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SUICIDAL BEHAVIOURS in MEN Kõlves, Kumpula and De Leo ISBN 978-0-9580882-4-4 WHO Collaborating Centre in and Training for Research Suicide Prevention Australian Males

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SUICIDAL BEHAVIOURS in MEN Kõlves, Kumpula and De Leo ISBN 978-0-9580882-4-4 WHO Collaborating Centre in and Training for Research Suicide Prevention Australian Males SUICIDAL BEHAVIOURS IN MEN BEHAVIOURS SUICIDAL Male suicide rates are almost universally higher than those of females around the world. In Australia, completed suicide is three- to four-times more common in men than in women, although women engage more in non-fatal suicidal behaviours. Specific male groups — such as Indigenous men, men of sexual minorities, old and young men, and men working in stressful conditions or who are imprisoned — are at an even greater risk of suicide. This publication aims to investigate the phenomenon of suicidal behaviour in men. It presents current research on the factors behind male vulnerability to suicide, how male suicides can be prevented, and activities currently undertaken that aim to reduce suicidal behaviours, with a focus on and De Leo Kumpula Kõlves, Australian males. WHO Collaborating Centre for Research and Training in Suicide Prevention ISBN 978-0-9580882-4-4 Suicidal behaviours in men: Determinants and prevention in Australia Kairi Kõlves, Eeva-Katri Kumpula and Diego De Leo Australian Institute for Suicide Research and Prevention National Centre of Excellence in Suicide Prevention WHO Collaborating Centre for Research and Training in Suicide Prevention Griffi th University Suggested quotation: Kairi Kõlves, Eeva-Katri Kumpula and Diego De Leo (eds.) (2013) Suicidal behaviours in men: determinants and prevention. Australian Institute for Suicide Research and Prevention, Brisbane Copyright © Australian Institute for Suicide Research and Prevention, 2013 This work is copyrighted. Apart from any use as permitted under the Copyright Act, 1968, no part may be reproduced without prior permission from the Australian Institute for Suicide Research and Prevention. Inquiries regarding this publication should be directed to: Australian Institute for Suicide Research and Prevention Mt Gravatt Campus Griffi th University Mt Gravatt, Qld 4122 Phone: (07) 3735 3382 Fax: (07) 3735 3450 email: aisrap@griffi th.edu.au Please refer to the National Library of Australia for Cataloguing-in-Publication details: www.nla.gov.au Author: Kõlves, Kairi, author. Title: Suicidal behaviours in men : determinants and prevention in Australia / Kairi Kõlves ; Eeva-Katri Kumpula ; Diego De Leo. ISBN: 9780958088244 (paperback) Subjects: Suicidal behavior--Australia. Men--Australia. Young men--Australia. Suicide--Australia. Suicide--Australia--Prevention. Other Authors/Contributors: Kumpula, Eeva-Katri, author. De Leo, Diego, 1951- author. Australian Institute for Suicide Research and Prevention, issuing body. Dewey Number: 362.280994 Design and production by Longueville Media www.longuevillemedia.com.au Tel. (02) 9362 8441 Acknowledgements The present publication has been requested by the We would like to acknowledge Professor John Australian Suicide Prevention Advisory Council O’Gorman for his thorough proofreading and Dr (ASPAC) and funded by the Commonwealth Delaney Skerrett for his additional comments. We Department of Health and Ageing. The report will would also like to thank ASPAC members for their assist the Council in their formation of advice to valuable comments. the Minister for Mental Health and Ageing. Contents Executive Summary 1 Chapter 1 4 Epidemiology of male suicidal behaviours Jerneja Sveticic, Allison Milner, Kairi Kõlves and Diego De Leo Chapter 2 31 Determinants of suicidal behaviours in men Kairi Kõlves, Lay San Too, Eeva-Katri Kumpula and Diego De Leo Chapter 3 63 Male suicide risk groups Kairi Kõlves, Lay San Too, Jerneja Sveticic, Kathy McKay, Naoko Ide and Diego De Leo Chapter 4 91 Male suicides in different settings Lay San Too, Kairi Kõlves and Diego De Leo Chapter 5 106 Direct and indirect costs of suicide Allison Milner and Diego De Leo Chapter 6 111 Male help seeking Lay San Too, Kairi Kõlves and Diego De Leo Chapter 7 115 Suicide prevention for men Eeva-Katri Kumpula, Kairi Kõlves, Naoko Ide, Kathy McKay and Diego De Leo Conclusions and implications 160 References 165 Appendix A 227 List of Figures Figure 1. Change of global suicide rates, 1950–2000 ......................................................................4 Figure 2. Age-standardised suicide rates for males, 50 countries with highest rates ................ 