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Social Psychiatry and Psychiatric Epidemiology

Published in:

01-06-2012 | Original Paper

Gender differences in suicide methods

Authors: Valerie J. Callanan, Mark S. Davis

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 6/2012

Abstract

Introduction

Gender differences in suicide completion rates have been attributed to the differences in lethality of suicide methods chosen by men and women, but few empirical studies have investigated factors other than demographic characteristics that might explain this differential.

Methods

Data from the 621 suicides in Summit County, Ohio during 1997–2006 were disaggregated by gender to compare known correlates of suicide risk on three methods of suicide—firearm, hanging and drug poisoning.

Results

Compared to women, men who completed suicide with firearms were more likely to be married and committed the act at home. Unmarried men were likelier to hang themselves than married men, but unmarried women were less likely to hang themselves than married women. Men with a history of depression were more likely to suicide by hanging, but women with depression were half as likely to hang themselves compared to the women without a history of depression. Men with a history of substance abuse were more likely to suicide by poisoning than men without such history, but substance abuse history had no influence on women’s use of poisoning to suicide. For both sexes, the odds of suicide by poisoning were significantly higher for those on psychiatric medications.

The study period of Kposowa and McElvain [39] covered 1998–2001, which is subsumed within our study period, and they collected a similar number of usable cases (643) to the data in this study (621).

IRB approval was obtained from the author’s respective universities.

Cohen’s Kappa was not estimated given the coding protocol.

Analysis was limited to these three suicide methods because the other methods used had too few cases, which precluded multivariate analyses.

Specific types of substance abuse were not examined due to lack of statistical power.

The percentage of men who used firearms to suicide in Summit County during the period 1997–2006 was lower than the percentage of male firearm suicides for the entire state for that time period (51.7 and 57.8%, respectively), whereas the percentage of female suicides in the county who used firearms was higher than female firearm suicides in the state (38.3 and 31.4%, respectively). Of interest, firearms remain the most common means of suicide for females in our population, similar to earlier trends reported by Kaplan et al. [40], but different from more recent statistics that show poisoning has once again become the most common method among women in Ohio (40.3%) as well as the United States (34.6%) [41].

If we remove the cases that died in the hospital, 76.1% of their sample committed suicide at home (408/536), which was very close to the percent of cases in our sample that committed suicide at home.

Although VIF and tolerance are normally associated with tests of multicollinearity of OLS regression models, as Menard [43] argues, [since] “the concern is with the relationship among the independent variables, the functional form of the model for the dependent variable is irrelevant to the estimation of collinearity” (p. 76).

Z = (b ₁ − b ₂)/√(SEb ₁ ² + SEb ₂ ² ).

A model was run on the male subsample that included these factors, but neither place of suicide or being on psychiatric medication was related to suicide hangings among men.

Kaplan and Geling [45] found that female firearm suicide rates were higher in the Pacific region that included California than in the East North Central region that included Ohio. But aggregating data by region may obscure differences in firearm ownership, possession and use that could vary by state or smaller geographic areas.

Centers for Disease Control and Prevention (2009) Suicide fact sheet http://www.cdc.gov/violenceprevention/pdf/Suicide-FactSheet-a.pdf. Accessed 8 Dec 2009

Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R (2002) World report on violence and health. World Health Organization, Geneva

Moscicki E (1994) Gender differences in completed and attempted suicides. Ann Epidemiol 4:152–158PubMedCrossRef

Cannetto SS, Lester D (1995) The epidemiology of women’s suicidal behavior. In: Canetto SS, Lester D (eds) Women and suicidal behavior. Springer, New York, pp 35–57

Romero MP, Wintemute GJ (2002) The epidemiology of firearm suicide in the United States. J Urban Health 79:39–48PubMedCrossRef

Tadros G, Salib E (2000) Age and methods in fatal self harm (FSH). Is there a link? Int J Geriatr Psychiatry 15:848–852PubMedCrossRef

Cantor C, Neulinger K (2000) The epidemiology of suicide and attempted suicide among young Australians. Aust N Z J Psychiatry 34:370–387PubMedCrossRef

Stack S (2000) Suicide: a 15-year review of the sociological literature. Part I: cultural and economic factors. Suicide Life Threat Behav 30:145–162PubMed

Marks MS, Geling O (1999) Sociodemographic and geographic patterns of firearm suicide in the United States, 1989–1993. Health Place 5:179–185CrossRef

10.

