The roles of culture and gender in the relationship between divorce and suicide risk: a meta-analysis.

With some exceptions, literature has consistently shown that divorced populations are at higher risk for suicide than married ones. Here we make use of coefficients of aggravation (COAs), suicide rate ratios of the divorcees over the married, to study patterns of COAs and test the contribution of international sociocultural factors and gender to the relationship between divorce and suicide. We conducted a systematic search of electronic databases to identify ecological studies reporting suicide rates and ratios of those rates within different marital statuses between Jan 1, 2000 and Dec 31, 2013. In total, ten studies consisting in suicide statistics of eleven countries/areas were selected. Using random-effect modeling, we noted that the pooled COA for men and women were 3.49 (95% CI 2.43-4.56) and 3.15 (95% CI 1.74-4.56), suggesting both divorced men and women exhibited a greater risk of suicide than their married counterparts. Subgroup analyses revealed that COAs in Asian countries are significantly higher than those in non-Asian ones. Among the sociocultural measures retrieved from the HOFSTEDE index and the World Values Surveys, we noted significant associations between COA and four measures, including the individualism-collectivism score, the long-term orientation scores, the survival/self-expression score, and the gender inequality indices. The magnitudes and the directions of the associations however differ by sex. The results confirm that overall divorced people have an aggregate higher suicide risk than married ones. The method used in our research could reveal what cultural indicators are exerting effect on the relationship between divorce and suicide risk, which might change with sociocultural transition. More investigation into the relationships and then the construction of culturally appropriate suicide prevention policy is recommended.