A bright room with a wooden parquet floor in the Kulturquartier in Münster; large windows flood it with light and look out onto the green garden. One by one, people come in and sit down in the circle of chairs. Some faces are familiar – they have been coming on the third Monday of every month for some time. Others are joining the group for the first time. They all have one thing in common: they have lost someone close to them to suicide.

Matthias Bäcker has been through this painful experience twice: both his sons took their own lives as teenagers. Afterwards, he fell into a hole. ‘I needed help, but there was no group. Many crisis services weren’t as specialised as I would have wished.’ In 2024 he joined AGUS (Angehörige um Suizid e.V.), an association for people bereaved by suicide, set up a self-help group in Münster and created a space for sharing experiences and supporting one another. Because what also unites those affected are the questions that keep going round in their heads: ‘Why? Should I have noticed something? Could I have prevented it?’

Prof. Ute Lewitzka, who holds Germany’s first professorship in suicidology and suicide prevention, explains the statistics mainly by one factor: the choice of method. ‘They use methods that, medically speaking, are more likely to be fatal, whereas women tend to use less lethal methods.’

Women more often turn to medication, frequently without knowing the actual dose, which in many cases does not lead to death. That does not mean they are any less serious. For men, the chosen method is usually more violent and survival less likely.

According to Lewitzka, the traditional role model, with its evolutionary roots, is still a problem, because there are deeply entrenched social expectations that assign specific patterns of behaviour to each gender. Even in adolescence, she says, it is apparent that males find it harder to put emotions into words or to express them, and that they take less good care of themselves, both physically and mentally.

For many, strength means never showing weakness and bearing suffering alone. The ability to accept help is not taught as a skill but felt as a failure. The result: men only seek support once the crisis has already become existential – or they go without it altogether.

Added to this is a problem that was long overlooked: depression can produce different symptoms in men. Lewitzka explains that in women, depression often shows itself through classic symptoms such as sadness and low mood, whereas men tend to react with irritability and a short temper. Aggression, drinking, risk-taking – these can be masked symptoms of depression that doctors fail to recognise as such.

In the 1990s, the so-called Gotland study provided proof of how important the right diagnosis is: simply by teaching GPs to recognise and treat depression better, the suicide rate on the Swedish island fell by more than 60 per cent. ‘Incidentally, I believe it would save the system a lot of money and unnecessary tests if GPs learned how to deal with suicidal patients and the system gave them the time to have these conversations,’ Lewitzka adds.

Lina Kühne

But even as awareness of the problem grows: where can prevention reach men? Schools offer a big opportunity, because almost all children are there, and it is where they should learn how to deal with emotions. But it is not only teachers who have a role to play.

Matthias Bäcker knows these questions from his own painful experience and is still appalled at how little is taught about potential risks in educational settings. ‘When you think how much time children spend doing sport, too – sometimes that’s eight hours a week with a coach, and coaches need to be made aware of the issue,’ he says.

This is particularly important given the time children and young people spend on social media, where they find content that can be helpful, but also content that is dangerous. Media reports about suicide can have a positive effect by spreading knowledge and reducing stigma. At the same time, they carry risks if they trigger what is known as the Werther effect: copycat suicides after reports about famous people or detailed descriptions of methods.

And what about middle-aged and older men? Where are they? From the age of 45, health insurers in Germany cover urological check-ups – the subject could be raised there, where men go anyway, Lewitzka says. The problem is made worse by growing isolation in old age. ‘Loneliness is something different from isolation. And old men tend to be isolated. They really are alone,’ the suicidologist explains. A trip to the bakery in the morning as their only human contact – for many older men, that is reality.

Lewitzka stresses: ‘It’s important to say that there is never just one reason when it comes to suicide – complex factors are always involved.’ Biological factors, life events, social isolation, mental illness – they all interact and reinforce one another. But that also means there is a chance to intervene at every one of these points.

Research already knows that universal prevention measures can influence the suicide rate, which means the work has to be tailored to gender and age. Boys can learn to talk about emotions. Doctors can be trained to recognise depression in men. Prevention services can be taken to where men actually are. And society can begin to redefine masculinity.

^{_{A note on language: this article uses the terms ‘men’ and ‘women’ because the studies and statistics cited have so far worked exclusively with binary gender categories. Non-binary and trans people are not represented, or not adequately represented, in these data. The descriptions therefore follow the available research.}}

If you are having suicidal thoughts yourself, or know someone who needs help: in Germany, the TelefonSeelsorge helpline is free and available around the clock on 0800 111 0 111 or 0800 111 0 222. You can also contact your nearest psychiatric hospital or local support services, such as the suicide prevention and counselling service of the Diakonisches Werk Hannover on 0511 625028.