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Making Sense of Why Western Men Are So Much More Likely to Kill Themselves

American men are killing themselves at an alarming rate.

According to the CDC, suicide rates among middle-aged men jumped by 43 percent from 1999 to 2014, the largest increase for all ages and genders. The most frequent victims were white men, who accounted for 70 percent of suicides in 2015. These figures aren’t unique to Americans: Men in Western nations consistently die by suicide at higher rates than women. Case in point: The U.S. statistics proportionally mirror those in Australia, where suicide is the leading cause of premature mortality and nearly 20 percent of deaths among 40- to 44-year-old men are by their own hand.

No one knows this better than Jane Pirkis, director of the Centre for Mental Health in the Melbourne School of Population and Global Health, who has worked in suicide prevention for more than 20 years. Since 2013, she and her research team have followed 16,000 Australian men and boys aged 10–55 and collected a range of information, including their views on suicidal thinking and 11 “norms” of traditional masculinity. While significant correlation couldn’t be found between suicidal tendencies and these masculinity norms, they found a strong connection between such thoughts and men who believed in the importance of being self-reliant.

She recently spoke with me about the perils of stoicism, the tragic blokey-ness of construction work, and why men in 2017 are three times more likely than women to off themselves.

What drew you to male suicide?
If you work in suicide prevention, you can’t help but be interested in male suicide. In most Western countries, three-quarters of all suicides are by men and older boys. Women have higher rates of attempted suicide, but men are three times more likely to actually die from suicide.

Why?
That’s the $64,000 question. Some have said that men use more lethal means and are less likely to seek help from professional sources, both of which are true, but a bit blunt as far as reasons go. We were interested in seeing whether there were characteristics of being a man that were related to suicidal thinking.

How did you do that?
We used the Conformity to Masculine Norms Inventory questionnaire to measure how men view themselves against “norms” of traditional masculinity. Masculinity is a slippery concept, and there are many forms of it these days. But there’s still a pervasive, traditional form of masculinity in Western cultures. There are various instruments that have been designed to measure masculinity and how people view themselves against this notion, and the Conformity to Masculine Norms Inventory is one of them. It measures 11 factors.

Which are?
Attitudes to work, dominance, risk-taking, heterosexual presentation, power over women, emotional control, playboy-like attitudes, attitudes to violence, the importance of pursuing status and winning and the importance of self-reliance. Men who placed a premium on self-reliance had 34 percent greater odds of reporting thoughts of suicide or self-harm.

Why do you think that is?
When we looked at the data, we thought, That’s weird, you’d think self-reliance would be a good thing. Obviously, it is in a lot of circumstances. If you’re facing adversity, often you do want to be self-reliant. But it also can work in the opposite direction. Men who are used to solving problems for themselves and not relying on anyone else, if they do find they aren’t traveling so well, perhaps they’re less likely than other men to reach out for help either, either to their mates or to other sources of help.

You suggest it may be due to men growing up with an innate desire to present as stoic and strong. What do you mean by that?
Suicide is complex. I’d be hesitant to say there’s one specific cause. But it was interesting that even when we controlled for many risk factors for suicidal thinking, like depression, one aspect of masculinity — being stoic and self-reliant — stood out above the rest. The way men and boys view themselves is societally determined to a large extent. Masculinity has a broader definition than in the past, but the traditional view — being tough, not wearing your heart on your sleeve, etc. — is still fairly pervasive.

You found, for example, construction workers are at greater risk of suicide.
Construction sites are pretty blokey places. There’s often a culture of not talking about your problems or showing any weakness

Tell me about the Man Up documentary.
We received funding from the Movember Foundation to create a documentary on masculinity and mental health that took the form of a presenter-led journey through the world of masculinity and self-reliance and their relationship to depression and suicidal thinking. We evaluated it in randomized control trials and found that men who viewed Man Up significantly increased their likelihood for seeking help and encouraging a mate to seek help. That’s pretty compelling evidence that a population intervention could have such a big impact. It suggests that if men could join the conversation about suicide, it may be a first step toward prevention.

Do you think that’s the solution?
Suicide prevention interventions might want to take this connection into account, particularly given the size of the problem among men. If you’re developing a media campaign about suicide prevention, target men in a way that’s nonconfrontational and aware of this notion of self-reliance. Equally, mental health services that work with people who have suicidal thoughts might want to think whether there are particular things they might do that make those services more appealing to men given that men are less likely to use them.

Notions of masculinity aren’t just dreamed up by individuals—they’re imposed by society from childhood in subtle ways. So if a sense of needing to be self-reliant is an issue for some men, we as a society need to think about how we’re bringing up our boys and girls. Even today, boys are told not to cry and young men are told to toughen up. We should ask if there are things we’re doing as a society that mean our boys are raised to become men who feel like they should hold it all in and not show any signs that they’re not traveling so well.