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November 26, 2018

Men and Suicide

Reuel S. Amdur

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On November 22, the Royal Ottawa Hospital's psychiatrist-in-Chief Rajiv Bhatta gave a presentation on men and suicide. "Men have low rates of depression compared to women, yet they are four times more likely to die by suicide." Thus, of people with depression only a third are men, while some 75 to 80% of deaths by suicide are by men.

It can be argued that in fact the rate of male depression is higher.  Men are less likely to seek help and so there are undoubtedly many unreported cases of male depression.  We know that men are twice as likely to abuse or be dependent on alcohol, the most common addictive drug.  And men make up 70% to 80% of opioid deaths.  How many of these are really suicide?  We don’t know.

Another aspect of the lower rate of male depression is that of cultural selectivity.  Health care professionals, given a vignette about a person exhibiting certain symptoms and behaviours are, when the sex of the person is varied, more apt to make a diagnosis of depression for the woman than the man.

Why does all this matter?  Bhatta points out that the men involved really do suffer.  We can’t, he argues, continue to be silent to this epidemic.  The matter needs to be highlighted: “We can’t fix what we don’t see.”  And this rate of suicide affects more than just the men who kill themselves.  It affects families, communities, and the society generally.

Looking back to the experiment with the vignettes, we—including the medical community—need to re-evaluate our perceptions and biases.  We need to be aware of the situation.  And we need to take a strength-based approach to male mental health.  This approach involves focusing on positive male stereotypes such as honor and duty.  “Your family will not be better off.”  “Killing yourself does not help the people left behind.”  He noted that masculine stereotypes are not all positive, for example imprisonment and homelessness. 

Bhatta urged us to look at what other countries are doing to deal with the problem.  Australia has adopted a mental health strategy, and Britain now has a Ministry for Suicide Prevention and a Campaign Against Living Miserably (CALM).

During the time for comments, one man found unhelpful some of the themes emerging from the #Me Too movement, such as the phrase “toxic masculinity.”  In essence, he was saying that it is not helpful to put men down with negative stereotypes. 

In an interesting commentary, David Shackleton, Executive Director of Ottawa’s Centre for Men and Families, spoke of the sex ratio for suicide in other countries.  He found that the higher rate for men persisted in all countries with the exception of China.  He hypothesized that the higher female rate in that country may be related to the one-child policy.  This near-universality raises the question of a possible genetic factor.

Dr. Bhatta did not discuss the fact that female suicide attempts far exceed those of men.

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