MEN AND SUICIDE: THE ONGOING, SILENT EPIDEMIC

Looking back, looking forward…

Two years ago, for Men’s Health Month, I, in my role as Deputy Director with the SA Federation for Mental Health [SAFMH], with a personal, professional, and academic interest in men and mental health, spotlighted the issue of men and suicide and shared my own experiences with mental health problems, coupled with lots of facts and figures about the topic. I took part in several interviews and panel discussions, and there was a sense that the issue was gaining traction.

However, on the 10^th of May 2026, the South African Government News Agency published a piece in which the then-Minister in the Presidency for Women, Youth and Persons with Disabilities, Sindisiwe Chikunga, expressed serious concerns over the rising mental health crisis affecting boys and men in South Africa, calling for interventions at all levels of society to address what she described as a “silent national emergency”.

Too many men are carrying emotional pain in silence. Depression, anxiety, trauma, substance abuse, and social isolation are affecting men across all age groups, communities, and economic backgrounds. We must break the stigma that says men must suffer quietly”.

The then-Minister highlighted that factors such as unemployment, social pressures, substance abuse, economic hardship, family breakdowns, and unresolved trauma continued to cause significant psychological strain on men. Furthermore, she noted that these challenges were being further exacerbated by challenges such as limited access to mental health services, specifically in underserved and rural communities, and that untreated mental health conditions in men were leading to wider societal problems, such as instability within families, crime, substance dependency, and suicide.

On the 11^th of May 2026, The Citizen published an article entitled “Men account for 80% of suicides as national crisis deepens”, in which it was reported that, due to this worrying statistic, the Department of Women, Youth, and Persons with Disabilities had officially declared the issue a national crisis.

It therefore seemed important to me and SAFMH to once again focus on this topic, as men continue to lose their lives to suicide, often not talking about their mental health problems and struggling in silence with issues such as unaddressed anxiety and depression.

Getting the basics right…

It might seem odd to state what seems ‘obvious’ to most people, but to ensure that there is a consistent understanding of the correct terminology that is and should be used, let’s start right at the beginning, drawing on some definitions from the literature:

• When we talk about ‘suicide’, we refer to an incident where a person harms themselves with the aim of ending their life, and they lose their life as a result.
• When we talk about ‘suicidal thoughts’ [also called ‘suicidal ideation’], we refer to ideas or thoughts that are focused on death or suicide. However, it is important to note that experiencing suicidal ideation does not necessarily mean that someone will take their own life. It can, however, be a warning sign.
• When we talk about a ‘suicide attempt’, we refer to a person harming themself with the aim of ending their life. However, they do not lose their life in the process.

A key objective of suicide prevention is to eliminate the stigma attached to suicide and mental health problems so that people may feel more comfortable seeking help, should they need it. One way in which we can help do this is by being aware of the language we use. It is important, when talking about suicide or suicide attempts, that we avoid terms such as “successful suicide” or “failed suicide”, as these phrases can carry negative connotations. Other terms to avoid include “committed suicide”, which implies a degree of criminality, while terms such as “completed suicide” imply that earlier attempts had been made by the person, which might not be the case. These terms perpetuate the stigma associated with suicide, and people are strongly encouraged to take note of these guidelines and to avoid using such terms. More appropriate phrases to use when talking about suicide include “died of suicide”, “died by suicide”, along with “fatal suicide behaviour” and “suicide death”.

Suicide at a [global] glance…

Suicide is one of the most complex types of human behaviours to understand, as it counters our biological drive to reproduce and survive, along with the cultural idea that ‘existence is sacred’.

Suicide is a major global health problem, with around 727 000 people dying by suicide each year worldwide, while many more attempt suicide. This translates to more than one death per 100 being due to suicide. Suicide can occur at any point across the lifespan, and in 2021, it was the third leading cause of death in persons between the ages of 15 and 29. Suicide is also the 17^th leading cause of death across the entire lifespan.

Suicide is a global phenomenon, which is not just confined to high-income countries. Suicide occurs in all regions, and while 73% of global suicides took place in low-and middle-income countries in 2021, researchers have estimated this figure to be as high as 80%.

