Men, Depression, and Suicide: We Need to Talk About It

There are some things men have gotten very good at talking about.

Work. Sports. Money. Politics. The house. The kids. The car. The project that needs to get done this weekend.

But ask a man how he is actually doing?

That conversation can get a lot shorter.

For many men, there is still an unwritten expectation that difficult emotions should be handled privately. Keep working. Keep providing. Keep showing up. Figure it out. Don't burden anyone else with it.

Most of the time, that strategy can look a lot like strength from the outside.

Until it isn't working anymore.

September is Suicide Prevention Month, and if we're serious about suicide prevention—particularly among men—we have to become more comfortable talking about depression, hopelessness and suicide directly.

The Statistics on Men and Suicide Are Difficult to Ignore

In the United States, men die by suicide at a dramatically higher rate than women.

According to National Institute of Mental Health data, the suicide rate among males in 2023 was 22.8 deaths per 100,000 people, compared with 5.9 among females—nearly four times higher.

For men in the age range that makes up much of the workforce, our families and our communities, the numbers are particularly concerning.

In 2023, the suicide rate was:

• 21.2 per 100,000 for males ages 15–24

• 29.8 per 100,000 for males ages 25–44

• 29.2 per 100,000 for males ages 45–64

Suicide was also the second-leading cause of death among Americans ages 15–24 and 25–44 in 2023.

Those aren't just statistics.

They are sons, fathers, husbands, partners, brothers, friends, coworkers and neighbors.

And somewhere behind many of those deaths is a person who was experiencing a level of psychological pain that may not have been obvious to everyone around him.

Depression Doesn't Always Look Like Depression

When people imagine depression, they often picture someone who can't get out of bed, cries frequently or has completely withdrawn from life.

Sometimes depression looks exactly like that.

But not always.

A man can be depressed and still go to work.

He can coach his kid's team.

He can answer emails.

He can exercise.

He can make everyone laugh at dinner.

He can take care of his family while quietly feeling increasingly disconnected from himself.

Depression may show up as sadness, but it can also look like irritability, exhaustion, isolation, loss of interest, difficulty concentrating, changes in sleep, increased substance use or simply feeling like you're going through the motions of your life.

And depression among men is not rare. NIMH estimates that 6.2% of adult men experienced a major depressive episode during 2021.

Perhaps one of the most important things we can understand about suicide is that suicidal thoughts can occur in people who still appear functional.

Someone does not need to "look suicidal" for us to take their suffering seriously.

We Have to Get More Comfortable Asking the Question

One of the barriers to suicide prevention is our own discomfort with the subject.

We worry that asking someone about suicide will make the situation worse.

We worry that we won't know what to say if the answer is yes.

So instead, we sometimes ask:

"Everything good?"

And the answer is usually:

"Yeah, I'm good."

Conversation over.

Sometimes we need to go further.

"You've seemed different lately. How are you really doing?"

"Are you feeling hopeless?"

And when there is reason for concern:

"Have you been thinking about suicide?"

We shouldn't dance around the subject because we're afraid of making someone uncomfortable.

A difficult conversation is worth having.

For Men: Asking for Help Is an Action

I've worked with many men who are comfortable solving problems everywhere except inside themselves.

If the roof leaks, you fix it.

If something breaks at work, you handle it.

If your kid needs something, you show up.

But when anxiety, depression, grief, relationship problems or hopelessness start building, the instinct can be different:

"I'll deal with it."

Sometimes dealing with it means talking about it.

Therapy isn't about surrendering responsibility for your life to someone else. Good therapy should help you understand what is happening, identify patterns that aren't working and develop better ways of responding to the problems in front of you.

You still do the work.

You just don't necessarily have to do all of it alone.

Suicide Prevention Often Starts Earlier Than We Think

Suicide prevention isn't limited to responding to someone during an immediate crisis.

It can happen months or years earlier.

It's the guy who finally tells his friend that he's struggling.

It's the husband who tells his wife that he hasn't felt like himself lately.

It's the father who realizes his drinking has become his primary way of coping.

It's the friend who notices someone disappearing from the group and checks in.

It's the man who makes a therapy appointment before everything falls apart.

It's taking depression seriously when it first starts interfering with sleep, relationships, work, parenting or the ability to enjoy life.

Prevention can be surprisingly ordinary.

Sometimes it begins with one honest conversation.

If You're Struggling, Say Something

You don't need to wait until you're in crisis to ask for help.

And you don't need the perfect words.

You can simply say:

"I'm having a harder time than people realize."

That's enough to start.

Talk to your spouse. Talk to your friend. Talk to your brother. Talk to your doctor. Talk to a therapist.

And if you're worried about another man in your life, don't assume someone else will check on him.

Make the call.

Send the text.

Ask the uncomfortable question.

Sit with him long enough to hear the real answer.

We will never prevent every suicide through conversation alone. Suicide is complex, and effective prevention requires access to mental health care, crisis intervention, community support and appropriate treatment.

But silence certainly isn't helping us.

For men especially, changing the culture around mental health may begin with something incredibly simple:

It's okay to say you're not okay. And it's okay for another man to ask.

If you or someone you know is experiencing suicidal thoughts or is in emotional distress, call or text the 988 Suicide & Crisis Lifeline at 988. If there is an immediate danger or medical emergency, call 911 or go to the nearest emergency department.

Nick Ristoff, LMHC

Natural Light Counseling Services

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