Gender differences in suicide rates have been shown to be significant; there are highly asymmetric rates of attempted and completed suicide between males and females.[1] The gap, also called the gender paradox of suicidal behavior, can vary significantly between different countries.[2] Statistics indicate that males die much more often by means of suicide than do females; however, reported suicide attempts and thoughts are much more common among females than males
Gender paradox[edit]
| Rank | Country | Males | Females | Total | Year |
|---|---|---|---|---|---|
| 1 |  Lithuania | 68.1 | 12.9 | 38.6 | 2005 |
| 2 |  Belarus | 63.3 | 10.3 | 35.1 | 2003 |
| 3 |  Russia | 58.1 | 9.8 | 32.2 | 2005 |
| 4 |  Slovenia | 42.1 | 11.1 | 26.3 | 2006 |
| 5 |  Hungary | 42.3 | 11.2 | 26.0 | 2005 |
| 6 |  Kazakhstan | 45.0 | 8.1 | 25.9 | 2005 |
| 7 |  Latvia | 42.0 | 9.6 | 24.5 | 2005 |
| ... |  USA | 17.7 | 4.5 | 11 | 2005 |
The role that gender plays as a risk factor for suicide has been studied extensively. While females tend to show higher rates of reported nonfatal suicidal behavior, males have a much higher rate of completed suicide.[2] A 2008 study of suicide attempts by gender found that females have a higher rate of attempted suicide than males earlier in life, which decreases with age.[7] For males the rate of attempted suicide remains fairly constant when controlled for age. Males and females also tend to differ in their methods of suicide and responses to suicidal feelings.
Factors[edit]
Many researchers have attempted to find explanations for why gender is such a significant indicator for suicide. One common explanation relies on the social constructions of hegemonic masculinity andfemininity. In a review of the literature on gender and suicide, male suicide rates were explained in terms of traditional gender roles. Male gender roles tend to emphasize greater levels of strength, independence, and risk-taking behavior.[8] Reinforcement of this gender role often prevents males from seeking help for suicidal feelings and depression.[9]
Numerous other factors have been put forward as the cause of the gender paradox. Part of the gap may be explained by heightened levels of stress that result from traditional gender roles. For example, death of a spouse and divorce are risk factors for suicide in both genders, but the effect is somewhat mitigated for females.[10] In the Western world, females are more likely to maintain social and familial connections that they can turn to for support after losing their spouse.[10] Another factor closely tied to gender roles is employment status. Males' vulnerability may be heightened during times of unemployment because of gendered expectations that males should provide for themselves and their families.[9]
It has been noted that the gender gap is less stark in developing nations. One theory put forward for the smaller gap is the increased burden of motherhood due to cultural norms. In regions where the identity of females is constructed around the family, having young children may correlate with lower risks for suicide.[8] At the same time, stigma attached to infertility or having children outside of marriage can contribute to higher rates of suicide among women.[11]
In 2003, a group of sociologists examined the gender and suicide gap by considering how cultural factors impacted suicide rates. The four cultural factors; power-distance, individualism, uncertainty avoidance, and masculinity, were measured for 66 countries using data from the World Health Organization.[12] Cultural beliefs regarding individualism were most closely tied to the gender gap; countries that placed a higher value on individualism showed higher rates of male suicide. Power-difference, defined as the social separation of people based on finances or status, was a negative correlate to suicide, however countries with high levels of power-difference had higher rates of female suicide.[12] The study ultimately found that stabilizing cultural factors had a stronger effect on suicide rates for women than men.[12]
Differing methods by gender[edit]
Main article: Suicide methods
