The Other Health Risk For Middle-Aged Men: Suicide

Societal suppression of male emotion contributes to the 4th leading cause of death that no one talks about.

Congratulations! If you are between 45 -54 years old, you are officially “middle aged!” With this dawning of a new age comes new concerns, things perhaps you haven’t worried a lot about before.  Your primary care physician is probably telling you to be more conscious of your diet as your risk for diabetes is increasing. You are being encouraged to have a prostate exam at your next visit too. Your friends are even sending you emails about how to detect a stroke. Uplifting for sure! But let me ask you, who is talking to you about depression and suicide?

It’s ironic isn’t it? We will warn of you of diabetes, which is the 8th leading cause of death for your age bracket; make sure you know the signs of the 12th leading cause of death, a stroke; and even prostate cancer which is the 30th cause of death. Yet people are still afraid to talk to you about the 4th leading cause of death for your age group: suicide.

As a suicide prevention specialist at Riverside Trauma Center in Needham, Massachusetts , I have  been given the task of developing suicide prevention and depression awareness programs specific to middle-aged men. This is ironic in itself, as I am a relatively young (and charming) female, however the reality is that suicide is one of the most preventable tragedies our culture faces and yet we continue to avoid the much needed conversations about it. “Why is this?,” you may ask. The answers are many and complex. I think one of the most powerful causes is the stigma around suicide. I can remember a time when we would only say the words “AIDS” and “prostate cancer” in a hushed voice, and it seems as though we have made such progress in these areas.

Most of us now can speak openly, albeit not comfortably, about either topic, though not likely at a dinner party. But still the word “suicide” remains one said behind closed doors. Our fear of speaking the word is rooted in the underlying false belief that if we speak of it, somehow we increase the likelihood of it happening.  In the context of that fear and false belief, we in public health and mental health struggle to have the discussion needed to increase suicide prevention.  In this silence, we also send the message to those feeling depressed or considering suicide that they cannot talk about their experience.

This is only one of the problems, though. I believe the other even more devastating and damaging element is that feeling alone, sad and hopeless is simply not “manly.” At the same time, feeling angry (which is a common symptom of depression in men and boys) is seen as manly. What are some of the other common symptoms of depression you ask? Aggression, MANLY! Promiscuity, MANLY! Drinking beer (or any of your other favorite adult beverages), also MANLY! Men are discouraged from uttering the words “I feel,” often times leaving them feeling even more isolated and fearful of asking for help. This difficulty asking for support is especially challenging in the earliest stages of depression, which actually is the best time to deal with it.

Just to complicate it all a little more, men don’t tend to check in with each other. Don’t get me wrong: you will gladly ask if your pal saw the Pats game or if they heard Bruce Springsteen’s new, and might I add fantastic, album. But when is the last time you called your friend and said, “Hey, I haven’t seen you in a while. How are things going? Really man, are you doing alright?” That doesn’t happen nearly enough and sometimes those few words can save a life.

As you read my words, I’ll bet you can picture at least one friend that fits my description. He hasn’t been out with the guys – golfing, bowling or watching Sunday night football. He doesn’t laugh as much as he used to and he is somewhat of a downer. Maybe you know he hates his job, or he and his wife haven’t gotten along in years. Maybe he looks tired or never answers the phone anymore. So the real question becomes, how do you, as good men, take good care of one another?

So, if you are reading this and it makes you think of someone you know, call him. Check in. Tell him you miss seeing him. Reach out. Invite him to join you for an activity. Depression and suicidal thinking are not contagious. I am not just making this idea up; it’s based on a suicide prevention model called Question, Persuade, Refer (QPR).

The model encourages you to not only ask people how they are, but, if you see warning signs or if you are concerned about friends or co-workers, ask if they have thoughts of suicide. Then persuade the person that suicide is not the only option, and get him/her to someone who can help him if needed, seek immediate safety for the individual by calling 911. This model is intended to train non-mental health people how to help people who are suffering with despair, hopelessness and who may be contemplating taking their own lives.

Other options? I would also encourage you to check out “Man Therapy” at: It is a website geared towards men that uses humor and even takes place in Dr. Rich Mahogany’s manly office. It has great resources and is just plain fun to surf whether for yourself or with someone you care about in mind.

