'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality.

Abstract

Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.