Suicide rates in men are higher than in women in almost all countries across the world, despite women having higher rates of suicidal ideation and behaviour. Men are less often identified as persons at risk of suicide, and are more difficult to reach through suicide prevention interventions. Warning signs for suicide and deteriorations in men’s mental health are also often not recognised by those within their environments.

Suicide is a serious public health concern that requires a public health response. What is of great concern is that suicide statistics may be even higher than reported due to factors such as stigma, limited surveillance systems, and misclassifications.

Suicide in South Africa…

Approximately 23 suicides and 230 serious suicide attempts occur in South Africa every day. South Africa is ranked 10^th on the list of countries with the highest number of suicides, with a rate of almost 24 people per 100 000.

Of the 13 774 suicides recorded in South Africa in a particular year, 10 861 [78.85%] were men, while only 2 913 [21.15%] were women. These figures translated into a rate of almost 38 per 100 000 for men, and approximately 10 per 100 000 for women. As seen from the global trends and statistics mentioned earlier, South Africa is not unique in this regard: globally, male suicide rates are consistently higher than those of women.

Suicide has therefore been flagged as a major public health crisis in South Africa by researchers [and now also by government]. With around 80% of suicides being attributed to men in 2026, the issue is seriously affecting men’s life expectancy. Apart from socio-economic problems and inadequate mental health support services, as mentioned earlier, mental health stigma also continues to contribute to this crisis.

Suicide in men: the “Silent Epidemic”…

Suicide in men has been described as a “silent epidemic” due to the fact that it has a distressingly high incidence rate and is a major cause of death in men. This silent epidemic is perpetuated by several factors:

• Firstly, there is an apparent, overall lack of public awareness of the high rates of male suicide, especially when compared to other, more widely publicised threats to men’s health, for example HIV/AIDS.
• Secondly, while empirical evidence confirms that men [in Western nations in particular] die by suicide more frequently than women, with women showing higher rates of non-fatal suicidal behaviours, there are surprisingly few explanatory frameworks that have been developed to explain these patterns.
• Thirdly, few preventative policies or efforts have been developed and evaluated that specifically target male suicide. This further contributes to the lack of visibility of male suicide as a serious public health concern. Where gender is addressed, it is often treated as a ‘motionless’ demographic variable instead of a culturally facilitated social construct that cuts across other diversity factors such as age, sexual orientation, and race in very complex ways.
• Lastly, because of men’s general unwillingness to seek help for suicide-related problems, along with the stigma associated with mental health problems, it is not surprising that suicide in men is mostly invisible.

Men are five times more likely to lose their lives to suicide than women, and are more prone to using aggressive measures. While research has shown that women are diagnosed more than men with mental health conditions such as anxiety and depression, men are less likely to speak up about their feelings, until it’s too late. Instead, men are more likely to downplay the distress caused by symptoms of such conditions, and to address their anxiety and depression with poor coping behaviours, which increase their risk of such mental health conditions going unrecognised and untreated.

Society’s role in silencing men…

Because of societal ‘macho male’ stereotypes, which expect men to adopt a “boys don’t cry” and “man up” mentality, men don’t seek help. These attitudes, which depict men as fearless and brave, lead to men seeing themselves negatively when they struggle with a mental health condition. For these reasons, men see that seeking help places them in a vulnerable position.

Societies expect a lot from their men; men need to seem in control, confident, be the decisive voice of rationale and reason, and be decision-makers. Men are often portrayed as ‘the rock with a steady hand and mind’ in uncertain or troublesome times. They are stereotyped as protectors, dependable, providers, and fearless. However, ironically, the very traits that societies label men with can lead to men feeling emasculated and inadequate. It is therefore simply not realistic to expect men to always be the stronger sex, living by society’s mantras of “what makes a man” and needing to find ways of “pulling themselves together”.

Risk factors for suicide…

The reality is that there is no single cause for suicide. Although the strongest predictor of suicide is a history of suicidal behaviour or a previous suicide attempt, there is widespread recognition that the pathways to suicide are complex, multifactorial, and diverse.

