Suicide, a primary cause of death among middle-aged men (35-64 years old), is the leading cause of injury death among men in this age group in Michigan (state where study takes place). Reliance on traditional mental health services to reach out to and engage men in this age group has not resulted in increased suicide problem recognition or help-seeking behavior. While effective treatment for suicide exists, treatment cannot help men who don't identify as having a problem, and therefore don't see help. The field lacks effective and efficient programs and interventions that actively engage middle-aged men in evidence-based interventions to increase suicide problem identification and help-seeking behavior. We will examine the effectiveness of a comprehensive online screening and referral intervention, specifically designed for men ages 35-64. Primary outcomes include suicide behavior (suicide attempts and preparatory acts), suicide ideation and depression. Secondary outcomes include: attitudes toward help-seeking and help-seeking behavior; suicide risk factors (i.e., alcohol abuse, relationship conflicts, financial problems and interpersonal needs7); and the protective factor of social support. Men who score in the moderate-to-high risk range for depression on the depression screen, or any score for suicide ideation and/or behavior on the suicide screen, will be asked to participate in the study. Participants will be randomly assigned to one of two groups: Screening for Mental Health; or Screening for Mental Health, plus Man Therapy. Man Therapy is specifically designed for men who are at risk for suicide and less likely to engage in help-seeking behavior. A series of data analysis techniques will be used to evaluate the additive effect of Man Therapy. The core analysis will be a longitudinal mixed-model path analysis testing for between-group and within-group differences on primary and secondary outcomes. The model design will also include estimations of indirect effects (mediation and moderation). Data will be collected on primary outcomes of depression and suicidal behavior and ideation at baseline and then again at 2- and 12-weeks post randomization to study arm. Secondary outcomes will be measured 2- and 12-weeks post randomization to study arm. Using a sequential mixed-methods research design, researchers will interview a purposive sub-sample of men referred to both study arms to further assess and compare barriers and facilitators to men seeking suicide prevention services. This innovative study, which can be widely applicable to other states across the country, may advance suicide prevention among middle-aged men, a high-risk group for suicide who tend to be difficult to engage in suicide problem identification and help-seeking behavior.
The thrust of this study is to test a comprehensive, male-oriented, online screening and referral intervention program to prevent suicide among middle-aged men. If successful in decreasing suicide behavior and ideation and increasing suicide help-seeking behavior, this intervention could reduce suicide deaths and be widely applicable for suicide prevention across the country.
