Black Dog Institute and Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Faces in the Street, St Vincent's Hospital, St Vincent's Urban Mental Health Research Institute, Sydney, NSW, Australia.
Health Expect. 2018 Feb;21(1):261-269. doi: 10.1111/hex.12611. Epub 2017 Aug 14.
Men generally have higher rates of suicide, despite fewer overt indicators of risk. Differences in presentation and response suggest a need to better understand why suicide prevention is less effective for men.
To explore the views of at-risk men, friends and family about the tensions inherent in suicide prevention and to consider how prevention may be improved.
Secondary analysis of qualitative interview and focus group data, using thematic analysis techniques, alongside bracketing, construction and contextualisation.
A total of 35 men who had recently made a suicide attempt participated in interviews, and 47 family and friends of men who had made a suicide attempt took part in focus groups. Participants recounted their experiences with men's suicide attempts and associated interventions, and suggested ways in which suicide prevention may be improved.
Five tensions in perspectives emerged between men and their support networks, which complicated effective management of suicide risk: (i) respecting privacy vs monitoring risk, (ii) differentiating normal vs risky behaviour changes, (iii) familiarity vs anonymity in personal information disclosure, (iv) maintaining autonomy vs imposing constraints to limit risk, and (v) perceived need for vs failures of external support services.
Tension between the different perspectives increased systemic stress, compounding problems and risk, thereby decreasing the effectiveness of detection of and interventions for men at risk of suicide. Suggested solutions included improving risk communication, reducing reliance on single source supports and increasing intervention flexibility in response to individual needs.
尽管男性自杀的明显风险指标较少，但男性自杀率普遍较高。表现和反应上的差异表明，我们需要更好地理解为什么预防男性自杀的效果较差。
探讨处于自杀风险中的男性、他们的朋友和家人对预防自杀所固有的紧张局势的看法，并考虑如何改进预防措施。
使用主题分析技术，以及括号、建构和语境化等方法，对定性访谈和焦点小组数据进行二次分析。
共有 35 名最近有自杀企图的男性参与者接受了访谈，47 名男性自杀未遂者的家人和朋友参加了焦点小组。参与者讲述了他们与男性自杀企图及其相关干预的经历，并提出了如何改进自杀预防的方法。
男性及其支持网络之间出现了五种观点上的紧张关系，这些紧张关系使对自杀风险的有效管理变得复杂：（i）尊重隐私与监测风险，（ii）区分正常与危险的行为变化，（iii）个人信息披露中的熟悉与匿名，（iv）保持自主权与限制风险的约束，以及（v）感知外部支持服务的需求与失败。
不同观点之间的紧张关系增加了系统压力，使问题和风险复杂化，从而降低了对处于自杀风险中的男性的发现和干预的有效性。建议的解决方案包括改善风险沟通，减少对单一来源支持的依赖，并根据个人需求增加干预措施的灵活性。
