Male Suicide Research Articles

Targeted sequencing approach: Comprehensive analysis of DNA methylation and gene expression across blood and brain regions in suicide victims

Objectives Epigenetic mechanisms are involved in regulation of many pathologies, including suicidal behaviour. However, the factors through which epigenetics affect suicidal behaviour are not fully understood. Methods We analysed DNA methylation of eight neuropsychiatric genes (NR3C1, SLC6A4, HTR1A, TPH2, SKA2, MAOA, GABRA1, and NRIP3) in brain regions (hippocampus, insula, amygdala, Brodmann area 46) and blood of 25 male suicide victims and 28 male control subjects, using bisulphite next-generation sequencing. Results Comparing mean methylation values, notable changes were observed in NR3C1 (insula p-value = 0.05), HTR1A (insula p-value < 0.001, blood p-value = 0.001), SKA2 (insula p-value = 0.03, blood p-value = 0.016), MAOA (blood p-value < 0.001), GABRA1 (insula p-value = 0.05, blood p-value = 0.024) and NRIP3 (hippocampus p-value = 0.001, insula p-value = 0.002, amygdala p-value = 0.014). Comparing methylation pattern between blood and brain, similarity was observed between blood and insula for HTR1A. Gene expression analysis in hippocampus revealed changes in expression of NR3C1 (p-value = 0.049), SLC6A4 (p-value = 0.017) and HTR1A (p-value = 0.053). Conclusions Results provide an insight into the altered state of DNA methylation in suicidal behaviour. Epigenetic differences could therefore affect suicidal behaviour in both previously known and in novel neuropsychiatric candidate genes.

The Gendered Dimensions of Photovoice in Men’s Health Promotion Research

The use of photovoice in men’s health promotion research has grown significantly over the past 15 years. Initially mobilized as an elixir for men’s talk about health practices and illness experiences, participant-produced photographs and accompanying narratives have grown significantly in reach, influence, and application. The current article highlights the gendered dimensions of photovoice in men’s health promotion research across three studies addressing (1) psychosocial prostate cancer care, (2) fathers’ tobacco reduction and smoking cessation, and (3) male suicidality. Insights drawn from the psychosocial prostate cancer care project emphasize the plurality of masculinities, and the implications for health promoters treating the common treatment side effect of erectile dysfunction. The relational nature of gender is central to the fathers’ tobacco reduction and smoking cessation work whereby the well-being of partners and children strongly influenced men’s behavior changes amid guiding adjustments to smoke-free policies. The male suicidality research highlights the unmuting powers of photovoice for making visible the interiority of men’s mental illness, and the destigmatizing potentials for sharing participants’ accompanying narratives. Evident across the three projects are the gendered dimensions of photovoice processes and products for advancing understandings of, and avenues toward, promoting the health of men and their families. After reflecting on these advances, we offer recommendations for future men’s health promotion photovoice work.

Directing from the shadows: Women’s experiences of male relative suicide bereavement

AbstractSuicide bereavement evokes particular emotions that can hamper recovery processes, if neglected. This Interpretative Phenomenological Analysis (IPA) study explored five women’s experiences of bereavement following the death by suicide of a male relative. One superordinate theme, directing from the shadows, and three interrelated subordinate themes: roller coasting, speaking the unspeakable, and finding meaning and living with suicide were identified. This study highlights that women bereaved by suicide may occupy a complex position in the family when trying to balance caring for themselves and others, sometimes leading them to negate their own support and therapeutic needs. However, women in this study felt supported by timely, flexible and sensitive professional responses and found a proactive outreach approach, peer support groups and counselling helpful at different stages in their bereavement process.

Protocol for a cluster randomized control trial of the impact of the Breaking the Man Code workshops on adolescent boys\u2019 intentions to seek help

BackgroundMales in Australia and many other countries account for three-quarters of all deaths by suicide. School-based programs to support young men’s wellbeing have become increasingly common in recent years and show much promise to tackle the issue of male suicide by fostering protective factors and mitigating harmful factors. However, only a few of these programs have been evaluated. This trial seeks to address the lack of knowledge about the potential for school-based gender-transformative programs to have a positive impact on boys. Breaking the Man Code workshops, delivered by Tomorrow Man in Australia, challenge and transform harmful masculinities with young men with a view to ultimately reducing their suicide risk. The trial aims to examine whether adolescent boys who participate in the Breaking the Man Code workshop demonstrate an increase in their likelihood of seeking help for personal or emotional problems compared to boys waiting to take part in the workshop.MethodsA stratified cluster randomized controlled superiority trial with two parallel groups will be conducted. Schools will be randomly allocated 1:1, stratified by location of the schools (rural or urban), state (Victoria, NSW, or WA), and mode of workshop delivery (face-to-face or online), to the intervention group and waitlist control group.DiscussionThe Breaking the Man Code workshops show great promise as a school-based prevention intervention. The trial will fill a gap in knowledge that is critically needed to inform future interventions with boys and men. Some methodological challenges have been identified related to the COVID-19 pandemic in Australia, such as delays in ethics approvals and the need for Tomorrow Man to introduce an online delivery option for the workshop. The trial protocol has been designed to mitigate these challenges. The findings from the trial will be used to improve the workshops and will assist others who are designing and implementing suicide prevention interventions for boys and men.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12620001134910). Registered on 30 October 2020

