Robin Williams had the traits of a person likely to commit suicide
Actor who hanged himself had the traits: white, middle-aged male in late stages of career, a depressed substance abuser who sought treatment
If you tried to create a profile of someone at high risk of committing suicide, one likely example would look like this: A middle-aged or older white male towards the end of a successful career, who suffers from a serious medical problem as well as chronic depression and substance abuse, who recently completed treatment for either or both those psychological conditions and who is going through a difficult period, personally or professionally.
In short, that person would look a lot like Robin Williams, the 63-year-old actor and comedian who last week hanged himself in his home in the San Francisco Bay area of the US state of California.
While certainly not the only group susceptible to suicide - 39,518 people took their own lives in 2011 in the US - older white males with that cluster of characteristics have been on psychologists' radar at least since federal statistics released last year showed an alarming rise in their suicide rate between 1999 and 2010. The suicide rate for white men increased by nearly 40 per cent, to 34.2 per 100,000 people.
"This is certainly the demographic - middle-aged or older Caucasians," said Dost Ongur, associate professor of psychiatry at Harvard Medical School. "And certainly men with medical problems." Williams has said he suffered from heart problems.
Men account for only about 20 per cent of suicide attempts, but represent about 80 per cent of completed suicides, statistics show, almost certainly because they choose more lethal methods: guns and leaps from high places instead of drug overdoses, Ongur said.
Beyond the mechanics of suicide was a variety of risk factors that predisposed men, particularly middle-aged men, to suicide, experts said.
"Men are much less likely to seek help than women are," said Michelle Cornette, who is the executive director of the American Association of Suicidology. And "apart from seeking help professionally, [men] utilise their friendships in different ways. Men are less likely to disclose to a male friend that they are struggling psychologically".
At the same time, ageing may take a larger toll on the male psyche. Older men who value their self-reliance may find themselves less able to cope as they age, when they are no longer in their prime physically, sexually and at work.
"I often refer to them as being developmentally unsuccessful, because they're not equipped to handle the challenges of getting older if they are so tied into their masculinity … and making a lot of money," said Christopher Kilmartin, a psychology professor at the University of Mary Washington in the US state of Virginia.
"Things aren't the way they used to be," Ongur said. "The power you knew, the control you knew, aren't the same."
When depression, addiction and medical problems are added to the mix, the risk of a suicide attempt increases significantly. Williams was grappling with "severe depression", according to his publicist - a condition that creates hopelessness and despair, frequent precursors to suicidal ideation.
Substance abuse suppresses inhibition and can lead to an impulsive act.
Ironically, when depression was lifting or someone was released from rehab or treatment, they were also vulnerable to a suicide attempt, said Nadine Kaslow, a psychology professor and vice-chair of the Department of Psychiatry and Behavioural Sciences at Emory University School of Medicine. In recent months, Williams had gone through rehab again. In July, the Oscar winner spent a few weeks at the Hazelden addiction treatment centre in Minnesota, participating in a programme designed to reinforce sobriety.
During rehab, people often felt safe and protected, Kaslow said, "but when they come out, they may be overwhelmed by the world around them".
As men look back on their lives, they may become more reflective, asking themselves whether they focused on what really mattered to them, and what they were going to do next, Kaslow said.
An emerging area of interest for many mental health experts is the impact of feelings that the person who attempts suicide has begun to feel he is a burden to his family and friends, who, he believes, would be better off without him.
In the end, Cornette said, "regardless of what we end up learning from the police, no one but this guy's therapist, and maybe his friends and family, knew all these risk factors. It's speculation on our part".