HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

Trag­i­cal­ly, sui­cide is not as rare as one may think. In 2018, glob­al da­ta from the World Health Or­ga­ni­za­tion (WHO) re­ports an es­ti­mat­ed 793,000 sui­cide deaths world­wide. Most were men.

Al­so, it is not­ed, that women are more like­ly than men to at­tempt sui­cide, but the method cho­sen by men, make them more like­ly to com­plete the act be­fore any­one can in­ter­vene. One study of more than 4,000 hos­pi­tal pa­tients in the US, who had en­gaged in self-harm, found that the men had high­er lev­els of sui­ci­dal in­tent than the women.

Sui­cide is a huge­ly sen­si­tive, com­plex is­sue with a tan­gled mul­ti­tude of caus­es, and the very na­ture of a death by sui­cide means we can nev­er ful­ly know the rea­sons be­hind it.

Why are men strug­gling – and what can be done about it?

One key el­e­ment is com­mu­ni­ca­tion. It is too sim­plis­tic to say women are will­ing to share their prob­lems and men tend to bot­tle them up. But it is true that, for gen­er­a­tions, many so­ci­eties have en­cour­aged men to be “strong” and not ad­mit they are strug­gling.

It of­ten starts in child­hood. “We tell boys that “boys don’t cry”, we con­di­tion boys from a no­tice­ably young age to not ex­press emo­tion, be­cause to ex­press emo­tion is to be ‘weak’.

Mara Grunau, ex­ec­u­tive di­rec­tor at the Cen­tre for Sui­cide Pre­ven­tion, in Cana­da, points out it’s how we talk to our chil­dren and how we en­cour­age them to com­mu­ni­cate about them­selves too: “Moth­ers en­cour­age their girl chil­dren to ex­press their emo­tions way more than their boy chil­dren...and they share and iden­ti­fy feel­ings more,” she says. Where­as boys go through sim­i­lar episodes but are ex­pect­ed to be tough.

Rigid gen­der norms may make it dif­fi­cult for males to reach out and ask for sup­port when they need it. “It’s not that men don’t have the same is­sues as women – but they are less like­ly to recog­nise they have what­ev­er stress­es or men­tal health con­di­tions, that are putting them at greater risk for sui­cide.”

De­pres­sion is un­der­diag­nosed in men

If a per­son is not even cog­nizant he has a con­di­tion caus­ing dis­tress, then he is less aware that any­thing could be done to help him. Dan­ger­ous­ly, rather than seek­ing help through es­tab­lished chan­nels, some men may at­tempt to “self-med­icate”.

Men of­ten do not dis­close feel­ings of de­pres­sion to their doc­tors. When they do, it is of­ten de­scribed in terms of hav­ing prob­lems at work or in re­la­tion­ships. Men al­so tend to de­scribe their feel­ings as “stress” rather than sad­ness or hope­less­ness.

Men may be less like­ly to ad­mit when they feel vul­ner­a­ble, whether to them­selves, friends, or a GP. They al­so can be more ret­i­cent than women to see a doc­tor. A UK British Med­ical Jour­nal study found Gen­er­al Pri­ma­ry Care Con­sul­ta­tion rates were 32% low­er in men than women. Con­sul­ta­tion rates for de­pres­sion, as­sessed by whether pa­tients re­ceived an­ti­de­pres­sant pre­scrip­tions, were 8% low­er in men than women.

Eco­nom­ic down­turn adds risk

When there is an eco­nom­ic down­turn that re­sults in in­creased un­em­ploy­ment, for ex­am­ple, there tends to be an as­so­ci­at­ed in­crease in sui­cide, typ­i­cal­ly 18-24 months af­ter the down­turn. One 2018 study found that for every 1% in­crease in un­em­ploy­ment there is a 0.79% in­crease in the sui­cide rate.

