Sex and Gender-based Analysis of this topic
Definition
The suicide rate refers to the number of suicide deaths per 100,000 population, (age adjusted) [1]. Suicidal behaviours extend beyond suicide deaths to include suicide ideation (thoughts of suicide) as well as suicide attempts (suicidal behaviour not resulting in death). The Canadian suicide rate in 2005 was 12 per 100,000 for the total population (males and females); 5 deaths per 100 000 for females and 18 per 100 000 for males. Despite having lower suicide rates than men, women are twice as likely to attempt suicide [2] and be hospitalized for attempted suicide [3].
Sex Issues
Women’s biological and psychosocial characteristics can put them at risk of suicidal behaviour including; a higher rate of depression among women; higher occurrence of eating disorders; post-partum psychosis, mental health problems resulting from induced abortions; low levels of estrogen and serotonin during the menstrual cycle; exposure to domestic violence and childhood sexual abuse; and higher reported rates of anxiety and suicide ideation [4]. Biological factors such as pregnancy may protect women against suicide; suicide rates in pregnant women are approximately half those of non-pregnant women [4]. Generally, motherhood (with the exception of mothers with post-partum psychosis) and having young, dependent children have a protective affect against suicidal behaviours. By contrast, fatherhood does not seem to confer the same protective effect on males.
Gender Issues
Despite women’s risk factors for suicidal behaviours, the suicide rate is lower for women compared to men [1], meaning that women often suffer the consequences of a partner’s suicide which may leave women more vulnerable to their own suicide attempts.
Suicide rates also vary by age, with the highest rate of 10 per 100,000 for women aged 50-54. Men aged 45-49 have the highest suicide rate for males with 29 deaths per 100 000 [1]. The higher suicide rate in men compared to women may be attributed to a number of gender-related factors. Women are more likely than men to seek social support and/or professional help for emotional problems and to be more responsive to psychological and behavioural therapies for depression than men. Also, women are more likely to use less lethal methods of suicide than men and are alive post-attempt to seek help. Women may also be more likely to access social and health services because of better verbal and/or social skills.
Recent data suggest that Canadian women are beginning to use more lethal methods (hanging, suffocation, firearms, jumping), which account for a greater percentage of deaths. Between 2000 and 2004, 49% of female suicides involved lethal methods compared to 42% of female suicides resulting from self-poisoning [4].
Gender-specific approaches to suicide prevention are needed to address gender differences in suicide ideation and attempts. Since women are more likely to access services for a regular physician [5], regular physicians may be an important access point for women for women with suicidal ideation. Since women may end up in the emergency department following a suicide attempt, emergency department nurses may also play a pivotal role in frontline work with suicidal women. Women may also be more responsive to talk therapies, such as psychotherapy, which has been identified as a useful tool for individuals who have attempted suicide [6].
Diversity
Suicide in the Aboriginal population is more than 10 times the rate of the general Canadian population: the rate among First Nations in 2000 was 24 per 100,000 and the rate in all Inuit regions was 135 per 100 000 [3]. Specifically, First Nations women are more likely to have thought about committing suicide than men (33% versus 29%) and more likely to have attempted suicide (19% versus 13%) [7]. A similar pattern is prevalent among Métis women. Métis men are more likely to complete suicide, but 14% of Métis women reported having attempted suicide compared to 4% of Métis men [8]. The percentage of women who have considered attempting suicide is considerably higher in the Métis population (14%) compared to the general Canadian population (3.8%) [8, 9].
Gender differences in suicide ideation and attempts are apparent in youth suicide as well. For example, 21% of girls aged 15-17 reported attempting suicide, a rate that is three times that of boys in the same age group [10]. This pattern is apparent between males and females of all age groups.
Suicide tends to be a problem for Aboriginal youth as well. On-reserve First Nations youth (15 to 24 years) are 5-7 times more likely to die from suicide compared to the Canadian youth in the general population [11]. In British Columbia, between 2005 and 2007, 20% of youth suicides were among Aboriginal youth even though Aboriginal youth represent less than 6% of youth in British Columbia (based on Census 2001 population estimates) [12], with one quarter of those Aboriginal youth suicides being female [10]. Immigrants to Canada are much less likely to commit suicide than the general population [13], however one study found that recent immigrants in British Columbia were more likely to commit suicide compared to older generation immigrants [14].
Critique
Increased gender-specific approaches to suicide prevention are needed both to address the costs associated with the treatment and management of suicide attempts, including the resulting mental health care, as well as understanding suicidal behaviour, morbidity data, and the effects of a suicidal male on women and children. It is important for prevention, intervention, and postvention services be tailored to the needs of the specific population they are directed to. Suicide rates are likely to be underreported, due to stigma surrounding suicide, and the misclassification of deaths as accidents or injuries if the intent of the death is unknown, which is an issue with suicide data, internationally [15]. The rates of suicide ideation and attempts are also difficult to quantify due to misclassification, underreporting, and treatment of suicide victims in the home.
Current suicide data focus on mortality (suicide-related deaths) rather than suicide morbidity (ideation and attempted suicide), which is an important issue for women that may be masked when only examining completed suicide statistics. Increased data addressing the entire spectrum of suicidal behaviours, including ideation and attempts are needed to better understand suicidal behaviours in women [4]. Further research regarding suicide in Aboriginal populations, including suicide in youth, is needed better understand and prevent suicide in these populations.