408410

liffe et al.American Journal of Mens Health

JMH5510.1177/1557988311408410O

American Journal of Mens Health

Suicide From the Perspectives

5(5) 444454
The Author(s) 2011
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DOI: 10.1177/1557988311408410
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Depression: A Gender Analysis

John L. Oliffe, PhD1, Christina S. E. Han, BA1,

John S. Ogrodniczuk, PhD1, J.Craig Phillips, PhD, LLM1,
and Philippe Roy, MA2

Abstract
Depression can be a pathway to older mens suicide, yet the mechanisms by which this can occur are poorly understood.
A qualitative study of 22 older men who self-identified or were formally diagnosed with depression was conducted to
describe the connections between masculinity, depression, and suicide. Analyses of individual interviews revealed that
cumulative losses around social bonds were central to older mens depression, apathy for living, and thoughts about
suicide. Prominent were mens self-assessments of failing to fulfill breadwinner roles, judgments that led participants
to ruminate on their shortcomings amid recognizing their older age as limiting opportunities for redemption. Stigma
featured as a barrier for men acting on their suicidal thoughts, and guilt about the pain their suicide would evoke
on family and friends was a strong deterrent for mens self-harm. Overall, participants alignment to masculine ideals
influenced both the connectedness and detachment between older mens depression and suicide.

Keywords
older men, depression, suicide, masculinity

Introduction Of the many social factors underpinning mens depres-

Suicide is one of the leading causes of death in North
American men and particularly high is the incidence of
suicide among men 75 years and older (Statistics Canada,
2010; U.S. Census Bureau, 2010; U.S. National Center
for Health Statistics, 2007; please see Tables 1 and 2).
Numerous social and psychological factors are impli-
cated, and though the pathways to suicide vary, there is
consensus that severe depression can be a trigger for older
mens self-harm and suicide (Gunnell, Middleton, Whitley,
Dorling, & Frankel, 2003). In terms of cause, mens depres-
sion is reported to emerge from diverse sources, includ-
ing grief and loss around conjugal bereavement or divorce,
which in turn are significant risk factors for suicide (Elwert
& Christakis, 2008; Payne, Swami, & Stanistreet, 2008;
Schmutte, OConnell, Weiland, Lawless, & Davidson,
2009). Lost social bonds can also isolate men, partly
because women play a critical role in connecting men
socially and providing them with emotional support
(Bennett, 1998; Swami, Stanistreet, & Payne, 2008).
Implicated also as rendering older men who experience
depression vulnerable to suicide are comorbid physical
illnesses, functional limitations, and financial stresses
(Beautrais, 2002; Conwell et al., 2000).
sion and/or suicide, masculinity has attracted recent atten-
tion both in commentaries and empirical accounts. Work,
including the current qualitative study, has drawn on social
constructions of gender using Connells (1995) masculini-
ties framework to advance Courtenays (2000) adaptation
to mens health research by inductively deriving insights
about dominant ideals of masculinity, and how they influ-
ence boys and mens gender roles, identities, and relations
and their health and illness practices. Social construction-
ist gender studies have revealed connections between
masculinities and mens depression-related experiences.
Emslie, Ridge, Ziebland, and Hunts (2006) secondary
analysis of mens interviews derived from a study that
focused on depression-related issues found that longstand-
ing feelings of isolation and differencein addition to
sadness, guilt, detachment, anger, and fearwere central
1
University of British Columbia,Vancouver, British Columbia, Canada
2
Laval University, Quebec City, Quebec, Canada
Corresponding Author:
John L. Oliffe, School of Nursing, University of British Columbia, 302-
6190 Agronomy Road,Vancouver, British Columbia, Canada,V6T 1Z3
Email: john.oliffe@nursing.ubc.ca. Web: www.menshealthresearch.ubc.ca
Oliffe et al. 445

Table 1. U.S. Mens Suicide Rates by Age Group (2000-2006) crime, behaviors that ultimately increased their risk for
self-harm and suicide. The authors concluded that tradi-
Age (years) 2000 2001 2002 2003 2004 2005 2006
tional notions of masculinity informed and influenced
1-4 n/a n/a n/a n/a n/a n/a n/a mens actions within and across the big build processes
5-14 1.2 1.0 0.9 0.9 0.9 1.0 0.7 they described (Brownhill et al., 2005). Clearys (2005)
15-19 13.0 12.9 12.2 11.6 12.6 12.1 11.5 study of young Irishmen highlighted the constraining influ-
20-24 21.4 20.5 20.8 20.2 20.8 20.2 20.8 ences of hegemonic masculinity in mens silences around
25-34 19.6 21.0 20.5 20.6 20.4 19.9 19.7 distress, reluctance to disclose emotional matters, and
35-44 22.8 23.1 23.7 23.2 23.0 23.1 23.2 elaborate secret-keeping in concealing plans for suicide.
