Suicidal Differences: Review on Gender Differences in Suicide Intent

Introduction

In 2017, there were 47,173 reported deaths by suicide in America making suicide the 10th leading cause of death in the United States according to data from the American Foundation for Suicide Prevention (AFSP) (2017). The AFSP also reported that there were 1,400,000 suicidal attempts in 2017 as well. Based on statistics, men died by suicide 3.54 times more than women with 50.57% of the deaths being by firearm (The American Foundation for Suicide Prevention, 2017). Although men are more likely to die by suicide, women are 3 times more likely to attempt suicide. Research has found that 62% of women who complete suicide had previous attempts while 62% of men who complete suicide never having previous attempts (Schimelpfening, 2019). To gain an understanding of the differences that may explain why men complete more and women attempt more, a cross-national study conducted by Freeman et al. (2017) will be reviewed.

Purpose of the Research

The aims of this study were to explore differences in suicide intent and attempt between genders across age and country. Researchers aimed to clarify and increase knowledge of the role gender differences play in suicide intent. Researchers hypothesized that male attempts would be rated as having more lethal attempts more frequently than female attempts (Freeman et al., 2017).   

Theories

Social Integration Theory was first introduced by Emilie Durkheim in 1897. The idea of social integration is that a society needs its members to have social integration and moral regulation to be balanced or have equilibrium. When an individual within society does not have a balance they may develop disequilibrium, which can lead to suicide. According to this theory, increasing suicidal rates are a product of societal forces. The current study did not assess for factors triggering suicide intent/attempt which, so it is unknown whether or not intent to die or self-harm were due to disequilibrium caused by a lack of integration and regulation disrupted by external forces within society.

Research Methods

Sample

Researchers used collected data from the Optimising Suicide Prevention Programmes and their Implementation in (Europe OSPI-Europe) Project from Germany, Ireland, Hungary, and Portugal. All four countries provided a total of 8,189 suicide attempt records. Patient records used for the study were from males and females in age ranges less than 30, 30-45, and over 45 (Freeman et al., 2017). 

Data Collection 

To collect data, the 4 countries provided analyzed information from patient records. Each country adhered to a standard definition of suicide attempt and followed a standardized questionnaire and codebook to assure all records were analyzed the same. Clinical staff at the facilities chosen in these countries were trained in administering measurements and rating attempts and intent. Each country provided data between 2008 and 2012 with data coming from personal interviews of patients or retrospective patient record assessments (Freeman et al., 2017). 

Ethical Issues 

As the study did not use human subjects, informed consent was not required for all countries. Germany, which provided interviews with patients who attempted suicide, did obtain informed verbal consent at the beginning of each interview by trained staff. Researchers did obtain consent to use patient data through local ethics committees in each country as well as each country gaining approval from ethical reviews (Freeman et al., 2017). 

Measures/Variables 

The dependent variable assessed was suicide intent, which was classified by staff using Feuerlein Scale. The intent had 4 categories: Deliberate Self-Harm (DSH), Parasuicidal Pause (SP), which is suicidal behaviors used to escape something; Parasuicidal Gesture (SG), which is a manipulative act; and Serious Suicide Attempt (SSA), which is clear intent to die. The independent variables were gender, age, country, and methods of attempts. To measure gender differences a Chi-Square was done using two by four tables repeated using country and age (Freeman et al., 2017). 

Results

Data analysis supported both hypotheses. The final study sample consisted of 5,212 subjects, which is 63.65% of the original sample. Researchers found significant associations starting with suicide intent and gender. Females were rated as having significantly more SP and SG than males while males engage in SSA more significantly. There were no significant gender differences in age, but for all age groups, males were rates significantly more frequently as having SSA than females while females had more SG. When analyzing significant differences amongst the countries Hungary rated males more frequently as DSH and females as more SP. Ireland and Portugal both significantly rated females as having more SG and less SSA than males (Freeman et al., 2017). 

Summary

The study did use a cross-national sample of European Countries only, which is a limitation as different societal factors impact intent. A follow-up for this study would be to use data from various countries across the world and assess for triggers for intent. Another limitation is that not all countries were providing data for the exact same time period and some regions collected data by proxy while others used self-reports. Despite some limitations, the results have clinical and practical implications that can be used for policy making and intervention/prevention strategies. Further insight into societal factors is needed and further research on social integration techniques used as preventative measures is needed.

References

Freeman, A., Mergl, R., Kohls, E., Székely, A., Gusmao, R., Arensman, E., . . . Rummel-Kluge, C. (2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17, 234. doi:10.1186/s12888-017-1398-8

Schimelpfening, N. (2019, March 8). Differences in suicide among men and women. Very Well Mind. Retrieved from https://www.verywellmind.com/gender-differences-in-suicide-methods-1067508

The American Foundation for Suicide Prevention. (2017). Suicide statistics. Centers for Disease Control and Prevention (CDC). Retrieved from https://afsp.org/about-suicide/suicide-statistics/