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Cited by 205Suicide and Self-Harm StudiesGender Roles and Identity StudiesLGBTQ Health, Identity, and Policy

Masculinity and suicidal thinking

Open access
Pirkis, Jane, Spittal, Matthew J., Keogh, Louise, Mousaferiadis, Tass, Currier, Dianne·2017·Social Psychiatry and Psychiatric Epidemiology
DOI 10.1007/s00127-016-1324-2
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Abstract

Purpose Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence.

AI snapshot

Written from the paper’s full text.

TL;DR

In a large cross-sectional cohort of Australian men, only one of 11 dominant masculine norms—self-reliance—remained associated with suicidal thinking after adjustment. The study suggests self-reliance may be a masculine risk factor for suicidal ideation, though causality cannot be established.

Key findings

  • Among 13,884 men aged 18–55 in Wave 1 of Ten to Men, 9.5% reported suicidal thinking (bothered by thoughts of being better off dead or hurting themselves on several days or more in the past two weeks).
  • In univariate analyses, playboy, pursuit of status, and self-reliance conferred risk for suicidal thinking, while risk-taking and emotional control were protective; after adjusting for other CMNI-22 factors and covariates, only self-reliance remained significant (AOR = 1.34; 95% CI = 1.26–1.48).
  • Sensitivity analyses confirmed self-reliance as the only significant masculinity factor when controlling only for covariates (AOR = 1.34; 95% CI = 1.26–1.42); the total CMNI score was not significantly associated with suicidal thinking (AOR = 1.02; 95% CI = 1.00–1.03).
  • Significant covariates included not being married/de facto (AOR = 1.41; 95% CI = 1.20–1.66), a key life event in the previous 12 months (AOR = 1.88; 95% CI = 1.60–2.20), harmful/hazardous alcohol use (AOR = 1.41; 95% CI = 1.22–1.63), and depression symptoms in the previous 12 months (AOR = 4.73; 95% CI = 4.04–5.53); least socioeconomic disadvantage (AOR = 0.73; 95% CI = 0.57–0.94) and higher social support (AOR = 0.98; 95% CI = 0.98–0.98) were protective.

Methods

  • Cross-sectional analysis of baseline Wave 1 data from the Australian Longitudinal Study on Male Health (Ten to Men), including 13,884 men aged 18–55 recruited in 2013/14 via stratified, multi-stage, cluster random sampling; response fraction for this age range was 36%.
  • Suicidal ideation was measured with a single PHQ-9 item asking about thoughts of being better off dead or hurting oneself over the past two weeks; scores of 1 or more were deemed suicidal ideation.
  • Main predictors were the 11 factors of the CMNI-22; covariates included age, marital status, region, socioeconomic status, employment, social support, stressful life events, alcohol use, depression, and GP use. Univariate and multivariate logistic regression were used with p < 0.01, plus sensitivity analyses; analyses used Stata 13.1.

Limitations

  • Paper-stated: cross-sectional data mean causality cannot be ascribed to the self-reliance–suicidality association; reliance on self-report; sampling underrepresents males in remote areas and/or not proficient in English; the single PHQ-9 item combines passive and active suicidal ideation and is not a suicide-specific instrument; the outcome is suicidal thinking, whereas the excess male rate occurs for suicide.
  • Paper-stated: firmer conclusions require longitudinal Wave 2 data and additional research on other points of the suicide continuum, particularly suicide.
  • Evident from text: the sample is restricted to men aged 18–55, so findings may not generalize to younger or older men or to women.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00127-016-1324-2

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Having relatively high levels of social support was protective against suicidal thinking (AOR = 0.98; 95%CI = 0.98-0.98).

    “as was having relatively high levels of social support (AOR = 0.98; 95%CI = 0.98-0.98).”
    Quote in the paperSubstantial claim
  • Findingown data

    Experiencing a key life event in the previous 12 months was associated with increased odds of suicidal thinking (AOR = 1.88; 95%CI = 1.60-2.20).

    “experiencing a key life event in the previous 12 months (AOR = 1.88; 95%CI = 1.60-2.20)”
    Quote in the paperSubstantial claim
  • Findingown data

    Residing in an area of the least socio-economic disadvantage was protective against suicidal thinking (AOR = 0.73; 95%CI = 0.57-0.94).

    “Residing in an area of the least socio-economic disadvantage was protective (AOR = 0.73; 95%CI = 0.57-0.94)”
    Quote in the paperSubstantial claim
  • Findingown data

    Having experienced symptoms of depression in the previous 12 months was associated with increased odds of suicidal thinking (AOR = 4.73; 95%CI = 4.04-5.53).