45-54 22.4 23.4 24.4 24.4 24.8 25.2 26.2 Oliffe, Ogrodniczuk, Bottorff, Johnson, and Hoyaks
55-64 19.4 21.1 22.2 22.3 22.1 22.2 22.7 (2010) study of middle-age men who experienced depres-
65-74 22.7 24.6 24.7 23.4 22.6 22.7 22.7 sion found how aligning with masculine ideals could prompt
75-84 38.6 27.8 38.1 35.1 34.8 35.8 33.3 participants to counter suicidal thoughts or draw them
85 57.5 51.1 50.7 47.8 45.0 45.0 43.2
closer to self-harm and suicide.
Although linkages between masculinity and mens
Note. n/a = not applicable.
Source. Adapted from U.S. Census Bureau (2010). depression and/or suicide have been described, much of
this literature has focused on young and/or middle-age
Table 2. Canadian Mens Suicide Rates by Age Group (2003- men (Schmutte et al., 2009). Yet, implicitly, much of the
2007) literature addressing older mens depression reveals cause-
effect relations that are intricately connected to masculin-
Age (years) 2003 2004 2005 2006 2007
ity. For example, advancing age can be accompanied by
10-14 1.7 1.6 1.7 1.2 1.7 reduced physical, mental, and emotional strength (Gunnell,
15-19 14.8 14.7 13.4 10.1 11.4 Platt, & Hawton, 2009) and masculine protector and pro-
20-24 22.1 19.2 20.1 18.9 19.6 vider roles can be lost through unemployment, retirement,
25-29 18.3 19.9 17.5 15.5 19.9 and illness (Gilchrist, Howarth, & Sullivan, 2007; Schmutte
30-34 20.3 23.0 19.6 16.6 16.5 et al., 2009). A study of elderly widowers by Bennett (2007)
35-39 27.4 23.2 24.9 21.7 21.8 found that emotional suppression, especially in public, amid
40-44 26.1 23.1 27.2 24.2 21.9 embodying masculine ideals of control, rationality, respon-
45-49 26.4 25.4 28.8 26.1 27.0 sibility, and successful action were key to mens efforts for
50-54 26.5 25.7 25.7 22.8 25.3 preventing depression. Despite often experiencing signifi-
55-59 25.3 21.6 22.2 24.5 21.5 cant suffering, men tend to internalize, suppress and/or
60-64 22.5 17.6 17.5 22.3 17.9 deny emotional distress (Cantor & Slater, 1995; Thompson,
65-69 19.7 14.5 18.3 17.4 14.2 2008), a practice that reflects traditional Western mascu-
70-74 17.9 17.0 17.0 14.0 15.5
linity, which avows the display of emotion as decidedly
75-79 19.2 19.3 22.7 23.4 20.9
feminine and transgressing masculine ideals (Byrne &
80-84 19.8 20.6 19.4 18.4 23.5
Raphael, 1997). It follows that mens suicide rates may, at
85-89 22.6 26.8 21.4 29.2 23.8
90 40.6 19.2 20.1 35.7 18.3 least in part, reflect the stress of self- and social expec-
tations about embodying traditional breadwinner and
Source. Adapted from Statistics Canada (2010). family man masculine roles (Chuick et al., 2009). Such
interpretations are supported by a study examining older
to participants accounts of their depression. Also high- mens suicide notes which revealed guilt, regret, and blame
lighted have been recursive relationships between college as key themes (Salib, Cawley, & Healy, 2002).
