Suicidal behavior in men with comorbid depression and substance use disorders: Roles of active substance use, exposure to combat in the military, and alterations in testosterone levels

Suicide is a leading cause of death worldwide and, as such, remains an important public health issue. This is a particularly important topic of discussion in thinking of men's mental health as men are far more likely than women to complete suicide. Studies attempting to determine the factors that lead to suicide have been able to formulate numerous risk factors for suicide, but efficient tools for early targeting and intervention remain elusive. In this chapter we discuss two cases of men with serious suicidal behaviors that presented to our psychiatric units. Using these cases as a guide for discussion, we then evaluate the literature with respect to male-specific risk factors for suicide. Included in our discussion will be how military service and trauma may put men at higher risk for suicide, how alterations in alcohol and substance consumption may trend men more specifically towards suicidal behavior, and how alterations in serum testosterone may present a male specific risk factor for worsening depression and suicidal behavior. By considering these important factors and how they apply to specific populations, we hope to drive the process forward of developing more effective early interventions for at risk populations.