Early marriage, stressful life events and risk of suicide and suicide attempt: a case\u2013control study in Iran

BackgroundEarly Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.MethodsA case–control study was conducted based on the registry for suicide in Malekan county in Iran during 2016–18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel–Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.ResultsThe proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10–15 years, while no association was found for age groups of 26–40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19—9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.ConclusionsWe found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

Masculinity and mental illness in and after men's intimate partner relationships

Male suicide continues to be a significant issue worldwide for which there are a myriad of social risk factors. Amongst these, distressed and/or disrupted (i.e., separation, divorce) intimate partner relationships are known to heighten men's mental illness and suicide risk. The current qualitative study offers novel insights to the connections between masculinity and mental illness in and after men's intimate partner relationships. Drawing from in-depth interviews with 47 Canadian and Australian men, three themes were inductively derived: 1) The trouble inside, 2) Breaking up and breaking down, and 3) Finding help. The ‘trouble inside’ results revealed relationship transitions wherein challenges to couple dynamics flowed from diverse life course events (conflict, illness, bereavement, co-parenting). Partnership transgressions (most often infidelity) also featured to heighten men's mental illness vulnerabilities and threaten the feasibility of the relationship. ‘Breaking up and breaking down’ chronicled participants' anxiety, depression and suicidality in the aftermath of their relationship ending. Herein, substance use and other maladaptive behaviours were used by men to blunt feelings and/or self-medicate mental illness. These strategies were ineffectual for moving on from blaming partners or grieving the loss of support and social connectedness provided by ex-partners. ‘Finding help’ included men's eventual self-help, uptake of informal assistance from friends and family, formal professional care services, and the use of facilitated male peer group resources. Norming the use of these diverse help resources were men's alignments to strength-based asset-building masculine ideals, wherein their help-seeking was bridged to, and reflective of their (albeit latent) commitment to better managing their mental health and future relationships. Highlighting the gendered dimensions of mental illness in men's intimate partner relationships, the current study also thoughtfully considers content and contexts for the delivery of tailored upstream suicide prevention programs focussed on men building better relationships.

Identifying Occupation Groups for Suicide Prevention: A Statewide Data Linkage Study

Objective To identify suicide rates by occupation category in Utah and describe the hospital history and circumstances of suicide decedents in the occupation category that had the state's highest rate and highest number of suicides: Construction and Extraction. Method We used data on suicide decedents from the National Violent Death Reporting System (NVDRS) for 2005–2015 (n = 4,590) to calculate sex- and occupation-specific suicide rates among adults 18–65 years old in Utah. For working-age men who died by suicide during the years 2014–2015 (n = 623), we linked NVDRS data with decedents’ hospital histories. Results One in five working-age men who took their life in Utah worked in Construction and Extraction, the single Bureau of Labor Statistics occupation category with both the highest number (n = 719) and rate of suicides (86.4/100,000 men vs. a range of 15.3–66.2 for other occupations). For females, there was no occupation group that had both high rates of suicide and high numbers of suicides compared with other occupations, so there was no clear occupation group to focus on in the same way there was for men. Using linked data for 2014–2015 deaths, 58% of men in Construction and Extraction who died by suicide had been diagnosed in the hospital in the past three years with a substance abuse or mental health problem, and a quarter (25%) tested positive for opioids on post-mortem examination. Nearly half (48%) of 2014–2015 male suicide decedents in Construction and Extraction were reported to have intimate partner problems, about a quarter (26%) had a criminal problem, a quarter (25%) were unemployed, and over half (54%) died by gunshot. Conclusions Linked data identified Construction and Extraction as a potentially high-impact occupation group for suicide prevention and suggested potential contexts for intervention. HIGHLIGHTS Construction and Extraction stands out as an occupation group with a very high number and rate of suicides. Two-thirds of male decedents in Construction and Extraction had a substance abuse problem. For Utah females, there were no occupations with both high rates and high numbers of suicides.