The reported difference in suicide rates for males and females is partially a result of the methods used by each gender. Although females attempt suicide at a higher rate, they are more likely to use methods that are less immediately lethal. Males frequently complete suicide via high mortality actions such as hanging, carbon-monoxide poisoning, and gun violence. This is in contrast to females, who tend to rely on drug overdosing.[13] While overdosing can be deadly, it is less immediate and therefore more likely to be caught before death occurs. In Europe, where the gender discrepancy is the greatest, a study found that the most frequent method of suicide among both genders was hanging, however the use of hanging was much higher in males (54.3%) than in females (35.6%). The same study found that the second most common methods were fire arms for men and poisoning for women.[14]
Methods of suicide are frequently correlated with both with traditional gender roles and availability of different methods. Men are more likely than women to both use and own firearms, which could account for the higher rates of firearm death among males. In nations where firearms have been banned, there is a drop in male suicides via gun but no change in females.[8] Females may tend towards less lethal methods of suicide because of gendered ideas about attractiveness.[8][13]
Preventative strategies[edit]
Public policy in most nations does not reflect the reality of gender-based factors on suicide. In the United States both the Department of Health and Human Services and the American Foundation for Suicide Prevention address different methods of reducing suicide but do not recognize the separate needs of males and females.[8] In 2002, the English Department of Health launched a suicide prevention campaign that was aimed at high-risk groups including young men, prisoners, and those with mental health disorders.[8] Campaign Against Living Miserably is a charity in the UK that attempts to highlight this issue for public discussion. Researchers have also recommended more aggressive and long-term treatment and follow up for males that show indications of suicidal thoughts. Shifting cultural attitudes about gender roles and norms, and especially ideas about masculinity, may also contribute to closing the gender gap. Some studies have found that because young females are at a higher risk of attempting suicide, policies tailored towards this demographic are most effective at reducing overall rates.[15]
It is important to note that there is no specifically male or female suicide pattern that applies in all cases. Prevention policies tailored towards males can also apply to females cases, and vice versa.[13]
Rates[edit]
The incidence of completed suicide is vastly higher among males than females among all age groups in most of the world.
United States[edit]
In the United States, the male to female suicide death ratio varies between 3:1 to 10:1.[16] Typically males die from suicide three to four times more often as females, and not unusually five or more times as often. Females report attempting suicide at a higher rate than males in the United States. When accounting for parasuicide, the rate between males and females shifts to 1:2. This is likely due to several factors, including a higher risk for depression among females in the United States.[17] Use of mental health resources may be a significant contributor to gendered suicide rates in the US. Studies have shown that females are 13-21% more likely than males to receive a psychiatric affective diagnosis.[18]While 72-89% of females who suicided had contact with a mental health professional at some point in their life, only 41-58% of males who suicided had made use of this resource.[18]
Within the US there are variances in gendered rates of suicide by ethnic group.[19] A 2008 study showed that the rate of suicide death is highest among American Indian and Alaskan Native males, and lowest among African American females.[19] Rates of attempted suicide are highest among American Indian and Alaskan Native females and lowest among African American and White males.[19] This reflects the general trend expected by the gender paradox. Explanations for why rates of attempted and completed suicide vary by ethnicity are often based on cultural differences. Among African American victims, it has been suggested that females usually have better access to communal and familial relations that may mitigate other risk factors for suicide. Among Hispanic populations, the same study showed that cultural values of marianismo, which emphasizes female docility and deference to males, may help explain the higher rate of suicide among Latinas relative to Latinos.[19] The authors of this study did not extrapolate their conclusions on ethnicity to populations outside the United States.
