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Overlooked, underfunded: Men in the middle years (MIMY) suicides

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Men in the middle years — that is, men between the ages of 35 to 64 — make up less than a fifth of the U.S. population. They also account for 40 percent of suicides.

As I mentioned in the Suicide Prevention Resource Center’s (SPRC) Spark Talk video, because of the large number of people in this demographic and its high rate of suicide, it will not be possible to reduce the overall number of suicides in the U.S. unless the MIMY suicide rate drops.

Disproportionate public investment in suicide prevention

Funding information from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that in 2016, just over $56.9 million was invested in suicide prevention for the age group 0-24 years. This demographic accounted for 5,511 suicide deaths.

Public investment in suicide prevention, by age group. Data by SAMHSA. -- Graphic by ForefrontBy comparison, $2 million was invested in suicide prevention for the age group 25 years and above (37,262 deaths). 

Expressed another way, 97% of public investment in suicide prevention was applied to 13% of the population at risk, and 3% was applied to 87% of the population at risk.  

Disproportionate awareness

Psychiatrist Eric Caine, who will be the American Association of Suicidology’s 2017 recipient of the Louis I. Dublin Award for lifetime achievement in suicide prevention, has noted that survivor-guided advocacy drives the field of suicidology.

Suicide loss survivors largely define the energy, priorities, and yes – funding allocations – of the suicide prevention field. Suicides with higher emotional impact tend to motivate stronger calls to action. 

So where does that leave deaths among men in the middle years? 

Characteristics of MIMY who are at risk of suicide

As reviewed in SPRC’s recent publication, Preventing Suicide Among Men in the Middle Years: Recommendations for Suicide Prevention Programs, about 41 percent of men aged 35 to 64 who attempted suicide were arrested and booked for a criminal offense within a year before the attempt. 

Among men aged 40 to 65 who died by suicide, 39 percent struggled with alcohol or substance use disorder. About 38 percent had experienced intimate partner problems (often as perpetrators of domestic violence). 

In Washington State, the pattern is similar: In 2006, the Washington State Domestic Violence Fatality Review revealed the relationship between domestic violence and suicide among suicide decedents in 2003. 

Sixteen female suicide decedents had a court-documented history of domestic violence victimization. Among male suicide decedents, eighty-seven had a court-documented history of domestic violence perpetration. In other words, male perpetrators accounted for more than five times the number of suicide deaths relative to female victims. 

On these men in the middle years, Dr. Caine suggests, “Many do not elicit sympathetic responses from their families, spouses, or children: they burn their bridges and have disruptive life experiences not long before death.”

What can be done

Addressing suicide among men in the middle years requires a review of our priorities. It means extending investment and outreach to those who do not “elicit sympathetic responses.” 

Furthermore, expanding the scope of existing suicide prevention efforts is important.

Pull quote graphic by Forefront

Because men in the middle years are less likely to be found in schools, college campuses, medical clinics or mental health clinics, traditional paradigms of suicide prevention are likely to miss large numbers of the population at risk.

Places to start

Given that more than half of the suicide deaths among men in the middle years are by firearm, partnerships with organizations representing firearms retailers and firearms owners represent a promising starting point for addressing MIMY suicides. 

Building on the example of New Hampshire’s Gun Shop Project, the Forefront-sponsored Safer Homes initiative includes work to engage firearms retailers in the work of suicide prevention.  With representation from the Second Amendment Foundation, the National Rifle Association, the Alliance for Gun Responsibility, the Seattle Police Department, Harborview Injury Prevention and Research Center and the Washington State Psychiatric Association among other organizations.

These partnerships have demonstrated that groups with disparate views can find common ground on the issue of suicide prevention. 

Given the representation of men in the middle years in particular industries, work-based programs also represent a starting point for suicide prevention efforts.  For example, Forefront’s partnership with Lakeside Industries is intended to address the elevated suicide risk within the male-dominated construction industry. 

Open to suggestions

No off-the-shelf programs currently exist for preventing suicide among men in the middle years, suggesting the field is open for innovation.

There are a couple of ways to approach this:

Social geography approach: Where MIMY are likely to be found
Social ecology approach: Where higher-risk men are likely to be found

As Washington State moves forward with data collection through the National Violent Death Reporting System, we may have more insights on earlier points of intervention for men at risk. 

The Suicide Prevention Resource Center’s recent publication, Preventing Suicide Among Men in the Middle Years: Recommendations for Suicide Prevention Programs, offers principles to organize interventions. We are open to your suggestions on new ways to interpret these principles to address suicide among men in the middle years.

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Jeffrey Sung's picture
Jeffrey Sung, M.D.
Jeffrey Sung, M.D. is an acting instructor with the University of Washington Department of Psychiatry and Behavioral Sciences. In 2015, he received the Sue Eastgard Training Excellence Award in 2015, for his work with Wellspring Counseling's Working with Suicidal Clients training for mental health professionals.