"I Never Saw a Future": Childhood Trauma and Suicidality Among Sexual Minority Women.

While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities.

Men on Losing a Male to Suicide: A Gender Analysis.

Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men's overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The "unforeseen suicides" referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, "rationalized suicides" detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause-effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, "managing emotions" whereby participants distanced themselves, but also drew meaning from the suicide.

"I should have ":A Photovoice Study With Women Who Have Lost a Man to Suicide.

While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women's narratives drew upon feminine ideals of caring for men's health, which in turn gave rise to feelings of guilt over the man's suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women's postsuicide bereavement support programs should integrate a critical gender approach.

Photovoice Ethics: Critical Reflections From Men's Mental Health Research.

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men's depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice.

"You've Gotta Be That Tough Crust Exterior Man": Depression and Suicide in Rural-Based Men.

Suicide rates in Canada are highest among rural men. Drawing on photovoice interviews with 13 women and two men living in a small rural Canadian town who lost a man to suicide, we inductively derived three themes to describe how contextual factors influence rural men's experiences of depression and responses to suicidal thoughts: (a) hiding depression and its cause, (b) manly self-medicating, and (c) mobilizing prevention. Further discussed is how gender relations and ideals of masculinity within rural milieu can inhibit men's acknowledgment of and help seeking for mental illness issues. Participants strongly endorsed a multifaceted approach to the destabilization of dominant ideals of masculinity that likely contribute to depression and suicide in rural men.

Picturing Masculinities: Using Photoelicitation in Men's Health Research.

This article explores the use of photo-elicitation methods in two men's health studies. Discussed are the ways that photo-elicitation can facilitate conversation about health issues that might be otherwise challenging to access. In the first study, researchers explored 35 young men's experiences of grief following the accidental death of a male peer. In the second study, researchers describe 64 fathers' perceptions about their roles and identity with respect to child safety and risk. Photographs and accompanying narratives were analyzed and results were theorized using a masculinities framework. Discussed are the benefits of photo-elicitation, which include facilitating conversation about emotions, garnering insight into the structures and identities of masculinity in the context of men's health. Considered also are some methodological challenges amid recommendations for ensuring reflexive practices. Based on the findings it is concluded that photo-elicitation can innovatively advance qualitative research in men's health.

"Things I did not know": Retrospectives on a Canadian rural male youth suicide using an instrumental photovoice case study.

In Canada, it is young, rural-based men who are at the greatest risk of suicide. While there is no consensus on the reasons for this, evidence points to contextual social factors including isolation, lack of confidential services, and pressure to uphold restrictive norms of rural masculinity. In this article, we share findings drawn from an instrumental photovoice case study to distil factors contributing to the suicide of a young, Canadian, rural-based man. Integrating photovoice methods and in-depth qualitative, we conducted interviews with seven family members and close friends of the deceased. The interviews and image data were analyzed using constant comparative methods to discern themes related to participants' reflections on and perceptions about rural male suicide. Three inductively derived themes, "Missing the signs," "Living up to his public image," and "Down in Rural Canada," reflect the challenges that survivors and young rural men can experience in attempting to be comply with restrictive dominant ideals of masculinity. We conclude that community-based suicide prevention efforts would benefit from gender-sensitive and place-specific approaches to advancing men's mental health by making tangibly available and affirming an array of masculinities to foster the well-being of young, rural-based men.

Injury, Interiority, and Isolation in Men's Suicidality.

Men's high suicide rates have been linked to individual risk factors including history of being abused as a child, single marital status, and financial difficulties. While it has also been suggested that the normative influences of hegemonic masculinities are implicated in men's suicide, the gendered experiences of male suicidality are poorly understood. In the current photovoice study, 20 men who previously had suicidal thoughts, plans, and/or attempts were interviewed as a means to better understanding the connections between masculinities and their experiences of suicidality. The study findings revealed injury, interiority, and isolation as interconnected themes characterizing men's suicidality. Injury comprised an array of childhood and/or cumulative traumas that fueled men's ruminating thoughts inhibiting recovery and limiting hopes for improved life quality. In attempting to blunt these traumas, many men described self-injuring through the overuse of alcohol and other drugs. The interiority theme revealed how suicidal thoughts can fuel hopelessness amid summonsing remedies from within. The challenges to self-manage, especially when experiencing muddled thinking and negative thought were evident, and led some participants to summons exterior resources to counter suicidality. Isolation included separateness from others, and was linked to abandonment issues and not having a job and/or partner. Self-isolating also featured as a protection strategy to avoid troubling others and/or reducing exposure to additional noxious stimuli. The study findings suggest multiple intervention points and strategies, the majority of which are premised on promoting men's social connectedness. The destigmatizing value of photovoice methods is also discussed.

Men's depression and suicide literacy: a nationally representative Canadian survey.

