mortality patterns in a cohort of 49 321 Swedish men tested for compulsory military training in 1969.
The measure of masculinity consisted of a five-grade ranking from the conscription information that comprised leisure interests and occupational preferences. Information on all-cause mortality, alcohol-related mortality, suicide, mortality from other violent causes and mortality from cardiovascular disease was collected from national registers for 1970-2003. The analyses were performed using Cox proportional hazard models with hazard ratios as estimates of relative risk.
For all-cause mortality, the crude relative risks versus ordinary masculinity were: lowest masculinity 1.98 (95% CI 1.71 to 2.31), low masculinity 1.38 (95% CI 1.24 to 1.53), high masculinity 0.90 (95% CI 0.81 to 1.01) and highest masculinity 0.78 (95% CI 0.62 to 0.97). After adjustments for childhood class, smoking, alcohol drinking, blood pressure, short stature, psychiatric disorder, low intelligence and contact with police or childcare authorities, conscripts who were ranked lowest on masculinity had a remaining increased relative risk of all-cause mortality (1.49; 95% CI 1.28 to 1.75) and suicide (1. 79; 95% CI 1.31 to 2.43). For mortality from violent causes other than suicide, no statistically significant associations were demonstrated.
Earlier research has proposed that masculinity may hold both positive and negative aspects regarding lifetime health. The major conclusion here is that being ranked less masculine is associated with higher mortality.
Around the world girls and women have higher rates of suicidal ideation and behavior but lower rates of suicide than boys and men. There is, however, significant variability in gender patterns and meanings suicidal behavior within and across cultures. For example, in the United States, suicide is most common among older "White" men, and is typically considered masculine behavior. Women who kill themselves are viewed as acting like men, and therefore deviant. By contrast, in other societies, including China, suicide is viewed as an act of the powerless, and is most frequent in young women. In these societies, men who kill themselves are considered weak and effeminate. The cultural diversity in gender patterns and interpretations of suicidal behavior challenges essentialist perspectives on gender and suicidal behavior. It also challenges the assumption, common in industrialized countries, that women are protected from suicide as long as they stay "feminine" and subsumed within the family. This cultural diversity also points to the pitfalls of theorizing about clinical phenomena as if they were culture-free, and calls for culturally grounded theory, research, and practice.
To review the scientific evidence supporting an association between unemployment and adverse health outcomes and to assess the evidence on the basis of the epidemiologic criteria for causation.
MEDLINE was searched for all relevant articles with the use of the MeSH terms "unemployment," "employment," "job loss," "economy" and a range of mortality and morbidity outcomes. A secondary search was conducted for references from the primary search articles, review articles or published commentaries. Data and definitions of unemployment were drawn from Statistics Canada publications.
Selection focused on articles published in the 1980s and 1990s. English-language reports of aggregate-level research (involving an entire population), such as time-series analyses, and studies of individual subjects, such as cross-sectional, case-control or cohort studies, were reviewed. In total, the authors reviewed 46 articles that described original studies.
Information was sought on the association (if any) between unemployment and health outcomes such as mortality rates, specific causes of death, incidence of physical and mental disorders and the use of health care services. Information was extracted on the nature of the association (positive or negative), measures of association (relative risk, odds ratio or standardized mortality ratio), and the direction of causation (whether unemployment caused ill health or vice versa).
Most aggregate-level studies reported a positive association between national unemployment rates and rates of overall mortality and mortality due to cardiovascular disease and suicide. However, the relation between unemployment rates and motor-vehicle fatality rates may be inverse. Large, census-based cohort studies showed higher rates of overall mortality, death due to cardiovascular disease and suicide among unemployed men and women than among either employed people or the general population. Workers laid off because of factory closure have reported more symptoms and illnesses than employed people; some of these reports have been validated objectively. Unemployed people may be more likely than employed people to visit physicians, take medications or be admitted to general hospitals. A possible association between unemployment and rates of admission to psychiatric hospitals is complicated by other institutional and environmental factors.
Evaluated on an epidemiologic basis, the evidence suggests a strong, positive association between unemployment and many adverse health outcomes. Whether unemployment causes these adverse outcomes is less straightforward, however, because there are likely many mediating and confounding factors, which may be social, economic or clinical. Many authors have suggested mechanisms of causation, but further research is needed to test these hypotheses.
