Suicide and attempted suicide: study of perceived sex differences

The Origins and Evolution of the Field of Masculinity and Suicide: A Bibliometric and Content Analysis of the Research Field

BACKGROUND

In most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time.

METHODS

We retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs.

RESULTS

We included 452 publications (1954-2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality.

CONCLUSION

The research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men.HIGHLIGHTSMasculinity and suicide as a field is not new, with its origins in the literature dating back to 1954.More than half of the total research output in the field (1954-2021) has been published in the last five years.Early work focused on individual-level risk factors to male suicide (e.g., severe mental illness), while contemporary research focused on social and cultural determinants of male suicide (e.g., help-seeking).

Language, culture, gender, and intersectionalities in suicide theory, research, and prevention: Challenges and changes

Over the decades suicidology has experienced many challenges and changes. Language, culture, gender, and intersectionalities of experience have been domains of challenge and change. In this article I document my contributions to suicidology's transformation in these domains. These contributions include challenging stigmatizing and biased suicide-language (e.g., expressions like "successful" and "failed" suicide); questioning gender myths of suicidal behaviors (e.g., the myth that women and men are opposites in terms of suicide motives); the gender-paradox-of-suicide idea; and suicide-scripts theory and research. I then describe the evolution of suicide-scripts theory. Suicide-scripts theory builds on evidence that in each culture there are unique situations when suicidal behavior is expected from specific people, using specific methods, and with specific social consequences. The theory posits that these scripts contribute to variations in suicidality across cultures, and within cultures, across sociodemographic groups, intersectionally. Studies using a diversity of methodologies and focusing on a diversity of sociodemographic groups and cultures point to the role of suicide scripts in suicidality. The article concludes with a discussion of the implications, for suicide prevention, of suicide-scripts theory and evidence.

The Role of Masculinity and Depressive Symptoms in Predicting Suicidal Ideation in Homeless Men

Men's suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation. Homeless men (n = 94) completed questionnaires at a resource center in the Rocky Mountain Western United States. Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men's suicidal ideation. An externalizing-internalizing model of predicting suicide in men and men's adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.

Sex Differences in Attitudes Toward Suicide: Do Males Stigmatize Males?

This study compares female and male reactions to troubled female and male target figures. The results replicate the findings of four earlier studies that showed that females are move sympathetic than males toward suicidal target figures. Unlike previous studies, however, by using a non-suicidal comparison condition, this study also shows that female sympathy ratings were not influenced by whether or not target figures were suicidal. Male ratings did show such an influence: males were most sympathetic to non-suicidal male targets and least sympathetic to suicidal male targets. Results are discussed in the light of sex-role stereotyping of males.

For Whom is Suicide Accepted: The Utility Effect

It has been established by previous studies that suicide is more acceptable for some people than it is for others, and the main objective of the present study was to investigate the relationship between attitudes toward suicidal behavior and the suicidal person's socioeconomic status. Swedish university students read one of eight manipulated case stories in which a person engages in suicidal behavior and then completed the Suicide Attitudes and Attribution Scale (SAAS), which was constructed for this occasion. The data measured six factors, which also served as dependent variables in ANOVAs. Some of the results indicate that the suicidal behavior of an individual of high socioeconomic status is viewed more negatively than the same behavior displayed by an unemployed individual in a social welfare program.

The Early Demise of the “Stronger” Sex: Gender-Related Causes of Sex Differences in Longevity

It is well documented that males die at younger ages than females. Although the sex differential in longevity has some basis in biology, many gender-related socialization practices in place in American culture build on existing genetic predispositions to cause males to be more vulnerable than females to early death, especially violent death and death from heart disease. Demographic data are presented to document premature death rates for men relative to women, especially violent death from accidents, suicide, and homicide. A hierarchy of causes of death that is increasingly subject to human influence is presented along with a multidimensional model for understanding early death among males. Conclusions are offered for some reconsiderations of masculinity that would be helpful in reducing the sex differential in longevity.

