A relevant risk factor
Twenty-two deaths occurred among the Add Health participants. Of those participants, 21 were men (odds ratio, 21.7; 95% confidence interval, 2.9-161; P less than .001).
The analysis showed that all nine risks for suicide that were highlighted in previous research were positively associated with HTM, with small to medium effect sizes. Of these, the most pronounced was family member suicide, with an OR of 1.89 (95% CI, 1.3-2.7).
Most tellingly, HTM men were 2.4 times more likely to end their lives by suicide than were men not defined as such (95% CI, 0.99-6.0; P less than .046). Nevertheless, HTM men were also 1.45 times less likely to report suicidal ideation (OR, 0.69; 95% CI, 0.60-0.81; P less than .001). There was no association between HTM and nonfatal suicide attempts.
Interestingly, HTM men were slightly more likely to report easy access to guns (OR, 1.1; 95% CI, 1.01-1.20; P less than .04), but they had lower levels of depression (Cohen’s d, 0.17; P less than .001).
HTM not only has a direct association with suicide but also with a web of indirect effects as well, thanks to its association with all the other risks identified in the previous study by another group of investigators.
HTM may be an underlying influence in male suicide that increases the probability of externalizing such behavioral risk factors as anger, violence, gun access, and school problems.
The finding that almost all of the people who died by suicide were men underscores the central role that gender plays in these tragedies. As such, the investigators hope that the study prompts more research, as well as intervention efforts aimed at the role of masculinity in suicide.
“There are already things going on around the world to try to address the risk factors of masculinity for suicide death,” Dr. Coleman said. “So even though we haven’t had the evidence that it’s a risk factor, people have been operating under that assumption anyway.
“Hopefully our research contributes to raising the profile that high traditional masculinity is a relevant risk factor that we can organize prevention and treatment around.”
An important contribution
Mark S. Kaplan, DrPH, commenting on the findings in an interview, said the study makes an important contribution to suicide research.
“Any study that tries to link a living sample with death data, as they did here, is important,” said Dr. Kaplan, professor of social welfare at the Luskin School of Public Affairs of the University of California, Los Angeles.
“It’s also important because it begins to scratch the surface of more proximal or distal factors that are associated with suicide, and masculinity is one of those factors,” Dr. Kaplan added.
“In an incremental way, it begins to add to the puzzle of why men have a higher mortality rate than their female counterparts. Because when it comes to suicide, men and women really are apples and oranges.”
Dr. Kaplan believes HTM is one of several traits that may lead men to take their own lives.
“There are all sorts of other issues. For example, masculinity might be interacting with some of the harsh socioeconomic conditions that many men face. I think all of this points to the real need to understand why men die from suicide,” he said.
The Add Health study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. No direct support was received from the grant for the current study. Dr. Coleman and Dr. Kaplan have disclosed no relevant financial relationships.
A version of this article first appeared on Medscape.com.