Suicide in men has been described as a “silent epidemic”: because of its high incidence and substantial contribution to men’s mortality, and silent because of a lack of public awareness, a paucity of explanatory research, and the reluctance of men to seek help for suicide-related concerns.
A statistical overview demonstrates a shockingly high rate of death by suicide for men compared with women, and a need to focus attention on prevention, screening, treatment, and service delivery.
Promising lines of research include identification of clinical indicators specifically predictive of male suicide and exploration of precipitating and predisposing factors that distinguish male suicide and account for the substantial gender disparity.
Only by breaking the silence—building public awareness, refining explanatory frameworks, implementing preventive strategies, and undertaking research—will we overcome this epidemic.
A lack of public awareness and too few explanatory frameworks and preventive efforts specifically targeting male suicide have made a major public health problem largely invisible.
The silence surrounding suicide among men is also striking and warrants comment. First, there appears to be an overall lack of public awareness regarding the high rates of suicide among men, especially relative to other more highly publicized threats to men’s health, such as HIV/AIDS, that account for far fewer premature deaths among males each year (e.g., in 2005 45 male deaths were attributed to AIDS in Canada in contrast to 2857 male deaths from suicide)
A few preventive efforts or policies specifically targeting male suicide have been developed or evaluated, which further contributes to its lack of visibility as a major public health problem. When gender is addressed it is often treated as a static demographic variable as opposed to a culturally mediated social construction that intersects with other diversity markers such as race, sexual orientation, and age in highly complex ways.
Magnitude of the problem
Men have a shockingly high rate of death by suicide compared with women. Across all countries reporting these data (except China and India) males show a suicide rate that is 3.0 to 7.5 times that of women. In Canada, the male suicide rate is about three times that of women.
• The male suicide rate increases fairly steadily with age, peaking in the late 40s, then falling significantly and rising again in the 80s.
• Male rates are greater than female rates at all ages and substantially greater across most of the lifespan.
It is apparent that our knowledge of men’s suicide is lagging behind changes in the age-specific incidence of this cause of death. Until we understand the underlying reasons for this relative increase in men’s suicide rates in middle age, including potential cohort effects, we will not be able to implement effective preventive action.
While the analysis of suicide rates is highly informative, some epidemiologists have argued that a more useful way to evaluate suicide impact is in terms of potential years of life lost (PYLL), which reflects both mortality rate and age at which death occurs:
We do not fully understand the complexity of suicide, including the reasons for the gender difference in suicidal behavior. This makes it particularly challenging to develop effective prevention programs that can address the high rates of suicide in men specifically.
What are the factors contributing to men’s higher rate of death by suicide; and, in particular, why do such a high proportion of male suicide attempts end in death? As noted in a recent review of suicide risk screening, “dramatic differences in suicide behaviors among men and women… have drawn little attention. A better understanding of these variations may have direct implications for screening and treatment strategies, and they warrant further research.”
One line of investigation has focused on suicide methods. A well-established finding is that men are more likely to use suicide methods of high lethality, methods with increased risk of death.
For example, a recent pan-European study found that the highly lethal methods of hanging and firearms were more likely to be used by men. Sixty-two percent of males, versus 40% of females, used hanging or firearms in their suicidal actions.
Other investigators have confirmed that compared with suicidal women who use firearms to shoot themselves in the body, men are more apt to shoot themselves in the head, increasing the likelihood of death.
These findings suggest that restricting access to firearms might be a way to achieve a relative reduction in male suicide, and there is some tentative support for this as an important suicide prevention strategy.
In contrast, it is next to impossible to reduce access to ligatures and suspension points commonly used in hanging deaths since these materials are widely available in the community.
BC Medical Journal, re edited by Review and Mail