关于自杀的事实是一个不可否认的事实：男人占世界上绝大多数的自杀。在欧洲，男子约占完整的自杀的80％，而在美洲，男性约占已完成的自杀的75％。

在加拿大，每年大约有3,000名男性因自杀而死，这转化为每周50多人死亡。在里面美国around 35,000 men die by suicide every year, which translates to around one every 15 minutes. This has led Professor Dan Bilsker to宣布我们正处于“男性自杀的寂静流行”之中。

A growing problem

Worryingly, rates of male suicide appear to be rising, after a period of declining rates. For example, a US Centers for Disease Control and Prevention (CDC)报告指出，在美国，经过年龄调整的男性自杀率显示出从1980年代中期到2006年的略有下降。

但是同一份报告指出，从2006年到2017年，男性自杀率每年增加约2％，反映出自1999年以来男性自杀率增加了26％。这些上升的利率表明，现有的预防自杀方法可能会缺失。

在deed, three of the central arguments of my upcoming bookMen’s Issues and Men’s Mental Health（Springer，印刷中）是男性预防自杀的主要方法（男性的心理健康per se）insufficiently address the issue because they:

• Are too narrowly focused on the singular concept of masculinity, lacking peripheral vision to examine important aspects of social context;
• 有时，通过将手指指向所谓的男性赤字，例如固执和沉默，以无助的“责备和羞辱”方法；和
• 不足以以男性敏感或对男性友好的“优势方法”为基础，该方法以男性倾向和偏好为基础。

在stead of this rather one-dimensional and patronizing approach, I argue that a better framework to understand and address male suicide (and men’s mental healthper se）may be a public health framework known as健康的社会决定因素。

一种更新的方法

该框架涉及检查各种社会因素与健康成果之间的关系，并使用结果来构建目标和量身定制的计划和干预措施。这通常包括对人群的仔细比较，包括年龄，性别和种族。

在自杀方面，这种分析表明，某些男性的某些子群体特别有自杀的风险。这包括：（i）原住民；（ii）离婚的男人；（iii）退伍军人；（iv）失业者；（v）患有精神疾病的男性。

What are the common factors underlying high rates of suicide in the above groups? To a greater or lesser extent, men in these groups frequently face high levels of isolation, social stigma and financial strain. They may also be stereotyped on account of their demographic, and there may be a lack of public empathy for their plight, meaning few safety nets or supports.

社会融合和疏远

事实上,男人的一个共同因素在这些团体may be real or perceived rejection from mainstream society, leading to ongoing feelings of disaffection and estrangement. In short, an underlying factor explaining high rates of suicide in such disparate groups may be a strong sense ofsocial alienation，，，，characterized by a diminished sense of meaning and purpose in life, which in turn can weaken primary生活的原因。

例如，西方国家的成年男子的社会融合通常是由有意义的参与提供的：（i）核心家庭；（ii）劳动力。因此，核心家庭的瓦解或失业可能会对男性产生特别有害的影响，尤其是因为在提供服务中通常会忽略此人群。

同样，针对诸如精神疾病，退伍军人和原住民等人群的刻板印象可能首先阻碍了进入劳动力和约会机会，从而导致缺乏社会融合和持续的边缘化。

Implications for prevention

健康框架的社会决定因素对预防男性自杀有影响，这表明了多管齐的方法的重要性。

这可以包括为经历艰难过渡（例如离婚或失业）的男性提供量身定制的男性敏感支持。它还可以包括针对来自特定亚文化的弱势群体（包括原住民和退伍军人）的有针对性和文化适当的支持。

And while the official mental health system indubitably has a role to play, locally grounded community-driven programs must also be tasked to help vulnerable men, especially asresearch表明男人通常喜欢这样的空间。

This can include local peer support groups, faith-based organizations or other non-profits. Such organizations are well placed to address the loneliness, social alienation and diminished sense of meaning and purpose in life that is often implicated in male suicide.

盒子外的这种思想可能有助于解决男性自杀的沉默危机。