mens masculinities and depression (Oliffe, Kelly, et al., Idealized masculinities also prescribe characteristics
2010) and how varying configurations of masculinity of autonomy and self-reliance, which can influence mens
connect to mens depression triggers, early symptoms, risky self-management strategies and discursively shape
external overflow, and maladaptive coping (Chuick et al., their reluctance to engage professional mental health care
2009). services (Real, 1997; Rochlen et al., 2010; Rutz & Rihmer,
Social constructionist gender studies have also been 2007). Health-related stigma whereby a person can be neg-
used to describe linkages between masculinity and mens atively identified and disapproved of because of a mental
depression and suicide. Brownhill, Wilhelm, Barclay, and or physical health issue (Goffman, 1963) can be particu-
Schmied (2005) detailed the potential for a cascade of larly critical and pervasive for men who are deemed to be
events in which mens internalizing and avoidance of personally and morally responsible for their own health
problems and/or self-medicating with alcohol and other and illness (Greaves, Oliffe, Ponic, Kelly, & Bottorff,
drugs was linked to risk-taking, violence, aggression, and 2010), and in the specific context of suicide, their own
446 American Journal of Mens Health 5(5)

death. Reluctance to seek help and maladaptive self-man- Table 3. Participants Demographic Information (N = 22)
agement strategies such as self-medicating depression
Demographic n Percentage
and suicidal ideation with alcohol and other drugs (Riska,
2009) may also be a by-product of stigma, and contribute Age (years)a
to the discordant relationship between mens high suicide 55-59 3 13
rates and low rates of clinically diagnosed depression 60-64 5 23
(Mkinen & Wasserman, 2000; Rihmer, Belso, & Kiss, 65-69 5 23
2002; Rutz & Rihmer, 2007). 70-74 4 18
7579 5 23
Employment status
The Current Study Employed full time/part time 9 41
The goal of the current study and article is to describe link- Unemployed 6 27
ages between masculinity, depression and suicide among Retired 7 32
Marital status
older men, as a means to directing men-centered mental
Married 3 13
health care services. Interpretive descriptive methodology,
Common-law 12 55
in which an in-depth understanding of the participants
Separated 1 5
experiences is sought, was used (Thorne, 2008). Influenced
Divorced 4 18
by grounded theory, naturalistic inquiry, and ethnography,
Widowed 2 9
interpretive description affords selection from a variety of Ethnic background
data collection methods to present a conceptual description Caucasian 20 91
discussing thematic patterns and commonalities character- Asian 2 9
izing a clinical phenomenon (Thorne, 2008). In addressing Sexual orientation
the overarching research question, How does masculinity Heterosexual 20 91
shape older mens perspectives and practices around depres- Homosexual 2 9
sion and suicide?, qualitative traditions central to interpre-
a. Age range = 55-79 years; mean SD = 67.81 6.92 years.
tive description, including the researchers co-construction
in collecting and interpreting the data, and their commit-
ment to inductively deriving the findings, were followed
(Morse & Field, 1995). and time of the participants choice. Researchers explained
to participants that the interview was not intended as a form
of therapy but rather as an opportunity for us to better
Methods understand older mens depression-related experiences.
Participants Baccalaureate- and masters-prepared researchers, trained
in qualitative interview methods conducted the interviews,
A total of 22 English-speaking men ranging in age from and participants received a nominal honorarium of Canadian
55 to 79 years (M = 67.8 years; SD = 6.92) who self- $30 to acknowledge the time spent and their contribution to
identified (n = 8; 37%) or self-reported that they had the study. Participants provided demographic data and
previously been clinically diagnosed by a health care completed the 21-item Beck Depression InventorySecond
professional (n = 14; 63%) with depression participated in Edition (BDI-II; Beck, Steer, & Brown, 1996; see Table 4).
the study (see Table 3). In all, 19 of the 22 participants BDI-II has been assessed for its reliability and validity
were Anglo-Canadian and 3 participants were of Asian (with the specific inclusion of an alpha coefficient) in
ancestry. Participants lived in Vancouver (n = 12; 55%), a numerous studies including research with a group of young
city of 550,000 in Western Canada, and Kelowna (n = 10; incarcerated men (Palmer & Binks, 2008), and its inclu-
45%), a regional city in the interior of British Columbia sion in the current study was based on a desire to use broad
with a population of 165,000. Postcards, brochures, fly- categories to describe the severity of participants depres-
ers, and newspaper advertisements described the study sion at interview.
