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Doctors and psychologists are testing new ways to treat a long-running mental-health crisis: high rates of suicide among middle-aged and older men.

Men overall have a suicide rate between three and four times as high as women, according to data from the Centers for Disease Control and Prevention. One reason is that men tend to choose more lethal means—most often firearms—when they attempt. Men are also less likely than women to seek mental-health help. And men’s anxiety and depression often come across as anger or irritability rather than worry and sadness, so conditions that can raise the risk of suicide can go undiagnosed and untreated.

Researchers are investigating new approaches amid rising concern about mental health coming out of the pandemic, and after years in which suicide rates remained stubbornly high. One study found promise in men’s groups aimed at building resilience and camaraderie, particularly among men struggling with the transition to retirement. Another asks men to create “hope kits" with reminders of what they have to live for, such as pictures of loved ones. Another study used videos to show men how they might talk to their doctors about suicidal thoughts, with language that frames getting help as a way of taking charge.

“For many men, by the time we’re in middle age, the idea that we should keep our vulnerabilities to ourselves is so overlearned, so well-rehearsed," says Michael Addis, a professor of psychology at Clark University in Worcester, Mass.

For years, middle-aged and older men were the groups most likely to die by suicide. The suicide rate in 2020 was 27.3 per 100,000 among men ages 45 to 64, and 40.5 per 100,000 among men ages 75 and older, according to the most recent CDC data. The rate among men ages 25 to 44 overtook that of 45- to 64-year-old men in 2020, to rise to 28.3 per 100,000.

Loneliness and social isolation are risk factors, and men tend to become more socially isolated as they age, Dr. Addis notes. Men are also more likely to self-medicate with drugs and alcohol, which can mask other mental-health issues and lower inhibitions.

Health problems, physical pain and the losses that can begin to emerge in midlife can hit men hard, says Sherry Beaudreau, a clinical psychologist and lead investigator of a continuing U.S. Department of Veterans Affairs-funded study of a problem-solving therapy to reduce suicidal thinking in older veterans, the majority of whom are men. Dr. Beaudreau’s treatment, like some others being tried, modifies an existing therapy, which could make implementing it easier and quicker.

Marnin J. Heisel, a professor of psychiatry at the University of Western Ontario,is examining “meaning-centered" groups for men, especially those having trouble with the transition to retirement. Men complete exercises such as reflecting on the positive impact they have made on others and imagining how they can keep contributing to their families and communities. The support and camaraderie the groups engender are also important, Dr. Heisel says.

After 12 sessions, participants in the groups reported significantly higher scores on measures of life satisfaction and psychological well-being, and significant reductions in symptoms of depression and thoughts of killing themselves, according to a study involving 30 men ages 55 and older published in 2020 in the journal Clinical Gerontologist.

Researchers at the University of Pennsylvania’s Perelman School of Medicine are testing therapy to change the negative thoughts that can fuel distress associated with suicide risk and boost reasons for living, says Gregory K. Brown, director of the Penn Center for the Prevention of Suicide. As part of the treatment, men between the ages of 50 and 70 with suicidal thoughts create physical “hope kits" with reminders of what they have to live for.

Other efforts aim to identify at-risk men and encourage them to seek help. Researchers at the University of California, Davis and colleagues developed an interactive tablet-based computer program for men to use in the waiting room at their doctor’s office. The program includes videos showing men discussing suicidal thoughts with their doctors.

“We use these sort of stereotypically masculine analogies that [discussing mental health] is taking charge, doing the right thing for you and your family," says Anthony Jerant, a professor and chair of the department of family and community medicine at UC Davis.

Men who used the program were much more likely to discuss their suicidal thoughts with their medical providers, according to a study involving 48 men with suicidal thoughts published in 2020 in the Journal of General Internal Medicine.

Men who are able to share their struggles can find help.

In the fall of 2019, Steve Siple, now 54, was in a dark place. He was between jobs, trying to break into a new industry and, with college on the horizon for the youngest of his three children, facing tremendous financial stress. He was also struggling with the transition to an empty nest. “I was searching for what’s next in my life and the purpose," he says.

He had thoughts of killing himself. “I didn’t tell anyone," he says. Not his wife and not his longtime therapist, whom Mr. Siple had seen off and on for depression and anxiety in the wake of his own father’s suicide.

A friend, sensing something was wrong, asked Mr. Siple if he was thinking about killing himself. Through tears, he admitted that he was.

“It was relieving but exhausting at the same time," said Mr. Siple, a senior manager at a financial-services technology company in Birmingham, Ala., who has volunteered with the American Foundation for Suicide Prevention.

The friend’s question opened the door to get help, he says. He told his therapist about his thoughts and increased the frequency of his therapy sessions. He leaned on his family and his Christian faith.

“There should be no shame or stigma" around getting help for suicidal thoughts and behaviors, says Christine Yu Moutier, chief medical officer for the American Foundation for Suicide Prevention. “Prevention is possible."

 

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