Suicide occurs most often when health problems and stressors converge, leading to an experience of despair and hopelessness. Depression is the mental health condition most commonly linked to suicide, but it often goes undiagnosed or untreated. Conditions like depression, along with substance use problems and anxiety, increase the risk for suicide, especially if these go unaddressed. This is problematic because the symptoms of anxiety and depression are not in keeping with men’s perceptions of masculinity. Instruments that are used for detecting and diagnosing depression are often not designed to pick up ‘male depression’ because men are more likely to show signs of depression through poor impulse control, substance abuse, risk-taking behaviour, irritability, and anger. However, even though it is not reported in depression surveys, many men who die by suicide do so because of depression.

When talking about suicide, ‘risk factors’ refer to conditions or characteristics that increase the chances that a person may attempt suicide.

Risk factors for suicide include:

• Grief.
• Misuse of alcohol or drugs.
• Loss.
• Low self-esteem.
• Social isolation.

Some additional risk factors also include:

• Having a history of sexual or physical abuse.
• Imprisonment.
• Losing a loved one through illness or trauma.
• An inability to form or sustain meaningful relationships.

Being bisexual, gay, transgender, and experiencing discrimination or not receiving support from others can also be risk factors for suicide.

In addition, the American Foundation for Suicide Prevention consolidates suicide risk factors into a useful ‘three-dimensional’ model:

1. Health:
   1. Mental health conditions, including depression, anxiety disorders, substance use problems, schizophrenia, bipolar disorder, conduct disorder, and personality traits such as poor relationships, mood changes, and aggression.
   2. Traumatic brain injury.
   3. Serious physical health problems, including pain or terminal illness.

2. Environmental:
   1. Prolonged stress, caused by, for example, bullying, harassment, unemployment, or relationship problems.
   2. Stressful life events, including rejection, divorce [or relationship breakdown], financial crises, or life transitions.
   3. Exposure to someone else’s suicide, or to sensationalised or graphic accounts of suicide.
   4. Access to lethal means such as drugs and firearms.
   5. Discrimination

3. Historical:
   1. Having a family history of suicide.
   2. Childhood neglect, trauma, or abuse.
   3. Previous suicide attempts.
   4. Generational trauma [this type of trauma happens when an overwhelmingly negative experience causes knock-on effects that are passed down in a person’s family. It is also sometimes called transgenerational or intergenerational trauma].

It is also important to note that the risk for male suicide changes with life circumstances and age. For example, it has been found that unemployment and relationship breakdowns are factors that present a significantly larger risk for men than for women. Marriage can have a protective effect by providing meaningful social support and helping to reduce risky behaviours that often increase the risk for suicide, while men being separated from their children has been identified as a primary cause of suicide in many coroners’ inquests.

Warning signs of suicide…

Things to be very aware of when you are concerned that someone might be suicidal are a change in their behaviour or the appearance of completely new behaviours. This should be especially concerning if the changed or new behaviour is related to a loss, change, or a painful event. Most people who die by suicide show one or more warning signs, either through what they do or what they say. However, not everyone will necessarily show signs of suicidal thoughts, and even if they do, the signs can be subtle and can vary greatly from person to person.

The American Foundation for Suicide Prevention provides a useful ‘three-dimensional’ model of warning signs:

1. Talking – this involves a person talking about:
   1. Feeling hopeless.
   2. Taking their own life.
   3. Experiencing unbearable pain.
   4. Feeling trapped.
   5. Having no reason to live.
   6. Being a burden to others.

2. Behaviour – behaviours that might point to a risk, especially if it is related to a loss, change, or painful event:
   1. Sleeping too much or too little.
   2. Researching ways to end their lives, for example through online searches for potential suicide methods.
   3. Increased use of drugs or alcohol.
   4. Isolating themselves from friends and family.
   5. Withdrawing from activities.
   6. Agression.
   7. Fatigue.
   8. Calling or visiting people to say goodbye.

3. Mood – people who are contemplating suicide often show one or more of the following moods:
   1. Anxiety.
   2. Depression.
   3. A loss of interest.
   4. Shame.
   5. Humiliation.
   6. Anger.
   7. Agitation.
   8. Irritability.

