 We're joined by Dr. Dan Bilsker, who is a professor of psychology at Simon Fraser University, and the co-author of the paper, The Silent Epidemic of Male Suicide. First of all, thank you, Dr. Bilsker, for joining us today. That's fine. For those of us who are not familiar with your research, could you give us an overview on your paper and the epidemic of male suicide? All right. What the paper does is take a look at the prevalence of male suicide in Canadian data, and observing that there's quite an extraordinarily high rate of death by suicide among men in Canada and the US and in European countries and many countries of the world. This has been true for quite a long time. Looked at the patterns that have been changing over time in terms of which age group among men are most at risk for suicide, which is now looking like we're talking primarily or at the peak about men who are in their mid-50s, which is a new phenomenon. It's not something that's really been noted before that middle-aged men in our Western society would be most at risk of dying by suicide. In the paper, we pull together some of the knowledge about this or what might be going on and really try to identify the gaps in our knowledge, how little we know about this phenomenon, about factors that drive male suicide, about differences between the genders in terms of propensity towards death by suicide, how that fits into people's lives, their means of coping, their emotional status, their social position. There's so much that we don't know about this very dramatic and extremely troubling phenomenon that's observed in the data. So this paper was an attempt to start to highlight what the problem is, the magnitude of the problem, and to highlight areas where we have gaps in our knowledge and at least to begin to suggest what we might do to start to fill in those gaps of knowledge and respond more effectively to this very substantial problem. Now, I saw in the paper that suicide attempts were still higher among females than males. And it's always been true in the data that women are three or four times as likely to attempt suicide, and yet, men are three or four times as likely to die by suicide. Very, very interesting and surprising discrepancy there. It really challenges our model of what suicide is and how it fits into a phenomenon like depression, et cetera. But what it's telling us at the most elementary level is that when men are attempting suicide, they're doing so in a much more lethal way. They're using more lethal methods, far more likely to use firearms. They are intent to die, and they don't seem to be carrying out this attempt in a manner that's likely to be rescued or be reaching out to others or warning or alerting others of their intention. When men become suicidal, on average, as a tendency, they're far more likely to help what's called a subtle intention to die. They've reached that point where they're feeling hopeless and cornered and without options. Far more dramatically, perhaps, than is true for women, and when they make that determination to attempt suicide, they do so in a manner that is going to be far more likely to be lethal and to end their lives. So there's something different about the way men even think about suicide once they're in that state, once they've reached that level. There are a number of factors that seem to be contributing to that difference. Women may attempt suicide, and it may be part of what used to be called a cry for help, but at least getting at the idea that there may be some element of communicating their distress or some sense that they might be assisted or rescued, where men seem to not have that belief. They're not acting as though they're expecting any kind of rescue or assistance. They're acting as though they simply have decided to end it and are not seeing any alternatives. Suicide is often linked with depression, and two are very closely intertwined. What can you tell us about each gender's susceptibility to depression? Are men more likely or equally likely to suffer from depression as women? What this drives home is how little the concept of depression actually tells us. We don't really understand what depression is. We don't really have a lot of knowledge about the situations, the patterns that drive people into severe depression or into that point where they feel so hopeless that they actually contemplate suicide. So what's remarkable is for all of the talk we've done about mental health, how little substantive knowledge we have about what's going on inside, the thoughts, the emotions, the experiences of those people who become so severely despairing, so severely hopeless that they actually contemplate ending their lives. With men, they're far less likely to be diagnosed with depression, to report depressive symptoms, but truly what do we make of that? Really what suicide is about is hopelessness and emotional suffering. Not the same as depression. It's a much more complex idea. The ways in which people can suffer emotionally, the ways in which they can feel hopeless and despairing are far more various and far more complex than a very crude concept like clinical depression can possibly capture. And I think that's what we see. We see men who are obviously suffering so intensely that they're willing to end their lives and yet may not be appearing or reporting the symptoms of depression. So I think we need a much broader and more complex understanding of human suffering and despair and hopelessness than is given to us by the very crude clinical concept of depression. So where does that begin? Where do we, or where do you as professionals start to tackle that problem? Well one of the factors that needs to be looked at are a few things that have begun to be identified about the way men cope with emotional suffering that may be raising their risk for depression. One of these is a tendency for men to deal with emotional suffering by increasing their use of alcohol. Now being intoxicated on alcohol has definitely been shown to be a contributing factor to suicidal behavior. An individual who is not thinking clearly because they're quite intoxicated, who has lost many of their normal inhibitions in the context of that intoxicated state is someone who is far more likely to act in a dangerous, self-injurious, or life-threatening manner. So there we have one of those factors and men are far more likely to be abusers of alcohol than are women. Again, these are huge discrepancies. So when you have a man who is dealing with a situation of emotional suffering, perhaps it's a relationship loss or a job loss or other kinds of interpersonal conflict, when that individual is not very good at dealing with interpersonal problems and not skilled at interpersonal problem solving, for example, and I think in general, that is still true that women are better at interpersonal problem solving and that individual is not good at reaching out for support or assistance from friends or family members or