Europe[edit]
The gender-suicide gap is generally highest in Western countries. Among the nations of Europe, the gender gap is particularly large in Eastern European countries such asLithuania, Belarus, and Hungary. Some researchers attribute the higher rates in former Soviet countries to be a remnant of recent political instability. An increased focus on family under Soviet control led to females becoming more highly valued. Rapid economic fluctuations prevented males from providing fully for their families, which prevented them from fulfilling their traditional gender role. Combined, these factors could account for the gender gap.[9][14] Other research indicates that higher instances of alcoholism among males in these nations may be to blame.[20]
Non-western nations[edit]
Excess male mortality from suicide is also evident from data from non-Western countries. In 1979-81, out of 74 countries with a non-zero suicide rate, 69 countries had male suicide rates greater than females, two reported equal rates for the sexes (Seychelles and Kenya), three reported female rates exceeding male rates (Papua New Guinea, Macau, and French Guiana).[21] The contrast is even greater today, with WHO statistics showing China as the only country where the suicide rate of female matches or exceeds that of males.[22] Barraclough found that the female rates of those aged 5–14 equaled or exceeded the male rates only in 14 countries, mainly in South America and Asia.[23]
China[edit]
In most countries, most committed suicides are made by men, but in China women are 40% more likely to commit suicide.[24] It has been found that suicide makes up for about 30% of deaths of women living in rural China.[25] Traditional gender roles in China hold women responsible for keeping the family happy and intact. Suicide for women in China is shown in literature to be an acceptable way to avoid disgrace that may be brought to themselves or their families.[24] One explanation for increased suicide in women in China is that pesticides are easily accessible and tend to be used in many suicide attempts made by women. Another explanation is that women are seen as subservient to men due to Chinese gender roles. Thirdly, difficult living conditions and strict views on marriage and family values cause women high stress which is a risk factor for suicidal behavior.[26] The rate of nonlethal suicidal behavior is 40 to 60 percent higher in women as it is in men. This is due to the fact that more women are depressed than men, and also that depression is correlated with suicide attempts.[24]
-----------------------------------------------------------------------------------------------------------------------------------------
BANGLADESH: When sexual harassment leads to suicide
DHAKA, 13 December 2010 (IRIN) - Sexual harassment against girls and women in Bangladesh is turning deadly: 28 women have committed suicide this year and another seven attempted it to escape frequent sexual harassment, says a Dhaka-based human rights organization, Ain O Salish Kendra (ASK).
A father also committed suicide fearing social insult after his daughter was harassed and in other cases, stalkers killed three women, reported the NGO.
According to the Bangladesh National Women Lawyers’ Association, almost 90 percent of girls aged 10-18 years have experienced what is known locally as “eve-teasing”, where boys intercept girls on the street, and shout obscenities, laugh at them or grab their clothes.
Eve-teasing has escalated ever since girls and women started entering formal education and employment in larger numbers in the 1980s, said Paul Subrata Malakar, from the NGO Plan International, in Dhaka.
ImpactsOn 16 November, Sharmin*, a 20-year-old student in Dinanjpur, (400km northwest of Dhaka), was returning home from college when a stalker forcibly held her hand and tried to hug her.
Since then, her parents say, she has stopped going to college.
“As sexual violence is happening on the way to school, it will panic parents and the parents will discourage their daughters from going to school,” said Rekha Saha, director of Dhaka-based NGO, Steps Towards Development.
In a country where 1.5 million girls (out of 10.4 million eligible) are not enrolled in school, an unknown number are avoiding school out of fear and humiliation of daily harassment.
Since January of this year, ASK has received 61 complaints from girls who had dropped out of school because they were harassed.
Moreover, in a country where more than 64 percent of girls marry before they are 18, some parents have pushed eve-teasing victims into early marriage to “protect” their honour and safety, said Malakar and Saha.
Causes
Ishrat Shamim, a gender studies expert and professor of sociology at Dhaka University, is calling for further investigation into the causes of the rise in violence against women.
“[The] mindset of both men and women is important. Many men, also women, believe women are second-class citizens after men. [While] women’s participation in education, the labour force and other activities is increasing, men are not yet to get used to seeing women outside the home.”
Changing this mindset has proven to be a long-standing obstacle.
“In a male-dominant society, eve-teasing can be viewed as a rite of passage for boys on their way to becoming men,” said Malakar of Plan International. “All the steps [we take] will be futile unless the male segment of the society change its patriarchal mindset.”
The fact that girls are hesitant to report violence has made studying and fighting the phenomenon even more difficult.
“Many girls believe that if they complain, their parents and community leaders will blame her,” said Sayeda*, a 14-year-old student in the capital, Dhaka.
mw/cm/pt/mw
A father also committed suicide fearing social insult after his daughter was harassed and in other cases, stalkers killed three women, reported the NGO.
According to the Bangladesh National Women Lawyers’ Association, almost 90 percent of girls aged 10-18 years have experienced what is known locally as “eve-teasing”, where boys intercept girls on the street, and shout obscenities, laugh at them or grab their clothes.
Eve-teasing has escalated ever since girls and women started entering formal education and employment in larger numbers in the 1980s, said Paul Subrata Malakar, from the NGO Plan International, in Dhaka.
