Male Suicide: A Public Health Emergency

Male suicide is a global public health crisis. In almost every country, more men die by suicide than women. In the United States and the United Kingdom, suicide is a leading cause of death for men. Scientists urgently need to understand both risk factors and interventions to help more men access a meaningful life.

With these goals in mind, our research team reviewed two decades of research into male suicide. We looked at 78 studies encapsulating insights from over 1,695 people. The studies came from 18 countries, including Canada, the UK, Australia, Brazil, Ghana, Uganda, and Norway. We examined all English language studies that used qualitative or mixed methods, were peer-reviewed, and involved participants aged 18 and over. In addition, participants in these studies were men who have experienced suicidal thoughts, feelings, or attempts or people bereaved by male suicide.

In 96% of studies, cultural norms of masculinity seemed to increase suicide risk. Cultural norms of masculinity refer to expectations for how men should behave in specific communities or cultures. Our study identified the following norms as potentially elevating male suicide risk: suppression of emotions, pressure for men to succeed, and diminishing men's needs for relationships. Pressure to conform to these norms meant some men seemed to experience dysregulation within three core psychological areas: 1. their emotions; 2. sense of self; and 3. relationships with others.  Dysregulation, in this context, means thoughts and feelings have become overwhelming and difficult to control. In our review, we saw evidence that men's emotions, their thoughts and feelings about themselves, and their relationships with others became full of pain and hard to manage. It's crucial to understand that these three areas—emotions, self, and relationships—are all connected. Like cogs in a wheel caught in a chain reaction, harm in one area can lead to harm in others. The interaction of these harms seemed to increase men's emotional pain and suicide risk.

In 92% of studies, emotional suppression appeared to increase suicide risk. Norms that encourage men to hide their emotions and cope with problems alone left some men vulnerable to overwhelming psychological pain without any effective release. As painful challenges in life increased, some men's emotions became overwhelming. To cope with their distress, many men used behaviours like drinking or drugs which provided temporary relief but left many men feeling ashamed and isolated over the long term. Many men appeared trapped in pain, feeling like it would never end. A desire to escape this overwhelming distress was the most frequent description of suicidal behaviours. A 36-year-old man in Australia who had attempted suicide described his emotional isolation as follows: "I'm a dad of three kids and a husband. I've got a good job. I don't want you to know that I'm so sad that I cry at red lights." (Fogarty et al., 2018, p. 264)

In 76% of studies, pressures to meet standards of male success seemed to increase suicide risk. In our data, standards of male success related to various areas of life, including work, money, exams, relationships, sexuality, and health. When men thought they were not meeting these standards of male success, they felt like a failure. Some men described hiding their feelings of failure by pretending they were doing well which exacerbated shame and loneliness. Certain men described their suicidal thoughts and behaviors as a means to escape feelings of failure. A Brazilian man described his suicide attempt in the following way: "I tried to set up a business for myself and my family and it didn't work. I lost money and there was no other alternative except killing myself" (Ribeiro et al., 2016, p. 5). To a lesser extent, men described suicide as a means to regain control over a life spiraling out of control due to not meeting male standards of success. 

In 82% of studies, suppressing relationship needs seemed to increase suicide risk. Masculine norms of emotional suppression, self-reliance, and independence appeared to affect how some men built and navigated relationships with others. Some men described extreme isolation and loneliness, difficulties in trusting others, problems managing relationship intimacy, relationship conflict, and breakdowns. Some men described overwhelming isolation or consuming relationship-related difficulties as driving their suicidal despair. Another Brazilian man who had attempted suicide shared the following regarding his suicide attempt: "My family slowly abandoned me, or rather, I abandoned them and ended up alone …and I would often get depressed, drink, use drugs and would really feel like ending it, end all the suffering that my life had become. (Ribeiro et al., 2016, p. 4)

Recovering a Meaningful Life

We also reviewed the 78 studies to identify factors that help men cope with suicidal distress.  We have 22 recommendations to support men's recovery. These recommendations revolve around three primary goals for men at suicide risk: increase understanding and management of emotions, build more compassionate ideas of the self, and strengthen relationships with others. Interventions that provide psychological and practical help to tackle issues like debt or addiction would support men at suicide risk. Doctors and therapists should be trained to identify how masculinity norms impact some men's suicidal pain, including how men express distress. Peer and community support groups could help men reluctant to seek medical support.  At a societal level, we need to broaden ideas of masculinity and celebrate male emotions, develop expansive male selfhoods, and foster male intimacy and connection with others. Our study underscores the importance of collectively acknowledging the harm some aspects of our cultures may inflict on certain men. We hope our meta-analysis of male suicide risk can contribute towards a deeper and more compassionate conversation about the male experience and motivate changes to protect men from suicidal despair.

For Further Reading

Bennett, S., Robb, K. A., Zortea, T. C., Dickson, A., Richardson, C., & O'Connor, R. C. (2023). Male suicide risk and recovery factors: A systematic review and qualitative metasynthesis of two decades of research. Psychological Bulletin, 149(7-8), 371–417. https://doi.org/10.1037/bul0000397

Fogarty, A. S., Spurrier, M., Player, M. J., Wilhelm, K., Whittle, E. L., Shand, F., Christensen, H., & Proudfoot, J. (2018). Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data. Health Expectations, 21(1), 261–269. https://doi.org/10.1111/hex.12611

Ribeiro, D. B., Terra, M. G., Soccol, K. L. S., Schneider, J. F., Camillo, L. A., & Plein, F. A. D. S. (2016). Reasons for attempting suicide among men who use alcohol and other drugs. Revista Gaúcha de Enfermagem, 37(1), Article e54896. https://doi.org/10.1590/1983-1447.2016.01.54896

Susanna Bennett is a PhD candidate at The University of Glasgow exploring male suicide risk and recovery factors.