2925650

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.