If you are that guy I described-feeling down, things don’t matter any more, maybe you can’t see things ever getting better- reach out to someone. Make plans. Treat the depression. Having spent time with way too many survivors (those left behind due to suicide), I promise you, there are people who care. You have many options. You can speak with your physician, you can find a counselor, you can call the National Suicide Prevention Lifeline (1-800-273-TALK.)

Calling a hotline or a counselor too big a step for you? Consider other things that might help: look at self-help resources online, volunteer to help others, call an old friend or relative who you’ve not talked to in a while, make a list of things for which you are (or have been) grateful, get a pet, play with that pet daily.  Trouble sleeping? (Which is often part of being depressed?) Ask your doc for ideas about better sleep habits, or check out online for some suggestions.

In 2009, there were nearly 37,000 lives lost to suicide and countless others left behind. That’s 37,000 lives cut short, dreams forever extinguished. That’s countless more who are left knowing that there will be no new memories, no more birthdays or holidays with their loved one. Suicide hurts everyone. It is our intention and hope that through education, increased awareness and most importantly an increase in compassion, we can help people see that there are other choices. We want me to see that there are more reasons to keep fighting and living then not. Will you join us in this mission?

For more resources, please explore the following articles/websites or call 1-800-273-talk:Suicide Prevention:

Signs of Depression:

For Veterans:


Photo credit: Flickr / humbert15


  1. Sarah, now don’t take this wrong. It’s just that whatever drives you to pursue this problem that men have in general, soceity doesn’t share it! It’s not that people are afraid to speak of this problem, it’s just that they DON’T CARE! For all I know it may be tied to the ‘Disposability’ of men, but the fact is , there’s an article on this site about gendered kids underware that’s gotten about 5X the response! If you reverse the gender and state 37,000 WOMEN died by their own hand in 2009, think of the uproar that would cause! A specific color would be designated and pro athletes in every major sport would be wearing matching wrist bands ,gloves, shoes, hats etc. Look, I’m not ‘crying the blues’. I.m just stating ‘That’s the way it is.’

  2. clair horne says:

    Richard my apology extended to you too .You too make some good points.

  3. Sarah,

    The world of ‘men disclosing a childhood full of abuse” is full of guys 45-55 yrs-old. By this time, lots of life equity has been spent. Surely our youth is spent. For some, we look back and see “I never allowed myself to deal with ‘that!!'” Or maybe it was repressed a bit and suddenly kicks the door open into out lives.

    For many, the flood of memories, rage, pain, grief, etc is all too much to handle, and we check-out.

    No man will deal with Childhood Sexual Abuse until he’s ready, but society and the medical, religious and everything-else-world can certainly make it more acceptable to do so early in life, because middle-age is NO time to be dealing with such weapons-grade plutonium.

    I was hospitalized for sexual abuse physical injury in childhood. They did not want to investigate back then.
    I was hospitalized twice in adulthood for the emotional ramifications of the abuse. Even in these times, mental health professionals did not want to deal with the topic.

    All they had to suggest was “forgive and move-on, but we don’t deal with that here.”

    I’m seeing FAR too many teen and adult men leaving the stage, rather than dealing with the default societal roadblocks and scorn. But there are a lot of us working to change things for the youngest victims.

    Thank you for writing this excellent article. Guys whom have ‘been there’ read it with a degree of inter-mesh others won’t “get.”

    • Sarah Gaer says:

      Let me start by saying I am so sorry for what you have been through and your feeling that those who were supposed to support you didn’t, as if you were not in enough pain. Sexual abuse is another one of those topics that so many people (men and women) experience and yet we seem so afraid to talk about it. The ability to forgive is only one small part of the puzzle, and should be presented as for the benefit of the survivor and not the offender. With all of that said, I would like to think that the mental health field and medical fields have come a long way since your experiences but I know that it is entirely dependent on who you interact with. I always hope that when people seek mental health counseling they know that it is ok if they don’t feel comfortable with someone, to tell them or find someone else instead of giving up on counseling. A bad match can be damaging and at the same time, a good match can change a person’s life.
      Thank you for speaking up about your experiences. I believe that these uncomfortable and painful conversations are the route to making our nation, our community, our families, our counselors and educators and ourselves healthier and stronger! Be well.

      • Sarah, by the time most men make it to ‘middle age’, the one thing you realize is that the only person you can depend on is the one that looks back at you in the mirror. And when he doesn’t ‘give a s**t’, you’re in trouble!
        P.S. as someone who’s ‘stood on the edge’ I can tell you it’s not depression itself, but despair that ‘does the trick’.

