Re-visioning male suicide through a social determinants lens

In a blog for Suicide Prevention Awareness Month, Rob Whitley argues for a better framework to understand and address male suicide as discussed in his upcoming book Men’s Issues and Men’s Mental Health.

There is one undeniable fact regarding suicide: men make up the vast majority of completed suicides across the world. In Europe, men make up around 80% of completed suicides, while in the Americas men make up around 75% of completed suicides.

In Canada, about 3,000 men die by suicide per year, which translates to over 50 deaths per week. In the United States around 35,000 men die by suicide every year, which translates to around one every 15 minutes. This has led Professor Dan Bilsker to declare that we are in the midst of a “silent epidemic of male suicide”.

A growing problem

Worryingly, rates of male suicide appear to be rising, after a period of declining rates. For example, a US Centers for Disease Control and Prevention (CDC) report noted that age-adjusted male suicide rates in the US showed a period of slight decline from the mid-1980s to 2006.

But this same report notes that male suicide increased by around 2% per year from 2006 to 2017, reflecting a 26% increase in male suicides since 1999. These rising rates suggest that existing approaches to suicide prevention may be missing the mark.

Indeed, three of the central arguments of my upcoming book Men’s Issues and Men’s Mental Health (Springer, in press) are that dominant approaches to male suicide prevention (and men’s mental health per se) insufficiently address the issue because they:

  • Are too narrowly focused on the singular concept of masculinity, lacking peripheral vision to examine important aspects of social context;
  • Sometimes take an unhelpful ‘blaming and shaming’ approach by pointing the finger at alleged male deficits such as stubbornness and reticence; and
  • Insufficiently take a male-sensitive or male-friendly ‘strengths-based approach’ that builds on male proclivities and preferences.

Instead of this rather one-dimensional and patronizing approach, I argue that a better framework to understand and address male suicide (and men’s mental health per se) may be a public health framework known as the social determinants of health.

 A renewed approach

This framework involves examining the relationship between various social factors and health outcomes, using the results to build targeted and tailored programs and interventions. This typically includes careful comparisons by demographic including age, gender and ethnicity.

Silhouette of a man's head

In terms of suicide, such an analysis reveals that certain sub-groups of men are at particular risk of suicide. This includes: (i) Aboriginal men; (ii) divorced men; (iii) military veterans; (iv) unemployed men; and (v) men with mental illness.

What are the common factors underlying high rates of suicide in the above groups? To a greater or lesser extent, men in these groups frequently face high levels of isolation, social stigma and financial strain. They may also be stereotyped on account of their demographic, and there may be a lack of public empathy for their plight, meaning few safety nets or supports.

Social integration and alienation

Indeed, a common factor among men in these groups may be real or perceived rejection from mainstream society, leading to ongoing feelings of disaffection and estrangement. In short, an underlying factor explaining high rates of suicide in such disparate groups may be a strong sense of social alienation, characterized by a diminished sense of meaning and purpose in life, which in turn can weaken primary reasons for living.

Psychologist making notes during therapy session with male soldier

For example, the social integration of adult men in western countries is typically provided by meaningful participation in: (i) a nuclear family; and (ii) the workforce. As such, disintegration of a nuclear family or loss of employment can have a particularly pernicious effect on men, especially as this demographic is typically overlooked in the provision of services.

Likewise, stigmatizing stereotypes targeted at groups such as people with mental illness, military veterans and Aboriginal people may impede entry into the workforce and dating opportunities in the first place, thus contributing to a lack of social integration and ongoing marginalization.

Implications for prevention

A social determinants of health framework has implications for male suicide prevention, suggesting the importance of a multi-pronged approach.

This can include the provision of tailored male-sensitive supports for men undergoing difficult transitions such as divorce or job loss. It can also include targeted and culturally appropriate supports for vulnerable men from specific sub-cultures, including Aboriginal men and military veterans.

Depressed man

And while the official mental health system indubitably has a role to play, locally grounded community-driven programs must also be tasked to help vulnerable men, especially as research indicates that men often prefer such spaces.

This can include local peer support groups, faith-based organizations or other non-profits. Such organizations are well placed to address the loneliness, social alienation and diminished sense of meaning and purpose in life that is often implicated in male suicide.

Such thinking outside the box may help address the silent crisis of male suicide.

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