High suicide rates in specific regions or ethnic groups may be masked by falls in national rates for young men

In the second Series paper, Suicide in young men, a group of researchers led by Dr Alexandra Pitman of UCL (University College London) Mental Health Sciences Unit, UK, examine another under-investigated area of suicide research.  After reviewing research published over the last decade, they found strikingly few studies distinguishing the factors which identify those young men (aged 19 – 30) at greatest risk of suicide.

There were also very few studies determining which suicide prevention interventions are effective in young men. This was surprising both because suicide is second only to accidental death among global causes of mortality for men of this age group, and because of the media attention which suicide in young men tends to receive.

The issue of suicide in young men suffers from many of the same problems as research into adolescent suicide, particularly underestimation of suicide rates and misattribution of deaths to accidents. In some countries – notably Brazil, Singapore, Lithuania and Ireland – suicide rates in young men are rising.  Worrying trends are also observed in the rise of new and highly lethal methods of suicide, the spread of which may have been exacerbated by the use of new media.

Although globally, absolute rates of suicide in young men are approximately equivalent in high-income countries to those in low- and middle-income countries, suicide does account for a greater proportion of deaths in high-income countries due to the greater contribution of violence and road deaths in low- and middle-income countries.  Nonetheless, middle-aged men appear to represent the group at highest suicide risk in many countries.  Only in China and rural India do fewer young men than young women die by suicide. 

The global picture also shows national suicide rates for young men falling in countries such as England and Wales, Australia, China and the USA.  However, a fall in overall rates can mask worrying problems in specific regions, particularly rural areas, lower socio-economic groups, and specific ethnic groups.  For example in England and Wales, and in Australia, suicide rates appear to be rising among young men in rural areas but falling among young men in urban areas. For young men in specific ethnic groups, those with the highest suicide rates internationally are white men in South Africa, first-generation Eastern European and Caribbean immigrants to England and Wales, and the indigenous populations of Norway, Australia, New Zealand, Canada and the USA.

According to Dr Pitman, “The specific risk factors for suicide that affect young men are poorly understood, with few studies having specifically examined them or the effectiveness of suicide prevention interventions in young men.  The reasons for having neglected this area of research are the difficulties in designing studies large enough to assess these factors. Besides the tragic consequences of each suicide death for family and friends, the worldwide economic and social costs of suicide in this group are substantial.  The cost of each young man dying by suicide in the UK has been estimated as £1.67 million in 2009 prices. Ongoing concerns about the health outcomes of young men suggest that public health agencies should focus on identifying effective local means of preventing accidental death and suicide in this group.”

Dr Pitman and colleagues highlight the importance of restricting the means by which young men attempt suicide. Such efforts have been successful in Scotland (where the withdrawal of co-proxamol was followed by a reduction in poisoning deaths among young men) and Sri Lanka (where pesticide import restrictions were followed by declines in young male suicide rates).  However, as Dr Pitman points out: “Unfortunately, the methods common in high income countries (especially hanging) are also the hardest to restrict,” suggesting that encouraging young men to seek help for their problems – particularly depression and substance misuse – should be an area for statutory agencies to investigate further.