and invited potential participants to contact the project Although an interview guide was used, participants
manager. were encouraged to share details about what was most
relevant to them in an effort to foster conversation, rather
than formally trade questions and answers. Although the
Procedure interviews were not specifically focused on issues per-
Following ethics approval and completion of a written taining to suicide, the participants volunteered informa-
consent form, individual in-depth, semistructured inter- tion about suicide and openly shared their experiences
views lasting 60 to 90 minutes were conducted at a location and perceptions. The content and severity of participants
Oliffe et al. 447
Table 4. Participants Depression Characteristics (N = 22)
Characteristic
Clinically diagnosed with depression
Yes
No
Year(s) with clinical diagnosis of depression (of 14 participants)
Diagnosed (of 14 participants) with depression by a
Doctor
Psychologist
Psychiatrist
Currently on treatment (n = 14)
Group counseling
Medication(s)
Beck Depression Inventory score
<15 (mild depression)
15-30 (moderate depression)
>30 (severe depression)
Not available (did not complete)
thoughts about suicide, and the specific linkages to depres-
sion revealed all the men as having direct experiences with
suicidal thoughts. Within this context specific interview
questions were included such as, what are your thoughts
around self-harm and suicide?, along with prompts
including, can you tell me more about that? and, what
was that like for you? Interviewers provided a printed list
of mental health service resources to the participants, and
followed guidelines for ceasing interviews and referring
interviewees to professional care services if they observed
any participant distress. Digitally recorded interviews were
transcribed verbatim excluding identifying information,
reviewed for accuracy, and labeled with an identifier
code.
Data Analysis
Within qualitative studies, in addition to the study findings,
research questions can be inductively derived based on
what is shared by the participants. The interview data
were mined for instances whereby participants detailed
their perspectives about suicide, and experiences around
suicidal thoughts and the connections to their depression.
From this parent code, labeled Suicide, a data subset was
derived, abstracted and independently read by the authors.
Entire interviews and the coded suicide data were discussed
by the authors with the overarching research question in
mind: How does masculinity shape older mens perspec-
tives and practices around depression and suicide? In line
with some components of consensual qualitative research
(CQR; Hill et al., 2005), the authors worked to consen-
sus around core ideas before moving to cross-analysis.
Range M SD n Percentage
14 64
8 36
1-40 17.28 14.09
4 29
2 14
8 57
4 29
10 71
2-46 18.19 11.33
10 46
8 36
3 13
1 5
Specifically, through repeated readings of the interview
data with the research question in mind, ideas and
interpretations about recurring and converging pat-
terns were discussed and developed by the research team.
In the cross-analysis phase the team met to generate key
concepts, and preliminary themes were inductively derived
and labeled, along with illustrative examples drawn from
the core idea data. Descriptive notes were used to define
emergent themes so that relationships between them could
be developed. Themes defined as coherent patternsboth
within and across the datawere identified and devel-
oped through these iterative processes (Hammersley &
Atkinson, 1995). The relevant empirical and masculini-
ties literature was also revisited to prompt questions
about the data and to further develop the analyses (Spradley,
1980). Cohesive sampling, the collection of rich data, and
analyses engaging all the participant data and commitment
to reaching author consensus were key to claiming satura-
tion (Morse, 1995).
Results
As per Hill, Thompson, and Williams (1997) and Hill et al.s
(2005) approach to classifying qualitative findings the first
two themes, cumulative loss and failed providers are
general (i.e., all the participants are represented) and the
third theme, stigma and suicide, was typical in that it applied
to more than half the participants. Though the findings
are detailed in three discrete themes, the overlap between
the themes reflects their connectedness in the mens
lives, and distilled in what follows are the issues consis-
tently discussed by the participants.
448 American Journal of Mens Health 5(5)
Cumulative Loss
In locating their depression and contextualizing perspec-
tives about suicide, the participants detailed numerous and
cumulative losses across their lives. Permeating the mens
interviews was an insistence that many issues, rather than
one particular incident, had fuelled their depression. For
example, a 62-year-old man described a series of chal-
lenges, including job loss, financial hardship, the death of
close friends, and his daughters chronic illness as strong
contributors to his depression and emergent thoughts about
suicide. Moreover, the grief that emerged from each of
these events lay unresolved which, retrospectively, he
suggested had led him to self-isolate, I guess it was anger
and frustration . . . I just tuned the world out. Extreme
lows punctuated the mens lives and ultimately prevailed
as losses accrued to overshadow and outweigh their life
accomplishments. A 66-year-old man explained that his
whole life had been like a rollercoaster ride as a result
of his poorly controlled depression:
When Ive gone into something like in university
or my flying or my locksmithing, I do very well,
but then all of a sudden I crash. Everything seems
to go wrong and I lose interest and I start hating the
world.
