Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: a qualitative study

Abstract

The potential for young men in crisis to be supported by their lay networks is an important issue for suicide prevention, due to the under-utilisation of healthcare services by this population. Central to the provision of lay support is the capability of social networks to recognise and respond effectively to young men's psychological distress and suicide risk. The aim of this qualitative study was to explore young men's narratives of peer suicide, in order to identify how they interpreted and responded to behavioural changes and indications of distress from their friend before suicide. In-depth qualitative interviews were conducted with 15 Irish males (aged 19-30 years) who had experienced the death by suicide of a male friend in the preceding five years. The data were analysed using a thematic approach.Through the analysis of the participants' stories and experiences, we identified several features of young male friendships and social interactions that could be addressed in order to strengthen the support available to young men in crisis. These included: the reluctance of young men to discuss emotional or personal issues within male friendships; the tendency to reveal worries and emotion only within the context of alcohol consumption; the tendency of friends to respond in a dismissive or disapproving way to communication of suicidal thoughts; the difficulty of knowing how to interpret a friend's inconsistent or ambiguous behaviour prior to suicide; and beliefs about the sort of person who takes their own life. Community-based suicide prevention initiatives must enhance the potential of young male social networks to support young men in crisis, through specific provisions for developing openness in communication and responsiveness, and improved education about suicide risk. What is known about this topic: Many young men do not engage with healthcare services prior to suicide. Lay support systems need to be capable of recognising and responding effectively to distress in young men who are outside the care of services. Previous research reported difficulties for lay people in deciphering indications of suicidal crisis. 3 What this paper adds: When indications of distress and suicidal thinking are observed in a young man, effective responses from friends may be hindered by reluctance to raise emotional issues, disapproval of suicide, and factors which make it difficult to decide whether observations represent a real concern. Suicide prevention initiatives ought to strengthen communication within male peer support systems and increase awareness of suicide risk.

Perceptions of the Use of Alcohol and Drugs after Sudden Bereavement by Unnatural Causes: Analysis of Online Qualitative Data

“…Our findings of a male tendency to use alcohol to help discuss feelings is consistent with the findings of a qualitative study exploring the experience of young Irish men recently bereaved by the suicide of a male friend [38]. Interviewees described feeling reluctant to discuss their personal problems with other men, and found that when drinking together they were better able to disclose their concerns and feelings.…”

Signs of current suicidality in men: A systematic review

“…These findings are not definitive, and are based on studies with a variety of methodological approaches and levels of ROB. However, the pattern of findings reflect recommendations that any disclosure of suicidal ideation or intent must not be minimised or dismissed[47], particularly when this is paired with problem solving difficulties and experiences of intense negative emotion such as anger.…”

“…Gould et al[48] found that telephone crisis supporters at a national telephone helpline identified four caller profiles that they considered to reflect imminent risk of suicide. Whether these profiles can accurately and reliably identify suicidality is tempered by research indicating that individuals’ identification of signs of suicide may be biased by assumptions about suicide and gender [47,49,50]. Combined with the findings of this review, this suggests that currently, most research reflects the interpretation, rather than expression of suicide signs, which may limit the utility of signs of suicide that are currently reported in literature for identifying suicidal men.…”

Confidence and Intentions to Help a Person at Risk of Suicide

“…Men showed a consistently lower likelihood of intending to carry out recommended actions and a higher likelihood of intending to carry out nonrecommended actions when helping a person in distress or at risk of suicide. Previous research has suggested that these gender differences might result from men having more negative attitudes toward suicide prevention (Schwartz, Pyle, Dowd, & Sheehan, ), a reduced ability to recognize the warning signs of suicide (Burns & Rapee, ; Marshall & Dunstan, ), reduced perceptions that a person at risk of suicide needs assistance (Reavley, Morgan, & Jorm, ; Sweeney, Owens, & Malone, ), greater reluctance to discuss emotional difficulties, and greater stigma toward suicidal ideation (Sweeney et al., ). Suicide prevention campaigns might, therefore, need to focus on some of these antecedents to affect helping intentions and behaviors.…”