Some additional warning signs of suicidal thoughts or behaviours in men include:

• Severe mood swings.
• Talking about death or dying.
• In addition to the aforementioned changes to sleeping patterns, it is also important to take note of changes to the person’s eating habits and other aspects of their normal routine that might show signs of change.
• Engaging in risky behaviours.
• A person obtaining a firearm or other means by which they are able to die by suicide.
• Giving away belongings or money.

Men and help-seeking behaviour…

Even though mental health problems are extremely common [in 2025, the World Health Organization estimated that over one billion people were living with mental health conditions], there is still a stigma attached to these conditions, which often makes it difficult for people to talk about them. While men and women both experience stigma when seeking help for mental health problems, men are less likely than women to seek help for mental health problems. This leads to increased physical and psychological strain, along with vast relational, personal, and economic costs, which helps to explain the disproportionately higher male suicide rate when compared to women. An example of these ‘costs’ is the fact that men are more likely to stop therapy early, along with general negative attitudes about seeking help. Men’s reluctance to seek help persists despite the existing public health concerns about their mental health, specifically in terms of men’s higher propensity for suicide, along with other serious concerns related to mental health, including stress, sexual dysfunction, and alcohol use and abuse. While untreated mental health problems can have a serious impact on the development and health of males, such problems can also impact family members.

Men’s negative attitudes towards help-seeking can be linked to the mental distress and stigma that can result from their inability to perform family and work roles while coping with mental health problems. These attitudes can also often stem from trying to avoid talking about painful feelings and stressful life events because of stigma and ‘masculine norms’. These masculine norms refer to the previously discussed cultural standards and societal expectations that define how men are supposed to behave, think, and feel. These norms, often grounded in traditional gender roles and reinforced through education, family dynamics, the media, and workplace culture, can include:

• Heterosexuality.
• Sexual dominance.
• Aggression.
• Physical strength.
• Competitiveness.
• Dominance.
• Emotional stoicism [e.g. “real men don’t cry”].
• Financial independence.
• Status as a provider.

These expectations shape perceptions about how “real men” are defined, and often ‘penalise’ men who deviate from these norms.

The consequences of not speaking out can worsen mental health conditions as men tend to find inappropriate coping strategies, which might help ‘numb’ the symptoms temporarily, but which could develop into dependencies that eventually spiral out of control. These coping strategies may include:

• Reckless behaviour.
• Gambling
• Abuse
• The use of alcohol and drugs.

If they remain untreated, conditions such as depression and anxiety can trigger anger in men, leading to behaviours such as:

• Outbursts
• Violence.
• Abusiveness.
• Bullying.
• Irratibility.
• Explosive and quick temper bursts.
• Being touchy.
• Feeling cranky.
• Being edgy.
• Being impatient.
• Feeling helpless or hopeless.

It is therefore important to take note of the symptoms of depression:

• Persistent empty or sad mood.
• Feelings of worthlessness, self-criticism, helplessness, pessimism, and hopelessness.
• A decrease in energy, and feeling fatigued and ‘run down’.
• Insomnia [this occurs when a person experiences disruptions in how they function or feel because they are not sleeping enough or well enough; approximately 10% of the world’s population experiences insomnia, which qualifies as a medical condition].
• Hypersomnia [this condition makes it difficult or impossible for a person to stay awake during the day; this can happen even if the person is getting healthy, full amounts of sleep at night. The inability to control when you fall asleep can impact a person’s social and work life].
• Early morning awakening, or oversleeping.
• Difficulty remembering, making decisions, and concentrating.
• A deterioration in social relationships.
• Persistent physical symptoms that do not go away despite treatment, for example, digestive problems, headaches, and chronic pain.
• Losing pleasure or interest in activities and hobbies that were previously enjoyed.
• Increased use of drugs and alcohol.
• Appetite and/or weight gain or loss, or overeating.
• Irritability, hostility, and restlessness.
• Thoughts of death or suicide.
• Suicide attempts.