ImpactsOn 16 November, Sharmin*, a 20-year-old student in Dinanjpur, (400km northwest of Dhaka), was returning home from college when a stalker forcibly held her hand and tried to hug her.
Since then, her parents say, she has stopped going to college.
“As sexual violence is happening on the way to school, it will panic parents and the parents will discourage their daughters from going to school,” said Rekha Saha, director of Dhaka-based NGO, Steps Towards Development.
In a country where 1.5 million girls (out of 10.4 million eligible) are not enrolled in school, an unknown number are avoiding school out of fear and humiliation of daily harassment.
Since January of this year, ASK has received 61 complaints from girls who had dropped out of school because they were harassed.
Moreover, in a country where more than 64 percent of girls marry before they are 18, some parents have pushed eve-teasing victims into early marriage to “protect” their honour and safety, said Malakar and Saha.
Causes
Ishrat Shamim, a gender studies expert and professor of sociology at Dhaka University, is calling for further investigation into the causes of the rise in violence against women.
“[The] mindset of both men and women is important. Many men, also women, believe women are second-class citizens after men. [While] women’s participation in education, the labour force and other activities is increasing, men are not yet to get used to seeing women outside the home.”
Changing this mindset has proven to be a long-standing obstacle.
“In a male-dominant society, eve-teasing can be viewed as a rite of passage for boys on their way to becoming men,” said Malakar of Plan International. “All the steps [we take] will be futile unless the male segment of the society change its patriarchal mindset.”
The fact that girls are hesitant to report violence has made studying and fighting the phenomenon even more difficult.
“Many girls believe that if they complain, their parents and community leaders will blame her,” said Sayeda*, a 14-year-old student in the capital, Dhaka.
mw/cm/pt/mw
------------------------------------------------------------------------
A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:
A National (U.S.) and International Perspective ----by Jennifer Langhinrichsen-Rohling, Ph.D.
University of South Alabama
Abstract
Evidence was reviewed for national (U.S.) and international sex differences in suicidal behavior.
Suicidal behavior included suicide ideation, suicide attempts, and suicide completions, as well as
suicide-prone behaviors. Across most countries, females have higher rates of suicide ideation and
more frequent suicide attempts than males; females also score higher than males on measures of
suicidality that overlap with depression assessments. However, males generally have higher rates
of suicide completions. Therefore, identification of at-risk males remains an important task. Yet,
common suicide prediction self-report measures identify more females than males. Using a
measure of suicide proneness that assessed engagement in traditionally defined suicidal behavior,
as well as engagement in risky and/or illness producing behaviors, United States males were
found to be more suicide-prone than females. This measure has not yet been used internationally.
These results were used to argue that the ability to detect male and female suicidal individuals is
enhanced by utilizing both traditional and non-traditional suicide proneness measures. Reviewed
research revealed similar suicidal risk factors for males and females. However, the prevalence
and strength of prediction of certain risk factors were found to vary gender-specifically. These
findings support the utility of gender-sensitive suicide assessment, prevention and intervention
strategies.3
A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:
A National (U.S.) and International Perspective
Introduction- Sex Differences in Suicide
The purpose of this paper is to conduct a gendered analysis of sex differences in the
frequency, risk factors, and outcome of a broad range of suicidal behavior occurring within the
United States and around the world. According to official statistics (e.g., World Health Statistics
Annual, 1998), in many countries, there are differences in the rate and expression of men and
women’s suicidal behavior. For example, in the United States, across most age groups, men
complete suicide more often than women, yet women attempt suicide more often than men
(McIntosh, 1993; National Center for Health Statistics, 1994). The trend for males to complete
suicide more than females was also found in all but one of the 56 countries catalogued by Lester
(1997). Furthermore, Lester (1997) concluded, “While male suicide rates seem to be rising
worldwide, females rates do not." Lester (1998) reviewed the international statistics on youth
suicide and came to the same conclusion; male youth were more likely to experience an increase
in their suicide rates than female youth. These findings suggest that sex differences in rates of
suicide completion’s are becoming more pronounced over time (males greater than females).
