Mental Health 535rates may be underestimated, and men’s
suicide attempts may be underestimated.
Because women use more ambiguous meth-
ods than men to commit suicide, women’s
actual suicides may be underestimated as
some are classified as other causes of death
(e.g., accidental). Because attempting sui-
cide is inconsistent with the strength of the
male gender role, men may be less likely than
women to admit to a suicide attempt, leading
to a greater underestimation of men’s than
women’s suicide attempts. Women also are
more likely than men to express their emo-
tions, which might include reports of think-
ing about suicide and suicide attempts. To
the extent that is the case, it will be more dif-
ficult to identify men than women who are
at risk for suicide (Langhinrichsen-Rohling
et al., 2009).Factors Associated with Suicide Among Adults
Among adults, suicide and suicide attempts
have been linked to substance abuse and de-
pression. The link of suicide to depression
is problematic, however, because a suicide
attempt might lead to a diagnosis of depres-
sion. One study of suicide attempters found
that depression predicted subsequent sui-
cide within the next six years for both men
and women (Skogman, Alsen, & Ojehagen,
2004). The link of mental illness to suicide
is stronger in women than men, but this
could be an artifact of women being more
likely than men to seek help for mental ill-
ness (Payne et al., 2008). Men who commit
suicide are less likely than women who com-
mit suicide to have used mental health ser-
vices. By contrast, alcohol use and abuse are
more strongly related to suicide in men than
women, perhaps because drinking alcohol is
a more socially acceptable way for men to re-
spond to mental illness.Suicide attempts are difficult to esti-
mate, however. For example, an overdose
of drugs can be interpreted as a suicide at-
tempt or as an accident. Here, men’s suicide
attempts may be underreported because at-
tempting suicide and not succeeding are con-
sidered weak behaviors inconsistent with the
strength and decisiveness of the male gen-
der role. Thus, men may be less likely than
women to admit making a suicide attempt,
and clinicians may be less likely to consider
the possibility that a drug overdose in a man
was a suicide attempt.The Gender Paradox
A theoretical explanation for the gender par-
adox is gender-role socialization (Payne et al.,
2008). Suicide is not viewed as acceptable
but it is viewed as less unacceptable among
men than women. Suicide is considered mas-
culine behavior. However, suicide attempts
are considered feminine behavior. Among
men, committing suicide is considered to
be a powerful response to some kind of fail-
ure; attempting but not completing a suicide
is construed as weak behavior and viewed
negatively, especially in men. The gender
paradox in suicide attempts and suicide rates
is most prominent among adolescents and
young adults, the very people who are most
concerned with adhering to gender roles.
Gender roles also influence the method
used to commit suicide. Men are more likely
than women to be familiar with guns, and
men may be more willing to use violent
methods to commit suicide because they are
less likely than women to be concerned with
the appearance of their body following sui-
cide (Payne et al., 2008).
As alluded to earlier, there is also a
methodological explanation for the paradox
of men’s higher suicide rates and women’s
higher suicide attempts. Women’s suicideM13_HELG0185_04_SE_C13.indd 535 6/21/11 12:55 PM