BY LAURA MICHAEL

A boy poses in a picture for suicide awareness day. Although raising awareness through days like this are very important, initiatives to counter the societal flaws that lead to high suicide rates and to target subsets of the population, like white middle aged men, that have high suicide rates must be viewed as necessary, life-saving public health measures. Source: Flickr.

In recent years, both the American government and public have given increasing amounts of attention to mental health issues and awareness on college campuses and among adolescents. While college students and adolescents represent two vulnerable populations in America, they are not necessarily at the highest risk for suicide. Although white men historically maintain a place of privilege in the United States, they represent one subpopulation at the highest risk for death by suicide. 1 In 2015, the crude suicide rate for white non-Hispanic males aged 40 to 65 was 36.84 per 100,000 people, more than twice the rate of suicide in the general American population.2

An inadequate analysis might claim that the elevated rate of suicide among middle aged white men exists simply because they have higher prevalence of mental illnesses such as depression. Research, however, shows that women, not men, have a higher incidence and prevalence of depression.3 While suicide has long been linked to depression, high rates of suicide are not the definitive product of high rates of depression; as a result, not every case of depression will result in suicide or even suicidal thoughts. A 2001 study of members of five US ethnic groups and both sexes found white males to have the highest suicide rate relative to prevalence of depression over the course of one year.4 This study, however, did not attempt to define a causal relationship between gender, race, and suicide. Societal and cultural explanations for the elevated rates of suicide among people within specific subpopulations, especially middle aged white men, must be investigated. As Jason Houle, PhD, articulated in a report published in Sociological Perspectives, “we often think of suicide as an individual act, but the social and physical environment is really an important determinant of suicide.”5

Part of the explanation for the elevated rate of fatal suicides among middle aged white men in America is that, on a broad level, men of all races and ethnicities are more likely to die by suicide than women.1 Although women attempt suicide at a greater rate than men, the mortality rate of suicide is significantly higher among men than women. 6 In 2015, the age adjusted suicide rate in white men was almost four times as high as that of white women.2 One explanation for this paradox is that men are more likely to use methods of high lethality such as guns and hanging, whereas women are more likely to attempt suicide by methods that can be reversed, such as drug overdoses and poisoning.6 The high prevalence of suicide among middle class white males, however, cannot be reduced to a gun control issue because it is next to impossible to regulate the materials needed for other equally lethal methods such as hanging.7

The difference in the lethality of methods chosen by men and women explains the gender disparity in fatal suicides, but the motivation behind these different types of self-harm is more difficult to determine. One theory that could explain the increased rate of suicide amongst white males is “cultural script theory,” which posits that social expectations can influence people’s choices. The idea of cultural scripts is not specific to the study of suicide, but its proponents believe that societies in which men more frequently die by suicide have cultures that view fatal suicide as a dignified masculine behavior, but attempting suicide or committing non-fatal self-harm as a weak feminine behavior.3 According to the cultural script theory, this phenomenon ultimately creates a vicious cycle in which “cultural expectations about gender and suicidal behavior function as scripts; individuals refer to these scripts as a model for their suicidal behavior, and to make sense of others’ suicidal behavior.”3 The cultural script theory provides a social explanation for the difference in suicide methodology and fatality between men and women in the United States and other English-speaking Western countries such as Canada, New Zealand, and the United Kingdom.

Although women are more likely to attempt suicide, men are more likely to die by suicide. In 2015 white men in the United States had an age adjusted suicide rate of 23.6 per 100,000 whereas white women in the United States had an age adjusted rate of 6.92 per 100,000.

Aside from the gender gap, middle-aged white men still make up a particularly large percentage of the deaths by suicide in the United States. A 1977 study found that “there is reason to believe that the mechanisms for unleashing suicidal thoughts are no different in blacks and whites.”8 In other words, the same characteristics lead to an increased likelihood of suicide in black men as in white men. After coming to this conclusion, the study sought to explain the disparity in suicide fatalities between white and black men by investigating whether these “mechanisms” occurred more frequently in white men than in black men. In an analysis of the general population, the study found that white men were more likely to be unmarried, to know someone who had committed suicide, to feel that suicide was sometimes justified, and to lack pride in becoming older. While this study demonstrated a potential association between these attitudes and race, it was not able to conclusively determine which specific variables accounted for the high risk of suicide in older white men because it lacked a completely representative sample.

