No Country for Middle-Aged Men? An Intersectional Approach to Explore Sources of Psychological Distress and Patterns of Seeking Support among Middle-Aged Men Considered ‘At Risk’ of Suicide in Ireland

Main Article Content

Shane O'Donnell
Noel Richardson

Abstract

In many high-income countries, the rate of suicide is highest among middle-aged men. Despite this, few studies have explored the factors that underpin psychological distress and support-seeking among this cohort. This qualitative study used an intersectional approach to account for the plurality of middle-age masculinities and to offer deeper insights into middle-age men’s mental health experiences. Focus groups and interviews were conducted with nine demographic groups of middle-aged men considered ‘at risk’ of suicide in Ireland (n=34). Data collection and data analysis were informed by the principles of grounded theory. A master code list and conceptual maps were developed from which four themes emerged. Theme 1 Reconciling Increasing Expectations with Diminishing Capacities to Achieve at Middle-Age captures various tensions that emanated from expectations on men to have acquired mastery of various gendered norms by middle-age that coincided with a reality of different manifestations of middle-aged vulnerability as well as large scale societal change in Ireland. Theme 2 Isolation at Middle-Age broadly describes a sense of loneliness at middle-age as a result of narrowing social circles, a lack of social outlets, relationship breakdown and living alone. For those men who experienced discrimination, prejudice or racism, their isolation tended to be more deep-rooted and multifaceted and was a particular source of psychological distress. The notion of a ‘double burden’ was central to Theme 3 Barriers to Support Seeking, and encapsulated men’s sense of shame in having to ask for help and ‘failing’ to manage their own problems. Theme 4 Catalysts for Change & Strategies for Improved Self-Care highlights what were seen as the foundations of good mental health for middle-aged men, as well as the value of educational programmes and social contact. The use of an intersectional approach in this study fostered a deeper understanding of the blended identities and wide range of mental health experiences of middle-age men which have informed training and resources currently being implemented under the auspices of ‘Connecting for Life’, Ireland’s strategy to reduce suicide.  