Taken as a whole, these data have been used to contend that there are inherent sex differences in
the extent and expression of suicidality, which need to be understood with a gender-sensitive
analysis. A gender-sensitive approach considers how the social, cultural, and power roles of men
and women, rather than inherent biological differences, can be used to better understand any
obtained sex differences in suicidal behavior (Gender and Health: Technical Paper, World Health
Organization, 1998).4
Based on suicide completion rate differences, it has typically bA Gendered Analysis of Sex Differences in Suicide-Related Behaviors:
A National (U.S.) and International Perspective
Introduction- Sex Differences in Suicide
The purpose of this paper is to conduct a gendered analysis of sex differences in the
frequency, risk factors, and outcome of a broad range of suicidal behavior occurring within the
United States and around the world. According to official statistics (e.g., World Health Statistics
Annual, 1998), in many countries, there are differences in the rate and expression of men and
women’s suicidal behavior. For example, in the United States, across most age groups, men
complete suicide more often than women, yet women attempt suicide more often than men
(McIntosh, 1993; National Center for Health Statistics, 1994). The trend for males to complete
suicide more than females was also found in all but one of the 56 countries catalogued by Lester
(1997). Furthermore, Lester (1997) concluded, “While male suicide rates seem to be rising
worldwide, females rates do not." Lester (1998) reviewed the international statistics on youth
suicide and came to the same conclusion; male youth were more likely to experience an increase
in their suicide rates than female youth. These findings suggest that sex differences in rates of
suicide completion’s are becoming more pronounced over time (males greater than females).
Taken as a whole, these data have been used to contend that there are inherent sex differences in
the extent and expression of suicidality, which need to be understood with a gender-sensitive
analysis. A gender-sensitive approach considers how the social, cultural, and power roles of men
and women, rather than inherent biological differences, can be used to better understand any
obtained sex differences in suicidal behavior (Gender and Health: Technical Paper, World Health
Organization, 1998).4
Based on suicide completion rate differences, it has typically by been argued that the more
lethal suicidal behavior of men is what mainly needs to be understood for suicide prevention and
intervention purposes. However, some researchers have debated the extent, nature, and
interpretation of the suicide rate differences between males and females. For example, the
method hypothesis asserts that men and women are equally prone to self-destruction, but merely
chose different methods of suicide expression, because of their gender, that results in a different
levels of fatality (Garland and Zigler, 1993). They argue that gender roles dictate that men not
“fail” at suicide, which leads them to choose highly lethal methods of self-destruction.
Conversely, gender roles for women encourage delicacy and attention to appearance, even in
death. As a result, women may be more likely to choose a method that will not result in blood or
disfigurement (e.g., pills rather than guns). These methods tend to be less likely to result in
fatality, even if the intention to die was equally high for the woman. Certainly, since suicide
completion rates rely solely on outcome, they fail to account for intent (Kushner, 1985;
Langhinrichsen-Rohling, Sanders, Crane, & Monson, 1998). Individuals who unexpectedly
survive an intentional and lethal suicidal act are not counted in the completed suicide rates. Since
women appear to be more likely than men to select suicide methods that allow time for discovery
and intervention (e.g., overdose), women might be more likely than men to survive what could be
a completed suicide. Not counting these occurrences would result in an underreporting of
females’ potentially lethal suicidal behavior.
In fact, many researchers have suggested the reported magnitude of the suicide mortality
sex differential is not accurate, because of the difficulties inherent in collecting valid data about
completed suicides (Madge & Harvey, 1999). Less valid official data is thought to occur because
of the classification biases of individual coroners and physicians, and as well as differences in5
state and national laws regarding suicide determination. For example, at times, in some areas
within the United States, it has only been possible to consider a death by suicide if the deceased
left a suicide note. There may be gender differences in the likelihood of this documentation.
State, regional, and national differences in suicide classification rules can result in generalized
underreporting and can also lead to age, sex, and racial group rate biases (Holinger, Offer, Barter,
& Bell, 1994). Even without excessively stringent decision rules such as noted above, it is
possible that a number of suicides are labeled “accidents” because there is not enough evidence
to conclude conclusively that they are suicides. It has been estimated that the actual incidence of
suicide in groups with a high rate of accidental death might be up to three times the official
recorded level (Madge & Harvey, 1999). Since these types of suicides may be more utilized by
women than men, female suicides may be more likely to be underreported. In fact, in a study of
the adequacy of official suicide statistics, Phillips and Ruth (1993) conclude that suicides can be
misclassified into at least five other causes of death. They state that suicides are most likely to be
underreported for groups with low official suicide rates, namely females and African-Americans.