Cultural and economic patterns from 130 sociological works on suicide from 1981 to 1995 are reviewed in this article. The traditional Durkheimian perspective on suicide was often questioned by research on the impact of the mass media, alcohol, class, modernization, religion, and politics. Major theoretical developments included the application of differential identification theory to Phillips's model of copycat suicide, the application of criminology's opportunity theory to suicide, and new explanations for the link between alcohol and the social suicide rate. Explanations are reviewed for the major new suicide trend: after half a century of convergence, male and female suicide rates are diverging. Finally, the review notes patterns of continued stability in suicide research findings in areas such as racial differences and economic strain.
Suicide and premature death due to coronary heart disease, violence, accidents, drug or alcohol abuse are strikingly male phenomena, particularly in the young and middle-aged groups. Rates of offending behaviour, conduct disorders, suicide and depression are even rising, and give evidence to a high gender-related vulnerability of young men. In explaining this vulnerability, the gender perspective offers an analytical tool to integrate structural and cultural factors. It is shown that traditional masculinity is a key risk factor for male vulnerability promoting maladaptive coping strategies such as emotional unexpressiveness, reluctance to seek help, or alcohol abuse. This basic male disposition is shown to increase psychosocial stress due to different societal conditions: to changes in male gender-role, to postmodern individualism and to rapid social change in Eastern Europe and Russia. Relying on empirical data and theoretical explanations, a gender model of male vulnerability is proposed. It is concluded that the gender gap in suicide and premature death can most likely be explained by perceived reduction in social role opportunities leading to social exclusion.
Suicide risk was addressed in relation to the joint effect of factors regarding family structure, socioeconomics, demographics, mental illness, and family history of suicide and mental illness, as well as gender differences in risk factors.
Data were drawn from four national Danish longitudinal registers. Subjects were all 21,169 persons who committed suicide in 1981-1997 and 423,128 live comparison subjects matched for age, gender, and calendar time of suicide by using a nested case-control design. The effect of risk factors was estimated through conditional logistic regression. The interaction of gender with the risk factors was examined by using the log likelihood ratio test. The population attributable risk was calculated.
Of the risk factors examined in the study, a history of hospitalization for psychiatric disorder was associated with the highest odds ratio and the highest attributable risk for suicide. Cohabiting or single marital status, unemployment, low income, retirement, disability, sickness-related absence from work, and a family history of suicide and/or psychiatric disorders were also significant risk factors for suicide. Moreover, these factors had different effects in male and female subjects. A psychiatric disorder was more likely to increase suicide risk in female than in male subjects. Being single was associated with higher suicide risk in male subjects, and having a young child with lower suicide risk in female subjects. Unemployment and low income had stronger effects on suicide in male subjects. Living in an urban area was associated with higher suicide risk in female subjects and a lower risk in male subjects. A family history of suicide raised suicide risk slightly more in female than in male subjects.
Suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide. The effect of most risk factors differs significantly by gender.
It is unclear why approximately 10% of suicide completers seem to be psychiatrically normal. To better understand this issue, we studied suicide completers without an axis I diagnosis and compared them, on measures of psychopathology other than axis I, to normal controls and suicide cases with axis I psychopathology.
168 suicide cases were examined by way of a psychological autopsy with the best possible informant. Sixteen cases did not meet criteria for an axis I diagnosis; each of these cases was then age and gender matched to 52 suicide completers with an axis I disorder and 110 normal controls.
Fourteen of sixteen suicide cases without an axis I diagnosis had detectable abnormalities that were more similar to the axis I diagnosed suicide group than to a living group. Both suicide groups were similar in the total number of past suicide attempts, the total number of individuals with an axis II disorder, and similar scores on measures of impulsive-aggressive behaviors.
These findings suggest that most of the individuals who committed suicide and appeared psychiatrically normal after a psychological autopsy may probably have an underlying psychiatric process that the psychological autopsy method, as commonly carried out, failed to detect.
It is well known that most suicide cases meet criteria for a psychiatric disorder. However, rates of specific disorders vary considerably between studies and little information is known about gender and geographic differences. This study provides overall rates of total and specific psychiatric disorders in suicide completers and presents evidence supporting gender and geographic differences in their relative proportion.
We carried out a review of studies in which psychological autopsy studies of suicide completers were performed. Studies were identified by means of MEDLINE database searches and by scanning the reference list of relevant publications. Twenty-three variables were defined, 16 of which evaluating psychiatric disorders. Mantel-Haenszel Weighted Odds Ratios were estimated for these 16 outcome variables.