more health providers for that matter. And again, men have been shown to be far less likely to reach out for help when they're in some kind of psychological crisis that are women. You put those things together, the propensity to rely on alcohol, the lack of health seeking, the difficulty with interpersonal problem solving, and you can end up with someone who really is not very skilled at coping with emotional suffering in a way that is going to be effective. And you may have someone who really runs out of options very quickly or believes they have and feels that they've reached a dead end. That experience of feeling that you're at a dead end, there are no options, there's no hope, and your situation is unbearable, is the situation where people will consider suicide or become actively suicidal. So you really want to be giving men coping skills and tools for dealing more effectively with interpersonal problem solving, with relationship or occupational problems, with coping with their own emotional suffering more effectively, with reaching out for help, not relying on alcohol as a means to feel better when they're in an emotional crisis. Put those things together, and I think those at least are our best bets for improving our response to this very problematic, quite terrible social phenomena. What are also like the social factors that contribute towards this disparity between suicide rates? Well, there's been a lot of attention lately to this finding, I noticed, that while it used to be true that the peak for suicidal behavior would have been in late teens, let's say, early adulthood, and another peak in some of the data occurs where people are in their 80s or suffering from serious illness or debilitating functional impairment, et cetera. But now to find that the peak for suicidal behavior in men, in fact, is in the mid-50s, is a new phenomenon. So a lot of people are trying to figure out what in the world is going on that would be causing this huge shift. One of those social factors that has been suggested is perhaps it's something to do to what's happening to men in the workforce. But perhaps there are situations where men who are in their mid-50s have expectations of their career, which are no longer being met. They may feel relegated to more powerless-type positions within organizations. There may be a kind of ageism which is starting to operate so that what once was respected as experience and acquired knowledge now may be seen as simply having outdated skills or outdated forms of knowledge or approaches. So maybe the men are being pushed to one side in decision-making. They may actually be being fired from their positions when they would have expected to be doing well at the peak of their career. So you may have a discrepancy between what an individual expects to be happening and what is actually going on in the social structure in terms of their roles. Those discrepancies can cause people to feel a sense of despair, of frustration, and so forth that may drive that kind of emotional suffering and that kind of very dangerous behavior. So do you think the solution is gonna come from addressing the social factors more or the individual factors more? Well, I think it's pretty difficult to shift something like how society responds to individuals at different age groups. I mean, I'm not quite sure how you go about doing that kind of social experiment, but I think there's more potential in terms of reaching out at a population level to men in terms of enhancing their capacity for coping with distress, enhancing their interpersonal problem solving, training primary care providers, family physicians, and so forth to identify men who are getting into a sense of desperation or hopelessness, even if they don't present as depression. I think a lot of training in the primary care setting might well be quite helpful. There are also things that are being done now called gatekeeper training, where you may go into an actual work site and you identify certain individuals who are trusted by others and you train them to be good at allowing others to identify when they're going through an emotional crisis when they may even have suicidal thoughts. Not really counsel the person but at least give them some good advice, refer them appropriately to services they might get. So you have someone who can become the go-to person within a setting and some of these studies are being done in traditionally male settings or locales or employment areas, whether say construction or the military, et cetera, and you're enhancing the ability of men, you're lowering the barriers to seeking help to identifying their problem to being referred appropriately. So when you identify and train these people to be gatekeepers into a support system, you can make it much easier for men to speak about their distress and to be helped with it. Now you mentioned earlier that most of the research was done with Western cultures. As far as I know, now if there has been research in other cultures, then I know there was some interest within China in the last few years because of a number of suicides that were happening at a particular kind of industrial setting. And evidently, there were a number of people, I think it was primarily men, I actually am not positive about that data, who were committing suicide in the context of feeling essentially overworked, feeling desperate, cut off in their families, et cetera. And there began, I think, to be a lot of awareness that you couldn't ignore these as personal problems, but they affect, well they affect the whole workforce, they affect the whole society. So I think there was the beginning of real interest in how do we respond to this? I don't know what's happened in the intervening years. I'm hoping that there was continued progress with reaching out, providing more support to individuals who are feeling that kind of desperation. So finally, I wanted to ask you what advice you might have for people who are currently dealing with depression or perhaps thoughts of suicide? Well, when someone is actually dealing with thoughts of suicide, it really is a good idea to talk it over with family members, with a healthcare provider, usually in primary care, to at least start to get a sense of what sort of support systems therapy might be available, et cetera. On our website at SFU for our research group called CARMA, which is Center for Applied Research in Mental Health and Addiction, going to our website where we have a number of self-care tools, anti-depressant skills workbook, is a self-care workbook for learning how to manage depression better. There's even a handout called coping with suicidal thoughts to help someone begin to get on top of this, but really there's no substitute for reaching out, generally to the healthcare system, to learn what kind of counseling or therapy or support is available to get on top of these thoughts and to stay safe. Thank you very much for your time. Absolutely, I'm glad to do it.