Suicide In Men Research Articles

MP21-19 THE PREVALENCE AND BIOPSYCHOSOCIAL PREDICTORS OF SUICIDALITY IN MEN WITH PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2018MP21-19 THE PREVALENCE AND BIOPSYCHOSOCIAL PREDICTORS OF SUICIDALITY IN MEN WITH PROSTATE CANCER Jason Izard, D. Robert Siemens, Phylicia Verreault, Angela Black, and Dean Tripp Jason IzardJason Izard More articles by this author , D. Robert SiemensD. Robert Siemens More articles by this author , Phylicia VerreaultPhylicia Verreault More articles by this author , Angela BlackAngela Black More articles by this author , and Dean TrippDean Tripp More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.710AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (PCa) is associated with depression above levels reported in the general population. There is a positive association between PCa diagnosis and suicide. The first aim of this study is to establish a point prevalence for suicidality among patients diagnosed with PCa. The second aim is to evaluate what biopsychosocial variables best predict greater risk of suicidality in men with PCa. METHODS Participants were recruited from the ambulatory PCa clinics at Queen′s University and through direct invitation from an online PCa support group (Prostate Cancer Canada). All willing participants were directed to the online survey. Hierarchical regression was used to predict suicidality (SBQ-R), with stage of PCa, length of diagnosis, number of comorbidities, number of treatments, exposure to suicide, functional, emotional and social well-being subscales of the FACT-P, hopelessness, stress catastrophizing, fears about death, and perceived interpersonal burdensomeness and thwarted belongingness scales (INQ-10). RESULTS At time of submission, 243 participants completed the survey. Of those 77% of participants were diagnosed with localized PCa and 23% with advanced PCa. The most common treatments received were prostatectomy (63%), radiotherapy (42%), and androgen-deprivation therapy (37%). In regard to suicidality, 16.9% were classified as at-risk cases using a general population cut-score, while 10.3% were classified as at-risk cases using an inpatient population cutoff. The regression analyses indicated that greater hopelessness (β=0.32) was the strongest predictor of suicidality. Previous exposure to suicide (β=0.26), reduced functional wellbeing (β=-0.21), higher exposure to suicide (β=0.26), shorter length of diagnosis (β=-0.16) and greater perceived burdensomeness (β=0.23) were all associated with increased suicidality. Cancer stage was not a significant predictor of suicide behaviors. CONCLUSIONS Although exposure to suicide, length of diagnosis and reduced functional well-being were associated with greater suicidality, perceived burdensomeness, or the extent to which individuals perceived themselves as burden for their family and friends, and hopelessness appear to be more salient clinical targets. Screening and identifying troublesome cognitive patterns in patients with PCa may be beneficial in reducing suicidality. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e270 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Izard More articles by this author D. Robert Siemens More articles by this author Phylicia Verreault More articles by this author Angela Black More articles by this author Dean Tripp More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intervention among Suicidal Men: Future Directions for Telephone Crisis Support Research.

Telephone crisis support is a confidential, accessible, and immediate service that is uniquely set up to reduce male suicide deaths through crisis intervention. However, research focusing on telephone crisis support with suicidal men is currently limited. To highlight the need to address service delivery for men experiencing suicidal crisis, this perspective article identifies key challenges facing current telephone crisis support research and proposes that understanding of the role of telephone crisis helplines in supporting suicidal men may be strengthened by careful examination of the context of telephone crisis support, together with the impact this has on help-provision for male suicidal callers. In particular, the impact of the time- and information-poor context of telephone crisis support on crisis-line staff’s identification of, and response to, male callers with thoughts of suicide is examined. Future directions for research in the provision of telephone crisis support for suicidal men are discussed.

Problematizing Men's Suicide, Mental Health, and Well-Being.

The Province of Quebec, Canada (PQ), witnessed a drastic rise in suicide among adult men between 1990 and 2000, followed by a continuous drop since then. At the end of the 1990s, men's suicide became recognized as a social issue, leading to implementation of gender-responsive strategies focusing on positive aspects of masculinity. Many of these strategies received positive assessments. This article offers a critical overview of the evolution of social responses to men's suicide in PQ. We highlight elements of success with examples of interventions targeting men directly, professionals who work with men, and natural support networks of men. Results and discussion suggest the benefits to shift towards salutogenic, gender-transformative approach to men's suicide prevention. Closing remarks question the current gaps and upcoming challenges in suicide prevention among men.

Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data.

