Preventing Male Suicide by Breaking Up the ‘Toxic Combination’

George Bush signed a presidential declaration in 1989 naming the 1990s the “Decade of the Brain.” The initiative was a “national research endeavor to better understand how the brain (and nervous system) is organized, how it functions, why it sometimes fails to function, and what can be done to prevent and treat dysfunction.” One of the stated goals of the Decade of the Brain was a 10 percent reduction in suicide by 2020. 

Fast forward to 2019, and it’s clear the Decade of the Brain missed its mark, at least in terms of preventing suicide. Between 1999 and 2017, suicide rates have risen 33 percent and it is now the 10th leading cause of death in the United States, across all demographics. In fact, the CDC reported twice as many suicides (47,173) as homicides (19,510) in 2017. Perhaps surprisingly, government data also shows that men commit suicide 3.5 times more often than women. 

“I think there’s an unfortunate misconception that women are more likely to succumb to depression and therefore to suicide,” Dr. Nahas says. “The reality is that women will attempt suicide more often than men, but men will more often ensure that their attempts are successful.”

Methods of suicide across genders is a large and complex topic that requires a separate conversation, but it is worth noting that the higher “success” rate among male suicides can be attributed to using more lethal means. According to the American Foundation for Suicide Prevention, firearms accounted for almost 51 percent of the more than 47,000 suicides in 2017.

Identifying red flags or “imminent risk factors” for potentially suicidal behavior is not as straightforward as one might imagine. Certainly, depression, substance abuse, stressful life events, and family history can all be contributors but they don’t present themselves in every person the same way.  

Media portrayals of suicidal behavior depict stressed out businessmen who lost everything in the stock market or raging lovers who caught cheating spouses. Those cases, however, are the exception. “These are less than 10 percent of all completed suicides,” Nahas says. “Which is not necessarily the narrative that the general public thinks about.” 

Instead, Nahas explains, there is a “toxic combination” that accounts for up to 90 percent of completed suicides. “Acute stressors combined with some specified type of mental illness —  the two biggest culprits are depression and substance abuse, and even more critical is the combination of both.” 

The outlook becomes a bit more ominous when considering one out of every five U.S. adults will suffer from mental illness over the course of their lifetime. Preventing suicide is about breaking up the toxic combination, and to do so, Nahas says, we need to do a better job of isolating the stressors — psychological, physical, or social — from the mental illness.

If the goal is to dilute or break up the toxic combination of substance abuse and mental illness, it’s critical to identify those protective factors that will stop destructive action.

“In addition to experiencing emotional pain or having a negative outlook on life, at least according to the official psychiatric criteria we go by, there ought to be a drop in daily function for at least two weeks,” Nahas explains. 

Daily function can include inconsistency with work attendance or performance, failing in their day-to-day routine, or being emotionally absent from home or school activities in which they usually participate, Nahas says. Not all of the people displaying these symptoms are going to be contemplating suicide, he reminds, but taking protective action early can identify someone within a risk zone.  

And, simply asking someone if they’re thinking about hurting themselves can also be tremendously effective.  

“One of the big myths out there in our society is that if I were to ask a person who might be struggling with suicidal ideation, ‘Are you feeling suicidal?’ that somehow I will push them into acting,” Nahas says. “This is a complete myth and completely untrue. [Feeling suicidal] isn’t a character weakness.”

The medical community is a long way from being able to easily predict and prevent suicide. The prevalence of firearms in America and the fact that men often resort to more lethal forms of suicide makes preventing suicide in men all the more difficult. 

However, friends, families, and colleagues can help break up the toxic combination of substance abuse and mental illness by diligently observing the men in their lives for red flags, providing safety and support without judgment, and proactively addressing the issues they see.