title: Exploring the relationship between male gender, male psychology, and male suicide risk and recovery
Creators: name: Bennett, Susanna
Publisher: name: University of Glasgow
Year: 2024

description: Background:
Globally, one of the most consistent facts about suicide is that men are more likely to die than women. In the United Kingdom, suicide is the leading cause of death among men under the age of 50. The magnitude of the male suicide crisis demands urgent investigation into its causes and strategies to reduce its prevalence. Despite the persistent gender disparity in suicide rates, there has been limited research specifically focused on male suicide, and even less exploring the relationship between male gender, male psychology, and suicide. This thesis undertakes preliminary, exploratory study research to enhance our understanding of how gendered aspects of male psychology may intersect with male suicide risk and recovery. The objective of this thesis is to generate new knowledge and propose hypotheses regarding potential phenomena associated with male suicide risk and recovery. As such, this thesis has four overarching aims: 1) Conduct basic, exploratory research to advance our understanding of male gender, male psychology and male suicide; 2) Develop our understanding of the psychological pathways underpinning male suicide risk and recovery factors, including potential psychological distinctions between proximal/distal risk and potential psychological distinctions between men with thoughts of suicide and men who have attempted suicide; 3) Explore the barriers men who are suicidal experience in seeking professional support; and 4) Develop an agenda of research priorities to guide the next iteration of male suicide research. 

Methods:
This thesis is comprised of 4 empirical chapters. It begins in Chapter 3, with a systematic review and meta-synthesis of qualitative literature, conducted to investigate male suicide risk and recovery factors (N = 78 studies). Chapter 4 was a global cross-sectional study to explore psychosocial differences between men who have attempted suicide, men with suicidal ideation and men with no suicidal history. Chapter 5 was a qualitative thematic analysis of the barriers men who are suicidal experience in accessing professional support. The thesis concludes with a Delphi study (Chapter 6) working with lived experience experts to develop an agenda of research priorities to progress the field of male suicide.

Results:
Findings from Study 1, the systematic review, revealed a potential association between norms of masculinity and suicide risk in 96% of studies. Masculine norms related to male emotional suppression, failing to meet standards of male success and the devaluing of men’s interpersonal needs appeared to 1) increase men's psychological pain, and 2) diminish men's ability to regulate that pain, which we suggested elevates distal/proximal suicide risk. Findings were synthesized into two novel models to help better understand male suicide risk and recovery, the ‘3 ‘D’ Model of Masculine Norms and Male Suicide Risk’ (3 ‘D’ Risk) and ‘3’R’ Model of Male Suicide Recovery’ (3 ‘R’ Recovery). We made 22 recommendations for future male suicide research and 7 recommendations for theoretical exploration.

Findings from Study 2 suggested that dysregulation in the domains of emotions, self and interpersonal connections increased progressively between men who are not suicidal, men who have thoughts of suicide and men who have attempted suicide. Findings indicated that higher levels of loneliness and having a mental health diagnosis (MHD) increased the odds of suicidal ideation category membership compared to controls. Higher levels of having a MHD, and being non-heterosexual increased the odds of suicide attempt category membership compared to controls. Finally, higher levels of financial strain, having a MHD, being nonheterosexual, more restrictive attitudes to emotional expression, and lower levels of mattering to others, increased the odds of suicide attempt group membership compared to suicidal ideation.

Findings from Study 3 emphasized the significance of exploring how male gender interacts with men's help-seeking behaviours. The cultural suppression of men's emotions appeared to contribute to a lack of psychological capacity within some men to seek and utilize support. Some men perceived help-seeking as socially transgressive which is potentially linked to societal expectations for men to exhibit strength and suppress their pain. Masculine norms of self-reliance meant some men appeared to prefer to self-manage their distress. Concerns about potential negative consequences of seeking help - such as hospitalization - seemed to weigh heavily on the minds of men experiencing suicidal despair and who felt conditioned to maintain control and achieve success. Based on our findings we made 21 recommendations for services and public health messaging to increase men's help-seeking behaviours.

Study 4 utilized the expertise of 242 lived-experience suicide experts and 10 international academic/clinical male suicide experts to develop a research agenda of 22 priorities for male suicide work. Questions related to ten thematic domains: 1) Relationships with others, 2) Relationship with self, 3) Relationship with emotions, 4) Mental Health, 5) Suicidal behaviours, 6) Early life experiences, 7) Structural challenges, 8) Cultural challenges, 9) Atrisk groups, and 10) Support and recovery. 

Conclusion:
This thesis contributes four empirical studies to the male suicide evidence-base, including one of the first literature reviews of its kind - a qualitative meta-synthesis and systematic review of male suicide risk and recovery factors - as well as a cross-sectional, qualitative, and modified Delphi study. From these studies, eight recommendations for male suicide theory development and 60 recommendations for future research, prevention, and intervention are made. Male suicide rates indicate that certain men face profound challenges in accessing a fulfilling and meaningful life. Our research findings emphasize the importance of adopting a gender sensitive approach to suicide prevention and research that acknowledges the impact masculine norms may have on male behaviour and how male distress is perceived and addressed by others. Given the complexity of male suicide, interventions may be necessary at various levels, ranging from individual men to cultural shifts. It is crucial to approach this work without demonizing or pathologizing masculinity. Instead, the insights gained from this thesis suggest that enhancing our understanding of cultural norms of masculinity and how they may increase some men’s exposure to psychological pain, their tools to regulate that pain, and how that pain is read and responded to by others, are potentially critical.