Attitudes Toward Suicide: Past, Present and Future

This article maintains that it is important to understand how any given society views the act of suicide. It traces the forces that have shaped attitudes toward suicide in the Western world, documenting the change from viewing suicide as a sin to viewing it as a mental health problem. It also discusses recent methods of assessing attitudes toward suicide, including both normed and non-normed approaches. Finally, it calls for new types of research in the area of attitudes toward suicide that will permit finer-grained analyses of this most complex human behavior.

Two decades of adolescent suicides assessed at Milan University's medicolegal unit: Epidemiology, forensic pathology and psychopathology

AIM

to analyze the cases of suicide committed by adolescents in and around the city of Milan over a 20-year period (1993-2012).

MATERIALS AND METHODS

cases of suicide involving individuals between 10 and 19 years of age were drawn from 20,757 autopsies performed by the Medico-legal Unit at Milan University. Seventy-eight cases were considered (20 females and 58 males, with the ratio of 1:2.9), and their clinical and circumstantial histories, epidemiology, forensic pathology and psychopathological issues were analyzed.

RESULT

Adolescents were involved in 2.23% of all suicides committed in Milan during the period examined. The "mean" victim is a male without psychiatric disease, aged between 16 and 19, that commits suicide outdoors.

CONCLUSIONS

In the majority of cases, there were no premonitory signs, nor any particular contingent or remote reason that might explain these violent deaths, which therefore remain "impulsive".

I Would Rather Just Go Through With It Than Be Called a Wussy: An Exploration of How a Group of Young South African Men Think and Talk About Suicide

Worldwide suicide is a deeply gendered phenomenon. In South Africa, approximately 80% of suicide completers are male. This study aimed to investigate how a group of young South African men understand and think about suicidal behavior. In-depth semistructured interviews and thematic analysis using a grounded theory approach revealed that this group of young South African men had permissive attitudes to suicide and viewed suicide as a morally defensible alternative in specific situations. They spoke of suicide as a goal-directed behavior that provides a means of regaining control, asserting power, communicating, and rendering oneself visible. From this perspective, suicide was understood as a brave act requiring strength and determination. These data have congruence with the Theory of Gender and Health, which proposes that constructions of masculinity may be implicated in the attitudes and beliefs young men in South Africa hold toward suicide.

Lack of racial and sex stereotypes in the prediction of completed suicide

A sample of 252 college students was presented with vignettes and asked to predict the likelihood that the protagonist in each vignette would complete suicide. The crisis confronting the protagonist significantly affected judgments of the likelihood of completed suicide, but neither the race nor the sex of the protagonist affected this judgment, suggesting that sex and racial stereotypes about who completes suicide may no longer exist.

Suicide among Italian adolescents: 1970-2002

The purpose of the present study was to analyze sex and regional differences in the suicide rate of adolescents and the methods they used for suicide in Italy during the period 1970-2002. Temporal trends and regional variations in suicide for Italian adolescents were retrieved from the Italian database on mortality for the period 1970-2002, collected by the Italian Census Bureau and processed by the Italian National Institute of Health-Statistics Unit. In the period 1970-2002, 3,069 adolescent suicides were monitored in Italy. Analyses of these suicides identified significant differences by region of residence and sex. Males were 2.1 times more likely than females to kill themselves. Male and female suicides had inverse trends in the years analyzed, so that the sex difference at the present time is the result of a continuous increase in male suicides and a decrease in female suicides since 1970. The dramatic peaks observed over the time period studied cannot be attributed to a single cause, indicating that further studies are needed to better understand the phenomenon.

Suicide among indigenous peoples: the usefulness of the Human Relations Area Files

The present note describes the resource for studying suicide in indigenous peoples provided by the Human Relations Area Files and describes three ways in which these files can illuminate suicidal behavior: testing theories of suicide, exploring the linguistics of suicide, and challenging myths about suicide.

Inter-regional variations in men's attitudes, suicide rates and sociodemographics in Quebec (Canada)

BACKGROUND

Suicide rates can vary quite considerably and attitudes regarding suicide may explain part of the variation.

METHOD

The present study investigated, across the 17 regions of Quebec (Canada), men's attitudes towards suicide, expressing pain and help seeking, as they are related to suicide rates and sociodemographic variables (unemployment, divorce/separation, income and education).

