Male suicide risk and recovery factors: a systematic review and qualitative meta-synthesis of two decades of research

Suicide is a gendered phenomenon, where male deaths outnumber those of women virtually everywhere in the world. Quantitative work has dominated suicide research producing important insights but only a limited understanding of why more men die by suicide. We conducted a qualitative meta-synthesis and systematic review of 20 years of narratives both from men who are suicidal and from people who are bereaved by male suicide to identify putative risk and recovery factors. We identified 78 studies that encapsulated insights from over 1,695 people. Using Thomas and Harden’s Thematic Synthesis Method, our analysis is built on 1,333 basic codes, 24 descriptive themes, and four analytical themes. We noted an association between cultural norms of masculinity and suicide risk in 96% of studies. Norms relating to male emotional suppression, failing to meet standards of male success, and the devaluing of men’s interpersonal needs appeared to be associated with dysregulated psychological pain and suicide risk. Although masculinity is not pathological, we speculate that the interaction and accumulation of cultural harms to men’s emotions, self, and interpersonal connections may potentially distinguish men who are suicidal from men who are not. Supporting men to understand and regulate emotions and suicidal pain, expanding possibilities for masculine identity, and building meaningful interpersonal connections were reported as helping support recovery from suicidal crises. Though our sample was predominantly White, cis-gendered, and English speaking, and the underlying research designs prevent strong causal inferences, we discuss possible implications of these findings for male suicide intervention and suggestions for future research.