Twenty-seven studies comprising 3275 suicides were included, of which, 87.3% (SD 10.0%) had been diagnosed with a mental disorder prior to their death. There were major gender differences. Diagnoses of substance-related problems (OR = 3.58; 95% CI: 2.78-4.61), personality disorders (OR = 2.01; 95% CI: 1.38-2.95) and childhood disorders (OR = 4.95; 95% CI: 2.69-9.31) were more common among male suicides, whereas affective disorders (OR = 0.66; 95% CI: 0.53-0.83), including depressive disorders (OR = 0.53; 95% CI: 0.42-0.68) were less common among males. Geographical differences are also likely to be present in the relative proportion of psychiatric diagnoses among suicides.
Although psychopathology clearly mediates suicide risk, gender and geographical differences seem to exist in the relative proportion of the specific psychiatric disorders found among suicide completers.
In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated.
To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research.
Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide.
Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented.
Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing.
Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.
The relative contribution of psychosocial and clinical risk factors to suicide among Chinese populations is an important issue. In Hong Kong, this issue requires vigorous examination in light of a 50% increase in suicide rate between 1997 and 2003.
Using a case-control psychological autopsy method, 150 suicide deceased were compared with 150 living controls matched by age and gender. Semi-structured interviews were conducted with the next-of-kin of the subjects. Data were collected on a wide range of potential risk and protective factors, including demographic, life event, clinical and psychological variables. The relative contribution of these factors towards suicide was examined in a multiple logistic regression model.
Six factors were found to significantly and independently contribute to suicide: unemployment, indebtedness, being single, social support, psychiatric illness, and history of past attempts.
Both psychosocial and clinical factors are important in suicides in Hong Kong. They seem to have mediated suicide risk independently. In addition, socio-economic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong.
Clinical judgments about the likelihood of suicide attempt would be aided by an index of risk factors that could be quickly assessed in diverse settings. We sought to develop such a risk index for 12-month suicide attempts among suicide ideators.
The National Comorbidity Survey Replication (NCS-R), a household survey of adults aged 18+, assessed the 12-month occurrence of suicide ideation, plans and attempts in a subsample of 5692 respondents. Retrospectively assessed correlates include history of prior suicidality, sociodemographics, parental psychopathology and 12-month DSM-IV disorders.
Twelve-month prevalence estimates of suicide ideation, plans and attempts are 2.6, 0.7 and 0.4% respectively. Although ideators with a plan are more likely to make an attempt (31.9%) than those without a plan (9.6%), 43% of attempts were described as unplanned. History of prior attempts is the strongest correlate of 12-month attempts. Other significant correlates include shorter duration of ideation, presence of a suicide plan, and several sociodemographic and parental psychopathology variables. Twelve-month disorders are not powerful correlates. A four-category summary index of correlates is strongly related to attempts among ideators [area under the receiver operator characteristic curve (AUC)=0.88]. The distribution (conditional probability of attempt) of the risk index is: 19.0% very low (0.0%), 51.1% low (3.5%), 16.2% intermediate (21.3%), and 13.7% high (78.1%). Two-thirds (67.1%) of attempts were made by ideators in the high-risk category.
A short, preliminary risk index based on retrospectively reported responses to fully structured questions is strongly correlated with 12-month suicide attempts among ideators, with a high concentration of attempts among high-risk ideators.
To explore the risk of suicide associated with occupation while evaluating the impact of socio-economic, demographic and psychiatric differences.
A nested case-control study with 3195 suicides and 63 900 matched controls. Information on causes of death, occupation, psychiatric admission, marital status and socio-economic factors was obtained from routine registers.
Across the 55 occupations investigated, the risk of suicide ranged from 2.73 [95% confidence interval (CI) 1.77-4.22] among doctors to 0.44 (95% CI 0.27-0.72) among architects and engineers compared with primary school teachers. With the exception of doctors and nurses, most of the excess risk of suicide associated with particular occupations is explained by the social and economic characteristics of people in those occupations. Much, but not all, of the excess risk in doctors and nurses is due to their increased use of self-poisoning, a method for which they have the knowledge to use effectively. Occupation has little association with suicide among people who suffer from a psychiatric illness, except for doctors, where the excess risk is 3.62 (p=0.007).
Most of the considerable variation in suicide risk across occupations is explained by socio-economic factors, except for doctors and nurses. Apart from in doctors, the risk of suicide has little association with occupation among people who suffer from a psychiatric illness. Restriction of access to lethal means is an important strategy in suicide prevention.
The association between toxoplasmosis and psychiatric disorders has been reported in a few anecdotal reports.
A case of depression with toxoplasma seropositivity is presented. The patient with depression showed poor response to antidepressants, for which he was investigated and was found positive on the serological test for the toxoplasma. The response to antidepressant treatment improved only after adequate treatment for toxoplasma.