Gender Differences in Committing Suicide in Thailand

Background: The purpose of this study was to investigate gender differences in suicide in Thailand. Methods: The observational investigation was carried out by scrutinizing existing historical data over a 25-year period, from 1994 to 2020. Data were obtained from the Thai Department of Mental Health and WHO cause of death data. We use the codes ICD-10 (X60-X84) to identify mortality due to different methods of suicide. Results: During a 25-year study period, the range of suicide rates per 100,000 people varied between 3.97–8.59, and the mean (standard deviation, SD) was 6.66 (0.99). Male rates were higher than female rates (t = 23.43; p &lt; 0.001). The mean suicide rate (SD) for men was 10.44 (1.56) and 2.97 (0.56) in women. There were statistically significant differences between genders in terms of suicide rates among age groups (p &lt; 0.001). Suicide rates were higher in men and in all those aged 20–59 years and 60 years and older. Age 30–39 years were the majority group of the suicide rate, the mean (SD) was 9.99 (2.21), 16.82 (3.89) in men, and 3.17 (0.60) in women. The most common means of suicide during the study period is hanging (62.32%); it also has an increasing trend each year in both men and women. Followed by pesticide poisoning (20.66%), and unspecified means (7.70%). Hanging, pesticides, gun and firearm, and drug overdose were found to be the highest incidence in men between 20 and 39 years of age. The incidence rate of suicide was found to be higher in men in all suicide methods with gender ratios 6:1. Gun and firearm were the highest proportion of means of completed suicides in males (15:1), followed by sharp objects, other specified means, and alcohol suicide (the same ratio 6:1). Conclusions: Compared to women, in all ages, men have a higher rate of completing suicide. Several suicide completers employed violent means of self-harm that were impossible to rescue, especially hanging, guns, and firearms, and jumping from high places. Therefore, suicide screening and suicide monitoring systems need to be advocated and implemented on a regular basis.

Background of suicide amidst COVID-19 pandemic in India: A review of published literature

Background and Objectives: Globally, suicide is a pertinent public health crisis that affects almost all nations cross-culturally. Suicide is one of the leading causes of death in many countries, even before the COVID-19 pandemic hit worldwide. India, a nation developing rapidly, is also not free from the leashes of suicide deaths. COVID-19 augmented the rate of suicide due to multifaceted determinants. Adequate empirical evidence about data on suicide is also scarce. Materials and Methods: This review synthesizes determinants, available demographic correlates, and reported rates of suicide published in the Indian context. The authors conducted a thorough literature search to find published English free full-text scientific articles related to suicide during the COVID-19 pandemic in the Indian context. Databases relied on for literature were PubMed, Google scholar, and PLOS one databases using comprehensive search strategies to avail the maximum number of studies. Results: Ten out of 76 studies available in the initial search were analyzed thoroughly for ruling out determinants, rates, and sociodemographic correlates of suicide. Fear of COVID-19 infection, financial crisis, mental breakdown, and job loss are cardinal reasons attributed for suicide, and male suicides are more prevalent in this arena. Interpretation and Conclusions: Findings portray factors such as fear of COVID-19 diagnosis, apprehension to become infected, financial crisis, loss of job, and isolation are some of the significant determinants quoted out. The study points out the need for multifaceted policies in preventing this public health crisis.

Gender differences in death during hospitalization following a survived suicide attempt in Taiwan from 1998 to 2015: a cross-sectional study

Background: This study examines gender differences in death during hospitalization following a survived suicide attempt. The outcome of death during hospitalization following a survived suicide attempt and yearly rate of suicide attempts ending in hospitalization is examined. Methods: Data on 53,670 hospitalized patients injured by suicide attempt between January 1, 1998, and December 31, 2015, were collected from the National Health Insurance Database. From 1998 to 2015, 24,052 male patients and 29,618 female patients were screened and matched by age, gender, and filing date. Multinomial logistic regression was used to analyze the risk of death in terms of gender differences and suicide and hospitalization. p &lt; 0.05 was considered statistically significant. Results: The risk of death during hospitalization after a survived suicide attempt of hospitalized male suicide patients was 1.694 times that of females (adjusted odds ratio (AOR) = 1.694, 95% confidence interval (CI) = 1.569–1.829). The risk of suicide and hospital death for male patients older than 65 years was 3.608 times that of male patients aged 10–24 years (AOR = 3.608, 95% CI = 2.914–4.468) and 6.648 times that of females (AOR = 6.648, 95% CI = 5.105–8.658). Every 1-point increase in the Charlson Comorbidity Index score of male suicide patients increased the risk of suicide hospital death by 5.6%, which indicates that the number or severity of the complications experienced by hospitalized male suicide patients was higher than that of women. Conclusions: Although men comprised a smaller proportion of hospitalized individuals following a survived suicide attempt, they also arrived in more critical condition and were more likely to die during their hospitalization. The increasing trend of female suicide attempt hospitalization rates is greater than that of males and yearly rate of suicide attempts ending in hospitalization is examined.