BACKGROUND: Male suicide prevention strategies include diagnosis and effective management of men's depression. Fundamental to suicide prevention efforts is public awareness, which in turn, is influenced by literacy levels about men's depression and suicide. AIM: The aim of this study is to examine sex differences in mental health literacy with respect to men's depression and suicide among a cohort of Canadian respondents. METHODS: About 901 English-speaking Canadian men and women completed online survey questionnaires to evaluate mental health literacy levels using 10-item D-Lit and 8-item LOSS questionnaires, which assess factual knowledge concerning men's depression and suicide. Statistical tests (Chi-square, z-test) were used to identify significant differences between sex sub-groups at 95% confidence. RESULTS: Overall, respondents correctly identified 67% of questions measuring literacy levels about male depression. Respondents' male suicide literacy was significantly poorer at 53.7%. Misperceptions were especially evident in terms of differentiating men's depressive symptoms from other mental illnesses, estimating prevalence and identifying factors linked to male suicide. Significant sex differences highlighted that females had higher literacy levels than men in regard to male depression. CONCLUSIONS: Implementing gender sensitive and specific programs to target and advance literacy levels about men's depression may be key to ultimately reducing depression and suicide among men in Canada.

Stigma in Male Depression and Suicide: A Canadian Sex Comparison Study.

Stigma in men's depression and suicide can restrict help-seeking, reduce treatment compliance and deter individuals from confiding in friends and family. In this article we report sex comparison findings from a national survey of English-speaking adult Canadians about stigmatized beliefs concerning male depression and suicide. Among respondents without direct experience of depression or suicide (n = 541) more than a third endorsed the view that men with depression are unpredictable. Overall, a greater proportion of males endorsed stigmatizing views about male depression compared to female respondents. A greater proportion of female respondents endorsed items indicating that men who suicide are disconnected, lost and lonely. Male and female respondents with direct personal experience of depression or suicide (n = 360) strongly endorsed stigmatizing attitudes toward themselves and a greater proportion of male respondents indicated that they would be embarrassed about seeking help for depression.

"Dulling the Edges": Young Men's Use of Alcohol to Deal With Grief Following the Death of a Male Friend.

BACKGROUND: The death of a male friend can be challenging for men because expressions of grief can be governed and restrained by dominant ideals of masculinity. It is common for young men to engage in health risk practices, such as alcohol overuse, to deal with feelings of sadness. OBJECTIVE: This qualitative study investigated the ways that young men use alcohol in the process of grieving the accidental death of a male friend. METHOD: Participants included 35 men 19 to 25 years old and 22 men 26 to 35 years old who participated in individual semistructured interviews between 2010 and 2012. RESULTS: Methodology informed by grounded theory and narrative analysis was used to analyse and interpret the transcribed interviews, focusing on the ways that men used alcohol in the grief process. Through data analysis we inductively derived three themes: (1) Using Alcohol to Dull the Pain, (2) Using Alcohol to Purge Sadness, and (3) Troubled Drinking. CONCLUSIONS: This study provides evidence to show that men's binge drinking following tragic loss is a means to express emotion and connect with others. Health interventions for young men who have lost a male peer need to be sensitive to gendered norms that inform grief practices and work with them to discern pathways toward recovery that promote long-term wellness.

Living for the moment: men situating risk-taking after the death of a friend.

The primary cause of death for men under the age of 30 is unintentional injury and, despite health-promotion efforts and programme interventions, male injury and death rates have not decreased in recent years. Drawing on 22 interviews from a study of men, risk and grief, we describe how a risk-related tragedy shaped the participants' understandings of and practices of risk-taking. The findings indicate that most participants did not alter their perceptions and engagement in risky practices, which reflected their alignment to masculine ideals within specific communities of practice where risk-taking was normalised and valorised. Continued reliance on risky practices following the death of a friend was predominantly expressed as 'living for the moment,' where caution and safety were framed as conservative practices that undermined and diluted the robustness ideally embodied by this subgroup of young men. Two main themes: living life, accepting death and upping the ante illustrate how risk-taking can persist following a death. A smaller group of participants articulated a different viewpoint; reining in risk practices, to describe their risk management approaches after the death of a male friend. This novel study confirms the ongoing challenge of reducing men's risk-taking practices, even after the death of a friend.

Men, Masculinities, and Murder-Suicide.

Murder-suicide (M-S) is a complex phenomenon that can involve a multifaceted set of interrelated biological and social factors. M-S is also sexed and gendered in that the perpetrators are most often male and their underpinning motives and actions link to masculinities in an array of diverse ways. With the overarching goal to describe connections between men, masculinities, and M-S, 296 newspaper articles describing 45 North American M-S cases were analyzed. The inductively derived findings revealed three themes: (a) domestic desperation, (b) workplace justice, and (c) school retaliation. Cases in the domestic desperation theme were characterized by the murder of a family member(s) and were often underpinned by men's self-perceptions of failing to provide economic security. Workplace justice cases emerged from men's grievances around paid-work, job insecurity, and perceptions of being bullied and/or marginalized by coworkers or supervisors. The school retaliation cases were strongly linked to "pay back" against individuals and/or society for the hardships endured by M-S perpetrators. Prevailing across the three themes was men's loss of control in their lives, hopelessness, and marginalized masculine identities. Also evident were men's alignments to hegemonic masculinities in reasserting one's masculine self by protesting the perceived marginalization invoked on them. Overall, the findings give pause to consider the need for men-centered M-S prevention strategies to quell the catastrophic impacts of this long-standing but understudied men's health issue.