RESULTS

Most correlations were non-significant. However, in regions with an above-average educational level and with higher divorce/separation rates, men had better attitudes towards expressing pain. Furthermore, in regions where men were more inclined to express pain, suicide rates were lower. Also, significant positive correlations were found between suicide rates and low educational level, but also between an increase in suicide rates and an increase in income level.

CONCLUSIONS

Where the aetiology of suicide is concerned, researchers must examine both sociodemographic factors and the psychological factors associated with them.

Beliefs about gender differences in methods and causes of suicide

Forty undergraduate students (20 males, 20 females) made judgments about the relationship between an individual's gender and the method of suicide most likely to be chosen by that individual. The perceived relationship between different precipitating events for suicide and the method of suicide were also examined, as were the participants' judgments about the moral justification of suicide in response to different traumatic situations. The results indicated clear and consistent beliefs about the relationship between the gender of the potential suicide victim, the method of suicide likely to be chosen, and whether or not the cause of the suicide was judged harshly or sympathetically. Understanding how the gender of an at-risk individual interacts with an observer's beliefs and moral perspective should help us predict when suicide threats will be taken seriously and what form of intervention will take place.

Understanding suicide in Australian farmers

OBJECTIVE

Male farmers in Australia have an elevated risk of suicide. The aims of this study were to investigate the rate of mental health problems amongst farmers compared with non-farmer rural residents and to investigate what additional factors might contribute to an increased risk of suicide amongst farmers.

METHOD

This study used a combination of quantitative and qualitative approaches. First, using self-report questionnaire data, we compared rates of mental health problems (a common correlate of suicide) and a number of personality measures between farmers (n=371) and non-farming rural residents (n=380). In addition, semi-structured interviews with farmers (n=32) were used to gain a richer understanding of how the context of farming and mental health interact.

RESULTS

Five key findings emerged from the study. First, in the quantitative study, we found no support for the proposition that farmers experience higher rates of mental health problems than do non-farmer rural residents, but we identified potentially important personality differences between farmers and non-farmers, with levels of conscientiousness being significantly higher amongst farmers and levels of neuroticism being significantly lower. A strong association between maleness and farming was also found. In the qualitative study, participants indicated that farming is an environment in which individuals experienced a range of stressors but have limited capacity to acknowledge or express these. In addition, there appeared to be significant attitudinal barriers to seeking help for those who may have mental health problems, particularly male farmers.

CONCLUSION

The elevated rate of suicide amongst farmers does not seem to be simply explained by an elevated rate of mental health problems. Individual personality, gender and community attitudes that limit a person's ability to acknowledge or express mental health problems and seek help for these may be significant risk factors for suicide in farmers.

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents

Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.

Explaining the gender difference in self-reported suicide attempts: a nationally representative study of Norwegian adolescents

Predictors of self-reported suicide attempts were studied cross-sectionally and prospectively in order to discern which variables may account for the gender difference in such reports. A representative sample of Norwegian students (N= 9,679) in grades 7-12 were followed from 1992 to 1994. More girls (10.4%) than boys (6.0%) reported a previous attempt and more girls (3.3%) than boys (1.9%) reported an attempt during the study period. The gender difference in previous suicide attempts was significantly reduced when depressed mood was controlled, and was no longer significant when disordered eating was included. There was no gender difference in future attempts when previous attempts, depressed mood, physical appearance, pubertal timing, and romantic involvement were controlled. Girls' higher level of risk factors may account for their higher level of self-reported nonfatal suicidal behavior.

Gender issues in youth suicidal behaviour

There are gender differences in youth suicidal behaviour that are evident in childhood and persist throughout adolescence and young adulthood. In Western countries, young females are twice as likely as males to report suicidal ideation and suicide attempt behaviour. However, despite the fact that females make more suicide attempts, males are three- to fourfold more likely to die by suicide than females. This paper reviews the epidemiological evidence for gender differences in suicidal ideation, attempted suicide and completed suicide among young people and explores possible reasons for the observed differences. These reasons include differences in methods, intent, ascertainment, the cultural acceptability of suicide, psychopathology (including substance abuse, mood disorder, externalizing behaviours and propensity to violence), and psychosocial differences between males and females. While it is often suggested that gender differences in youth suicidal behaviour may be explained solely or predominantly by method choice, careful examination suggests that the issues are much more complex. In fact, females may enjoy more protection from suicide than males in a number of areas.