Furthermore, there may be other reasons to underreport suicide that change the validity of
the reported rates. For example, Kushner (1985) has argued that cultural notions of femininity, in
conjunction with societal beliefs that women’s suicidal behaviors are a direct reflection of
relationship failures may provide subtle incentives for family members, physicians, and public
health officials to underreport female suicide completions. In the United States, the construct of
femininity does not typically include completed suicide. Instead, women are thought to “attempt”
suicide and commit suicidal gestures as a “cry for help” (Canetto, 1992-93). Furthermore,
motherhood in many cultures is considered a sacred gender role. Many cultures hold the value
that mothers are not supposed to abandon their children, so there may be additional reasons to6
underreport female suicides in which children are left. However, this stands in contrast to some
data revealing that single mothers in some countries might be at particular risk for suicidality
(Weitoft, Haglund, & Rosen, 2000).
As a contrast, male suicide has been viewed in some cultures as a legitimate answer to
economic difficulties and other potential humiliations. Explanations of men’s suicides have often
focused on issues of performance and achievement (Canetto, 1992-93), rather than love, which is
evoked for women’s suicides. Male suicide has also, at times, been socially sanctioned as a
patriarchic duty (i.e., Kamikaze). Certainly, these gender and culture values can effect how a
death is classified. Generally, because of these gender roles, it has been thought that women’s
suicides are underreported.
Some biases, however, might also differentially lower the official rate of male suicide.
For example, Rockett and Thomas (1999) reported that over half of both the official
unintentional firearm deaths and those of undetermined intent among males aged 18 to 21 years
of age in Israel were ultimately determined to be misclassified suicides. Overall, because
gendered and cultured biases can alter the reported rates of both female and male completed
suicide, it is difficult to know the true gender differential when comparing completed suicide
rates from different states, regions, and countries.
Consequently, Kushner and others have argued that it is more appropriate to combine the
rates of fatal and nonfatal suicidal behavior when comparing the suicidal behavior of men and
women (Kushner, 1985; Langhinrichsen et al., 1998). When this data comparison strategy is
employed, women are found to be at greater risk than men for suicidal behavior. In fact, using
this logic, Canetto and Lester (1995b) conclude that while suicidologists have tended to focus
almost exclusively on suicide mortality, which is typically male and quite infrequent, from an7
epidemiological standpoint, the nonfatal suicidal behavior engaged in by women is more
normative and certainly equally worthy of attention. Considering the potential biases and their
possibly conflicting impact on male and female completed suicide rates, in the current paper, it is
argued that a complete understanding of both the fatal and nonfatal suicidal behavior of men and
women is necessary to inform suicide prevention and intervention efforts.
Evidence was reviewed for national (U.S.) and international sex differences in suicidal behavior.
Suicidal behavior included suicide ideation, suicide attempts, and suicide completions, as well as
suicide-prone behaviors. Across most countries, females have higher rates of suicide ideation and
more frequent suicide attempts than males; females also score higher than males on measures of
suicidality that overlap with depression assessments. However, males generally have higher rates
of suicide completions. Therefore, identification of at-risk males remains an important task. Yet,
common suicide prediction self-report measures identify more females than males. Using a
measure of suicide proneness that assessed engagement in traditionally defined suicidal behavior,
as well as engagement in risky and/or illness producing behaviors, United States males were
found to be more suicide-prone than females. This measure has not yet been used internationally.