In this example, the pattern of loss eventually lim-
ited the mans energy and interest for taking up recre-
ational activities and pursuing work interests. Amid
these restrictions, his intimate relationship fractured
and many social bonds were severed, leading to a cas-
cade of losses:
Even with my second wife, I cant hug her, weve
never had a close relationship Ive always pushed
her away. My older son wont talk to me now
because he just doesnt like the way that Ive treated
my wife.
As men grew older, reversing these trends and find-
ing opportunities for redemption faltered. Instead, life-
long struggles and depression-induced fatigue spread,
and recognition of their older age and mortality grew.
The mens life quality was eroded to a point where their
efforts for fighting depression were questioned because
the number and quality of years that they were presum-
ably fighting for were negligible. A combination of
loss, unresolved grief and fatigue underpinned mens
depression, manifesting as nihilism. A 75-year-old
electrician made reference to the many sites of failure
in suggesting their cumulative toll had quelled his inter-
est for living:
I start each day wondering what the point is con-
tinuing. In the words of I think it was Marc Twain
thousands of years before I was born, I knew noth-
ing and I wasnt greatly inconvenienced.
Yet, rather than positioning suicide as the solution to this
quandary, participants described their profound disinterest
in living, for which they hoped death might emerge natu-
rally as a by-product of older age or accident. A 75-year-
old man harbored irreconcilable regrets and profound
melancholy in suggesting:
If I was confronted with a serious life and death situa-
tion, I wouldnt fight all that hard to stay on the alive
side. I would say well my time has come and thats
that. I dont want to fight this. I might not win anyway.
A 66-year-old man assured us that he didnt have the
nerve or whatever it takes to kill myself recalling how,
even as a younger man choosing a military tour of Vietnam
as the perfect place to die did not come to fruition.
Similarly, a 62-year-old salesman declared that he didnt
want to do anything like blow my head off . . . but on the
other hand I dont want to be alive.
In sum, amid significant unresolved grief mens apathy
and disquiet prevailed, and real, imagined, and anticipated
loss fuelled profound sadness and anxiety about being
unable to stem or accept what had been lost. Although
resilient in assuring us that suicide was not an option the
participants indicated they had thought about, and for the
most part, welcomed death as providing the ultimate
respite from lifelong challenges and the hopelessness they
endured. As Havens (1965) suggests, suicide most often
emerges from multiple factorsa knot of circumstances
tightening around a single time and place, and in this
regard, participants seemed vulnerable to self-harm in
giving up their fight against depression.
Failed Providers
Participants depression and suicidal thoughts were most
often linked to perceptions that their lives had been of little
consequence, especially in terms of failing to build a
career and wealth as a means to fulfilling breadwinner
roles. A 62-year-old participant explained that he had
fallen short of his and societys expectations that he be the
primary provider for his family, and in particular he had
failed to meet the needs of his daughter, who was disabled
and confined to a wheelchair:
You havent accomplished what you set out to do
and set your family up, so as they say, I never did
figure out a way to do it.
Oliffe et al. 449
Typically, a lifetime of work was detailed by partici-
pants during the interview, demonstrating how mens
masculine identities were strongly linked to what they do
or did for a living. A 55-year-old bus driver revealed the
centrality of his working man identity:
I dont know whats going to happen if I have to
retire. I really like being somebody . . . whatever
that somebody is, environmental tech or a safety
guy or a bus driver, and when I wasnt working, I
didnt have the identity of you know whats your
job and I find that really difficult.
A 64-year-old participant confirmed that many older
men relied heavily on work, and that retirement, redun-
dancy, and/or retrenchment were significant threats:
A lot of men who have been working for one com-
pany for a lot of years, when suddenly that stops,
their whole life has been revolving around the job .
. . they find themselves at a loose end with nothing
to do. No purpose in life anymore.
As younger men, participants had goals, made plans,
and had high hopes for what they might achieve in their
working lives. However, as older men, paid work had
ceased or fewer work years remained and the potential
for job advancement or a flourishing career were dimin-
ished. Competing with younger and relatively cheaper
workers was also stressful, as a 62-year-old administra-
tor explained,
Id hired all the other staff so they could then bring
in a person that was half my age at two thirds my
salary and he basically just ran the systems I had
set up . . . Im getting pretty old and Im not that
employable or people perceive you as being old.
