Tensions in perspectives on suicide prevention between men who have attempted suicide and their support networks: Secondary analysis of qualitative data

Abstract

BackgroundMen generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men.ObjectiveTo explore the views of at‐risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved.DesignSecondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation.Setting and participantsA total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved.ResultsFive tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services.ConclusionTension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.

A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

“…The sample was also, of course, limited to those with internet access and the demographics showed that men, black, Asian and minority ethnic (BAME) groups were under‐represented. Additionally, the relatively low number of carer participants prevented separate analysis of this group who might have different needs to service users, as has been reported in research about suicide …”

Critical Issues in Men’s Mental Health

“…12 Follow-up analyses highlight some tensions between suicidal men and their support systems that interfere with effective suicide prevention. 13 For example, it is difficult to identify which changes in behaviour signify imminent risk of an attempt v. normal fluctuations in mood; or difficulty in monitoring signs of risk while still affording at-risk men privacy and autonomy. Though recent work suggests that men are more likely than women to develop an 'acquired capability' for suicide through greater insensitivity to pain and reduced fear of death, 14 there is still considerable debate over the role of biology 15 v. social factors (e.g., men tend to have a higher occupational exposure to pain-habituating experiences 16 ).…”

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“…"…I wouldn't allow myself to show it to my friends and family. It was a stranger where it was kind of like you felt that if you were going to be judged it would be less than what it would be from family and friends" [24].…”

“…Consistently males reported frequent feelings of guilt and enragement with themselves, whilst also apprehensive of their difficulties being divulged. [24].…”