The role of gender and suicide precipitant in attitudes toward nonfatal suicide behavior

This study examined factors affecting young adults' attitudes about nonfatal suicidal behavior. It evaluated how respondent sex, respondent gender identity, the precipitant of the suicidal act (i.e., a relationship loss, an achievement failure, or a physical illness), and gender of the suicidal person influence reactions to a suicidal decision. In this study of nonfatal suicidal behavior, like in studies of suicide, attitudes were least negative when the suicidal act was in response to a physical illness. Men were more likely to agree with and accept the suicidal decision than women. Androgynous persons, on the other hand, tended to view the decision to kill oneself as foolish, independent of precipitant. They also reported less agreement, acceptance, and sympathy for such decision. The implications of these findings for the prevention of suicidal behaviors are considered. Because gender seems to play a role in the acceptability of suicidal behavior, prevention programs ought to explicitly examine gender issues in attitudes toward suicidal behavior.

Coping, meaning in life, and suicidal manifestations: examining gender differences

Life meaning and coping strategies were investigated as statistical predictors of suicidal manifestations in a sample of 298 university undergraduates. Participants completed measures of hopelessness, sense of coherence, purpose in life, coping for stressful situations, suicide ideation, prior suicide attempts, and self-reported likelihood of future suicidal behavior. Moderated multiple regression techniques examined the incremental validity of life meaning by coping interactions for predicting each suicide variable separately by gender. The interaction of sense of coherence and emotion-oriented coping made a unique, significant contribution to the statistical prediction of all suicide variables for women. For men, the interaction between sense of coherence and emotion-oriented coping contributed significantly to the statistical prediction of suicide ideation. All interactions remained significant when hopelessness was statistically controlled. The hypothesis that life meaning acts as a buffer between coping style and suicidal manifestations was partially supported. Implications for suicide prevention and intervention are discussed.

Youth suicidal behavior: assessment and intervention

In this article, the authors review the research on risk assessment of suicidal adolescents and describe the small body of randomized-clinical-treatment trials for this population. Research has yielded a fairly consistent set of direct and indirect risk factors for suicidal behavior in adolescents. The authors describe a variety of measures commonly used to assess these risk factors. Treatment studies targeting suicide are sparse for all ages. In the adult literature, evidence suggests clozapine, depot flupenthixol, lithium, and dialectical behavior therapy (DBT) are significantly more effective in decreasing suicidal behavior than placebo or Treatment as Usual. For adolescents, it is difficult to draw conclusions about treatment efficacy. In general, control conditions are just as effective at reducing suicidal behavior as experimental conditions. While some novel interventions for suicidal adolescents are described, there is a desperate need for more research to be conducted in order to advance this burgeoning field.

Why women are less likely than men to commit suicide

Major depression forms the background of upwards of half of all suicides. Women are twice as likely as men to experience major depression, yet women are one fourth as likely as men to take their own lives. Current and past explanations of this paradox are built on androcentric assumptions that women are deficient in some way. The reverse may be true where suicide is concerned. Men value independence and decisiveness, and they regard acknowledging a need for help as weakness and avoid it. Women value interdependence, and they consult friends and readily accept help. Women consider decisions in a relationship context, taking many things into consideration, and they feel freer to change their minds. It is argued here that women derive strength and protection from suicide by virtue of specific differences from men. Factors that protect women from suicide are opposite to vulnerability factors in men.

Social Reactions to Attempted Suicide: The Effects of Gender and Physical Attractiveness

The effects of gender of subject, gender of suicide attempter, and physical attractiveness of attempter on justification, emotional adjustment, and liking were investigated in this study. One hundred forty-eight male and female undergraduates (average age = 21.93 years) read a brief case history describing an individual who attempted suicide one week ago. Two-thirds of the subjects also received a photograPh. Subjects were randomly assigned to one of six groups: attractive female attempter, unattractive female attempter, no photograph female attempter, attractive male attempter, unattractive male attempter, and no photograph male attempter. Ratings of justification, emotional adjustment, and liking were measured using 7-point Likert-type questions. The MANOVA revealed significant main effects of gender of subject and physical attractiveness. Univariate analyses of these effects showed that females rated attempters significantly more justified than males and that attractive attempters were liked significantly more than unattractive and no photograph attempters.

