Insights into middle-aged men (40-70) who died by suicide: a nationwide mixed methods study in the Netherlands.

BACKGROUND: Globally, middle-aged men dominate suicide statistics in many regions. To understand their heightened vulnerability, we examine the interplay between sociodemographic factors, contextualized through psychosocial perspectives. METHODS: Data from Statistics Netherlands of all middle-aged men (40-70) who died by suicide between 2012 and 2021 (N = 6,656) and interview data from a psychosocial autopsy study of suicide decedents (n = 25) were combined. We applied a machine learning method on the population data to detect subgroups of middle-aged men with a higher risk of dying by suicide. To distil factors and nuances beyond sociodemographic categorization, we executed a thematic analysis on the interview data from the psychosocial autopsy study. RESULTS: On average the suicide rate for middle-aged men in the Netherlands was 21.3 per 100,000. The suicide rate was high (> 40 suicides per 100,000) for middle-aged men who received mental health care (114), received a disability benefit (55.9), lived alone (51.6), received social assistance (50.6), had somatic health care costs over €10,000 per year (49), or between €5,000 and €10,000 per year (43), or had a low household income (40.8). However, it became evident that suicide rates were significantly higher when these factors accumulated, with the combination of (i) received mental health care, (ii) lived alone, and (iii) received a disability benefit resulting in 289.1 suicides per 100,000. The thematic analysis contextualized sociodemographic risk factors by providing insight into underlying themes, including the experience of loss, disconnectedness, and debilitation. CONCLUSIONS: The data indicate that the accumulation of (mental) health, socioeconomic, and interpersonal hardships, carry significant risk for middle-aged men. The interaction of factors underscores the complexity of the origin of suicide, while also pointing to avenues for prevention efforts. Suicide prevention efforts must be integrated into the systems and contexts where middle-aged men are currently situated, which include clinical care, community settings, and social services. Future research should explore the support needs of middle-aged men with lived experience.