The symptoms of anxiety include:

• Physical symptoms:
  • Excessive sweating.
  • Muscle aches or tension.
  • Racing or pounding heart.
  • Experiencing dizziness or vertigo [this causes dizziness by making a person feel like they are spinning when they are not].
  • A sensation of choking.
  • Shortness of breath.
  • Agitation or restlessness.
  • Panic attacks [this refers to a sudden episode of intense fear, which leads to severe physical reactions even though there is no real danger or an apparent cause for the feeling. Panic attacks can be extremely frightening; when they occur, a person can think that they are losing control, that they are having a heart attack, and even that they may be dying].
  • Insomnia.
  • Feeling nauseous or having diarrhoea.
  • Experiencing irritable bowel syndrome [also known as IBS, this is a common condition that affects the stomach and intestines; symptoms can include bloating, gas, cramping, belly pain, constipation, diarrhoea, or both].

• Emotional symptoms:
  • Difficulty with concentration.
  • Persistent worries about things that could go wrong.
  • Feelings of dread.
  • Having nightmares or intrusive thoughts during which traumatic scenes are replayed in the person’s mind.
  • Being overly vigilant towards danger.
  • Avoidance.
  • Perceiving events and situations as threatening when they are not.
  • Catastrophic thinking.
  • Indecisiveness and a fear of making the wrong decisions.
  • A fear of losing control.
  • Absentmindedness.
  • Mood swings.
  • Edginess and feeling irritable.

What we can do to help prevent suicide in men…

It is important to recognise the detrimental effects that hegemonic masculinity can have on the occurrence and rates of suicide in men, and to recognise the particularly negative impact it can have on vulnerable men, for example, adolescents and young men, homeless men, and men with depression, addiction problems, and other mental health issues. Hegemonic masculinity is defined as a set of values, established by men in power, that functions to include and exclude, and to structure society in gender-unequal ways, while combining a number of features:

• A hierarchy of masculinity.
• Unequal access among men to power over other men and women.
• An interplay between men’s ideals, their identities, power, interactions, and patriarchy [a social system that has historically given primary privilege and power to men in various dimensions of society, including economics, politics, and culture, with an influence extending across various components of life, contributing to disproportions in employment opportunities, education, and income between genders, while also playing a role in normalising gender-based violence and the exertion of control over women’s reproductive rights].

Because of all this, it is also important to recognise men’s diverse experiences with masculinity, as it can enable people to better understand men’s perspectives, including their relationship with mental health and suicide. As we’ve seen, gender expectations, shaped by generational, social, and cultural factors, influence how men cope with their emotions, stress, and psychological challenges. Acknowledging these complexities allows for the development of more personalised interventions, which target the specific mental health challenges that men face, ultimately improving access to support and reducing the risk of suicide.

The following strategies can be used by communities and individuals to help reduce the risk of male suicide:

• Watching out for signs of depression: remember that depression in men can manifest in behaviours such as:
  • Social withdrawal.
  • Irratability.
  • A loss of pleasure or interest.
  • Anxiety.
  • Engaging in risky behaviours.
  • Being unable to keep up with normal daily tasks.
  • Misusing alcohol and drugs.
  • Physical pains and complaints.

• Offering support: if you notice signs of depression, ask what you can do to help, and let the person know that you are there to help and listen.
• Not ignoring the signs: don’t dismiss or make light of comments that point to suicidal thoughts or behaviours. If you hear someone talk about suicide or make a statement about suicide, encourage them to see their GP or a mental health professional.

Other ways to help reduce suicide in men include:

• Actively identify men who might be at risk and offer them support.
• Teach men problem-solving and coping skills to help them manage problems they might be experiencing with relationships, at work, or with their health.
• Create opportunities to bring people together to find support and build social connections.
• Ensure that mental health support options are readily available.
• Restrict access to lethal means of suicide, for example, prescription medications or firearms.

It is crucial to remember that practical and emotional support is important; the warning signs that have been listed in this article do not inevitably lead to suicide, but these should never be ignored. In some instances, the person might not be motivated to seek help for themselves, so it often falls on other people to provide support by listening, offering encouragement, and even [in some instances] challenging the preconceptions that the person might hold about themselves, for example, their worth to society and their abilities.