Fathers' views on their financial situations, father-child activities, and preventing child injuries.

Unintentional injuries are a leading public health problem for children, particularly among those living at lower socioeconomic levels. Parents play an important preventive role, and the aim of this study was to examine fathers' views on the role of their family financial situation in preventing children's injuries. In-depth interviews were conducted with 15 fathers of children 2 to 7 years living in western Canada. Questions solicited fathers' views about their financial situation and their child injury prevention efforts. Data analysis was underpinned by masculinity theory and guided by constant comparative grounded theory methods. Findings included that fathers living with fewer financial limitations emphasized use of safety equipment and aligned themselves with provider and protector masculine ideals. Fathers with moderate financial constraint described more child-centered safety efforts and efforts to manage finances. Those facing greatest constraint demonstrated aspects of marginalized masculinities, whereby they acknowledged their economic provider limitations while strongly aligning with the protector role. These findings hold relevance for development of interventions aimed at reducing child injury risk inequities. Taking into account how masculinities may shape their beliefs and practices can inform design of father-centered interventions for men living at different points on the socioeconomic spectrum.

Heterosexual gender relations in and around childhood risk and safety.

Injuries are a leading cause of child death, and safety interventions frequently target mothers. Fathers are largely ignored despite their increasing childcare involvement. In our qualitative study with 18 Canadian heterosexual couples parenting children 2 to 7 years old, we examined dyadic decision making and negotiations related to child safety and risk engagement in recreational activities. Parents viewed recreation as an important component of men's childcare, but women remained burdened with mundane tasks. Most couples perceived men as being more comfortable with risk than women, and three negotiation patterns emerged: fathers as risk experts; mothers countering fathers' risk; and fathers acknowledging mothers' safety concerns but persisting in risk activities. Our findings suggest that contemporary involved fathering practices privilege men in the outdoors and can erode women's control for protecting children from unintentional injury. We recommend promoting involved fathering that empowers both parents and developing injury-prevention strategies incorporating both fathers' and mothers' perspectives.

After the death of a friend: young men's grief and masculine identities.

Young men can have an uncomfortable relationship with grief. Socially constructed masculine ideals dictate that men be stoic in the aftermath of loss, most often expressing their sadness and despair as anger. Perhaps because of alignment to such masculine ideals little research has been done to explore young men's grief--and chronicle the ways they think about loss, their responses and how they go about describing their identities after a tragic event. Using qualitative individual interviews and photo elicitation methods, we investigated the ways in which 25 men aged 19-25 grieved the accidental death of a male friend. The study was conducted from April 2010-December 2011. Causes of death were diverse, and included motor vehicle accidents, adventure sports, drug overdose and fights. The findings revealed men's predominant grief responses as emptiness, anger, stoicism and sentimentality. Participants' description of their grief responses illustrated the ways in which they struggled to reconcile feelings of vulnerability and manly ideals of strength and stoicism. We gained insight into men's grief practices by looking at the ways in which they aligned themselves with a post-loss masculine identity. These identities, which included the adventurer, father-figure and the lamplighter, revealed gender-specific processes through which men understood and actively dealt with their tragic loss. The results offer novel insights to men's grief and identity work that may serve to affirm other men's experiences as well as guide counselling services targeted to young men.

Men on fathering in the context of children's unintentional injury prevention.

Injuries are a leading cause of death for children, and parental safety behaviors are fundamental to child injury prevention. Fathers' perspectives are largely absent. Our novel research connects masculinities, fathering, and childhood injury. Sixteen fathers of children aged 2 to 7 years in two Canadian urban settings participated in photo-elicitation interviews detailing activities they enjoyed with their children and concerns regarding child safety. Participants described how elements of risk, protection, and emotional connection influenced their approach to fathering as it related to injury prevention. Most men considered engaging children in risk as key to facilitating development and described strategies for protecting their children while engaging in risk. Many men identified how the presence of an emotional connection to their children allowed them to gauge optimal levels of risk and protection. There exists a tremendous opportunity to work with fathers to assist in their efforts to keep their children safe.

Building capacity for community-based participatory research for health disparities in Canada: the case of "Partnerships in Community Health Research".

Enthusiasm for community-based participatory research (CBPR) is increasing among health researchers and practitioners in addressing health disparities. Although there are many benefits of CBPR, such as its ability to democratize knowledge and link research to community action and social change, there are also perils that researchers can encounter that can threaten the integrity of the research and undermine relationships. Despite the increasing demand for CBPR-qualified individuals, few programs exist that are capable of facilitating in-depth and experiential training for both students and those working in communities. This article reviews the Partnerships in Community Health Research (PCHR), a training program at the University of British Columbia that between 2001 and 2009 has equipped graduate student and community-based learners with knowledge, skills, and experience to engage together more effectively using CBPR. With case studies of PCHR learner projects, this article illustrates some of the important successes and lessons learned in preparing CBPR-qualified researchers and community-based professionals in Canada.