The case suggests a probable association between toxoplasmosis and depression.
This paper examines the causal effect of job loss on overall and cause-specific mortality. Using linked employer-employee register data, we identified the job losses due to all establishment closures in Sweden in 1987 and 1988. Hence, we have extended the case study approach, which has dominated the plant closure literature, and also been able to remedy most weaknesses associated with previous studies. We found that the overall mortality risk for men was increased by 44 percent during the first four years following job loss. For women and in the longer run we found no effects. The short-run excess mortality was mainly attributed to increased risk of suicides and alcohol-related causes of death. For both sexes, the increase in suicides was about twofold for both men and women, while the increase in alcohol-related causes of death was somewhat less.
This chapter examines the data regarding the prevalence of psychiatric disorders and suicide risk among gay and bisexual men in the United States. It begins by examining the methodological underpinnings of research on gay and bisexual men's health and mental health. It then provides an in-depth review of the evidence for health disparities affecting gay and bisexual men for a range of psychiatric disorders including depression and other affective disorders, anxiety disorders, and suicide symptoms. The chapter discusses the role of social context as one explanation for the increased prevalence of mental health disorders among gay and bisexual men, including the effects of homophobia and discrimination. It ends with recommendations for future research.
Psychologists will be better prepared to intervene effectively with male clients if they can assess how their male clients' experiences as men in society have contributed to their presenting problems. In this article, the author reviews how masculine gender role strain contributes to men's cognitive distortions and leads to, for example, aggressiveness, an overemphasis on achievement, and relational and emotional disconnection. Eight areas of salient gender role messages for men are examined to facilitate clinicians' assessments of men's gender related cognitive distortions. In the final section of the article, issues salient to treating men who endorse these gender related cognitive distortions are discussed. By focusing on the influence of men's gender role socialization on presenting problems, it is hoped that clinicians may be empathic to the social context that contributes to men's cognitive distortions and clinicians can reduce the effects of gender role strain in male clients.
In addition to examining the social integration-regulation suicide thesis, we develop and test a racial inequality suicide
thesis to explain how socioeconomic status inequities between blacks and whites influence suicide risk among black males.
Negative binomial regression techniques are employed to model black male suicide counts for U.S. metropolitan areas in 1980.
Our findings demonstrate that the risk of black male suicide is higher in areas where occupational and income inequalities
between blacks and whites are greater. We also find detrimental effects associated with marital disruption and certain types
of family living arrangements. In light of our findings, we revisit our theory and make suggestions for additional research.
The purpose of this article is to examine firearm suicide in Queensland. In 2006, statistical data were gathered from all closed paper coronial files for the 12-month period of December 2003—December 2004. Of the 567 people who committed suicide in Queensland during this period, 48 (8.5%) used firearms. The following results emerge from this data: first, gun suicides are continuing to decrease in Queensland, most likely as a function of ongoing gun controls, a decrease accompanied by a lesser increase in other methods of suicide, thereby providing little support for substitution theory; second, men continue to be more likely to shoot themselves, particularly elderly men; third, firearms are more likely to be used in rural settings, and by those with no known history of mental illness or previous suicide attempts. Finally, in spite of otherwise very high suicide rates, Aborigines rarely employ firearms, using instead the culturally significant method of hanging.
If we look at today's high male suicide rates as the outermost evident proof for men being mentally ill and consider the links between an individual male's depression and their suicidality, a major challenge appears: to improve the determinants and preconditions for men's wellbeing and health even on an aggregate societal level.This means identifying and further increasing men's levels of autonomy, to counteract their helplessness, to facilitate a mutual and pluralistic gender tolerance, to support and restore males’ sense of social cohesion and existential meaning and to give, in a new way, a place for the often traditional masculine values of integrity, pride, status and dignity – even in our modern societies of gender transition.Females and males are ‘sitting in the same boat’. Both genders define and influence each other's identity and societal position. This means that men and women in a societal and/or individual crisis often become each other's problem, which can cause violence as well as suicide, with concomittant abuse, risk-taking behaviour and stress-related somatic disorders – all afflicting both genders.Thus, increasing understanding and communicative ability, as well as social interaction between genders, seems to be one of the strongest health promotional actions that can be carried out, on a political level, at a societal level, in families and directed to the individual person. This should be done in parallel with improving early detection and possibilities for therapeutic intervention, especially concerning common but atypical conditions of ‘male depression’ as well as depression-related aggression and suicidality.