    “and having experienced symptoms of depression in the previous 12 months (AOR = 4.73; 95% CI = 4.04-5.53).”
    Quote in the paperSubstantial claim
  • Findingown data

    After controlling for each of the other factors on the CMNI-22 and for the other covariates, only self-reliance remained significantly associated with suicidal thinking (AOR = 1.34; 95%CI = 1.26-1.48).

    “After controlling for each of the other factors on the CMNI-22 and for the other covariates, only one masculinity factor remained significant, namely self-reliance (AOR = 1.34; 95%CI = 1.26-1.48).”
    Quote in the paperSubstantial claim
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    In univariate analysis, the masculinity factors of playboy, pursuit of status and self-reliance conferred risk for suicidal thinking, and risk-taking and emotional control were protective against it.

    “In the univariate analysis, the masculinity factors of playboy, pursuit of status and self-reliance conferred risk for suicidal thinking, and risk-taking and emotional control were protective against it.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Men who conform to dominant masculine norms are more likely to engage in health risk behaviours and less likely to engage in health promotion behaviours.

    “studies in Australia -where the model of dominant masculinity embodies the above characteristics -have shown that men who conform to dominant masculine norms are more likely to engage in health risk behaviours and less likely to engage in health promotion behaviours [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Mahalik J, Walker G, Levi-Minzi M (2007) Masculinity and health behaviors in Australian men. Psychol Men Masculin 8(4):240–249 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Males and females react differently to stressful life events, with males more likely to withdraw, respond aggressively and/or experience depressive symptoms, particularly in the face of events like divorce/separation and work problems.

    “In addition, males and females are known to react differently to stressful life events, with males being more likely to withdraw, respond aggressively and/or experience depressive symptoms, particularly in the face of events like divorce/separation and work problems [5,6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Kendler K, Thornton L, Prescott C (2001) Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects. Am J Psychiatry 158(4):587–593 source

      Not checked in the free run.

    • cites [6] Tomova L, von Dawans B, Heinrichs M, Silani G, Lamm C (2014) Is stress affecting our ability to tune into others? Evidence for gender differences in the effects of stress on self-other distinction. Psychoneuroendocrinology 43:95–104 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These characteristics of dominant masculinity can be positive and adaptive but may also contribute to behaviours and cognitions that increase suicide risk.

    “These characteristics can be positive and adaptive in many ways, but may also contribute to behaviours and cognitions that increase suicide risk [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Cleary A (2012) Suicidal action, emotional expression, and the performance of masculinities. Soc Sci Med 74:498–505 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    In the suicide prevention literature, suicidality is often thought of as developing along a continuum that begins with suicidal thoughts, continues through suicidal plans and suicide attempts, and ends with suicide.

    “In the suicide prevention literature, suicidality is often thought of as developing along a continuum that begins with suicidal thoughts, continues through suicidal plans and suicide attempts that may increase in severity, and ends with suicide.[42]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CMNI-22 is an abbreviated version of the original 94-item CMNI designed to measure cognitive, behavioural and affective conformity to dominant masculine ideologies.

    “These were assessed by the Conformity to Masculine Norms Inventory (CMNI-22), which is an abbreviated version of the original 94-item CMNI that was designed to measure cognitive, behavioural and affective conformity to dominant masculine ideologies [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Mahalik J, Locke B, Ludlow L, Diemer M, Scott R, Gottfried M, Freitas G (2003) Development of the conformity to masculine norms inventory. Psychol Men Masculin 4(1):3–25 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The study used a proximal measure of suicidal thinking (past two weeks) while the primary predictor was a more ingrained characteristic without a specified timeframe.

    “Having said this, we did use a proximal measure of suicidal thinking as our outcome measure (the PHQ-9 provides an indication of suicidal thinking over the past two weeks), whereas our primary predictor variable was more related to a more ingrained characteristic (the CMIN-22 asks about levels of agreement with particular statements without specifying a timeframe).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Men who are self-reliant may believe they should be strong in adversity, consider feeling down a sign of weakness, and be unlikely to reach out to friends, family or professional sources for help.

    “Men who are self-reliant may believe that they should be strong in the face of any adversity, consider that feeling down is a sign of weakness, and be unlikely to reach out to friends, family or professional sources for help.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The study provides new insights that may assist in unravelling why males are more prone to suicide than females.

    “These limitations aside, the study provides new insights that may assist in unravelling the vexing question of why males are more prone to suicide than females.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The question of how characteristics of dominant masculinity might increase, or protect against, suicidal thoughts and behaviours has been under-researched.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are suggestions that the factor scores of the CMNI are more meaningful than the total score.