BackgroundMen generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men.ObjectiveTo explore the views of at‐risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved.DesignSecondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation.Setting and participantsA total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved.ResultsFive tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services.ConclusionTension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.

Signs of current suicidality in men: A systematic review.

Suicide signs have been identified by expert consensus and are relied on by service providers, community helpers’ and family members to identify suicidal men. Whether signs that are reported in suicide literature accurately describe male presentations of suicidality is unclear. A systematic review of the literature was conducted to identify male-specific signs of current suicidality and identify gaps in the literature for future research. Searches through Medline, CINAHL, PsychInfo and the Behavioral Sciences Collection, guided by the PRISMA-P statement, identified 12 studies that met the study eligibility criteria. Although the results generally reflected suicide signs identified by expert consensus, there is little research that has examined male-specific signs of the current suicidal state. This review highlights the need for scientific research to clarify male presentation of suicidality. Implications for future research to improve the prompt identification of suicidal men are discussed.

Diverse and Dynamic Interactions: A Model of Suicidal Men's Help Seeking as It Relates to Health Services.

There is a striking gender difference in suicide rates worldwide, with men accounting for approximately 80% of all suicide deaths. In contradictory public discussions, suicidal men are presented sometimes as victims of "poor" health services and sometimes as irremediable, "poor" help seekers. A more substantive theory of suicidal men's help seeking, which moves beyond homogenizing accounts to examine the complex interplay between help seeking and health services, is now required. Eighteen life history interviews were undertaken with men who had engaged in nonfatal suicide. Interviews were analyzed within a theoretical framework of gender relations. The findings challenge static and uniform notions of suicidal men's help seeking. While a few men actively avoided health services, others actively sought help, and in many cases help-seeking practices were triggered by unsolicited encounters with health services. Responsibility for help-seeking behavior did not rest solely with suicidal men. Men's help-seeking practices could either be facilitated or blocked by the character of the professional support that was available. Men in this study overwhelmingly rejected services that framed emotional distress and suicidal behavior as mental illness.

Commentary: Help-Seeking Patterns and Attitudes to Treatment amongst Men Who Attempted Suicide.

The Journal of Mental Health has published an article, “Help-seeking patterns and attitudes to treatment amongst men who attempted suicide” by Cleary (1). The author followed up 52 men, aged between 18 and 30 years, who made a medically serious suicide attempt for 6–8.5 years. The author reported that at the time of discharge from a hospital all patients were referred to psychiatric outpatient services but one-third (32.7%) never presented and 20% attended only for a short period of time. Almost half (48%) of the sample made a subsequent attempt, and 12% completed suicide. Suicide in men is a difficult issue and has been described as a “silent epidemic” (2–5). In the United States and Canada, men die from suicide attempts three to four times more often than females (6). Male suicide rates are larger than female rates at all ages (6). From 1999 to 2010, the suicide rate among Americans aged 35–64 years grew by almost 30%, to 17.6 deaths per 100,000 people, up from 13.7% (7). While suicide rates are increasing among both middle-aged men and women, much more men take their own lives. In 2010, the suicide rate for middle-aged men was 27.3 deaths per 100,000, whereas for women, it was 8.1 deaths per 100,000. In Europe, men commit suicides 3–10 times more frequently than women (4, 6). The gender-suicide gap is especially large in some Eastern European countries, such as Poland, Hungary, Lithuania, Latvia, Ukraine, and Belarus. After accidents, suicide is now the second most common cause of death in 15- to 24-year-old males in the United Kingdom, and it is even the leading cause of death in several other European countries in this age group (8). Lack of help seeking among men is one of the most important issues in the field of men’s mental health (9). It contributes to high suicide rates in men. Cleary (1) states that “Factors contributing to low take-up of services include lack of awareness of psychiatric symptoms, reluctance to disclose distress and negative attitudes to seeking professional help.” All three mentioned factors indicate that mental and non-mental health professionals should do a better job evaluating, educating, and treating men. This is the most important conclusion that can be drawn from the study by Cleary (1) who pointed out that “A considerable level of unmet need is implied here and young males may need more assertive outreach” and “More nuanced training for frontline, especially A&E/‘Accident and Emergency’/, staff in suicidal behaviour would both improve attitudes and increase detection rates for those with serious suicidal intent.” Indeed, men’s lack of help seeking may be related to a lack of training, interest, and responsiveness from some psychiatrists, other mental health and non-mental health clinicians who sometimes treat depressed, anxious, and/or suicidal men in an incompetent and unempathic manner (4). Clinicians often do not diagnose mood disorders and/or suicidality in men, because they have a history of impulsive–aggressive behavior and/or alcohol and drug abuse that misleads to diagnoses of personality disorders and/or substance use disorder. Among men, and young men, especially, masculinity is directly associated with receiving less health care and particularly psychiatric services (3, 4, 9–11). Public health education interventions targeting misconceptions among males that a lifestyle involving poor self-care and lack of help seeking is masculine are needed. Men should be encouraged to use the available resources such as community mental health clinics, self-help, and peer-support groups. In the United States, military veterans can use the facilities of the Veterans’ Health Administration system (12). In summary, better education of both medical professionals and the general public about men’s mental health issues is necessary and may reduce suicidality in men.