Perspectives on Race, Gender and Power Differentials in Lived Experiences of Failed Suicide Bombers in Pakistan

The study documents lived experiences of failed suicide bombers in Pakistan. It describes the influence and impact of social structures like gender, geography race and ethnicity with reference to their experiencing of suicide bombing. The study also characterizes the power relations in their interactional contexts entailing in unquestioning submission and support to militant organizations. Owing to ideological charged conditions and overwhelming existence of terrorist organisation certain regions and ethnicities in Pakistan exhibit unusual inclination to suicide terrorism. The article also argues the strategic necessity and ideological under pining of feminizing suicide terrorism in Pakistan by terrorist outfits. Feminizing of suicide terrorism in Pakistan is driven by out of strategic and political expediency. Women in Pakistan are enlisted mostly by means of physical and emotional coercion, exploitation of familial ties and patriarchal influences. The lived experiences of the male and female suicide bombers gathered from in-depth interviews and secondary data delineate the factors and process of ‘zombification’. Keywords: Female suicide bombers, Suicide bombing, gender, race and ethnicity, terrorism, power.

Socio-economic determinants of suicide rates in transforming China: A spatial-temporal analysis from 1990 to 2015

SummaryBackgroundChina has experienced dramatic social changes in the last three decades. This study aimed to investigate socio-economic factors related to suicide rates in China from 1990 to 2015, and examine how the impacts of these factors on suicide rates changed over time.MethodsSuicide rates in 31 provinces in mainland China between 1990 and 2015 were obtained from the Global Burden of Disease (GBD) Study 2019. Temporal-spatial modelling was applied to assess the effects of GDP per capita, urbanization, migration, employment, divorce, proportions of children and older adults on provincial overall, male and female suicide rates.FindingsThe overall suicide rate in China declined from 18·1 /100,000 in 1990 to 8·6 /100,000 in 2015, with considerable spatial variation in the magnitude of decline across provinces. The protective effects of increasing in GDP per capita, and urbanization, on provincial suicide rate were strong in 1990 (log GDP: -3·56 [95% CI: -6·15, -0·96], urbanisation: -0·07 [-0·14, -0·01]), however these effects were negligible by 2015. The association between employment and suicide rates has shifted from positive to negative over the study period, while migration remained a constant risk factor for high suicide rates (0·04 [0.00, 0·09]).InterpretationThis study highlighted the dynamic effects of economic and social factors on suicide rates in the context of transforming China. To maintain further reductions in suicide rates cannot rely simply on improving people's materialistic and economic conditions. A more holistic approach to improve overall population well-being is needed.FundingHumanities and Social Sciences Prestigious Fellowship (37000320) and the General Research Fund (17611619) at the University of Hong Kong.

A time-series analysis of the association between alcohol and suicide in Australia

Introduction800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017. Materials and methodsAge and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined. ResultsA 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality. DiscussionContemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

Opposite nonlinear effects of unemployment and sentiment on male and female suicide rates: Evidence from Australia

We investigate gender differences in the effects of unemployment and sentiment on suicide rates. Using monthly Australian data, we find a positive relationship between the unemployment rate and the suicide rate, and a negative relationship between consumer sentiment and the suicide rate. However, there is strong evidence of nonlinearity in the effects of both unemployment and sentiment on suicide rates, with substantial gender differences. For men, an increase in the unemployment rate increases the suicide rate, but an unemployment decrease has no effect; we find the opposite for women. For men, an increase in sentiment has stronger effects on the suicide rate than a decrease in sentiment. Again, we observe the opposite effect for women. Among sentiment components, forward-looking expectations are stronger predictors of suicide rates than present conditions. Sentiment has a much stronger effect on male suicide rates than on female suicide rates.

A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males.

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis “Gender differences in self-reporting symptom of depression,” suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

Sociodemographic Analysis of Suicide Rates Among Older Adults Living in Ecuador: 1997-2019.

