The death of Anthony Bourdain this week is a somber reminder that men make up the bulk of suicides in the U.S. and beyond.

Men die by suicide almost four times more often than women, with the rate of suicide highest in middle age, according to the American Foundation for Suicide Prevention.

It's unknown what caused Bourdain to take his own life, but depression is a leading risk factor for suicide.

Bourdain died just as the Centers for Disease Control and Prevention reported suicide rates were up by 30 percent across the nation since 1999, with rates increasing among both sexes, and all racial and ethnic groups. Designer Kate Spade, who took her life Tuesday, was another recent high-profile example of the troubling trend.

Suicide is a serious but preventable public health problem. If you or a loved one need help, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or visit https://t.co/iZM9Oo3FAT. #VitalSigns pic.twitter.com/qFh6C1nBP1 — CDC (@CDCgov) June 8, 2018

Warning signs

Experts urge friends and family members of men and women at risk for suicide to always reach out and ask questions like: Are you having thoughts of killing yourself?

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The American Foundation for Suicide Prevention says warning signs include:

talking about suicide, feeling hopeless, having no reason to live or being a burden to others

using more alcohol or drugs

withdrawing from family and friends or activities

sleeping too much or too little

calling people to say goodbye

giving away possessions

irritability, depression, anger or anxiety

"If you are concerned about a loved one, you should express your concern. Some people have the misconception that asking a person about suicide will increase the risk, but in reality asking does not increase the risk of suicide, but can save a life," said Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation.

If you or someone you know is at risk of suicide please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for more additional resources.

The specter of depression

Men may seem strong and steady, but almost half, 49 percent, felt more depressed than they admitted to the people in their lives, according to a TODAY-commissioned report "State of Men 2016," a Berland Strategy online survey of 1,001 adult males. The survey was conducted as part of a series on men's health with The Dr. Oz Show.

Almost half of men, 45 percent, believed mental health issues could be solved on their own.

"Men are good deniers. Men are good at soldiering on and not showing their emotions. That's an important quality to have on the battlefield because you don't want the enemy to know that you're weak... but it's not so good if it keeps you from seeing your doctor," said psychiatrist Dr. Stephen Snyder, associate clinical professor at Mt. Sinai Hospital, New York.

Many keep suicidal thoughts to themselves

Thoughts of suicide are extremely serious, but 45 percent of men in the TODAY report revealed they likely would not discuss them with a friend. More than half, 53 percent, said they would not be very likely to recognize if one of their male friends was at risk for suicide.

Instead of feeling overtly sad and hopeless, men who are depressed may feel tired, irritable and angry, the National Institute of Mental Health notes. They may have trouble sleeping and lose interest in their work, family, or hobbies.

Kevin Hines — who attempted suicide in 2000 when he was 19 and now works with the charity Movember to bring awareness to the issue — believes men hold it all in because they fear being judged.

"Men are so focused on the ideal of masculinity and how they have to appear to be, we forget to cry. We forget to be emotional, to show vulnerability, to show pain," Hines said.

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