High Traditional Masculinity and Suicide: Testing Direct, Moderation and Mediation Models

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Project Summary Suicide is the tenth leading cause of death in the US, and the eighth in men.17 In the US, approximately 75% of suicide deaths are among men.2 The large male-female gender ratio in suicide deaths points to a possible pathway to understanding suicidal behavior – identifying what accounts for the greater prevalence of male suicides may provide a leverage point for suicide prevention and intervention with those at risk of suicide. Coleman and colleagues’ finding that high traditional masculinity (HTM) men were 2.4 times more likely to die by suicide7 was the first study to show this connection, and it is consistent with theoretical models of the role of masculinity socialization in suicide death15,18,19 and qualitative studies of men and suicidality.20 If the preliminary evidence of a link of HTM to suicide death7 is shown to be robust, it will bring new energy and attention to gender-role informed suicide prevention and intervention. The General Social Survey – National Death Index (GSS-NDI), the data source for this study, is a series of annual or every-other year nationally representative surveys (the GSS) that was matched with death records starting in 2011.32,33 The GSS-NDI provides an unparalleled opportunity to test the relationship of HTM to suicide death, to provide the first known information about how this varies by gender, age and race/ethnicity, and to examine possible mediators of the relationship of HTM to suicide death including suicide acceptability and externalizing behavior. Most research on masculinity and suicidal ideation or attempts uses self-report measures of endorsement of masculine norms or masculinity ideology,5,6 while our research group is developing use of an indirect latent probability model of gender role orientation, the m-f factor, novel to suicide research but previously used in other substantive areas with the Add Health dataset48,49 as well other large cohort studies.50 Following Coleman and colleagues 2020, we will code those scoring 1 standard deviation or higher on m-f factor as HTM. Cox survival modeling will be used to test the direct relationship of HTM, moderation of the HTM – suicide relationship by demographics, and mediators of the HTM-suicide relationship. The novel use of m-f factor in suicide research, paired with the innovation of linking studies to death records, unlocks the potential to study the effect of masculinity on suicide death. The representative sample GSS- NDI delivers an unprecedented diversity of age, gender and race/ethnicity among suicide decedents, providing a robust and nuanced test of the masculinity-suicide death hypothesis, advancing the science of masculinity and suicide beyond theorized linkages and preliminary results.