Article Details

Section
Articles

References

1. World Health Organisation. Preventing suicide - A global imperative. Geneva: World Health Organisation; 2014.
2. Beautrais AL. Gender issues in youth suicidal behaviour. Emerg Med. 2002;14:35-42.
3. Schrijvers DL, Bollen J, Sabbe BG. The gender para-dox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138(1-2):19-26.
4. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28(1):1-23.
5. Moller-Leimkuhler AM. The gender gap in suicide and premature death or: why are men so vulnerable? Eur Arch Psychiatry Clin Neurosci. 2003;253(1):1-8.
6. Connell RW, Messerschmidt JW. Hegemonic Masculinity. Gend Soc. 2005;19(6):829-59.
7. Apesoa-Varano EC, Barker JC, Hinton L. “If You Were Like Me, You Would Consider It Too”: Suicide, Older Men, and Masculinity. Soc Ment Health. 2018;8(2):157-73.
8. Coleman D. Traditional Masculinity as a Risk Factor for Suicidal Ideation: Cross-Sectional and Prospective Evidence from a Study of Young Adults. Arch Suicide Res. 2015;19(3):366-84.
9. Mac An Ghaill M, Haywood C. Understanding boys’: thinking through boys, masculinity and suicide. Soc Sci Med. 2012;74(4):482-9.
10. Oliffe JL, Creighton G, Robertson S, et al. Injury, Interiority, and Isolation in Men’s Suicidality. Am J Mens Health. 2017;11(4):888-99.
11. Richardson N, Clarke N, Fowler C. Young men and suicide project: a report on the all-Ireland young men and suicide project. Carlow: Institute of Technology Carlow; 2013.
12. Scourfield J. Suicidal Masculinities. Sociol Res Online. 2005;10(2):35-44.
13. Payne S, Swami V, Stanistreet DL. The social construction of gender and its influence on suicide: a review of the literature. J Men’s Health. 2008;5(1):23-35.
14. Pirkis J, Spittal MJ, Keogh L, et al. Masculinity and suicidal thinking. Soc Psychiatry Psychiatr Epidemiol. 2017;52(3):319-27.
15. Carrigan T, Connell B, Lee J. Toward a new sociology of masculinity. Theory Soc. 1985;14(5):551-604.
16. Turner JC, Oakes PJ, Haslam SA, McGarty C. Self and collective: cognition and social context. Pers Soc Psychol Bull. 1994;20:454-63.
17. Galdas PM, Cheater F, Marshall P. Men and health help-seeking behaviour: literature review. J Adv Nurs. 2005;49(6):616-23.
18. Brownhill S, Willhelm K, Barclay L, Schmied V. ‘Big build’: hidden depression in men. Aust N Z J Psychiatry. 2005;39(10):921-31.
19. Centre for Disease Control & Prevention. Suicide among adults aged 35-64 years -United States, 1999-2010. Atlanta: Centre for Disease Control & Prevention; 2013.
20. Burns RA. Sex and age trends in Australia’s suicide rate over the last decade: something is still seriously wrong with men in mid and late life. Psychiatry Res. 2016;245:224-9.
21. Office of National Statistics. Suicides in the UK: 2018 Registrations. Registered deaths in the UK from suicide analysed by sex, age, area of usual residence of the deceased and suicide method. 2019.https://www.ons. gov.uk//peoplepopulationandcommunity/birthsdeath-sandmarriages/deaths/bulletins/suicideintheunitedkingdom/2018registrations Accessed February 18, 2020.
22. Canada Statistics. Leading causes of death, total population, by age group: table 13-10-0394-01. 2018. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action/pid=1310039401 Accessed June 26, 2018.
23. Coronial Services of New Zealand. Chief coronor national provisional suicide statistics: provisional figure, August 2017. 2018. https://coronialservices.justice. govt.nz/suicide/annual-suicide-statistics-since-2011/ Accessed June 26, 2018.
24. Grazioli VS, Bagge CL, Studer J, et al. Depressive symptoms, alcohol use and coping drinking motives: Examining various pathways to suicide attempts among young men. J Affect Disord. 2018;232:243-51.
25. Pitman A, Krysinska K, Osborn D, King M. Suicide in young men. The Lancet. 2012;379(9834):2383-92.
26. Rice SM, Kealy D, Oliffe JL, Ogrodniczuk JS. Exter-nalizing depression symptoms among Canadian males with recent suicidal ideation: A focus on young men. Early Interv Psychiatry. 2019;13(2):308-13.
27. van Sabben E, Paulsen-Becejac L. An enquiry into young men at risk of suicide in the UK. Nurs Child Young People. 2018;30(4):42-5.
28. Shiner M, Scourfield J, Fincham B, Langer S. When things fall apart: Gender and suicide across the life-course. Soc Sci Med. 2009;69(5):738-46.
29. Hempstead KA, Phillips JA. Rising suicide among adults aged 40-64 years: the role of job and financial circumstances. Am J Prev Med. 2015;48(5): 491-500.
30. Stone DM, Holland KM, Schiff LB, McIntosh WL. Mixed Methods Analysis of Sex Differences in Life Stressors of Middle-Aged Suicides. Am J Prev Med. 2016;51(5 Suppl 3):S209-S18.
31. Wyllie C, Platt S, Brownlie J, et al. Men, suicide and society: why disadvantaged men in mid-life die by suicide. Surrey: Samaritans; 2012.