The current investigation explores the association between rates of household firearm ownership and suicide across the 50 states. Prior ecologic research on the relationship between firearm prevalence and suicide has been criticized for using problematic proxy-based, rather than survey-based, estimates of firearm prevalence and for failing to control for potential psychological risk factors for suicide. We address these two criticisms by using recently available state-level survey-based estimates of household firearm ownership, serious mental illness, and alcohol/illicit substance use and dependence.
Negative binomial regression was used to assess the relationship between household firearm ownership rates and rates of firearm, nonfirearm, and overall suicide for both sexes and for four age groups. Analyses controlled for rates of poverty, urbanization, unemployment, mental illness, and drug and alcohol dependence and abuse.
US residents of all ages and both sexes are more likely to die from suicide when they live in areas where more households contain firearms. A positive and significant association exists between levels of household firearm ownership and rates of firearm and overall suicide; rates of nonfirearm suicide were not associated with levels of household firearm ownership.
Household firearm ownership levels are strongly associated with higher rates of suicide, consistent with the hypothesis that the availability of lethal means increases the rate of completed suicide.
Objective. This article addresses the relationship between suicide mortality and family structure and socioeconomic status for U.S. adult men and women.
Methods. We use Cox proportional hazard models and individual-level, prospective data from the National Health Interview Survey Linked Mortality File (1986–2002) to examine adult suicide mortality.
Results. Larger families and employment are associated with lower risks of suicide for both men and women. Low levels of education or being divorced or separated, widowed, or never married are associated with increased risks of suicide among men, but not among women.
Conclusions. We find important sex differences in the relationship between suicide mortality and marital status and education. Future suicide research should use both aggregate and individual-level data and recognize important sex differences in the relationship between risk factors and suicide mortality—a central cause of preventable death in the United States.
Military veterans are particularly vulnerable to suicide compared with their civilian peers. Scant attention has been devoted to the problem of firearm suicide among veterans, particularly women. The purpose of this study was to examine the rate, prevalence, and relative odds of firearm use among veteran suicide decedents in the general population.
The analyses are based on data derived from 28,534 suicide decedents from the 2003 to 2006 National Violent Death Reporting System.
Across the age groups, male and female veterans had higher firearm suicide rates than nonveterans. Among males and females, younger veterans (18-34 years) had the highest firearm and total suicide rates. The male and female veteran suicide decedents were, respectively, 1.3 and 1.6 times more likely to use firearms relative to nonveterans after adjusting for age, marital status, race, and region of residence.
Although violent death and the use of firearms are generally associated with men, the results reported here suggest that firearms among female veterans deserve particular attention among health professionals within and outside the veterans affairs system. In addition, the focus should not be exclusively on the Operation Enduring Freedom/Operation Iraqi Freedom military cohort but also on men and women who served in earlier combat theaters, including the Gulf war, Vietnam Era, Korean Conflict, and World War II.
Individual and aggregate-level studies in at least seven countries have yielded significant positive correlations for suicide with unemployment, particularly for men of younger age groups. Unemployment may act as a stressful life event leading to suicide; however, the correlation of general population suicide rates with measures of unemployment in a cross-national study of 27 countries was not statistically significant, and the magnitude was small. To be certain, further data on unemployment rates would be needed for a larger number of countries, particularly with low income.
That males have higher suicide rates than females is one of the most empirically documented social facts in suicidology, but the reasons for this continue to be debated. For the present paper, we tested a neglected contributing factor to the gender suicide ratio: wound site or the area of the body that is wounded in firearm suicides. Males may have a higher suicide rate, in part, due to their greater likelihood than women for shooting themselves in the head as opposed to the body. This has been related to gender differences in fear of facial disfigurement and suicide intent. Data from the Wayne County Medical examiner's office regarding 807 suicides committed with firearms was analyzed. The dependent variable was dichotomous and referred to the location of the site of the wound: gunshot to the head vs. gunshot to the body. Controls for demographic covariates of suicide included age and race of the suicide victim. The results of the multivariate logistic regression analysis determined that women were 47% less apt than men to shoot themselves in the head. Further analysis determined that women were less apt than men to use shotguns and rifles in their suicides (weapons that make head shooting more awkward). The findings are consistent with the notion that women are more concerned than men with facial disfigurement, and that women have a lower desire to die than men.
Marital separation (as distinct from divorce) is rarely researched in the suicidological literature. Studies usually report on the statuses of 'separated' and 'divorced' as a combined category, possibly because demographic registries are not able to identify separation reliably. However, in most countries divorce only happens once the process of separation has settled which, in most cases, occurs a long time after the initial break-up.
