Qingsong Chang1, Paul S F Yip2, Ying-Yeh Chen3. 1. Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong. 2. Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong; Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Hong Kong. 3. Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan. Electronic address: ychen@tpech.gov.tw.
Abstract
BACKGROUND: To assess whether gender inequality determines the patterns of suicide gender ratios. METHODS: Using suicide data obtained from the World Health Organization Statistical Information System, 2012, suicide gender ratios were calculated and a world map of the ratios constructed. Forest plots were utilized to assess whether gender inequality (indicated by the Gender Inequality Index ["GII"] and male to female sex ratios at birth) moderated the worldwide patterns of suicide gender ratios. Regression analyses were then performed to estimate the extent to which gender inequality affects suicide gender ratios before and after controlling for human development level ("HDI"). RESULTS: Gradient relationships of suicide gender ratios across 3 tertiles of GII were observed (ratios = 2.03, 2.54, 3.51, respectively for high, moderate and low GII, P = 0.03). High sex ratio at birth was significantly associated with lower suicide gender ratio (ratio = 1.64 vs. 2.75, P = 0.00). Regression analyses showed that highest tertile of GII and high sex ratios at birth were significantly associated with lower suicide gender ratios (P = 0.00 and P = 0.00, respectively). When the level of human development level was controlled, high sex ratio at birth remained to be a significant determinant of suicide gender ratios (P = 0.00), whereas the significance of GII disappeared (P = 0.19). LIMITATIONS: The cross-sectional data do not allow for causal inferences. CONCLUSIONS: Male to female suicide ratios were higher in countries with more egalitarian gender norms. Strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.
BACKGROUND: To assess whether gender inequality determines the patterns of suicide gender ratios. METHODS: Using suicide data obtained from the World Health Organization Statistical Information System, 2012, suicide gender ratios were calculated and a world map of the ratios constructed. Forest plots were utilized to assess whether gender inequality (indicated by the Gender Inequality Index ["GII"] and male to female sex ratios at birth) moderated the worldwide patterns of suicide gender ratios. Regression analyses were then performed to estimate the extent to which gender inequality affects suicide gender ratios before and after controlling for human development level ("HDI"). RESULTS: Gradient relationships of suicide gender ratios across 3 tertiles of GII were observed (ratios = 2.03, 2.54, 3.51, respectively for high, moderate and low GII, P = 0.03). High sex ratio at birth was significantly associated with lower suicide gender ratio (ratio = 1.64 vs. 2.75, P = 0.00). Regression analyses showed that highest tertile of GII and high sex ratios at birth were significantly associated with lower suicide gender ratios (P = 0.00 and P = 0.00, respectively). When the level of human development level was controlled, high sex ratio at birth remained to be a significant determinant of suicide gender ratios (P = 0.00), whereas the significance of GII disappeared (P = 0.19). LIMITATIONS: The cross-sectional data do not allow for causal inferences. CONCLUSIONS: Male to female suicide ratios were higher in countries with more egalitarian gender norms. Strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.
Authors: Jane Pirkis; David Gunnell; Sangsoo Shin; Marcos Del Pozo-Banos; Vikas Arya; Pablo Analuisa Aguilar; Louis Appleby; S M Yasir Arafat; Ella Arensman; Jose Luis Ayuso-Mateos; Yatan Pal Singh Balhara; Jason Bantjes; Anna Baran; Chittaranjan Behera; Jose Bertolote; Guilherme Borges; Michael Bray; Petrana Brečić; Eric Caine; Raffaella Calati; Vladimir Carli; Giulio Castelpietra; Lai Fong Chan; Shu-Sen Chang; David Colchester; Maria Coss-Guzmán; David Crompton; Marko Ćurković; Rakhi Dandona; Eva De Jaegere; Diego De Leo; Eberhard A Deisenhammer; Jeremy Dwyer; Annette Erlangsen; Jeremy S Faust; Michele Fornaro; Sarah Fortune; Andrew Garrett; Guendalina Gentile; Rebekka Gerstner; Renske Gilissen; Madelyn Gould; Sudhir Kumar Gupta; Keith Hawton; Franziska Holz; Iurii Kamenshchikov; Navneet Kapur; Alexandr Kasal; Murad Khan; Olivia J Kirtley; Duleeka Knipe; Kairi Kõlves; Sarah C Kölzer; Hryhorii Krivda; Stuart Leske; Fabio Madeddu; Andrew Marshall; Anjum Memon; Ellenor Mittendorfer-Rutz; Paul Nestadt; Nikolay Neznanov; Thomas Niederkrotenthaler; Emma Nielsen; Merete Nordentoft; Herwig Oberlerchner; Rory C O'Connor; Rainer Papsdorf; Timo Partonen; Michael R Phillips; Steve Platt; Gwendolyn Portzky; Georg Psota; Ping Qin; Daniel Radeloff; Andreas Reif; Christine Reif-Leonhard; Mohsen Rezaeian; Nayda Román-Vázquez; Saska Roskar; Vsevolod Rozanov; Grant Sara; Karen Scavacini; Barbara Schneider; Natalia Semenova; Mark Sinyor; Stefano Tambuzzi; Ellen Townsend; Michiko Ueda; Danuta Wasserman; Roger T Webb; Petr Winkler; Paul S F Yip; Gil Zalsman; Riccardo Zoja; Ann John; Matthew J Spittal Journal: EClinicalMedicine Date: 2022-08-02