Dying to be a man: an integrated framework to explore the interactions of masculinity, the interpersonal theory of suicide, and the prototype/willingness model

Background

Men are disproportionately represented in suicide mortality statistics in almost all countries. [1] In Northern Ireland, men die by suicide approximately three times more frequently than women [2].

To better understand this disparate burden on men and boys, an integrated framework was developed to articulate the “join points” of the traits of High Traditional Masculinity (as defined by Connell) [3] with the Interpersonal Theory of Suicide [4] and the Prototype/Willingness Model.[5]

Methods

To test the framework, 30 adolescent boys aged 16-19 were recruited using trusted community partners, primarily youth centres and services working with young people in working-class communities to complete an interview exploring their social relationships and conceptions of masculine identity, as well as a questionnaire combining the Self-Harm Inventory[6] and a modified Collective Efficacy Scale[7,8].

A deductive thematic analysis of the interview transcripts was conducted in NVivo and results presented back to participants and their peers at the partner organisations to ensure validity.

Results

The model provides supportive explanation for the interactions of the performance of High Traditional Masculinity and the development of suicidal risk, augmented by the behavioural willingness to engage in high-risk activities in order to achieve the social image of masculine standing.

It also highlights opportunities for intervention to reduce unsafe or unhealthy behaviours and the development of poor behavioural health at two points.

Discussion

The Integrated Framework provides a template to better understand the gender-based development of the features of suicidal risk among adolescent boys and identify opportunities for intervention to reduce morbidity and mortality.