It has been hypothesised that separation might carry a far greater risk of suicide than divorce. The present study investigates the impact of separation on suicide risk by taking into account the effects of age and gender.
The incidence of suicide associated with marital status, age and gender was determined by comparing the Queensland Suicide Register (a large dataset of all suicides in Queensland from 1994 to 2004) with the QLD population through two different census datasets: the Registered Marital Status and the Social Marital Status. These two registries permit the isolation of the variable 'separated' with great reliability.
During the examined period, 6062 persons died by suicide in QLD (an average of 551 cases per year), with males outnumbering females by four to one. For both males and females separation created a risk of suicide at least 4 times higher than any other marital status. The risk was particularly high for males aged 15 to 24 (RR 91.62).
This study highlights a great variation in the incidence of suicide by marital status, age and gender, which suggests that these variables should not be studied in isolation. Furthermore, particularly in younger males, separation appears to be strongly associated with the risk of suicide.
Ever since Durkheim postulated a relationship between economic change and suicide there has been evidence of a general association between aggregate data on unemployment and the frequency of suicide. Quantitatively, however, the association has been variable and it is clear that due to differing cultural, social and individual determinants of suicide, the relationship is complex. Methodological difficulties abound with interpretation of aggregate data. Australian records for most of the present century are suitable for examining secular trends in suicide and unemployment by age group and gender to gain an indication of the extent to which both parameters may be causally related. An aggregate/ecological study was designed to incorporate quantitative and qualitative strategies. Annual age-adjusted male and female suicide rates and annual unemployment rates were derived for the period 1907-1990. Female suicide rates were generally stable throughout the period, whereas those for males demonstrated sharp fluctuations with the peaks coinciding with times of high unemployment. The association between suicide and unemployment for 15-24 year old males was comparatively high for the recent period, 1966-1990. The increasingly youthful contribution to male suicide was demonstrated by a rise in the loss of life years during 1973-1984. Despite the inability of any investigation based on aggregate data to establish an unequivocable causal relationship, no evidence was detected to suggest that relatively high population levels of unemployment were not related to the occurrence of suicide.
The hypothesis is proposed of a new subtype of depression named: stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression (SeCA depression). Biologically, these patients are characterized by impaired 5-HT synthesis and reduced 5-HT1A receptor sensitivity. Under normal conditions these functions proceed marginally; in times of stress they easily fail, due to sustained overproduction of cortisol. Psychopathologically this depression type shows the following characteristics: anxiety and aggression, not mood lowering, heralding a depressive episode; the personality structure shows 'character neurotic' impairments and tolerance for (certain) traumatic life events is low. As specific therapeutic agents selective 5-HT1A agonists and cortisol or CRH antagonists are proposed. Prophylactically, maintenance treatment with 5-HT1A agonists seems indicated as well as psychological interventions to increase the stressor threshold.
Several recent studies have found a higher lifetime prevalence of suicide attempts in homosexual males compared with heterosexual control subjects or population rates. These studies used either convenience samples, most without controls, or population-based samples in which confounding factors such as depression and substance abuse were not measured.
This study used twins from the population-based Vietnam Era Twin Registry, Hines, Ill. An analytic sample of 103 middle-aged male-male twin pairs from the registry was identified in which one member of the pair reported male sex partners after age 18 years while the other did not. Four lifetime symptoms of suicidality as measured by the Diagnostic Interview Schedule were analyzed: thoughts about death, wanting to die, thoughts about committing suicide, and attempted suicide. A composite measure of reporting at least one suicidality symptom was also assessed.
Same-gender sexual orientation is significantly associated with each of the suicidality measures. Unadjusted matched-pair odds ratios follow: 2.4 (95% confidence interval [CI], 1.2 - 4.6) for thoughts about death; 4.4 (95% CI, 1.7 - 11.6) for wanted to die; 4.1 (95% CI, 2.1 - 8.2) for suicidal ideation; 6.5 (95% CI, 1.5 - 28.8) for attempted suicide; and 5.1 (95% CI, 2.4 - 10.9) for any of the suicidal symptoms. After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7 - 8.81).
The substantially increased lifetime risk of suicidal behaviors in homosexual men is unlikely to be due solely to substance abuse or other psychiatric comorbidity. While the underlying causes of the suicidal behaviors remain unclear, future research needs to address the inadequacies in the measurement of both sexual orientation and suicidality in population-based samples.
