Understanding and Preventing Male Suicide

Introduction

Suicide is a significant public health issue in most countries. Suicide rates have been constant in the US and Canada, with some age and risk categories experiencing reduced suicide rates while increased suicide rates in other age groups and risk categories have made up the difference.

Male suicide has been commonly overlooked as suicide has not been seen as a gendered issue. Unfortunately, as more men than women die in virtually every country where the World Health Organization publishes data (2012) there exist the potential for significant reductions to be made in the suicide rate by interventions targeted specifically at men.

Suicide Statistics: A Comparison

Suicide rates are presented here for Canada, broken down by age range and gender.

Age Range	Male	Female	Total	Male % of Total
10 to 14	12	17	29	41.38%
15 to 19	140	58	198	70.71%
20 to 24	224	77	301	74.42%
25 to 29	198	63	261	75.86%
30 to 34	212	71	283	74.91%
35 to 39	220	68	288	76.39%
40 to 44	267	87	354	75.42%
45 to 49	318	114	432	73.61%
50 to 54	322	121	443	72.69%
55 to 59	273	102	375	72.80%
60 to 64	186	59	245	75.92%
65 to 69	117	33	150	78.00%
70 to 74	107	21	128	83.59%
75 to 79	78	23	101	77.23%
80 to 84	60	16	76	78.95%
85 to 89	36	13	49	73.47%
90 and older	10	3	13	76.92%
Total	2780	946	3726

As you can see, male suicides make up the majority of suicides in every age range except the 10-14 rate, where girls outnumbered boys. That is certainly worthy of further research by child suicide prevention specialists.

In Canada, suicide rates peak for men around 45-54, which contrasts with other countries where suicide rates increase with age after 30 and suicide rates in the elderly are the fastest growing group.

Suicide Methods

The most common method of suicide in the United States is firearms, accounting for 51% of the suicides in the US (Barber & Miller, 2014), followed by suffocation/hanging (25%), overdose/poisoning (17%) and other methods at 7.6%. (Centers for Disease Control and Prevention, 2013)

Because 85% of firearm suicide attempts result in death while only 2% of overdoses do (Vyrostek,  Annest, & Ryan, 2004), and because men most often choose methods like firearm and hanging over overdosing (Callanan & Davis, 2012), reducing access to firearms can significantly reduce the amount of male suicide.

Theories of Suicidal Behaviour

There are a number of theories that attempt to explain suicidal behaviour. These include the Interpersonal Theory of Suicide, the Stress-Diathesis Model, and the Integrated Motivational-Volitional Model. The interpersonal theory is detailed below.

The Interpersonal Theory of Suicide suggests that you need three elements for suicide to take place:

• Thwarted Belongingness
• Perceived Burdensomeness
• Acquired Suicide Capability

Thwarted belongingness involves feeling like you have no social support or that you do not belong in your peer group. This can also be called “alienation.” Men are known to have smaller social circles (McPherson, Smith-Lovin & Brashears, 2006) and fewer access to social support when they are distressed.

Perceived burdensomeness refers to the idea that you feel like a burden on those around you. For men, this can present as being unable to be a provider or support their family.

Finally, acquired suicide capability refers to events that give you the capability to die by suicide. This includes exposure to war, physical abuse, fighting, self-injurious behaviour (cutting, etc.), or other elements that desensitize you to painful or fear-inducing experiences.

Men are more likely than women to be victims and perpetrators of violence (Statistics Canada, 2006), they make up the majority of occupational injuries (Bureau of Labour Statistics, 2013) and sufferers of substance abuse (Cotto, 2010). All of these items can increase men’s suicidality.

Additionally, suicidal intent (desire to die) has been associated with use of more lethal suicide methods. What this means is that although women attempt suicide at a rate of 3x men do, they don’t intend to die. The goal of attempting suicide is to accomplish other means. Update Nov-1/15 This is in fact incorrect and there is research support to the idea that women have similar levels of suicide intent as men (Denning, Conwell, King & Cox, 2000).

Player et. al. (2015) suggest that male coping strategies are responsible. While women increase their social support and look outward when they are feeling suicidal, men often wall themselves off from others to avoid being a burden. This only amplifies their systems and increases their distress, which can prevent an interruption in the suicidal process that may happen with women.

Clinical Interventions to Reduce Male Suicide

Interventions for suicide that can help individual men include:

Counseling on Access to Lethal Means. By reducing access to lethal means like firearms you can reduce an individual’s chance of dying by suicide. Many suicide attempts are made impulsively and having a gun makes a suicide attempt much more lethal.

Treatment for substance abuse.  Many suicides involve drugs and alcohol and so getting off drugs and alcohol can reduce a person’s reason and ability to attempt suicide, both because of the impact of substance abuse on a person’s ability to function in their day-to-day life (especially as it relates to relationships) but also because drugs and alcohol can make people — young men especially — more impulsive.

Increasing social circles. The average man has a social circle smaller than women. This lack of close friends means that men are not able to express themselves emotionally.

Self-esteem training. This can be a part of counselling or therapy or an initiative on it’s own. Group environments in particular provide an opportunity to both build a man’s social skills and his self-esteem. The benefit of high self esteem is that it can reduce a man’s perception that he is a burden, one of the key elements for suicide.

Public Health Strategies to Reduce Male Suicide

From a public health perspective, there are a few interventions we can help reduce male suicide.

Getting more men in front of family doctors. Men have poor records of going to the doctor when they need to, or even for regular checkups. Because physical health issues can prevent men from working or otherwise providing for themselves (creating the feeling of burdensomeness), physical health care is an important element to reducing suicidal ideation.

Screening for suicide and substance abuse by family doctors. Once men are in front of their physician, it’s important that they’re able to recognize the signs and symptoms of suicidal ideation and substance abuse. It has been noted that mental health professionals are less likely to diagnose depression in men and this is also an area for exploration.

Improved services for sexual violence. With as many as 1 in 6 men experiencing sexual abuse/assault in their lifetime (Dube, Anda & Whitfield, 2005) and a lack of services like rape crisis centres that provide service to men, suicide as a result of the after-effects of abuse will continue to be a devastating issue.

Areas for Additional Research

Areas for additional research include whether men respond differently to standard treatments for depression or substance abuse, or if there are any ways to intervene with men experiencing suicidal ideation that are particularly effective.

Bibliography

Barber, C.W., Miller, M.J. (2014) Reducing a Suicidal Person’s Access to Lethal Means of Suicide: A Research Agenda. American Journal of Preventive Medicine. 47(3S2):S264–S272

Centers for Disease Control and Prevention. (2013) Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed Jun 21 2015 from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html

Denning, D.G., Conwell, Y., King, D., Cox, C. (2000) Method choice, intent, and gender in completed suicide. Journal of Suicide and Life Threatening Behaviour. 30(3). 282-288

Dube, S.R., Anda, R.F. & Whitfield, C.L., et al. (2005). Long-term consequences of childhood sexual abuse by gender of victim. American Journal of Preventive Medicine, 28, 430-438.