Despite these challenges, men were dedicated to work
as long as they could to ensure that they and/or their fami-
lies had enough money to live comfortably. A 79-year-old
participant, who worked in a clothing factory, said I
manage to keep the family going . . . the only pleasure I get
is to give them (his children and grandchildren) something.
I just gave my two granddaughters a car. Similarly, a
58-year-old participant who worked in sales assured us
that despite his discontent, Ill just keep on working, Ive
got to feed the wife and kids, Ill go to work anyway even
though life sucks. The fragility of the mens employment
and the modest jobs they had or had previously done were
ever present.
Although depression invoked barriers to establishing a
career, the ability to sustain or tolerate a job was also
challenging. A torrent of negative outcomes accompanied
mens unemployment and some participants positioned
suicide as an antidote to such failings, as a 55-year-old
bus driver revealed,
Job losses are a big deal for me . . . a really, really
big deal . . . really caused some life-changing events
. . . It was probably in the middle of looking for
work and beating myself up for not being a good
parent and not being a good person. I couldnt even
keep a job. It would be easier to just kill myself and
get on with it. Let the rest of the world manage
however they would.
Illustrated here are connections between mens mascu-
line identities and the roles that are contingent on their
capacity to work. Participants often self-assigned failed
provider labels based on their income or lack thereof,
while suicide offered an end to those shortcomings, and
closure to what had frequently been a lifelong battle to sus-
tain a fundamental manly enterpriseto work and provide
for family. These findings support Shiner, Scourfield,
Fincham, and Langer (2009) who suggest that work-related
problems and financial difficulties can strike a profound
blow to mens sense of purpose and belonging. In addi-
tion, as Robertson (2007) predicts, while work and per-
sonal attachments can be protective, under strain (as is
often the case with older mens depression), they can also
be a source of stress.
Stigma and Suicide
Noteworthy is that many participants positioned stigma
around suicide as a highly influential barrier to self-harm
or acting on thoughts about suicide. However, rather than
self-interest, participants consistently pointed to their
desire to protect family and friends from the distress,
shame, and/or guilt that would likely accompany their
suicide. A 58-year-old salesman told us a story about the
suicide of a close friend in explaining why he would never
take his own life, regardless of the emotional, physical,
and mental pain he experienced,
He got depressed, he had his young son down, went
home and hung himself . . . and the first person in the
door was his son, why did he do that? Why did he,
you know, why leave that last memory of his dad to
his son? Because he knew his son would find him
but maybe he didnt care.
Most men agreed that family was their primary reason
for living, and significant others directly and indirectly
influenced participants resistance to self-harm and sui-
cide. A 62-year-old administrators efforts for self-health
were taken up for his family. Within this context, he was
dedicated to protecting his family from the stigma that
would accompany his suicide:
450 American Journal of Mens Health 5(5)
If I hadnt have had family around, well whats to
stop me from committing suicide. I, it wouldnt
have mattered. It was just the fact that there were
people that were important to me that I didnt want
to disappoint. I guess thats what it was; I wasnt
prepared to disappoint them.
For a few men, the stigma associated with transgress-
ing particular spiritual and/or moral beliefs was also a
strong deterrent. A 78-year-old man explained, I dont
contemplate suicide. I absolutely dont. Im a Christian
and I have religious convictions that I kind of live by.
Common across the participants narratives was a desire
to remain true to their beliefs and family man values, and
avoid the stigma that would inevitably flow toward others
from taking ones life.
Some men explained that they had thoughtfully
considered how they might be able to take their own
life without attracting the stigma that typically accom-
panies suicide. In this context, participants pondered
a self-induced death that was not obviously suicide,
as a means to leaving a financial legacy for their fam-
ily. A 62-year-old administrator who was an avid kay-
aker described the complexities of achieving what would
pass as an accidental recreational death through
suicide:
She (his wife) knows Im a shore hugger. Ive drilled
that into kids that Ive taught. You never paddle
further away from shore than you care to swim. So
having someone have an accident 5 km off shore
would raise red flags. So um, as I say it I couldnt do
it anonymously so to speak.
Underpinning these thoughts, he explained, were care-
ful calculations about the dual benefits that his death would
bring. Specifically, the burden of his depression on his
family would be waylaid, and they would also be better off
financially if he were dead:
Its funny, you look at your life and you think ah
theyd (family) be better off without me. As a mat-
ter of fact with the insurance I carry, financially
they would be a hell of a lot better off without me.