People who have a loved one who shows signs of suicidal ideation or behaviours can help by:

• Asking the person if they are contemplating suicide.
• Listening to the person without downplaying their concerns.
• Sharing their own concerns about the situation with the person.
• Supporting and encouraging the person to seek professional help.
• Offering to accompany them to their treatment.
• Attempting to remove firearms and other potential means of suicide.
• Checking in with the person regularly to see how they are doing.

It is also important to note a number of protective factors that can help guard against suicidal behaviour:

• A feeling of connectedness to family.
• Having support from one’s community.
• Access to mental health care.
• Being proactive about mental health.
• Limited access to lethal means.
• Having effective coping and problem-solving skills.
• Religious and cultural beliefs can also assist if they encourage help-seeking and connecting, while discouraging suicidal behaviour, or if they aim to create a strong sense of self-esteem or purpose.

It is essential to seek emergency assistance from a crisis line or medical professional if a loved one is at immediate risk of suicide or if they have attempted suicide. It is also important that the person is not left on their own until help arrives or is accessed.

It is also important to acknowledge that supporting a person who is at risk of suicide can be very draining. It is therefore essential that caregivers also make an effort to look after themselves. These individuals may need to look for support from organisations, loved ones, and mental health professionals. It is also of the utmost importance to practice good self-care; this involves getting enough sleep, eating a balanced diet, spending time doing enjoyable activities, and exercising regularly.

Why suicide rates in men look different…

There are some overarching, consolidating theories about why men are at a greater risk of dying by suicide than women.

• Traditional male gender roles discourage men from expressing their emotions. Men are taught that they need to be tough and that they should not need to ask for help. These rigid gender norms can make it difficult for men to reach out and ask for help when needed.
• Depression is underdiagnosed in men. Men often choose not to disclose feelings of depression to professionals, and when they do, these are often described as problems related to relationships or work. Men also tend to describe their problematic feelings as “stress” instead of feelings of hopelessness or sadness.
• Men are less likely to seek help for their emotional problems. Research has shown that depression is diagnosed less frequently in men because of their tendency to deny having an illness, along with their tendency to self-treat and self-monitor their symptoms.
• Men are more likely to self-medicate depression symptoms with alcohol and other substances.

The [long] road ahead…

Every suicide is a tragedy [and to some degree a mystery] that impacts families, communities, and even entire countries, and has long-term effects on those who are left behind. But despite the fact that suicide occurs in all countries, and that the causes of suicide are varied and multiple, it can be prevented. Hopefully, this article has shown this and has provided you, the reader, with some useful information to help equip you in the universal battle against suicide. It’s prudent to reiterate again… With adequate support and treatment, suicide is preventable. But it is up to me, you, everyone, and anyone who thinks that they themselves or a loved one may be at risk of suicide should seek help urgently. It is also important to always remember that suicidal thoughts are never natural and that they should never be ignored. Don’t ever be afraid to reach out to or assist someone you are concerned about – your actions can save a life.

When I was busy compiling this article, I put out a call on all our organisation’s social media platforms, on our website, in our fortnightly e-newsletter, and even on my personal Facebook page for men to get in touch with me and share their thoughts and experiences about the content of this article, with the intention of adding some important lived experience to help bring the information included in the article to life. It is worth noting that, despite the call going out far and wide all over the country, not a single man got in touch with me or even made an enquiry about the article. Nothing. Zero. Just silence. Which I think says it all, more than all the content in this article.

This silence continues to hang heavily over the topic of ‘men and mental health’, most of all when you start talking about suicide. It is a curtain that, on the one hand, obscures the painful truth about men struggling to get by, and on the other, it is a barrier that hinders men from obtaining the help they need. Male suicide has remained a silent epidemic, but it cannot be allowed to remain as such. Only by BREAKING THE SILENCE – through building public awareness, improving explanatory frameworks, implementing effective preventative strategies, and doing more research on the matter – can we overcome this epidemic.

During Men’s Health Month, I want to echo the many calls from across the globe and urge men to SPEAK UP and ASK FOR HELP before it’s too late. Break the silence and break the stigma that it is “unmanly” or a sign of weakness to ask for help. We simply cannot continue to lose lives to suicide.

By Leon de Beer

Deputy Director, SA Federation for Mental Health

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