Suicide in Men

Suicide in Men

What might interrupt men's suicide? Results from an online survey of men

ObjectivesMen are almost two times more likely to die by suicide than women, yet little research has focused on what is required to prevent suicide among men. This paper aims...

What Interrupts Suicide Attempts in Men: A Qualitative Study.

Despite higher rates of suicide in men, there is a dearth of research examining the perspectives and experiences of males at risk of suicide, particularly in terms of understanding how interventions can be tailored to men’s specific needs. The current study aimed to examine factors assisting, complicating or inhibiting interventions for men at risk, as well as outlining the roles of family, friends and others in male suicide prevention. Thirty-five male suicide survivors completed one-to-one interviews, and forty-seven family and friends of male suicide survivors participated in eight focus groups. Thematic analysis revealed five major themes: (1) development of suicidal behaviours tends to follow a common path associated with specific types of risk factors (disrupted mood, unhelpful stoic beliefs and values, avoidant coping strategies, stressors), (2) men at risk of suicide tend to systematically misinterpret changes in their behaviour and thinking, (3) understanding mood and behavioural changes in men enables identification of opportunities to interrupt suicide progression, (4) distraction, provision of practical and emotional supports, along with professional intervention may effectively interrupt acute risk of harm, and (5) suicidal ideation may be reduced through provision of practical help to manage crises, and helping men to focus on obligations and their role within families. Findings suggest that interventions for men at risk of suicidal behaviours need to be tailored to specific risk indicators, developmental factors, care needs and individuals’ preferences. To our knowledge this is the first qualitative study to explore the experiences of both suicidal men and their family/friends after a suicide attempt, with the view to improve understanding of the processes which are effective in interrupting suicide and better inform interventions for men at risk.

Suicide in Men

Suicide in Men

King’s College London Student Clinical Ethics Committee case discussion: Should a homeless, potentially suicidal man, be admitted to hospital overnight for the purpose of addressing a short-term shelter problem?

Members of the Student Clinical Ethics Committee discussed the ethical issues arising in a case referred for consideration – a homeless man presenting to the emergency department of a busy London hospital with recent self-reported suicide attempts. Should he be admitted overnight in order to address a short-term shelter problem? The case study summarises the reflections of the Committee and focusses on the doctor’s duty of care and patient responsibility, benefits of admission and resource considerations.

Clustering Analysis of a Colombian Toxicological Database

ABSTRACT The database analysis allows the return of experience needed to support decision-making processes in risk management. A Colombian toxicological database (TED) developed and maintained by the Center of Safety Information and Chemical Products (CISPROQUIM by its Spanish abbreviation in) is analyzed here using a demographic clustering technique. Data-quality processes were performed on the raw data (more than 170 variables) and as a result the database was reduced to 20 meaningful variables. The variables characterized by values with categories were selected for clustering analysis: gender, age, type of emergency, emergency location, means of poisoning, product use, and physical state of the toxic substance. Clustering analysis showed that there are three profiles that are prevalent in the TED database: Young Adult Suicidal Woman, Unsupervised Child, and Man at Work. These profiles could not be identified using traditional statistical analyses performed on the data collected by CISPROQUIM or defined a priori from the categorical variables. The identification of vulnerable populations and the cause of the toxicological events are critical in order to develop national prevention programs and policies. The analysis described provided a methodology for a critical analysis of toxicological databases that can be applied to other databases such as security databases.

Providing Meaningful Care

Little is known about young suicidal men’s preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men’s initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man’s unique biography.