Likewise, the 66-year-old locksmith who had struggled
financially throughout his life suggested that
If I do it (suicide) properly I can arrange it so that
my wife and children will get my insurance money,
which they wont get if I commit suicide. So my
thoughts, I continually think how can I do it? How
can I kill myself without the insurance company
knowing that I killed myself? You know, make it
look like an accident.
Whereas Roeloffs et al. (2003) and Sirey et al. (2001)
suggest that stigma around mens depression can fuel
mens reluctance to seek professional medical help and/or
comply with treatments, our findings reveal how suicide-
related stigma can also inhibit older men from acting on
their suicidal thoughts.
Discussion
The current study supports many findings drawn from
previous work connecting masculinities and depression
(Addis, 2008; Chuick et al., 2009; Emslie et al., 2006;
Oliffe, Kelly, et al., 2010), and suicide (Cleary, 2005)
while further mapping the pathways between mens
depression and suicide (Brownhill et al., 2005; Oliffe,
Ogrodniczuk, et al., 2010). In sum, although the influ-
ences of masculine ideals on mens depression and sui-
cide are ever present, fine-grained analyses afforded
insights to how discrete aspects of masculinity can emerge
as risk or potential remedy. This is important because
made available are opportunities for transitioning descrip-
tive research toward interventions. Also afforded by our
novel study are rarely described insights about how older
mens masculinities intersect with suicidal thoughts
among participants who are clinically diagnosed or self-
identify as depressed. In connecting these emergent but
somewhat estranged bodies of knowledge, we are better
equipped to begin to consider the ingredients for older
mens suicide prevention programs. By soliciting the views
of participants who experience depression, we have also
responded to Schmutte et al.s (2009) call for qualitative
studies to better understand the complexities in and around
older mens suicide.
Some empirical weight and important contextual infor-
mation is also provided to interrogate Synnotts (2009)
assertion that the greatest risk factor for mens suicide is
masculinity. Permeating the three thematic findings are
poignant examples of how mens depression and thoughts
about suicide are mediated by their alignments to mascu-
line ideals around work and family. Visible are intricate
connections between work and family man identities and
masculine provider and protector roles, and their potential
to bolster or block mens efforts for managing suicidal
thoughts. In this regard, aligning to masculine ideals
emerges as neither entirely risky nor health promoting in
nature. For example, as Kilmartin (2007) poignantly articu-
lated, discourses of masculinity preserved and perpetuated on
stage and screen in stories such as Its a Wonderful Life
(Capra & Capra, 1945) and Death of a Salesman (Miller,
1949) can posit mens undetected suicide as rational and
selfless in making good on the patriarchal promise of
providing financial security to their family. Yet also evi-
dent in our study were mens efforts to protect their fam-
ily and provide for them through continuing their fight
against depression. In this regard work and family-centered
Oliffe et al. 451
masculine ideals can bolster mens resilience and afford
purpose to counter the thoughts about self-harm and sui-
cide that can flow from depression.
The findings from this study support Rochlen et al.s
(2010) recommendations for depression self-management
strategies that draw on mens alignment to work and physi-
cal activity. That said, as older men encounter reductions
in physical and mental strength, and work opportunities,
depressive episodes can be especially difficult to manage.
Perhaps this explains, at least in part, why the study par-
ticipants who worked were reluctant to retire despite their
self-reported fatigue and lethargy amid advancing age. In
addition, noteworthy is how the ideals of Freedom 55,
a retirement plan for leaving the workforce at 55 years of
age, have buckled within the current economic downturn
while life expectancy in many Western countries contin-
ues to rise. Having to work longer is a trend likely to con-
tinue for the baby boomers (born 1946-1964) rendering
more men susceptible to the challenges that arise from the
nexus of working in older age (in many cases to offset
escalating costs of living) despite deteriorating physical
and mental health.
Many recommendations focus on making adjustments
to professional mental health care services as the lynch-
pin to advancing the well-being of older men who expe-
rience depression (see Klap, Unroe, & Unutzer, 2003;
Luoma, Martin, & Pearson, 2002; Rutz, 2001; Strike,
Rhodes, Bergmans, & Links, 2006). As symptoms of mens
depression may differ from those of women to an extent
that they are inadequately captured by some generic diag-
nostic criteria and screening tools (Pollack, 1998; Rochlen
et al., 2010), it may be beneficial for clinicians to include
questions about work and family, as well as directly ask-
ing about older mens thoughts toward self-harm and
suicide.
