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Online Suicide Interventions
for Middle-Aged Men

By Susan A. Knight

In the United States, men commit suicide at a rate nearly four times higher than that of women. While the gender disparity has existed for decades, a new trend has emerged in recent years: rising suicide rates among middle-aged men. Clearly, there is a need for gender-specific and age-specific suicide intervention programs that can be implemented nationwide.

To help address this need, the University of Maryland, Baltimore School of Social Work has received a $1.28 million grant from the Centers for Disease Control and Prevention to lead a four-year study evaluating online suicide intervention programs. In collaboration with the Florida State University College of Social Work, researchers will evaluate two online programs targeting middle-aged men between the ages of 35 and 64: the intervention program Man Therapy and an online screening tool from Screening for Mental Health.

Both programs allow users to complete a brief, anonymous self-assessment to assess their behavioral health status. Feedback and recommendations are provided based on how users respond. Both assessments include questions that directly address suicidal ideation and behaviors. When a response indicates a high suicide risk, resources and links are provided immediately to prompt the user to access help.

Research for the study will take place in Michigan, where 200 men will be enrolled in the programs. In addition to measuring suicidal behaviors and evaluating suicide risk factors such as relationship problems and substance abuse, the researchers will be reviewing the men’s perceived level of social supports. The study will also evaluate the men’s help-seeking behaviors and their attitudes towards seeking professional mental health services. This is a key element in understanding and addressing the high suicide rate among this particular group.

Gender Differences in Help-Seeking Behaviors
Research has shown that men are less likely than women to self-identify psychosocial issues. Men are less likely to access informal emotional supports, and they are also less likely to proactively seek out professional support services to deal with mental health and other behavioral issues. Philip J. Osteen, PhD, MSW, an assistant professor and the project’s principal investigator at the Florida State University College of Social Work, notes that middle-aged men are the most resistant to personally identify signs of mental health problems, putting them at higher risk for more serious mental health issues and suicidal behaviors.

A variety of personal, cultural, and societal factors may contribute to men’s reluctance to seek help. But studies have shown that a key contributor is the impact of traditional gender role socialization and widely held views regarding what constitutes traditional masculine behavior. Masculinity and traditional male gender roles are often characterized by the display of strength and independence, coupled with avoidance of behavior that may be perceived as weakness, vulnerability, or dependency. According to the American Association of Suicidology (AAS), help-seeking requires vulnerability and the relinquishing of power to another, and therefore may be viewed as being diametrically opposed to the traditional male gender role.

Given these attitudes and their detrimental consequences, redefining help-seeking is essential. According to the AAS, men are more likely to respond to messages that emphasize help-seeking as the following: evidence of courage; an act of independence; potentially improving one’s performance; increasing one’s competence; and increasing a personal sense of, and other-perceived, control. The online program Man Therapy utilizes this type of male-friendly approach.

Man Therapy Online Program
Man Therapy redefines help-seeking; its language and images are designed to reinforce the central message that acknowledging, discussing, and getting help in order to address problems is indeed a masculine endeavor. In addition to using humor to address serious and sensitive issues, the program portrays help-seeking as sensible, practical, and responsible “manly” behavior.

Man Therapy is the result of a multiagency partnership involving the Carson J. Spencer Foundation, the Office of Suicide Prevention—Colorado Department of Public Health and Environment, and Cactus Marketing and Communications. Their strategy was to develop an intervention program that acknowledged and worked with (rather than trying to change) the existing attitudes of high-risk men within the target age group.

This unique program incorporates a number of novel approaches to make it more accessible, relatable, and meaningful for the intended audience. Issues are raised without using standard mental health terms. Independence and autonomy are emphasized, with a focus on self-help strategies and concrete steps for taking action toward specific goals. And the user experience is punctuated by the ongoing presence of Dr. Rich Mahogany, a fictional character who assists users in navigating the site, whose irreverent attitude and witty remarks aren’t just amusing; they reinforce the central message that talking about one’s problems, getting help, and fixing those problems is a masculine thing to do.