Background: Despite most suicides occurring in low-and-middle-income countries (LAMICs), limited reports on suicide rates in older adults among LAMICs are available. In Ecuador, high suicide rates have been reported among adolescents. Little is known about the epidemiology of suicides among older adults in Ecuador.Aim: To examine the sociodemographic characteristics of suicides among older adults living in Ecuador from 1997 to 2019.Methods: An observational study was conducted using Ecuador's National Institute of Census and Statistics database from 1997 to 2019 in Ecuadorians aged 60 and older. International Classification of Diseases 10th Revision (ICD-10) (X60-X84)-reported suicide deaths were included in addition to deaths of events of undetermined intent (Y21-Y33). Sex, age, ethnicity, educational level, and method of suicide were analyzed. Annual suicide rates were calculated per 100,000 by age, sex, and method. To examine the trends in rates of suicide, Joinpoint analysis using Poisson log-linear regression was used.Results: Suicide rates of female older adults remained relatively stable between 1997 and 2019 with an average annual percentage increase of 2.4%, while the male rates increased between 2002 and 2009, 2014 and 2016, and maintained relatively stable within the past 3 years (2017–2019). The annual age-adjusted male suicide rate was 29.8 per 100,000, while the female suicide rate was 5.26 per 100,000 during the study period. When adding deaths of undetermined intent, the annual male rate was 60.5 per 100,000, while the same rate was 14.3 for women. The most common suicide method was hanging (55.7%) followed by self-poisoning (26.0%). The highest suicide numbers were reported in urban districts, men, and those with lower education status.Conclusion: This study contributes to building the baseline for further studies on suicide rates of older adults in Ecuador. Results highlight priority areas of suicide prevention. By examining suicide trends over 23 years, findings can help inform policy and future interventions targeting suicide prevention.

Suicide and divorce in South Korea: focusing on types of divorce

ABSTRACT Using a panel of province-level data in South Korea over the last two decades, this paper examines the effect of divorce on female and male suicide rates. By focusing on the types of divorce and the reasons for divorce, I find that a higher mutual-consent divorce rate is associated with a decrease in female suicide rate, whereas the judicial divorce rate is positively associated with male suicide rate. For the reasons for divorce, I find that an increase in divorce rate caused by unfaithful acts, a representative reason for judicial divorce, raises female suicide rate, while divorce rates caused by main reasons for mutual-consent divorce are negatively associated with female suicide rate.

Analysing effects of financial support for regional suicide prevention programmes on methods of suicide completion in Japan between 2009 and 2018 using governmental statistical data

ObjectivesTo explore the mechanisms of reduction of suicide mortality in Japan (from 25.7 to 16.5 per 100 000 population) between 2009 and 2018, the present study determined the effects of...

823Suicide of welfare and care support workers: a retrospective mortality study in Australia 2001-2016

Abstract Background Emerging evidence suggests that people working in the welfare and health care industry have poorer mental health than other occupational groups; however, there has been little examination of suicide among this group. In this study, we examine suicide rates amongst welfare and care support workers and compare them to rates among human service workers, and all other occupations in Australia. Methods We used data from the National Coroners Information System (NCIS) to obtain records of death due to intentional self-harm between the years 2001 to 2016. We calculated age-standardised suicide rates and incident rate ratios to compare the suicide rates across different occupational groups. Results The age-standardised suicide rate of males is the highest amongst welfare and carers (24.1 per 100,000). After adjusting for age and year of death, we found that men working as welfare workers and carers have a significantly higher suicide rate than men working in other occupations (IRR 1.43, CI 1.2-1.7). Furthermore, male human service workers have a slightly lower rate of suicide than those working in other occupations (IRR 0.73: CI 0.66-0.82). The finding was similarly noted in female suicide deaths, however, the higher suicide rate in female welfare workers was not statistically significant (IRR 1.12 CI 0.9-1.39). Conclusion The suicide rates of welfare and care-related occupations are as high as occupations which are identified as at-risk occupations for male suicide in Australia. Key message There is a need for targeted programs to improve the suicide health literacy among welfare and care support workers.

The Great East Japan Earthquake and suicide: The long-term consequences and underlying mechanisms

How and why do major natural disasters affect suicide? This study revisits this question by focusing on the Great East Japan Earthquake (GEJE) in March 2011 as a historically important natural disaster. Using an event-study analysis, we assessed how the GEJE changed the suicide rates in the regions affected by it and whether its effect persisted, attenuated, or escalated over time. In addition, we explored the political and social channels underlying the relationship between the GEJE and suicide. Using prefecture-level data, our analysis reveals that suicide by men aged 40–64 years and 65 years and over showed a large decline in the GEJE-affected prefectures in the years following the earthquake, and this decline attenuated over time. Furthermore, following the GEJE, government spending increased while divorce rates decreased in the affected prefectures, both of which were correlated with male suicide rates. These findings indicate that suicide after major natural disasters is preventable when political and social reactions to disasters provide a safety net, especially for men.