Introduction: In the Netherlands, the risk of death by suicide is highest for middle aged men, compared to all other age groups. Depression and anxiety disorders are a risk factor for suicide. In order to gain more insight about why some men with depression or anxiety attempt suicide and others do not, we assessed risk factors for suicide attempts within a group of middle-aged men with anxiety and depression disorders.

Methods: We used data of the Netherlands Study on Depression and Anxiety (NESDA), which is a large ongoing cohort study of individuals with depression and anxiety disorders, that has been running for almost 20 years. We included men who were between 40 and 70 years at baseline and had not made an attempt before age 40 (n=457). We compared variables covering personality traits, sensation seeking, childhood trauma, work circumstances, social situation (e.g. having a partner) and economic situation (e.g. having financial problems), for men who did and men who did not attempt suicide.

Results: In univariate analyses, being absent from work for six months, having less control over work, high scores on neuroticism, low scores on openness, and childhood emotional and physical abuse and physical neglect were associated with suicide attempts. In multivariate analyses, only neuroticism (HR=1.99 (CI 1.30-3.04), p<0.01) was significant. Childhood physical neglect and control over work bordered significance (HR=1.46 (CI 1.00-2.12), p=0.05 and HR=0.70 (CI 0.49-1.00), p=0.05, respectively). There was no significant difference in other variables, such as those related to sensation seeking and to the social and economic situation of the men.

Conclusion: The risk for suicide attempts is increased in middle-aged men with a depression or anxiety disorder if they score high on neuroticism or low on openness or have experienced childhood abuse. While alertness for suicidal ideation is always warranted when treating depression or anxiety, these risk factors provide an extra indication for mental health professionals to ask about suicidal ideation. In addition, it is recommended to carefully assess the presence of childhood trauma in middle-aged men with a depression or anxiety disorder, since its impact can persist into middle age.