Hav­ing to wor­ry more about fi­nances or try­ing to find a job can ex­ac­er­bate men­tal health is­sues for any­one. But there are el­e­ments of so­cial pres­sure and iden­ti­ty cri­sis, too. “We’re brought up our en­tire lives to judge our­selves in com­par­i­son with our peers and to be eco­nom­i­cal­ly suc­cess­ful,” says Si­mon Gun­ning, the CEO of Cam­paign Against Liv­ing Mis­er­ably (CALM), a UK-based award-win­ning char­i­ty ded­i­cat­ed to pre­vent­ing male sui­cide. “When there are eco­nom­ic fac­tors we can’t con­trol, it be­comes very dif­fi­cult.”

Of course, it is im­por­tant to re­mem­ber that while an ex­ter­nal fac­tor might pre­cip­i­tate sui­ci­dal be­hav­iour in a per­son who is al­ready at risk, it is nev­er the sole cause.

Re­fram­ing help-seek­ing is im­por­tant

Men may avoid ask­ing for help be­cause they fear it is a sign of weak­ness. Find­ing ways to change this per­spec­tive is a crit­i­cal as­pect of re­duc­ing male sui­cide rates.

A 2019 study pub­lished in the Jour­nal of Men­tal Health found that re­ceiv­ing sup­port from a trust­ed and re­spect­ed friend can be an ef­fec­tive sui­cide pre­ven­tion strat­e­gy for men. Form­ing con­nec­tions with oth­er peo­ple who are go­ing through the same thing can al­so be help­ful. The study al­so found that re­fram­ing help-seek­ing as mas­cu­line be­hav­iour in­creas­es the like­li­hood that men will ask for help when they need it.

Pre­ven­tion

There are strate­gies that both in­di­vid­u­als and com­mu­ni­ties can utilise to help re­duce the risk of male sui­cide.

- Watch for signs of de­pres­sion. Symp­toms of de­pres­sion in men in­clude ir­ri­tabil­i­ty, so­cial with­draw­al, anx­i­ety, loss of in­ter­est or plea­sure, phys­i­cal pains and com­plaints, en­gag­ing in risky be­hav­iours, mis­us­ing drugs and al­co­hol, and be­ing un­able to keep up with nor­mal dai­ly tasks.

- Of­fer sup­port. If you no­tice signs of de­pres­sion, ask what you can do to help, and let him know that you are there to lis­ten and help.

- Don’t ig­nore the signs. Avoid dis­miss­ing or mak­ing light of com­ments that in­di­cate sui­ci­dal thoughts or be­hav­iours. If you hear sui­ci­dal talk or state­ments, en­cour­age him to talk to his doc­tor or ther­a­pist.

How­ev­er, peo­ple who feel sui­ci­dal of­ten re­port a cer­tain kind of tun­nel vi­sion, of be­ing un­able to see the broad­er pic­ture and think­ing on­ly in terms of black and white. In such cir­cum­stances, that in­di­vid­ual may not be mo­ti­vat­ed to seek out help for them­selves, and it of­ten falls on oth­ers to of­fer sup­port by lis­ten­ing, of­fer­ing en­cour­age­ment and some­times even chal­leng­ing the pre­con­cep­tions that peo­ple hold about them­selves such as their abil­i­ties and worth to so­ci­ety.

Oth­er ways to help re­duce male sui­cide:

- Iden­ti­fy men who are at risk and of­fer sup­port.

- Teach men cop­ing and prob­lem-solv­ing skills to help them man­age chal­lenges with work, re­la­tion­ships, and health is­sues.

- Make men­tal health sup­port op­tions read­i­ly avail­able.

- Cre­ate op­por­tu­ni­ties that bring groups of peo­ple to­geth­er so that they can form so­cial con­nec­tions and find sup­port.

- Re­strict ac­cess to lethal means of sui­cide, such as firearms and pre­scrip­tion drugs.

Ar­ti­fi­cial In­tel­li­gence play­ing huge roles

Tech­nol­o­gy is pre­sent­ing new op­tions too. Not every­one might want to un­bur­den them­selves to an­oth­er per­son, even over a helpline. But ar­ti­fi­cial in­tel­li­gence, such as chat­bots might al­low a vul­ner­a­ble per­son to com­mu­ni­cate and get the help they need with­out fear of judge­ment. We must con­tin­ue to pur­sue meth­ods and so­lu­tions to re­duce these un­for­giv­able rates.

Any life lost to sui­cide – whether male or fe­male – is a life too many.