This study sought to test the relationships between relative body weight and clinical depression, suicide ideation, and suicide attempts in an adult US general population sample.
Respondents were 40,086 African American and White participants interviewed in a national survey. Outcome measures were past-year major depression, suicide ideation, and suicide attempts diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The primary predictor was relative body weight, treated both continuously (i.e., body mass index [BMI]) and categorically in logistic regression analyses. Covariates included age, income and education, disease status, and drug and alcohol use.
Relative body weight was associated with major depression, suicide attempts, and suicide ideation, although relationships were different for men and women. Among women, increased BMI was associated with both major depression and suicide ideation. Among men, lower BMI was associated with major depression, suicide attempts, and suicide ideation. There were no racial differences.
Differences in BMI, or weight status, were associated with the probability of past-year major depression, suicide attempts, and suicide ideation. Longitudinal studies are needed to differentiate the causal pathways and mechanisms linking physical and psychiatric conditions.
Based on the experiences of the Gotland Study that education of general practitioners about depressive illness resulted in a statistically significant reduction in the number of female suicides, leaving the rate of male suicides almost unaffected, we propose the concept of a male depressive syndrome. This syndrome comprises a low stress tolerance, an acting-out behavior, a low impulse control, substance abuse and a hereditary loading of depressive illness, alcoholism and suicide. This notion is supported by data from The Amish study as well as the concept of van Praag of a stress-precipitated, cortisol-induced, serotonin-related and anxiety-driven depressive illness most often seen in males. In order to identify depressed males, the Gotland Male Depression Scale has been developed. Some preliminary data using the scale in a group of alcohol-dependant patients are presented.
Alcohol dependence and alcohol intoxication are important risk factors for suicidal behavior. However, the mechanism for the relationship remains unclear. This review presents a conceptual framework relating alcohol to suicidal behavior. Distal risk factors create a statistical potential for suicide. Alcohol dependence, as well as associated comorbid psychopathology and negative life events, act as distal risk factors for suicidal behavior. Proximal risk factors determine the timing of suicidal behavior by translating the statistical potential of distal risk factors into action. The acute effects of alcohol intoxication act as important proximal risk factors for suicidal behavior among the alcoholic and nonalcoholic alike. Mechanisms responsible for alcohol's ability to increase the proximal risk for suicidal behavior include alcohol's ability to: (1) increase psychological distress, (2) increase aggressiveness, (3) propel suicidal ideation into action through suicide-specific alcohol expectancies, and (4) constrict cognition which impairs the generation and implementation of alternative coping strategies. Moreover, the proximal risk factors associated with acute intoxication are consistent with Baumeister's (1990) escape theory of suicide. Suggestions for additional research are discussed, including the possibility that a nonlinear cusp catastrophe model characterizes the relationship between alcohol intoxication and suicidal behavior.
Although attempted suicide is one of the strongest predictors of completed suicide, few Japanese studies have described psychiatric differences between those who attempt suicide by overdose (OD) and those who use more violent methods (MV).
A total of 22 consecutively admitted MVs were compared to 78 ODs. All patients were referred for psychiatric evaluation during the same 3-year period.
The MV group was predominantly male (68%), whereas the OD group was predominantly female (72%). Using DSM-IV criteria, depressive disorders were most common in both groups, followed by psychotic disorders. The OD group had significantly more borderline patients. Contrary to previous reports, prior psychiatric contact was low in the MV group. MVs were more likely to complain of financial problems and to retain a definite wish to die after the attempt.
This study identified meaningful differences between the two groups of patients who attempted suicide.
To identify the significant factors associated with attempted suicide among men and women, and determine whether socioeconomic status (SES) and social support indictors, health risk factors, and lifetime history of medical and psychiatric illnesses can explain gender differences in attempted suicide.
We used data from 3357 men and 4004 women aged 17 to 39 years, who completed a mental disorder diagnostic interview as a part of the Third National Health and Nutrition Examination Survey, 1988-1994. Adjusted odds ratios (ORs) were calculated for the association between risk factors and attempted suicide.
The prevalence of lifetime attempted suicides was 7.58% (SE, 0.66) in women and 3.69% (SE, 0.49) in men. In men, low income and smoking were associated with attempted suicide, while attempted suicide in women was associated with poor self-evaluated health, low educational attainment, and drug use. A history of medical and psychiatric illnesses was associated with attempted suicide in both genders, for cancer/pulmonary disease, OR=2.89 (95% CI, 1.25-6.67) in men and 1.94 (1.09-3.45) in women; for major depressive disorder, OR=9.86 (5.08-19.14) in men and 5.00 (3.19-7.83) in women. The significant gender difference of attempted suicide prevalence remained after being adjusted for risk factors selected.