Reaching Men Where They’re Comfortable
During the study, the online screening tool from Screening for Mental Health will be examined on its own and in combination with Man Therapy. Screening from Mental Health aims to provide tools for mental health screening in the same way that that medical care professionals screen for physical diseases like cancer and diabetes. Such screening allows for earlier identification of mental health issues, which supports early intervention and more effective treatment.

While their screening tool uses a different approach to Man Therapy in terms of its overall tone, the two programs share the following key similarity: They are both designed to reach men wherever they’re most comfortable—in the privacy of their home. By virtue of being Web-based, both programs can be accessed any time, day or night, at the user’s convenience.

The ability to access the tools and resources quickly, privately, and anonymously serves to remove a number of potential barriers to getting help. There’s no need to spend time searching for appropriate community resources or attending a local community health clinic. The online delivery format allows users to start taking steps immediately to improve their mental health and well-being; when the user is ready, so are the tools.

In addition, both programs provide considerable flexibility for navigating through the content, giving users a measure of control as they use the tools and access the various features. And both programs provide information regarding available resources based on user input, so users can take further action without delay.

A Major Public Health Problem
More than 40,000 Americans die by suicide every year. However, this statistic does not reflect all the other lives affected. Jodi Jacobson Fray, PhD, MSW, is an associate professor at the University of Maryland, Baltimore School of Social Work and the project’s principal investigator. In a press release for the project, she referred to suicide as “a major public health problem that reaches deep into the communities it affects, devastating families, friends, and coworkers.”

The stigma associated with suicide often makes it difficult for survivors of suicide loss to reach out for support due to feelings of guilt and shame. At the same time, those around them may refrain from responding and offering support due to a lack of understanding or uncertainty about how best to respond. The isolating effect from the lack of social and emotional support can compound survivors’ feelings of guilt and shame, making it even more difficult for them to cope with the circumstances.

Survivors face other unique emotional challenges. Compared with other bereaved individuals, they are more likely to experience symptoms of PTSD. This may be associated with the intensity and psychological impact of the grieving process itself. Or, it may be directly linked to circumstances surrounding the suicide, such as the trauma of discovering the body of the suicide victim. Survivors are also at greater risk of developing complicated grief: a persistent, intense grief that that doesn’t diminish over time. Complicated grief can impair the survivor’s ability to function both physically and psychologically, and puts the individual at greater risk of developing major depression, suicidal ideation, and suicidal behaviors.

If the suicide intervention programs being evaluated prove to be effective in helping men at risk access the help they need, this won’t just save the lives of potential suicide victims; the benefit will extend to all those who would otherwise be left to cope with the aftermath of the loss.

Engaging a Hard-to-Reach Population
The complexity of suicide with its biological, psychological, social, and cultural factors makes it a challenging issue to address. By evaluating these online intervention programs and assessing their use among high-risk, middle-aged men, this study will provide valuable data and insights into the needs of this demographic group and how to meet those needs. As coinvestigator Tanya Sharpe, PhD, MSW, an associate professor at the University of Maryland, Baltimore School of Social Work notes, “These programs are designed so the at-risk men can be reached with minimal effort on their part, allowing them to access therapeutic programs without leaving home.” Using technology in this way to bring the tools and resources directly to the user has the potential to increase engagement and improve behavioral health outcomes within a population that has traditionally been hard to reach.

Development of interventions that can effectively reach and motivate these men to seek help requires collaboration between the suicidology, public health, mental health, marketing, and media communities, according to the AAS. If the findings from the Maryland-Florida study indicate that the cost-effective online tools being evaluated are able to promote help-seeking and treatment follow-through within this population, this will be an enormous asset for the development and expansion of Web-based suicide intervention programs and collaborative projects in future.

— Susan A. Knight works with organizations in the social services sector to help them get the most out of their client management software.