title: Acute and Chronic Risk Preceding Suicidal Crises Among Middle-Aged Men Without Known Mental Health and/or Substance Abuse Problems: An Exploratory Mixed-Methods Analysis.
abstract: BACKGROUND
  Suicides among men aged 35-64 years increased by 27% between 1999 and 2013, yet little research exists to examine the nature of the suicide risk within this population. Many men do not seek help if they have mental health problems and suicides may occur in reaction to stressful circumstances.
  
  
  OBJECTIVE
  We examined the precipitating circumstances of 600 suicides without known mental health or substance abuse (MH/SA) problems and with a recent crisis. Whether these suicides occurred within the context of an acute crisis only or in the context of chronic circumstances was observed.
  
  
  METHODS
  Using data from the National Violent Death Reporting System and employing mixed-methods analysis, we examined the circumstances and context of a census of middle-aged male suicides (n = 600) in seven states between 2005 and 2010.
  
  
  RESULTS
  Precipitating circumstances among this group involved intimate partner problems (IPP; 58.3%), criminal/legal problems (50.7%), job/financial problems (22.5%), and health problems (13.5%). Men with IPP and criminal/legal issues were more likely than men with health and/or job/financial issues to experience suicide in the context of an acute crisis only.
  
  
  CONCLUSIONS
  Suicides occurring in reaction to an acute crisis only or in the context of acute and chronic circumstances lend themselves to opportunities for intervention. Further implications are discussed.
authors.affiliation: 1 Department of Hematology, University of Washington, Seattle, WA, USA.
authors.forename: Lara B
authors.initials: LB
authors.lastname: Schiff
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Holland
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stone
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Logan
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: Khiya J
authors.initials: KJ
authors.lastname: Marshall
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: Brandi
authors.initials: B
authors.lastname: Martell
authors.affiliation: 2 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Bartholow
mesh_terms: D002908:Chronic Disease / Q000523:psychology; D059350:Chronic Pain / Q000523:psychology; D003415:Crime / Q000523:psychology; D034462:Dissent and Disputes; D054541:Family Conflict / Q000523:psychology; D006801:Humans; D008016:Life Change Events; D008297:Male; D008571:Men; D001523:Mental Disorders; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D036301:Qualitative Research; D012307:Risk Factors; D019966:Substance-Related Disorders; D013405:Suicide / Q000523:psychology; D014478:Unemployment / Q000523:psychology; D000092864:Suicide Prevention
keywords: crisis; middle-aged; mixed methods; qualitative; suicide