These results were used to argue that the ability to detect male and female suicidal individuals is
enhanced by utilizing both traditional and non-traditional suicide proneness measures. Reviewed
research revealed similar suicidal risk factors for males and females. However, the prevalence
and strength of prediction of certain risk factors were found to vary gender-specifically. These
findings support the utility of gender-sensitive suicide assessment, prevention and intervention
strategies.3
A Gendered Analysis of Sex Differences in Suicide-Related Behaviors:
A National (U.S.) and International Perspective
Introduction- Sex Differences in Suicide
The purpose of this paper is to conduct a gendered analysis of sex differences in the
frequency, risk factors, and outcome of a broad range of suicidal behavior occurring within the
United States and around the world. According to official statistics (e.g., World Health Statistics
Annual, 1998), in many countries, there are differences in the rate and expression of men and
women’s suicidal behavior. For example, in the United States, across most age groups, men
complete suicide more often than women, yet women attempt suicide more often than men
(McIntosh, 1993; National Center for Health Statistics, 1994). The trend for males to complete
suicide more than females was also found in all but one of the 56 countries catalogued by Lester
(1997). Furthermore, Lester (1997) concluded, “While male suicide rates seem to be rising
worldwide, females rates do not." Lester (1998) reviewed the international statistics on youth
suicide and came to the same conclusion; male youth were more likely to experience an increase
in their suicide rates than female youth. These findings suggest that sex differences in rates of
suicide completion’s are becoming more pronounced over time (males greater than females).
Taken as a whole, these data have been used to contend that there are inherent sex differences in
the extent and expression of suicidality, which need to be understood with a gender-sensitive
analysis. A gender-sensitive approach considers how the social, cultural, and power roles of men
and women, rather than inherent biological differences, can be used to better understand any
obtained sex differences in suicidal behavior (Gender and Health: Technical Paper, World Health
Organization, 1998).4
Based on suicide completion rate differences, it has typically bA Gendered Analysis of Sex Differences in Suicide-Related Behaviors:
A National (U.S.) and International Perspective
Introduction- Sex Differences in Suicide
The purpose of this paper is to conduct a gendered analysis of sex differences in the
frequency, risk factors, and outcome of a broad range of suicidal behavior occurring within the
United States and around the world. According to official statistics (e.g., World Health Statistics
Annual, 1998), in many countries, there are differences in the rate and expression of men and
women’s suicidal behavior. For example, in the United States, across most age groups, men
complete suicide more often than women, yet women attempt suicide more often than men
(McIntosh, 1993; National Center for Health Statistics, 1994). The trend for males to complete
suicide more than females was also found in all but one of the 56 countries catalogued by Lester
(1997). Furthermore, Lester (1997) concluded, “While male suicide rates seem to be rising
worldwide, females rates do not." Lester (1998) reviewed the international statistics on youth
suicide and came to the same conclusion; male youth were more likely to experience an increase
in their suicide rates than female youth. These findings suggest that sex differences in rates of
suicide completion’s are becoming more pronounced over time (males greater than females).
Taken as a whole, these data have been used to contend that there are inherent sex differences in
the extent and expression of suicidality, which need to be understood with a gender-sensitive
analysis. A gender-sensitive approach considers how the social, cultural, and power roles of men
and women, rather than inherent biological differences, can be used to better understand any
obtained sex differences in suicidal behavior (Gender and Health: Technical Paper, World Health
Organization, 1998).4
Based on suicide completion rate differences, it has typically by been argued that the more
lethal suicidal behavior of men is what mainly needs to be understood for suicide prevention and
intervention purposes. However, some researchers have debated the extent, nature, and
interpretation of the suicide rate differences between males and females. For example, the
method hypothesis asserts that men and women are equally prone to self-destruction, but merely
chose different methods of suicide expression, because of their gender, that results in a different
levels of fatality (Garland and Zigler, 1993). They argue that gender roles dictate that men not
“fail” at suicide, which leads them to choose highly lethal methods of self-destruction.
Conversely, gender roles for women encourage delicacy and attention to appearance, even in
death. As a result, women may be more likely to choose a method that will not result in blood or
disfigurement (e.g., pills rather than guns). These methods tend to be less likely to result in
fatality, even if the intention to die was equally high for the woman. Certainly, since suicide
completion rates rely solely on outcome, they fail to account for intent (Kushner, 1985;
Langhinrichsen-Rohling, Sanders, Crane, & Monson, 1998). Individuals who unexpectedly
survive an intentional and lethal suicidal act are not counted in the completed suicide rates. Since
women appear to be more likely than men to select suicide methods that allow time for discovery
and intervention (e.g., overdose), women might be more likely than men to survive what could be
a completed suicide. Not counting these occurrences would result in an underreporting of
females’ potentially lethal suicidal behavior.