In addition, bringing targeted virtual and community-
based programs to the attention of older men, as Kravitz
et al. (2011), Schmutte et al. (2009) and Williamson
(2010) suggest, can effectively message and connect men
with others and familiar activities. Especially promising
are men-centered mental health promotion and suicide
prevention programs that recognize how some idealized
masculine identities, roles, and relations can effectively
work for rather than against mens health (Wade, 2009).
For example, the National Institute of Mental Healths
Real men. Real depression campaign incorporates mas-
culine ideals of courage, strength, and physical fitness to
garner mens help-seeking and self-management (i.e., it
is brave to ask for help). Community-based initiatives,
including the Australian mens sheds (Golding, Brown,
Foley, Harvey, & Gleeson, 2007) and the U.K.s men in
sheds programs (Williamson, 2010) have successfully
attracted older men to workshop-type spaces in commu-
nity settings to provide opportunities for regular hands-on
activity by groups deliberately and mainly comprising men.
Many of the attendees are older men facing issues associ-
ated with a series of significant life change, such as aging,
retirement, isolation, unemployment, disability, and sepa-
ration, and report camaraderie and a sense of belonging
as key benefits of their participation in the groups
(Golding et al., 2007).
Limitations
Although generalizability was not the aim or claim of this
study, it is important to acknowledge four significant limi-
tations. First, whereas descriptive studies are the feedstock
for developing targeted health interventions, the current
study clearly resides within the former and is limited in
what can be reasonably claimed as valid for guiding
programs, policy and practice. Related to this, it is also
important to acknowledge that nearly half the participants
reported mild depression (via the BDI-II) and this signifi-
cantly limits the findings from the current study. Second,
related to the first limitation, services similar to the afore-
mentioned U.S., U.K., and Australian community-based
programs might remedy some of the suffering experienced
by depressed older men who reside in Canada; however,
the appeal and acceptability of these options was not for-
mally assessed in this study. Third, the cross-sectional
study design does not afford insights about changes (or
the processes that underpin change) across boys and
mens lives, which in turn influence their practices around
depression and suicide. Implicit to this limitation is the
acknowledgement that depressive symptoms and suicidal
thoughts reported by participants may very well reflect
long-standing mental health difficulties that predate their
entry into later adulthood. Fourth, although the current
study focused on older men and masculinities, there
may be gender similarities as well as differences between
older men and women in regard to depression and sui-
cidal thoughts.
These four limitations, however, offer direction for
future research that might usefully include testing the
findings drawn from this study in larger studies among
diverse subgroups of older men with Gender Role
Conflict Scale (Good & Wood, 1995) and/or Conformity
to Masculine Norms Inventory (Mahalik & Rochlen,
2006) research to more fully apprehend prevailing pat-
terns in how masculinities connect to mens depression and
suicide. In addition, conducting life course and longitudinal
studies to distil and address how particular transitions
(e.g., fatherhood, middle-age, disability, retirement) affect
mens depression and thoughts about suicide would pro-
vide further evidence on which to contextualize the
findings drawn from larger Gender Role Conflict Scale
and/or Conformity to Masculine Norms Inventory stud-
ies. Mixed sex samples and gender comparisons might
452 American Journal of Mens Health 5(5)
also afford important insights to the specific interplays
between femininities, masculinities, depression, and
suicide.
Conclusion
In further realizing the potential benefits (while also
recognizing the threats) of masculine ideals across mens
lives, strength-based approaches that highlight emotional
fitness and skill development to broaden mens self-
monitoring and management (e.g., ways to ask for help,
recognizing emotions, and mechanisms for emotional
management) may be especially useful for advancing the
mental health of older men who experience depression
and/or suicidal thoughts. In paying attention to what is
known about, as well as ensuring an ongoing commit-
ment to better understanding emergent linkages between
masculinity, depression, and suicide, the predominant
positioning of particular masculine norms or scripts as
artifact or outcome might be reconsidered to leverage
specific masculine ideals as mediating and ideally discon-
necting mens depression from self-harm and suicide.
Acknowledgments
Thanks to Melanie Phillips and Kristy Hoyak for their project
management and to Tina Thornton for her editorial assistance in
finalizing this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this
article:
This research and article was made possible by the Social
Science Humanities Research Council (SSHRC; Grant No.
11R28234). Career support for the first author is provided by a
Canadian Institutes of Health Research new investigator and a
Michael Smith Foundation for Health Research scholar award.
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