More women attempt suicide. More men die by suicide.

America faces a large and growing public health problem: suicide by men.

More than 38,000 men died by suicide in 2021, the highest number and rate of deaths in 20 years. Men die of suicide at four times the rate of women.

As a societal issue, male suicide has been somewhat overshadowed by the very real mental health crisis afflicting American women and girls.

Thirty-seven percent of women have been diagnosed with depression in their lifetimes, compared to 20 percent of men, and those rates are rising, according to Gallup survey data released Wednesday.

Paradoxically, women are more likely to attempt suicide, but men are more likely to die by suicide. The main reason is firearms.

A person who attempts suicide with a gun is many times more likely to die than someone who uses another method, such as pills or self-inflicted cuts. Firearms figure in only 5 percent of suicide attempts but in over half of deaths.

America may lead the developed world in suicide attempts, according to a 2008 study of suicidal ideation in 17 countries.

Many who attempt suicide are conflicted and irresolute. Too often, a gun makes the decision final.

“Even at the moment when the person has decided to make the attempt, there’s a lot of ambivalence,” said Elly Stout, a suicide prevention specialist at the nonprofit Education Development Center. “If you take a bunch of pills, there is a moment where you can change your mind.”

Between 2015 and 2020, federal data shows, 122,178 men died of suicide by firearm, compared to 19,297 women. Together, those deaths represented about 2.5 million years of lost human life.

The second most common method of suicide, suffocation, claimed 59,382 men and 17,088 women in that half-decade span. Suffocation typically means death by hanging, or by covering the head to cut off the supply of air.

Drug poisoning, which was the third most common, was the only significant suicide method more prevalent among women (16,678 deaths) than men (12,641).

The rise in male suicides mirrors the rise of guns in America. The nation purchased nearly 60 million firearms between 2020 and 2022, part of a larger cycle of panic-buying amid the COVID-19 pandemic.

More Americans died of gun violence in 2020 and 2021 than in any prior year on record. The majority of those deaths were suicides.

“Our suicide rates are very much tied to firearms,” said Mitch Prinstein, the John Van Seters Distinguished Professor of Psychology and Neuroscience at the University of North Carolina.

By age and gender, the demographic group most likely to die of suicide is elderly men. Men older than 75 died in suicides at a rate of 42.2 per 100,000 Americans in 2021, the highest quotient for men or women of any age.

“Some of that is kind of related to our stereotypes of masculinity,” said Julie Cerel, a suicide researcher at the University of Kentucky. “If you’re no longer in your prime, what’s the point of it all? People who are widowed, people who are no longer able to provide.”

Yet, over the past 20 years, suicides among elderly men are relatively flat.

More alarming, perhaps, is the swift rise in suicides among the young. The suicide rate for boys and young men in the 15-24 age group rose by nearly half between 2001 and 2021, from 16.5 per 100,000 people to 23.8.

The suicide rate for girls and women in the same age group more than doubled in the same span, to 6.1 per 100,000.

Suicides among girls ages 10-14, almost unknown 20 years ago, rose to 2.3 per 100,000 in 2021.

Girls and women, too, are dying by self-inflicted gunshot wounds in greater numbers than in years past.

“It used to be that firearms were rarely used by women,” Cerel said. “The myth used to be that women wouldn’t use methods of taking their life that would change how they look, essentially, and that doesn’t seem to be the case.”

The easy availability of firearms is an obvious factor in the prevalence of suicide among men. Other reasons speak to the essence of American masculinity.

Society encourages girls to open up about their mental health and to seek therapy for depression, a skill set discouraged in boys.

“Boys and men haven’t been socialized to talk about mental health concerns. They’ve historically been thought of as weaknesses,” Cerel said. “The expectation for males in this country is, they’re strong, they’re independent, they take care of themselves, they don’t need help.”

Women are twice as likely as men to seek mental health treatment, according to federal data.

And why are young people becoming more prone to suicide? One factor may be a sense of belonging, which, in recent years, seems to be slipping away.

Men, in particular, have struggled in recent years to make friends and form relationships.

“I think we don’t have as much of a sense of connectedness in our communities,” said Nadine Kaslow, a professor in the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine.

“When I was growing up, everybody in the neighborhood knew everybody,” Kaslow said. “That’s changed. It’s this sense of isolation and loneliness.”

Much was made of the nation’s collective ennui during the pandemic. Yet, suicide rates actually ticked down in 2020. Why? Because everyone was home.

“During the summer, during holiday breaks, during the pandemic, those rates actually went down,” Cerel said.

It’s true: People are actually less prone to suicide during the holidays. Suicide rates rise in spring and summer, “when people get away from each other and go out in the world,” Cerel said.

Solitude and suicide travel hand in hand. Humans don’t want to die where loved ones will find them, both because of the trauma such a discovery will inflict and because a loved one might try to save them.

Some of Cerel’s research focuses on exploding the myth that only a few loved ones suffer when someone dies by suicide.

A longstanding theory held that every suicide left roughly six people behind. Cerel found the number closer to 135, a massive circle of friends and loved ones who may need mental health support to endure the loss. Tragically, suicide can beget more suicide.

“For many people, losing someone to suicide opens the door to suicidality where it hadn’t been open before,” she said.

Social media plays an ambiguous role in suicide. Many reports have suggested a link between TikTok and Instagram and worsening mental health. But researchers see potential benefits in those platforms.

“Social media is a place where people who are marginalized can get help,” Cerel said. “And you can find online social support when you don’t have it at home.”

Our nation’s mental health investment stands in dire need, suicide experts say.

All Americans could benefit from an annual mental health checkup, on top of the standard physical checkup, Prinstein said.

Sadly, the mental health checkup isn’t really a thing, partly because of enduring stigmas around mental health.

Psychotherapists are spread thin. The nation spends hundreds of times more money training its medical workforce than preparing mental health providers, Prinstein said.

As a result, rural Americans may find themselves an hour’s drive from the nearest therapist, a scenario hard to imagine in medicine.

“There’s not as much access as we need,” Kaslow said.

If you are having thoughts of suicide, contact the 988 Suicide and Crisis Lifeline.  

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