  4. Clair Horne says:

    Good article, I think Richard has missed the point a little, whist demonstrating the point at the same time. As a middle aged woman I worry about my middle aged husband . It is a shame men don’t get together and talk more about “sensitive”issues. I hope this article helps someone .

    • It is a shame men don’t get together and talk more about “sensitive”issues

      i remember being a teen in the late80s, reading about ‘new man’, drumming groups. those men lowered the mask-of-masculinity to reveal the ‘softer emotions’.
      i also remember ‘new man ‘ disappeared and the armour and the mask of masculinity being quickly redonned when socially progressive, not socially conservative, supposedly socially progressive women ridiculed these men in newspaper columns, and tele discussion shows (which for young people together with the local library was the internet, before the internet) for being weak, wimpy.

      • clair horne says:

        Jameseq , point taken. very sorry , fingers engaged before brain . Wanted to delete comment once i’d posted it but couldn’t work out how.

        • hey no worries, (i too would love the ability to delete a comment within a certain time).
          my comment was not an attack, and i hope it was not perceived as such – im not the most socially fluent. it was just to point out why a good number of western middleage men behave the way they do

          • clair horne says:

            jameseq , thank you for your understanding . Your point is very good and i think very true.Also I have a son and find that boys have to walk a tightrope between being sensitive and appearing manly .

    • Richard Aubrey says:

      You presume two things: One is that men don’t, and the other is that it would help.
      This is the default position: To the extent men differ from women, they’re defective. They must manifest the same emotions and in the same way as women do–as the lady’s mags say they should–or there’s something wrong with them.

      • Sarah Gaer says:

        You are correct. I know many men who do talk to their friends about such issues. They may not do it the way I (as a woman) would, but they do it and it works. This article was more targeting the many men I have spoken with who report that they don’t/wouldn’t. They are not sure how to or if they should say anything at all in fear of making their friend, brother, etc. more self conscious, angry, eshamed, etc. . You are also correct in your questioning wether it would work/help. In some cases, it may not. The person’s depression/mental illness has become too severe and they feel that they cannot recover, which is why we encouarge people to address depression as early as possible. But in many, many cases it does help. The individual realizes that they are not as alone as they thought they were and that people won’t judge them. Isolation is one of the most concerning risk factors for suicide so if we can help reduce that feeling, we can help. Thank you so much for your thoughtful comments!

      • Today @Richard Aubrey is my hero….
        I’ve been thrashing around & he sums it up in less than 50 words.

        • Richard Aubrey says:

          Drew. You got power yet? Any views on FEMA?

          Bout fifteen years ago, I was in a terrible funk about something undone–and unthought of when I should have thought of it. Long story. An old friend, we go back to jump school, said, “You can’t fix somebody over a beer.” I thought about it and it took a lot of the pain out of my self-reproach. Simple enough. One sentence.
          So, sometimes it helps. But it was a short narrative followed by a single sentence.
          No wallowing.

  5. Richard Aubrey says:

    37,000 suicides. What number were middle-aged men?
    Place amongst other causes can be a matter of solving other causes.
    If lung crud–this is a hypo–were first in killing men, and suicide fifth, solving lung crud would elevate suicide to fourth without any change in the numbers.

    • I didn’t see where there was an answer in this thread about how many middle-aged men died by suicide (of the 38,364 suicides in the U.S. in 2010), so here it is, from WISQARS, the CDC’s online source of fatal injury data (at 14,263 men between the ages of 40 and 64 died by suicide in the U.S. in 2010, which is 37% of the total fatalities. In case there is variation regarding what age group people might consider “middle-aged,” I’ve inserted below the breakdown for male suicide in the U.S. by age group for 2010 (and included the death rate per 100,000 population). Please note that for men age 45-59 in the U.S., the suicide rate is more than 30 per 100K (and the rate for the entire U.S.population as a whole is about 12 per 100K), which highlights the gravity of the situation:

      AGE / #DEATHS / RATE-100K
      25-29 / 2,459 / 23.12
      30-34 / 2,184 / 21.85
      35-39 / 2,372 / 23.62
      40-44 / 2,661 / 25.60
      45-49 / 3,375 / 30.11
      50-54 / 3,358 / 30.71
      55-59 / 2,859 / 30.02
      60-64 / 2,010 / 24.88
      65-69 / 1,345 / 22.98

Speak Your Mind