Suicide flashpoint: Men in midlife
In 2016, seven out of ten suicide deaths were white males, according to the American Society of Suicide Prevention. (https://afsp.org/about-suicide/suicide-statistics/) Nationally, white men, ages 45-65, make up the group that is at greatest risk for suicide.
“Actual interventions tend to focus a lot on young people,” explained Dr. Robert Dubois, a psychologist who teaches at Waukesha County Technical College in Pewaukee, Wisconsin. “But if you really mine the data, you find that by far the greatest risk for suicide is among middle-aged men. And this holds true in Waukesha and Milwaukee counties as well as around the globe.”
In Milwaukee County, 74 percent of suicide deaths in 2017 were men and 83 percent of these were people over the age of 25, according to the 2017 Prevention Suicide Wisconsin Coalition Survey. (http://www.preventsuicidewi.org/Data/Sites/16/media/suicide-facts/2017-coalition-survey.pdf)
“Basically mid-life for both men and women tends to be the peak for suicidal deaths, although for men there is a second peak later in life,” DuBois said. “With women the rate tends to decline with age.”
By the time men get into their late 30s, 40s or 50s, they’ve reached that suicide flashpoint. They begin to realize they might not accomplish all that they had set out to do when they were just starting out in their 20s.
“Maybe they’re facing a divorce or experiencing the death of a parent,” said Dr. Tony Piparo, a Milwaukee-area sports performance psychologist, who has written and published a book on coping with depression and frequently speaks on suicide. “Then there are the economic changes that have been going on over the last decade or so – wages and opportunities going down and the chance for financial success becoming more limited. Men may find they are not able to take care of their families the way they had hoped or planned to do. All of these factors weigh heavily on men. Plus men are conditioned to hold everything inside.”
According to DuBois, women are far better at reaching out to others and sharing their feelings. Men, on the other hand, have been socialized to remain tough and to avoid feelings – both processing or talking about them openly.
“Men tend to externalize feelings,” DuBois said.“They tend to engage in aggressive behavior or turn to alcohol or other drugs to diffuse emotional pain and stress.”
And unfortunately, there is still a lot of stigma around mental health.
“Too many people are afraid to admit they suffer from a mental health issue like depression,” Piparo said. “And of course because we teach men that they’re not allowed to be weak in any way, especially mentally, we don’t arm them with the tools necessary to understand what’s going on with them inside.”
While alcohol and drugs can provide an escape in the short term, in the long run these coping behaviors backfire.
“Drugs and alcohol keep people from processing feelings and making the necessary changes so they can adapt and cope,” DuBois said. “And of course, drugs and alcohol can also fuel addiction, which actually makes problems worse.”
As the stress continues to grow, the emotional pain can become too overwhelming.
“They have all of this boiling up inside and believe the only option is to end their life, because it is the only way to end their pain,” Piparo said.
Retirement and post-retirement are also high-risk times for men, particularly when it is not planned.
“It might happen unexpectedly,” DuBois said. “Sometimes people are pushed into early retirement. In these cases, they don’t have the time to go through the normal process of retirement planning.”
For many people, work gives them a sense of purpose – a reason to get out of bed in the morning.
“If people don’t have something else besides work to give them a sense of purpose later in life, if they’re disconnected from family, widowed or divorced, retirement can be a really tough time,” DuBois said.
Another key difference between genders has to do with the means men and women use for suicide.
“Men tend to use firearms more frequently,” DuBois said. “Women use prescription drugs/drug overdose more frequently. Firearms have a 90 percent mortality rate. Drugs have about a 2 percent mortality rate.”
In the end, this means men have a three to four times higher suicide rate than women; while women have a three to four times higher suicide attempt rate.
“Unfortunately there is a growing concern that women are beginning to use firearms more frequently, particularly combat soldiers who are women,” DuBois said.
Focusing on policies that keep people in their homes and help them find good jobs is critical to impacting these trends.
“In terms of intervention, we know from research that some of the biggest factors are economic and related to work or housing,” DuBois said. “When people feel like they’re at a point when they’re not going to be able to survive and their basic needs are going to be met, they’re extremely vulnerable.”
Piparo has been focusing on helping people learn better techniques to cope with anxiety, depression and stress. According to Piparo, there are two important forces that combine to send people into a state of feeling helpless and hopeless — overactive fight or flight and negative programming that spirals down and out of control.
“When someone gets into a fight or flight mode, the pupils of their eyes dialate,” Piparo said. “Their breathing is shallow or they might hold their breath altogether. Very little oxygen is getting to the brain. The right and left hemispheres of the brain get disconnected. They aren’t able to focus and do the kind of thinking that is necessary to help us resolve problems.”
In times of acute stress, it’s important to remember that thoughts and feelings are fleeting.
“The way you feel right now, in terms of degree of pain your experiencing, the psychological ache that you’re confronting, is not really a good predictor of how you’re going to feel an hour from now, a day from now, a week from now, a month from now, a year from now,” DuBois said. “We need to learn not to make decisions based on negative feelings we may be having in the moment. We need to step away from those feelings and realize that although there are potentially things we can learn from the feeling we are experiencing, ultimately we do not want to act on them immediately. There are millions of people around the world who have been in really dark places and are now in a very different place and are very grateful that they did not die or attempt to die.”
DuBois would also like to get prevention and intervention programs in more work places.
“There are more interventions out there for youths, but not much for adults,” DuBois said. “We need to think out of the box in terms of how we reach men, who might be struggling with anxiety and depression or thinking about suicide. If we can get into employers and get people feeling safe about talking about these issues where they work, that might actually get people to feel more comfortable about reaching out to get help.”
Ultimately, we need men who are willing to step forward and talk about their struggles with anxiety, depression and stress.
“How do we make it cool to be an adult who is open about their own experiences dealing with past distress?” DuBois asked. “It would be great if more adults could be seen as role models and were really willing to go out of their way to be a gatekeeper and help identify people who might be struggling with thoughts of suicide.”
Piparo also believes there is reason to hope.
“We are starting to get better information out there about what is causing depression and offering new therapies and complementary therapies to work with medication and the cognitive behavioral approach,” Piparo said. “My hope is that yes, this will change with the younger generations. I think it is a strong possibility, and it’s what defines my work.”