We have been trying to unravel the pathways between men’s depression and suicide for a long time. This work has been driven by an uneasy relationship where men’s low rates of diagnosed depression starkly contrast with their high suicide rates. This isn’t to suggest that the only route to suicide is depression, but we know that depression is a significant risk factor for male suicide.
Deaths by suicide for Australian males occur at a rate three times greater than that for females.
The most recent Australian data reports male deaths due to suicide in 2018 at 2,320, with suicide rate amongst Aboriginal and Torres Strait Islander men more than double the national male rate.
Our aim is to map the pathways and factors that underpin connections between depression and suicide, so we can build targeted programs to help reduce male suicide.
We often compare the complexities of research on male depression and suicide to the complexities of the ‘black box’ flight recorder. Like all black box searches, we are looking for important information to better understand and guide future actions.
Three key insights have emerged from the latest research and our evolving interpretations guide the development of community-based programs to reduce male suicide.
Missing or mislabeling men’s depression
There is strong observation-based evidence suggesting that many men with depression express irritability, anger, substance use and risk-taking behaviours.
The challenge is for clinicians, family and friends to be aware of the potential for men’s depression to manifest or be displayed in these ways, and so appear differently to some of the things we might expect to see, like crying, introspection and sadness.
Misdiagnosis has major ramifications for clinicians. Do we need, particularly in initial consultations, to be establishing trust, asking more powerful questions that affirm men’s experiences and perhaps ease up on telling patients what to do?
If we can better diagnose male depression it would make available potential treatment pathways and these upstream efforts would help us reduce men’s suicide risk.
Outdated claims that men don’t go to the doctor
Some studies reveal that up to 60 per cent of men who die by suicide have accessed professional health care services in the year before their death. So, when we talk about men’s help-seeking for health and mental illness there are complexities as to how men who experience depression engage -and disengage – services.
Often it turns out that finding the right kind of help for an individual takes resilience. To put it another way, help-seeking in depression is rarely a one-time ask or a quick fix.
We also know that men who access help for depression are sustained in their efforts towards recovery by clinicians who offer shared treatment decision-making and strategies, explicitly bridged to effective self-management.
Being known by their clinician, establishing timelines and trust and clearly delineating specific responsibilities and deliverables amid pre-empting treatment costs, also strongly optimize professional mental health care services for men.
Connectedness is a man’s best friend
Social isolation can take many forms. Loneliness can accompany men’s transitions including retirement, bereavement, divorce and illness. Within these life changes, some men seemingly self-isolate.
Their linkages to others’ shift to such an extent that they no longer feel they ‘fit’ in with the people and pleasures they once enjoyed.
Vulnerabilities also permeate many men’s depression. The self and societal stigma that flow from mental illness can be dislocating, as can perceptions by some men that they are ‘failing the help’ they have sought.
In terms of remedy, connectedness is key but many positive forms of community connection have been eroded. The past fifteen years have seen ‘e-hugs’ or ‘e-likes’ take the place of real hugs and spoken words of affirmation and encouragement.
This has increased the need for community-based men’s programs like Men’s Sheds, but we need a more diverse range of community connections for men and they need to be developed at scale.
Movember have recently launched thirteen new programs to restore and strengthen the social connections of men. Targeted awareness-raising and research funding are now critically important.
So too are the people in men’s lives. We are convinced that with permission, men will speak about their depression-related vulnerabilities as a strength, rather than as a sign of weakness.
Returning to the black box metaphor, we have just begun to unravel some of the pathways between men’s depression and suicide.
Finding the black box is the first step, the next will be to unravel the data and use the findings to develop avenues to reduce longstanding rates of male suicide.