    “There are suggestions, however, that the factor scores are more meaningful than the total score [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Owen J (2010) Assessing the factor structures of the 55- and 22-item versions of the Conformity to Masculine Norms Inventory. Am J Men’s Health 5:118–128 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The original 94-item CMNI has good internal consistency, construct validity and discriminant validity.

    “When the original 94-item instrument was developed it was shown to have good internal consistency, construct validity and discriminant validity [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Mahalik J, Locke B, Ludlow L, Diemer M, Scott R, Gottfried M, Freitas G (2003) Development of the conformity to masculine norms inventory. Psychol Men Masculin 4(1):3–25 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The outcome was suicidal thinking, whereas the excess male rate occurs for suicide.

    “Finally, we acknowledge that our outcome was suicidal thinking, whereas the excess male rate occurs for suicide.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The current analysis used data from Wave 1 of Ten to Men and is cross-sectional in nature.

    “It is important to reiterate here that the current analysis used data from Wave 1 of Ten to Men, and is therefore cross-sectional in nature.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The response fraction for the restricted age range 18-55 years was 36%.

    “The response fraction for the restricted age range considered in the current paper (18-55 years) was 36%.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The analysis controlled for the effects of the alternative masculinity factors and each of the other covariates.

    “We then conducted univariate and multivariate logistic regression analyses to estimate the strength of association between the 11 masculinity factors and suicidal ideation, in each case controlling for the effects of the alternative masculinity factors and each of the other covariates and adopting p < 0.01 as our criterion for statistical significance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study relied on self-report.

    “Other limitations include our reliance on self-report”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premiseown data

    The study included only the six life events that had been found significantly associated with suicidality in a previous analysis of Ten to Men data.

    “For the current study, we included only the six life events that we had found to be significantly associated with suicidality in a previous analysis of Ten to Men data [29,30]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Currier D, Spittal MJ, Patton G, Pirkis J (2016) Life stress and thoughts of death: the relationship between life events and suicidal ideation in Australian men—cross-sectional analysis of Ten to Men baseline data. BMC Public Health 16(Suppl 3):1031. doi: 10.1186/s12889-016-3702-9 source

      Not checked in the free run.

    • cites [30] Babor T, Higgins-Biddle J, Saunders J, Monteiro M (2001) The alcohol use disorders identification test: guidelines for use in primary care, 2nd edn. World Health Organization, Geneva

      Not checked in the free run.

17 of 17

  • The paper relies on this without support.

    Masculinity is not a homogenous, universal construct; rather there are multiple masculinities that vary across and within time and place.

    “Masculinity is not a homogenous, universal construct; rather there are multiple masculinities.These vary across and within time and place.”

  • The paper relies on this without support.

    The question of how characteristics of dominant masculinity might increase, or protect against, suicidal thoughts and behaviours has been under-researched.

    “Overall, the question of how characteristics of dominant masculinity might increase, or protect against, suicidal thoughts and behaviours has been under-researched.”
2 of 2

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting dates for Wave 2 data availability

    Minor

    The paper says Wave 2 data will be available for analysis in early 2017, but later says they will be available later in 2016.

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References 38 · Cited by 205

Research works printed but not linked: 1

  1. World Health Organization (2014) preventing suicide: a global imperative. World Health Organization, Geneva

Authors
Pirkis, J., Spittal, M. J., Keogh, L., Mousaferiadis, T., & Currier, D.
Affiliations
The University of Melbourne (AU)
Corresponding author
Currier, Dianne
ORCID
Venue
Social Psychiatry and Psychiatric Epidemiology
Publisher
Springer Science and Business Media LLC
Published
2016-12-26
Volume
52
Issue
3
Pages
319-327
ISSN
  • 0933-7954 (ISSN-L)
  • 1433-9285
DOI
10.1007/s00127-016-1324-2
OpenAlex
W2562850754
Semantic Scholar
b85bb755f3e4cefdf8969fad2968c99e623a8d86
Cited by
205
References
38
Citations by year
2026: 15 · 2025: 22 · 2024: 15 · 2023: 31 · 2022: 23 · 2021: 39 · 2020: 24 · 2019: 18 · 2018: 13 · 2017: 5
FWCI
16.06
Type
journal article
Language
en
Update notices
erratum (2017-09-15)
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Funders
Department of Health, Australian Government
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Gender Studies › Gender Roles and Identity Studies
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
Keywords
masculinity, suicidal ideation, self-reliance, men's mental health, suicide prevention
MeSH terms
Adolescent, Adult, Australia, Humans, Longitudinal Studies, Male, Middle Aged, Young Adult, Masculinity, Suicidal Ideation

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