Gender-Specific Aspects of Suicide-Related Communication in a High Risk Sample of Psychiatric Inpatients

Abstract

Background: In addition to help-seeking behavior in a professional context, suicide-related communication (SRC) with that discloses suicidal thoughts and plans to relatives and significant others play a major role in suicide prevention. While studies revealed gender differences in help-seeking behavior in case of suicidal thoughts and intent in a professional context, the empirical evidence on SRC and gender is limited. The present study aims to examine gender-specific aspects of prevalence, recipients, pathways, and content of SRC in a high-risk sample of psychiatric inpatients. Results may provide information for the development of gender-specific suicide prevention measures. Methods: This study considered data on SRC among individuals who had been admitted to a psychiatric ward due to suicide attempt or to an increased suicide risk and have previously attempted suicide. In this high-risk sample of 219 psychiatric inpatients (56.2% female: n = 123), SRC was assessed using the Suicide Attempt Self Injury Interview (SASII) and was analyzed with a mixed-method design. Results: There are no significant differences (Chi 2 (4, n = 219) = 3.189, p = 0.074) in the frequencies of SCR between men and women. 34.4% (n = 33) of men and 46.3% (n = 57) of women reported SRC. Differences were found regarding the recipients. No differences in oral/written and explicit/implicit communication are evident. The most frequently addressed themes in SRC in men are exhaustion, resignation, and listlessness. For women, the suicide method is the most common topic, followed by the topics mentioned among men. Conclusions: A high proportion of participants reported having engaged in SRC. In contrast, the themes addressed are very ambiguous and not clearly suicide-related, especially among men. This can lead to difficulties in the interpretation of the statements by the recipients. Women seem to communicate more often with recipients who may provide assistance. These aspects ought to be considered for developing gender specific suicide prevention measures.

Men’s Behavior and Communication in the Days Prior to a Suicide—A Psychological Autopsy Study

“…These findings contradict the widespread assumption that most men do not communicate at all their suicidal thoughts. While men communicate their thoughts about suicide, they do so in a coded and indirect way so that most relatives are unable to recognize them as holding serious intent [19]. These findings are consistent with other studies on communication of distress and suicidal ideation [19,38].…”

“…While men communicate their thoughts about suicide, they do so in a coded and indirect way so that most relatives are unable to recognize them as holding serious intent [19]. These findings are consistent with other studies on communication of distress and suicidal ideation [19,38]. Men are more reluctant than women to disclose suicidal crises.…”

“…Men, however, seem to prefer indirect communication, such as "I have had enough of everything", resulting in suicidal ideation rarely being recognized from the outside [6,22]. However, it appears that men more often communicate their suicidal ideation with friends or with their partner, whereas women tend to contact the healthcare system, therefore becoming more likely to be identified as at risk [19]. Consequently, these gender-specific communication patterns prior to suicide mean that family members are often poorly informed about their relative's suicidal ideation.…”

“…Since men often have a smaller social support system and utilize much less the mental health care system, there are significantly fewer opportunities for them to communicate suicidal thoughts compared to women. While about 60-80% of all suicides are announced beforehand directly or indirectly, sometimes repeatedly, there seems to be no gender difference in the frequency of suicide-related communication [19]. Men, however, seem to prefer indirect communication, such as "I have had enough of everything", resulting in suicidal ideation rarely being recognized from the outside [6,22].…”

“…As a result, even the individual's close social circle often fails to grasp the severity of the symptomatology and misinterprets changes. However, it has also been shown that men themselves often do not recognize the severity of their own distress [19]. In addition to the already reduced willingness to seek help due to the prevailing masculinity norms, stigmatization, or fear of being seen as weak [12,20], men are less likely to feel they need psychosocial support, even if they report problems with their mental health [21].…”