32. Scourfield J, Evans R. Why Might Men Be More at Risk of Suicide After a Relationship Breakdown? Sociological Insights. Am J Mens Health. 2015;9(5):380-4.
33. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10-51.
34. Kalt A, Hossain M, Kiss L, Zimmerman C. Asylum Seekers, Violence and Health: A Systematic Review of Research in High-Income Host Countries. Am J Public Health. 2013;103(3):e30-e42.
35. Griffith DM, Ellis KR, Allen JO. An intersectional approach to social determinants of stress for African American men: men’s and women’s perspectives. Am J Mens Health. 2013;7(4 Suppl):19S-30S.
36. Cole ER. Intersectionality and research in psychology. Am Psychol. 2009;64(3):170-80.
37. Warner DF, Brown TH. Understanding how race/ ethnicity and gender define age-trajectories of disability: an intersectionality approach. Soc Sci Med. 2011;72(8):1236-48.
38. Hankivsky O. Women’s health, men’s health, and gender and health: implications of intersectionality. Soc Sci Med. 2012;74(11):1712-20.
39. National Office for Suicide Prevention. Briefing on CSO suicide figures 2019. 2019. https://www.hse.ie/ eng/services/list/4/mental-health-services/connecting-for-life/publications/nosp-briefing-cso-data-nov-2019. pdf Accessed June 18, 2020.
40. Corcoran P, Griffin E, Arensman E, Fitzgerald AP, Perry IJ. Impact of the economic recession and subsequent austerity on suicide and self-harm in Ireland: An interrupted time series analysis. Int J Epidemiol. 2015;44(3):969-77.
41. Ryan S. Report of the Commission to Inquire Child Abuse. Dublin: Stationary Office; 2009.
42. Thomson R. Citizens’ Evaluations of the Fulfillment of Election Pledges: Evidence from Ireland. J Politics. 2011;73(1):187-201.
43. Department of Health. Connecting for Life: Ireland’s national strategy to reduce suicide 2015-2020. Dublin: Department of Health; 2015.
44. Bloor M, Frankland J, Thomas M, Robson K. Focus groups in social research. London: Sage; 2001.
45. Morgan DL. Successful focus groups: Advancing the state of the art. California: Sage; 1993.
46. Keohane A, Richardson N. Negotiating Gender Norms to Support Men in Psychological Distress. Am J Mens Health. 2017;12(1):160-71.
47. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
48. Strauss A, Corbin J. Basics of Qualitative Research California: Sage Publications; 1998.
49. Shkolnikov VM, Cornia GA, Leon DA, Meslé F. Causes of the Russian mortality crisis: Evidence and interpretations. World Dev 1998;26(11):1995-2011.
50. Durkheim E. Le Suicide: Etude de socologie. Paris: Alcan; 1897.
51. Lachman ME, Teshale S, Agrigoroaei S. Midlife as a Pivotal Period in the Life Course: Balancing Growth and Decline at the Crossroads of Youth and Old Age. Int J Behav Dev. 2015;39(1):20-31.
52. Ebner NC, Freund AM, Baltes PB. Developmental changes in personal goal orientation from young to late adulthood: from striving for gains to maintenance and prevention of losses. Psychol Aging. 2006;21(4): 664-78.
53. Finke MS, Huston SJ, Sharpe DL. Balance sheets of early boomers: are they different from pre-boomers? Journal of Family and Economic Issues. 2006;27(3):542-61.
54. Freund AM, Ritter JO. Midlife crisis: a debate. Gerontology. 2009;55(5):582-91.
55. Gilbert P. Varieties of submissive behavior as forms of social defense: their evolution and role in depression. Sloman L, Gilbert P, editors. New Jersey: Eribaum 2000. 3-45 p.
56. O’Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. 2018;373(1754).
57. Wetherall K, Robb KA, O’Connor RC. An Examination of Social Comparison and Suicide Ideation Through the Lens of the Integrated Motivational-Volitional Model of Suicidal Behavior. Suicide Life Threat Behav. 2019;49(1):167-82.
58. O’Connor RC. The relations between perfectonism and suicidality: a systematic review. Suicide Life Threat Behav. 2007;37(6):698-714.
59. Kalt A, Hossain M, Kiss L, Zimmerman C. Asylum seekers, violence, and health: A systematic review of research in high-income host countries. Am J Public Health. 2013;103(3).
60. Van Orden KA, Witte TK, Cukrowicz KC, et al. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575-600.
61. Houle J, Mishara BL, Chagnon F. An empirical test of a mediation model of the impact of the traditional male gender role on suicidal behavior in men. J Affect Disord. 2008;107(1-3):37-43.
62. Mahalik JR, Burns SM, Syzdek M. Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Soc Sci Med. 2007;64(11):2201-9.
63. Kelly L, Harrison M, Richardson N, et al. The impact of a gender-specific physical activity intervention on the fitness and fatness profile of men in Ireland. Eur J Public Health. 2019;29(6):1154-60.
64. Lefkowich M, Richardson N. Men’s health in alternative spaces: exploring men’s sheds in Ireland. Health Promot Int. 2016;33(3):525-35.