Throughout the United States, suicide is social crisis that predominantly affects men. In the United States, male suicides outstrip female suicides on a scale of 4 to 1 (1). Male suicide is especially common among divorced men (2) and among men who are greater than 65 years of age (3).

A man who contemplates suicide is saying to himself, "I don't see any way out of this mess. There is no hope."

One of the reasons why men lose hope is because society itself downplays, distorts, or even ignores the problem. This Special Report documents three examples of this neglect.

Centers for Disease Control

The federal Centers for Disease Control (CDC), based in Atlanta, GA, is responsible for coordinating the federal government's efforts in disease prevention and health promotion. The CDC publishes a widely-read summary of health statistics and trends known as the Morbidity and Mortality Weekly Report (MMWR).

The March 20, 1998 issue of MMWR issued a report entitled, "Suicide among Black Youths -- United States, 1980-1995." The report analyzed trends in suicide rates among persons 10-19 years old over a 15-year period. The CDC report concluded that "suicidal behavior among all youths has increased; however, rates for black youths have increased more."

Unfortunately, this conclusion was grossly incorrect. This is what the data actually showed (4):

1. White males had the highest suicide rate, and that rate increased significantly from 1980 to 1995.

2. Black males had the second highest suicide rate, and that rate more than doubled over the 15 years.

3. While White females faced a slight increase in their suicide rate, their suicides were still a fraction of their male counterparts.

4. Among Black females, suicide rates were so low that statistical trends were unreliable.

Thus, an accurate summary of the data would have stated: "Suicidal behavior among male youths has increased signficantly; however, rates for black males have more than doubled."

World Health Organization

The World Health Organization recently issued its Report on Violence and Health. The report analyzes trends in violence in such areas as homicide, domestic violence, child abuse, and suicide. The report concludes that violence accounts for 14% of deaths among males, and 7% of deaths among females (5).

Chapter 7 of the report addresses Self-Directed Violence, which includes suicide. The chapter notes that suicide is the 13th leading cause of death internationally. However, the sex disparity is not even mentioned until the sixth page of the discussion.

The bland tone of the discussion also serves to downplay the seriousness of the disparity: On page 188, we learn, "Suicide rates are higher among men than women....On average, it appears that there are about three male suicides for every female one."

The use of the academic qualifier, "it appears," implies that substantial doubt exists about the validity of the statistics.

A more accurate statement would have said, "Male gender is the single most important risk factor for suicide. On average, the male-female ratio of suicides is 3.5 to 1."

National Institute of Mental Health

The NIH National Institute of Mental Health (NIMH) is the federal agency that is leading the national effort to research the causes and prevention of suicide.

These are the suicide prevention initiatives at the National Institute of Mental Health:

A. Research
The NIMH has a $1.3 billion research budget. The NIMH has developed a research initiative on suicide in youth (6). But not one penny of the NIMH budget is directed to researching suicide specifically in males.

B. Publications
The NIHM features a Fact Sheet on suicide in older adults (7). But the NIMH has no Fact Sheets or other publications that are male-specific.

C. Office for Special Populations
The NIMH has an Office for Special Populations that is designed to target high-risk populations (8). The Office is urging persons to pay more attention to the problems of women's health, which may ultimately decrease the attention paid to men's health.

Overcoming the Silence and the Neglect

In the CDC report, statistics were inappropriately combined, leading to the complete neglect of the crisis of male suicide.

In the WHO report, the sex disparity in suicide rates was not even discussed until the sixth page of the chapter, and even then, was explained using sanitized terminology.

At the National Institute of Mental Health, no male-specific research or publications are being sponsored, and the NIMH Office for Special Populations emphasizes the mental health needs of women, while ignoring the mental health needs of men.

Since suicide predominantly affects boys and men, suicide prevention programs need to be male-specific, and address the underlying social and psychological causes that affect men. This common sense principle is used in designing female-specific programs on osteoporosis, eating disorders, and breast cancer. But as we see, none of the federal suicide prevention programs meets this basic requirement.

The problem of male suicide has long been shrouded in silence and neglect. But we the living have the power to lift that shroud.

It's probably too late to get the CDC to redo their 1988 report. But it's not too late to complain to World Health Organization and the National Institute of Mental Health about their neglect of male suicide.

-Carey Roberts

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References

1. National Center for Health Statistics: Health, United States, 2002. Hyattsville, MD, Table 30.

2. Kposowa AJ. Marital status and suicide in the National Longitudinal Mortality Study. Journal of Epidemiology and Community Health 2000; 54: 254-261.

3. Centers for Disease Control: Suicide among Older Persons, United States, 1980-1992. Morbidity and Mortality Weekly Report, January 12, 1996.

4. Would a US Federal Agency Mislead the Public and Endanger Children to Protect a Cabinet Secretary's Feminist Agenda? www.responsibleopposing.com/comment/suicide.html. 1998.

5. Krug E: WHO Report on Violence and Health, Geneva: World Health Organization, 2002.

6. http://grants1.nih.gov/grants/guide/pa-files/PA-00-077.html

7. www.nimh.nih.gov/publicat/elderlydepsuicide.cfm

8. www.nimh.nih.gov/osp/index.htm

WHO: Dr. Etienne Krug, kruge@who.int

NIMH: Dr. Thomas Insel, Director, ti4g@nih.gov