Depression and suicide in men

Written by Dr Ciaran Mulholland, consultant psychiatrist/senior lecturer in mental health

Risk factors for suicide

As well as being male, several other risk factors for suicide have been identified.

Age: suicide in men peaks in the 20s and again in the 60s and 70s.

Unemployment: the suicide rate has been shown to rise and fall with the unemployment rate in a number of countries - half of the record 33,000 people who committed suicide in Japan in 1999 were unemployed.

Social isolation: those who kill themselves often live alone and have little contact with others; they may have been recently widowed or have never married.

Chronic illness: any chronic illness increases the risk of suicide.

Certain occupations: people with certain occupations are more likely to die by suicide, for example farmers (who usually work alone, may be unmarried and have access to the means of suicide, such as a shotgun or poisonous weedkiller).

Many of the above risk factors affect men more than women. It is important to remember that many people are subject to these factors, but only a tiny minority of them will end their own lives.

Other factors are also significant. The most important risk factor is the presence of a mental illness. The most important protective factor is the presence of good support from family or friends.

Mental illness

Research has shown that the vast majority of those who kill themselves are mentally ill at the time of their death. Two thirds are troubled by a depressive illness and 20 per cent by alcoholism.

Of people with severe depressive illnesses, 10-15 per cent will commit suicide. Paradoxically, as mentioned above, depressive illnesses are more common in women, but suicide is more common in men. Several possible explanations exist for this apparent discrepancy.

The more severe the depression is, the more likely it is to lead to suicide. So one possibility is that more severe forms of depressive illness are equally common in men and women. In addition, once men are depressed, they are more likely to end their lives. They are also more likely to choose especially lethal methods when they attempt suicide, for example, hanging or shooting. Depressive illness among people under 25 years of age is probably much more common now than it was 50 years ago, which may account for one reason why the suicide rate is increasing in young men.

Alcoholism leads to suicide in 10 per cent of affected people. Alcoholism is much more common in men (though it is increasing rapidly among women).

Schizophrenia (a relatively uncommon condition affecting 1 in 100 of the population) leads to suicide in 10 per cent of affected people.

Why is the male suicide rate rising?

The reasons why the number of men taking their own lives has risen in recent years are far from clear. All of the proposed explanations share a common feature - the changing role of men in society.

Adolescence has been prolonged, with adulthood and independence reached at a much later age than previously. Two generations ago, work began at the age of 14; one generation ago at 16 years for most; now many men only achieve financial independence in their 20s.

Men have a more stressful time in achieving educational goals than in the past and are now less successful than women.

Work is much less secure and periods of unemployment are the norm for many (psychologically the threat of unemployment is at least as harmful as unemployment itself).

Alcohol use, and abuse, has increase markedly since the Second World War. Such use is often an attempt to cope with stress and to self-medicate symptoms.

Illegal drug abuse has become much more common (a correlation between the youth suicide rate and the rate of convictions for drug offences has been demonstrated in some countries).

Changes that are assumed to be symptoms of the 'breakdown of society' are associated with a rising suicide rate (examples include the rising divorce rate and falling church attendances).

Boys don't cry

In many societies, expressing emotions, for example sadness, fear, disappointment or regret, is seen as being less acceptable for boys than girls.

This cultural stereotype is very, very difficult to shake off, though the advent of 'new men' in the 1990s has made it more acceptable for men to open up to others.

If a man, particularly an older man, does cry openly, this is often a sign of severe depression and is taken very seriously indeed by health professionals.

Deliberate self-harm

Some of those who 'attempt' suicide do not actually intend to kill themselves. They mimic the act of suicide by taking an overdose or cutting themselves. They do so in an attempt to change an intolerable situation or gain attention from significant other people in their lives. This process is know as deliberate self-harm or parasuicide. Such people can get considerable relief of tension and anxiety from these acts. Deliberate self-harm is more common in women, though the proportion of men who self-harm is increasing.

Some 10-15 per cent of those who attempt suicide go on to complete suicide. In other words, 85-90 per cent do not.

How does suicide affect others?

It is not true that suicide hurts no one except the person who takes his or her life. Those who are left behind will typically go through a number of stages as they grieve - denial, anger, guilt, confusion, a protective wish to prove death was accidental, and, perhaps, depression and anxiety.

Barriers to effective treatment of depression in men

Men are less likely to recognise that they are under stress or unhappy, let alone ill.

Men are less likely to consult their doctor when distressed.

If they do consult their doctor, they are more likely to complain of physical symptoms (for example, stomachache) or vague ill-health.

Health professionals are often less likely to consider a diagnosis of mental illness in men.

Some of the young men who kill themselves without ever seeking help seem to not have an identifiable mental illness. Rather, they are troubled by a philosophical dilemma, a dis-ease (sic) of the soul, for which suicide seems the solution.

What can society do?

Something about modern life is killing more and more young men by suicide, but at the same time is not affecting young women. We need to know more about why this is happening and if necessary society must consider changes in the way we live to reduce the toll of suicide.

About 80 per cent of women who have committed suicide will have consulted their doctors and received treatment before their deaths.

Only 50 per cent of men will have done so.

For men aged less than 25 years of age, the proportion is only 20 per cent.

Education campaigns might help men, and young men in particular, to seek assistance rather than suffer in silence.

What can you do?

If you have any of the symptoms of depression outlined above, consult your doctor. If you have three or four symptoms, if you feel hopeless about the future, or if the thought of suicide has crossed your mind, you should contact your doctor urgently.

If you see the signs of depression in others, advise them to consult their doctor. If someone you know threatens suicide take the threat seriously.

Remember, depression is treatable, and suicide is avoidable.

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