title: Mixed Methods Analysis of Sex Differences in Life Stressors of Middle-Aged Suicides.
abstract: Between 1999 and 2013, rates of suicide in mid-life increased more than 30%. The purpose of this study is to examine life stressors impacting middle-aged suicide, to determine whether these stressors vary by sex, and to explore their co-occurrence.
  
  
  
  A random sample of 315 men and 315 women aged 35-64 years was selected from 17 states implementing the National Violent Death Reporting System from its inception in 2003 to 2011. Data collection took place between 2003 and 2011 and analysis occurred in 2015. Analysis included coding circumstances of death noted in the law enforcement and coroner/medical examiner reports using an investigator-designed coding instrument. Using the most commonly cited life stressors as a basis, thematic analyses were conducted for cases. Quantitative comparisons of the most common circumstances by sex were calculated via multivariable logistic regression.
  
  
  
  The five most common life stressors of suicide included intimate partner, job/financial, health, family, and criminal/legal problems. In adjusted analyses, job/financial problems and criminal/legal problems were more common among men, whereas health and family problems were more common among women. Men and women had similar rates of intimate partner problems. Life stressors also co-occurred, as found per qualitative and quantitative analyses.
  
  
  
  Men and women in mid-life have both common and unique circumstances preceding suicide. Prevention strategies that consider these circumstances and co-occurring circumstances are warranted.
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: dstone3@cdc.gov.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stone
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Holland
authors.affiliation: Division of Hematology, University of Washington, Seattle, Washington.
authors.forename: Lara B
authors.initials: LB
authors.lastname: Schiff
authors.affiliation: Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Wendy LiKamWa
authors.initials: WL
authors.lastname: McIntosh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D013315:Stress, Psychological; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States