Adolescents' attitudes toward suicide, and a suicidal peer: a comparison between Swedish and Turkish high school students

The present paper first presents the attitudes toward suicide and a suicidal classmate among 98 female and 69 male (N = 167) Swedish high school students. Secondly, the Swedish sample was compared with 167 (89 female and 78 male) Turkish high school students from a previous study. Among Swedish students, more males than females said that people have the right to commit suicide and suicide can be a solution to some problems. More females than males expressed a belief in life after death. Swedish adolescents were found to be holding more liberal attitudes toward suicide than Turkish adolescents. However, Turkish adolescents showed greater acceptance for a suicidal peer than Swedish adolescents. The results are discussed in terms of socio-cultural factors and related literature. The need for educational programs to provide basic knowledge about suicide and, effective ways of dealing with and helping suicidal peers is implicated.

Gender Differences in Attributions about Suicide and Alcohol Use

This research examined attributions that female and male college students made about an individual who committed suicide. The gender of the victim and whether alcohol use was involved were systematically varied. Results indicated that female and male respondents see the issues involved in suicide differently. Female respondents appear to place more emphasis on contextual clues such as alcohol use and gender of the actor. In addition, both female and male respondents tended to associate alcohol use and suicide for male actors but not for female actors. These results are discussed in terms of stereotypes that may be held for females and males vis-a-vis emotional expression and alcohol use. The use of population base rates in attributions about suicide and alcohol use is also considered. Directions for future research are also presented.

She Died for Love and He for Glory: Gender Myths of Suicidal Behavior

Epidemiological studies have long reported that, in North America, patterns of suicidal behavior differ by gender: women “attempt” suicide; men “complete” suicide. Theories of suicidal behavior also differ according to gender. Traditionally, women are said to be suicidal for love; men, for pride and performance. Are these gender differences “real?” Are women's attempts “failed” suicides? Do suicidal men “succeed” when they kill themselves? Is women's self-definition dependent on love? Is men's dependent on performance? Evidence currently available does not support traditional theories of gender and suicidal behavior. As culturally shared assumptions, however, traditional theories may influence the suicidal choices of women and men, as well as the assumptions and research methods of suicidologists.

Opinions about and reactions to suicide, and the social acceptance of a suicidal classmate among Turkish high school students

The present study investigated the opinions about suicide and reactions to a suicidal peer among 89 female and 78 male Turkish high school students. Females more than males believed that suicide should be discussed among friends. More males than females perceived suicidal persons to be mentally ill and to be punished in the other world. Females showed greater acceptance for a suicidal classmate than males. An attitude for openly discussing suicide was associated with higher acceptance of a suicidal classmate. Perceiving suicidal individuals to be mentally ill was associated with lower acceptance of a suicidal peer.

Gender roles, suicide attempts, and substance abuse

In this article, the focus is on a comparison of suicide attempts and substance abuse in the United States. It is argued that suicide attempts and substance abuse may function as psychologically equivalent but gender-specialized forms of self-injurious behaviors. Possible explanations for the gender segregation of suicide attempts and substance abuse are reviewed, and the benefits of crossover theories and treatments are presented.

Sex differences in peer responsiveness to suicide ideation

Two surveys assessing attitudes toward and beliefs about suicide were conducted with undergraduates. There were 473 participants in Survey I and 692 participants in Survey II. Sex differences were found in participants' receptivity to suicidal individuals, beliefs about the behavior of suicidal peers, attitudes concerning the worth of suicidal people, incidence of adolescent suicide, and morality of suicide. There was no sex difference in participants' own frequency or seriousness of suicide ideation or suicide attempts. Results are discussed in terms of hypotheses concerning traditional socialization of males and females, resulting in sex-role differentiation that may influence attitudes toward and beliefs about suicide.