In fact, many researchers have suggested the reported magnitude of the suicide mortality
sex differential is not accurate, because of the difficulties inherent in collecting valid data about
completed suicides (Madge & Harvey, 1999). Less valid official data is thought to occur because
of the classification biases of individual coroners and physicians, and as well as differences in5
state and national laws regarding suicide determination. For example, at times, in some areas
within the United States, it has only been possible to consider a death by suicide if the deceased
left a suicide note. There may be gender differences in the likelihood of this documentation.
State, regional, and national differences in suicide classification rules can result in generalized
underreporting and can also lead to age, sex, and racial group rate biases (Holinger, Offer, Barter,
& Bell, 1994). Even without excessively stringent decision rules such as noted above, it is
possible that a number of suicides are labeled “accidents” because there is not enough evidence
to conclude conclusively that they are suicides. It has been estimated that the actual incidence of
suicide in groups with a high rate of accidental death might be up to three times the official
recorded level (Madge & Harvey, 1999). Since these types of suicides may be more utilized by
women than men, female suicides may be more likely to be underreported. In fact, in a study of
the adequacy of official suicide statistics, Phillips and Ruth (1993) conclude that suicides can be
misclassified into at least five other causes of death. They state that suicides are most likely to be
underreported for groups with low official suicide rates, namely females and African-Americans.
Furthermore, there may be other reasons to underreport suicide that change the validity of
the reported rates. For example, Kushner (1985) has argued that cultural notions of femininity, in
conjunction with societal beliefs that women’s suicidal behaviors are a direct reflection of
relationship failures may provide subtle incentives for family members, physicians, and public
health officials to underreport female suicide completions. In the United States, the construct of
femininity does not typically include completed suicide. Instead, women are thought to “attempt”
suicide and commit suicidal gestures as a “cry for help” (Canetto, 1992-93). Furthermore,
motherhood in many cultures is considered a sacred gender role. Many cultures hold the value
that mothers are not supposed to abandon their children, so there may be additional reasons to6
underreport female suicides in which children are left. However, this stands in contrast to some
data revealing that single mothers in some countries might be at particular risk for suicidality
(Weitoft, Haglund, & Rosen, 2000).
As a contrast, male suicide has been viewed in some cultures as a legitimate answer to
economic difficulties and other potential humiliations. Explanations of men’s suicides have often
focused on issues of performance and achievement (Canetto, 1992-93), rather than love, which is
evoked for women’s suicides. Male suicide has also, at times, been socially sanctioned as a
patriarchic duty (i.e., Kamikaze). Certainly, these gender and culture values can effect how a
death is classified. Generally, because of these gender roles, it has been thought that women’s
suicides are underreported.
Some biases, however, might also differentially lower the official rate of male suicide.
For example, Rockett and Thomas (1999) reported that over half of both the official
unintentional firearm deaths and those of undetermined intent among males aged 18 to 21 years
of age in Israel were ultimately determined to be misclassified suicides. Overall, because
gendered and cultured biases can alter the reported rates of both female and male completed
suicide, it is difficult to know the true gender differential when comparing completed suicide
rates from different states, regions, and countries.
Consequently, Kushner and others have argued that it is more appropriate to combine the
rates of fatal and nonfatal suicidal behavior when comparing the suicidal behavior of men and
women (Kushner, 1985; Langhinrichsen et al., 1998). When this data comparison strategy is
employed, women are found to be at greater risk than men for suicidal behavior. In fact, using
this logic, Canetto and Lester (1995b) conclude that while suicidologists have tended to focus
almost exclusively on suicide mortality, which is typically male and quite infrequent, from an7
epidemiological standpoint, the nonfatal suicidal behavior engaged in by women is more
normative and certainly equally worthy of attention. Considering the potential biases and their
possibly conflicting impact on male and female completed suicide rates, in the current paper, it is
argued that a complete understanding of both the fatal and nonfatal suicidal behavior of men and
women is necessary to inform suicide prevention and intervention efforts.
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