6 Figure 3. World map of suicide rates in males (WHO 2011) ...........................................................7 Figure 4. Injury burden (DALYs) by specifi c cause expressed as: (a) proportions of total, (b) proportions by sex, and (c) proportions due to fatal and non-fatal outcomes, Australia, 2003 .........................................................................................................................10 Figure 5. Suicide rates by year and sex, Australia, 1964–2010 ....................................................11 Figure 6. Male-to-female suicide rate ratio, Australia, 1964–2010 ...............................................12 Figure 7. Trend of suicide rates in males by age groups, Australia, 1964–2010 ......................13 Figure 8. Suicide rates by age group and sex, Australia, 2001–2010 .........................................14 Figure 9. Age-standardised suicide rates by sex and state and territory, 2006–2010 ............16 Figure 10. Distribution of suicide methods used by males, Australia, 2001–2010 .....................17 Figure 11. Age-standardised suicide rates in males by major methods, Australia, 1975–1998.............................................................................................................19 Figure 12. Age-standardised rates of non-fatal suicidal behaviours by sex ...................................22 Figure 13. Persons presenting with non-fatal suicidal behaviours to the Emergency Department by age group and sex, 2005–2010 ............................24 Figure 14. Age-standardised rates of non-fatal suicidal behaviours, by year and sex .................25 Figure 15. Presentations and methods of non-fatal suicidal behaviours by sex, July 2004 to August 2010 .....................................................................................................26 Figure 16. The HPA axis and its connection to suicidality (A hyperactive HPA axis reacts too strongly to stress, increasing the risk of suicidality) .....................................32 Figure 17. Structural Equation Model of suicidality during separation among males ..................41 Figure 18. Stress-Diathesis Model of suicidal behaviour ...................................................................59 Figure 19. Stress-Vulnerability Model and development of the suicidal process .........................60 Figure 20. Multicausal model of suicide pathways ..............................................................................61 Figure 21. Suicide rates among 15–24 year olds, Australia, 1964–2010 ....................................64 Figure 22. Suicide rates in males aged 65–74 and 75+ years, Australia, 1964–2010 .............68 Figure 23. Age-standardised suicide rates by Aboriginal and Torres Strait Islander status, Queensland, 1994–2007 ......................................................................................................72 Figure 24. Male death rates (per 100,000) by Aboriginal and Torres Strait Islander status and age, 1999–2003 .....................................................................................................................73 Figure 25. Age-standardised suicide rate in metropolitan, regional and rural areas of Queensland, 2005 to 2007 ...................................................................................................77 Suicidal behaviours in men: Determinants and prevention in Australia vii Figure 26. The Seesaw Model of Bisexual and Gay Male Suicide ..................................................84 Figure 27. Australian and Queensland male fi rearm suicide trends, 1968–2004 ....................119 Figure 28. Limiting access to suicide means may disrupt the suicide process at several stages ................................................................................................................... 121 Figure 29. Illness cognition theory ........................................................................................................ 149 Figure 30. The four levels of the Nuremberg/European Alliance Against Depression project ................................................................................................153 Figure A1. Suicide rates among 15–24 year olds, Australia, 1964–2010 .................................227 Figure A2. Suicide rates among 25–34 year olds, Australia, 1964–2010 .................................227 Figure A3. Suicide rates among 35–44 year olds, Australia, 1964–2010 .................................228 Figure A4. Suicide rates among 45–54 year olds, Australia, 1964–2010 .................................229 Figure A5. Suicide rates among 55–64 year olds, Australia, 1964–2010 .................................229 Figure A6. Suicide rates among 65–74 year olds, Australia, 1964–2010 ..................................230 Figure A7. Suicide rates among 75+ year olds, Australia, 1964–2010 ...................................... 231 List of Tables Table 1. Selected countries with highest and lowest male-to-female ratio of suicide rates ..............8 Table 2. Male-to-female suicide rate ratio by age group, Australia, 2001–2010 .............................15 Table 3. Male-to-female suicide rate ratio by state and territory, 2006–2010 ..................................16 Table 4. Distribution of suicide methods used by sex, Australia,
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