Male suicide as a gendered phenomenon: Implications for telephone crisis support

To the Editor

Men present with similar suicide signs to women (Hunt et al., 2016a), but gender bias may lead to some signs being missed or misinterpreted. Cultural expectations of masculinity (e.g. aggression, stoicism) have been found to influence the suicidal individual’s help-seeking and access to means, in addition to influencing the interpretations of those who determine death by suicide (e.g. coroners). If similar interpretation biases exist among those providing suicide prevention, men’s signs of suicide may be missed or misinterpreted. This may have a role in explaining the difference in reported prevalence of male deaths by suicide compared to female deaths by suicide and may be exacerbated in the telephone crisis support context.

Telephone crisis support services are promoted internationally as a first response for suicide intervention. The immediacy, availability and confidentiality of these services offer specific opportunities to attract and respond to suicidal men. As a communication medium, the telephone also presents a unique set of limitations with potential to minimise the efficacy of intervention for suicidal male callers (Hunt et al., 2016b). Telephone crisis supporters (TCSs) decide how to best help suicidal men by interpreting verbal cues without the aid of non-verbal information and in most cases, without background information about the male caller or their current state (Hunt et al., 2016b). Gender categorisation is an aspect of automatic pattern recognition that occurs rapidly in the blinded telephone context from tone of voice, expression and semantic content (Ko et al., 2006) and may bias TCS’ decision-making, if faulty assumptions are made on the basis of gender categorisation. When responding to callers in the time and information-limited context, it seems likely that TCSs’ interpretation of men’s suicide signs and intervention needs will be guided, to some extent, by gender categorisation.

To understand the extent to which gender categorisation has an influence on intervention efficacy with suicidal men, a framework of TCS decision-making needs to be developed. Such a framework would provide direction for exploring how TCSs interpret men’s suicide signs, make support-relevant decisions and use support skills. If gender bias is found to impede intervention efficacy with suicidal male callers, TCS training that specifically targets gender bias might assist in reducing the prevalence of suicide among men utilising telephone crisis services.