Few studies have attempted to identify specific risk factors for suicide in white middle aged men, but some have investigated these risk factors in areas that happen to have large populations of middle aged white men. The states of Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, and Wyoming constitute a region that has come to be known as the “suicide belt” since sociologist Matt Wray noticed an alarming trend in the early 2000s. This “suicide belt” is disproportionately populated by middle-aged white men who are often socially isolated, unemployed, and have access to guns. Although suicides in these states occur outside of the middle aged white male population, the large concentration of white men in these areas enables data from the suicide belt to provide a useful indication of the risk factors that lead to high rates of white male suicide fatalities. Recent research has found, for example, that residential instability plays a large role in the suicide belt’s elevated suicide rates.5

The high rate of suicide deaths in older white men is most likely a result of a mix of many risk factors that, when combined, can be fatal. The common thread in research surrounding suicide in older white males is evidence of a sense of separation from society. The increasing rates of death by suicide among middle-aged white men, therefore, may indicate broader societal problems such as declining levels of social connectedness, weakened communal institutions, and fracturing along class, cultural, geographic, and educational lines.9 More research is necessary to identify specific risk factors so that public health officials can create more precise modes of suicide prevention. In the meantime, our health institutions must take broader steps to prevent suicide.

White men accounted for 7 out of 10 suicides in 2015.1 This is in part because they make up such a large portion of the American population, but also because the rate of suicide among middle-aged white men is so inflated. Middle-aged white men are a subset of the American population that deserves more attention when it comes to suicide prevention. Currently, suicide is the tenth leading cause of death in the United States.1 As treatments and prevention initiatives improve for biological diseases such as cancer and stroke, developed countries will continue to see deaths by suicide and the associated problems of overdose and addiction climb to the top of their mortality lists. Policy makers currently struggle to justify spending on anti-suicide measures because it is difficult to determine direct causes of suicide, and the complex set of risk factors for suicide hinders efforts to quantitatively evaluate the success of preventative initiatives. Even the studies cited in this paper are observational rather than experimental; as a result, while they are useful for theorizing, they cannot conclude direct causation. As difficult as the study of suicide may be, however, it is critically important. As researchers work to identify more specific risk factors for suicide, initiatives to counter the societal flaws that lead to high suicide rates and to provide prevention resources for high-risk populations, such as white middle aged men, must be viewed as necessary, life-saving public health measures.

 

No matter your age, gender identity, race, or ethnicity, suicide is never the solution. There is never shame in getting help. If you or someone you know needs help, please contact the resources below:

National Suicide Prevention Lifeline: 1-800-273-8255

Yale Walden Peer Counseling: (203)-432-8255

 

Laura Michael is a freshman in Pierson College. Laura is a prospective Applied Mathematics major. Contact her at laura.michael@yale.edu.

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References:

  1. American Foundation for Suicide Prevention. “Suicide Statistics — AFSP.” 2017. Accessed February 25, 2017. https://afsp.org/about-suicide/suicide-statistics/.
  2. cdc.gov. (2017). WISQARS Fatal Injury Reports. [online] Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate10_us.html Accessed 18 Mar. 2017.
  3. Canetto, Silvia Sara and Isaac Sakinovsky. “The Gender Paradox in Suicide.” Suicide and Life Threatening Behavior 28, no. 1 (1998): 1–23.
  4. Oquendo, Maria A., Steven P. Ellis, Steven Greenwald, Kevin M. Malone, Myrna M. Weissman, and J. John Mann. “Ethnic and Sex Differences in Suicide Rates Relative to Major Depression in the United States.” American Journal of Psychiatry158, no. 10 (October 2001): 1652–58. doi:10.1176/appi.ajp.158.10.1652.
  5. “Solving the Riddle of the U.S. Suicide Belt’.” June 12, 2013. Accessed February 25, 2017. http://www.rwjf.org/en/library/articles-and-news/2013/06/solving-the-riddle-of-the-u-s–suicide-belt.html.
  6. Bilsker, Dan and Jennifer White. “The Silent Epidemic of Male Suicide.” BC Medical Journal 53, no. 10 (February 2017). Accessed February 25, 2017. http://www.bcmj.org/articles/silent-epidemic-male-suicide.
  7. Sanger-katz, Margot. “Gun Deaths Are Mostly Suicides.” The Upshot (The New York Times), October 8, 2015. https://www.nytimes.com/2015/10/09/upshot/gun-deaths-are-mostly-suicides.html.
  8. Robins, Lee N., Patricia A. West, and George E. Murphy. “The High Rate of Suicide in Older White Men: A Study Testing Ten Hypotheses.” Social Psychiatry 12, no. 1 (1977): 1–20. doi:10.1007/bf00578977.
  9. Squires, David and David Blumenthal. “Mortality Trends Among Working-Age Whites: The Untold Story.” January 29, 2016. Accessed March 1, 2017. http://www.commonwealthfund.org/publications/issue-briefs/2016/jan/mortality-trends-among-middle-aged-whites.
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