Increased Use of Antidepressants in Women Decreases Suicides in Men

The suicide rate has decreased in many countries, while the use of antidepressants has increased. In our previous study, the decrease in suicide rate between 1994 and 2001 was greater in men than in women, but the increase in use of antidepressants was greater in women than in men. We hypothesized that the increase in the use of antidepressants in women associates with the decrease in suicide rate in men. Population-based suicide rate and reimbursed antidepressant prescriptions, an indicator of antidepressant use, between 1994 and 2001 in Finland were analyzed in the whole population. Variance in the suicide rates in men and women was explained by antidepressant prescriptions for men and women, age, time period, and geographical region in Poisson regression analyses. The decrease in suicide rate in men associated significantly with the increase in antidepressant prescriptions in women even though the model took into account the effect of increased antidepressant prescriptions in men, as well as the effects of age, time, and region (risk ratio [RR] = 0.70, P = .004, in the model without age; RR = 0.89, P = .048 in the complete model). However, the decrease in suicide rate in women did not associate with the increase in antidepressant prescriptions in men. Increased prescription of antidepressants in women associates with a decreased suicide rate in men. Increased use of antidepressive medication in women may decrease depressiveness in their microsocieties and thereby reduce the risk of suicides also in men.

Suicide and trauma: A case discussion

In this paper we explore the relationship between trauma and suicidal thoughts and behaviour. This exploration has a double perspective: a deeper understanding of trauma can illuminate the dynamics of suicidality; and the psychotherapeutic study of suicidal people increases our understanding of the impact of trauma. This discussion addresses three particular configurations: (a) the impact on the individual of the suicide of a close person; (b) the traumatic dimension of suicidal behaviour on the self; and (c) the impact of childhood traumatic experiences on the subsequent development of suicide. We describe the psychotherapy of a suicidal man, who had suffered many losses including that of his mother to suicide, as the basis for commentary by three discussants. The paper concludes that the approach linking trauma with suicide is a fruitful one and further study is recommended.

Case-Control Study in China of Risk Factors for Suicide in Men With Alcohol Use Disorders

This secondary analysis of China's National Psychological Autopsy Study assesses the risk factors for suicide among men with alcohol use disorders (AUDs)--the second most common psychiatric diagnosis among suicide decedents in China. Based on data collected from family members and close associates, the characteristics of 68 men with AUDs who died by suicide and 51 men with AUDs who died of other injuries at 23 geographically representative locations in China were compared using univariate and multivariate logistic regression models. Interactions between AUDs and other risk factors for suicide were explored using data from 448 male suicide decedents and 521 men who died from accidental injuries. After adjusting for covariates, risk factors for suicide among men with AUDs were history of previous suicide attempts (odds ratio [OR] = 46.72, 95% CI [4.70, 464.89]), acute negative life events in the 2 days before death (OR = 18.92, 95% CI [3.32, 107.88]), and comorbid major depressive disorder (OR = 14.65, 95% CI [2.93, 73.31]). These three factors accounted for 54.3% of the variance in outcome. There was a statistically significant interaction between AUDs and major depression; the association between major depression and suicide risk was weaker in men with AUDs than in men without AUDs. Among men with AUDs in China, prior suicidal behavior, acute life events, and major depression confer risk for suicide. However, the risk associated with depression in men with AUDs is somewhat less than the risk of suicide associated with depression in men without AUDs.

Marital Breakdown, Shame, and Suicidality in Men: A Direct Link?

The influence of feelings of shame originating from marital breakdown on suicidality is examined. The role of mental health problems as probable mediating factors is also considered. Internalized shame, state (related to separation) shame, and mental health problems were significantly correlated with the score for suicidality during separation in both genders. Tested structural equation model indicated that internalized shame was not directly linked to suicidality, but was mediated either by state shame or mental health problems in males in the context of separation. Our findings seem to indicate that separated males are more vulnerable to the experience of state shame in the context of separation, which might lead to the development of suicidality.

Psychiatrists Should Be Advocates for Gun-Control Laws

Psychiatrists Should Be Advocates for Gun-Control Laws

Suicidio y género en Antioquia (Colombia): estudio de autopsia psicológica

ObjectiveTo identify differences in the socio-demographic and clinical characteristics between suicidal men and women in a sample from Antioquia (Colombia). Method144 subjects who committed suicide between 2006 and 2007 were studied by means of a psychological autopsy. Gender differences and characteristics associated independently to being a man or a woman were determined. ResultsSignificant differences independent of sex were identified. Death by firearm, living alone and suicide under the effects of alcohol intoxication were associated with the male gender, whereas suicide at home and leaving a note were associated with the female gender. ConclusionsThe present study identified differences in socio-demographic and clinical variables, and characteristics of the suicide act, between men and women. In spite of its limitations, the present findings point towards the possibility of carrying out more specific actions in suicide prevention by taking gender into account.