There were significant gender differences in the risk factors for attempted suicide among young adults, and the gender difference in the prevalence of lifetime attempted suicides could not be explained by differential exposure to risk factors selected.
This article summarizes findings on demographic factors, distal risk factors, and proximal risk factors for suicide and reports recent data on suicide by Army personnel. In addition, the article offers recommendations to reduce the risk of suicide and suicide attempt in the Armed Services and suggests possible directions for future research on suicide in the military.
There are a large number of factors mediating suicide. Many studies have searched for a direct causal relationship between economic hardship and suicide, however, findings have been varied.
Suicide data was obtained from the Australian Bureau of Statistics for the period between January 1968 and August 2002. These were correlated with a suite of macroeconomic data including housing loan interest rates, unemployment rates, days lost to industrial disputes, Consumer Price Index, gross domestic product, and the Consumer Sentiment Index.
A total of 51845 males and 16327 females committed suicide between these dates. There were significant associations between suicide rates and eleven macroeconomic indicators for both genders in at least one age range. Data was divided into male and female and five age ranges and pooled ages. Analyses were conducted on these 132 datasets resulting in 80 significant findings. The data was generally stronger for indices measuring economic performance than indices measuring consumers' perceptions of the state of the economy. A striking difference between male and female trends was seen. Generally, male suicide rates increased with markers of economic adversity, while the opposite pattern was seen in females. There were significantly different patterns in age-stratified data, with for example higher housing loan interest rates having a positive association with suicide in younger people and a negative association in older age groups.
Macroeconomic trends are significantly associated with suicide. The patterns in males and females are very different, and there are further substantial age-related differences.
Suicide and other suicidal behaviours are markedly (though differently) patterned by gender. The increase in young male suicide rates in many countries has heightened interest in whether suicidal behaviours and ideation (thoughts) are related to masculinity. Relatively little research has explored the relationship between gender role attitudes and orientation and suicidal behaviours and ideation. Most research in this area has been conducted with young people.
We investigated whether gender role orientation (masculinity and femininity scores) and gender role attitudes were related to the reporting of serious suicidal thoughts in three generations (early adulthood, and early and late middle age) in a community sample.
Subjects (653 men and women aged around 23 years, 754 aged around 43 years, 722 aged around 63 years) completed home interviews with nurses as part of an ongoing longitudinal community-based study of social factors and health. These included measures of suicidal ideation (thoughts), attitudes to traditional gender roles, and a validated measure of gender role orientation (masculinity and femininity scores).
The prevalence of serious suicidal thoughts was higher in early adulthood (10% men, 15% women) than in early (4% men, 8% women) and late (6% men, 5% women) middle age. In early adulthood only sex was significantly related to suicidal thoughts, with women at higher risk (adjusted OR 1.74, 95% CI 1.01-3.00). In early middle age masculinity scores were negatively related to suicidal thoughts (adjusted OR for each unit increase in score 0.65: 95% CI 0.46-0.93), and more traditional views on gender roles were positively associated with suicidal thoughts (adjusted OR 1.48: 95% CI 1.07-2.04). In late middle age trends were in the same direction as in early middle age, but were not statistically significant. Femininity scores were unrelated to serious suicidal thoughts at any age.
The high rates of suicidal thoughts amongst men and women in early adulthood point to the importance of understanding mental health problems at this age. The results raise a number of questions and suggest that suicide researchers should pay more attention to gender roles and attitudes in older adults.
There are few (if any) population-based prospective studies that provide information on factors associated with temporal sequencing of suicide. In this prospective population-based study, the National Health Interview Survey (NHIS), 1986-1994, was linked to the National Death Index (NDI), 1986-1997, to assess factors that predict recent (within 12 months of interview, termed sooner) suicide versus suicide further in the future (more than 12 months after interview, termed later). Of the 653 completed suicides in the NHIS cohort, 13.4 percent completed suicide within a year of interview, and 86.6 percent did so after a year. Sooner decedents were more likely to be White, less educated, unemployed, and to use firearms than any other method compared with later decedents. Surprisingly, sooner decedents had higher levels of self-rated health at baseline. These results have substantial implications for clinicians and other professionals who interact with people at highest risk of suicide. Unfortunately, it may be unrealistic to expect that health care providers can modify the behavior of individuals at highest risk of suicide.
American Indians and suicide
- L. Olson
Suicide and no axis I psychopathology
- C. Ernst