Kosky RJ, Dundas P (2000) Death by hanging: implications for prevention of an important method of youth suicide. Aust N Z J Psychiatry 34:836–841PubMedCrossRef

11.

Denning DG, Conwell Y, King D, Cox C (2000) Method choice, intent and gender in completed suicide. Suicide Life Threat Behav 30:282–288PubMed

12.

Beck AT, Schuyler D, Herman I (1974) Development of suicidal intent scales. In: Beck AT, Resnick HLP, Letteri DJ (eds) The prediction of suicide. Charles Press, Bowie, pp 45–46

13.

Haw C, Hawton K, Houston K, Townsend E (2003) Correlates of relative lethality and suicidal intent among deliberate self-harm patients. Suicide Life Threat Behav 33:353–364PubMedCrossRef

14.

Nock MK, Kessler RC (2006) Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 115:616–623PubMedCrossRef

15.

Townsend E, Hawton K, Harriss L, Bale E, Bond A (2001) Substances used in deliberate self-poisoning 1985–1997: trends and associations with age, gender, repetition and suicide intent. Soc Psychiatry Psychiatr Epidemiol 36:228–234PubMedCrossRef

16.

Cannetto SS, Sakinofsky I (1998) The gender paradox in suicide. Suicide Life Threat Behav 28:1–23

17.

McIntosh JL, Santos JF (1982) Changing patterns in methods of suicide by race and sex. Suicide Life Threat Behav 12:221–233PubMed

18.

Smith TW, Smith RJ (1995) Changes in firearm ownership among women, 1980–1994. J Crim Law Criminol 86:133–149CrossRef

19.

Kellermann AL, Rivara FP, Somes G, Reay DT, Francisco J, Banton JG, Prodzinski J, Fligner C, Hackman BB (1992) Suicide in the home in relation to gun ownership. N Engl J Med 327:467–472PubMedCrossRef

20.

Wintemute GJ, Parham CA, Beaumont JJ, Wright M, Drake C (1999) Mortality among recent purchasers of handguns. N Engl J Med 341:1583–1589PubMedCrossRef

21.

Lester D (2000) Why people kill themselves. Charles Thomas, Springfield

22.

Stack S, Wasserman I (2009) Gender and suicide risk: the role of wound site. Suicide Life Threat Behav 39:13–20PubMedCrossRef

23.

Schmeling A, Strauch H, Rothschild MA (2001) Female suicides in Berlin with the use of firearms. Forensic Sci Int 124:178–181PubMedCrossRef

24.

Kaplan AG, Klein RB (1989) Women and suicide. In: Jacobs D, Brown HN (eds) Suicide: understanding and responding: Harvard Medical School perspectives. International Universities Press, Madison, pp 257–282

25.

Barber ME, Marzuk PM, Leon AC, Portera L (1998) Aborted suicide attempts: a new classification of suicidal behavior. Am J Psychiatry 155:385–389PubMed

26.

Rich CL, Ricketts JE, Fowler RC, Young D (1988) Some differences between men and women who commit suicide. Am J Psychiatry 145:718–722PubMed

27.

Steer RA, Beck AT, Garrison B, Lester D (1988) Eventual suicide in interrupted and uninterrupted attempters: a challenge to the cry-for-help hypothesis. Suicide Life Threat Behav 18:119–128PubMed

28.

Kessler RC, Borges G, Walters EE (1999) Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 56:617–626PubMedCrossRef

29.

Skogman K, Alsen M, Ojehagan A (2004) Sex differences in risk factors for suicide after attempted suicide: a follow-up study of 1052 suicide attempters. Soc Psychiatry Psychiatr Epidemiol 39:113–120PubMedCrossRef

30.

Conwell Y, Brent D (1995) Suicide and aging: I. Patterns of psychiatric diagnosis. Int Psychogeriatr 7:149–181PubMedCrossRef

31.

Grava G, Ceroni GB, Rucci P, Scudellari P (2006) Suicidal behavior and personality structure. Suicide Life Threat Behav 36:569–577PubMedCrossRef

32.

Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eschleman S et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from a national comorbidity survey. Arch Gen Psychiatry 51:8–19PubMedCrossRef

33.

Jick SS, Dean AD, Jick H (1995) Antidepressants and suicide. Br Med J 310:315–318CrossRef

34.

Cyranowski JM, Frank E, Young E, Shear K (2000) Adolescent onset of the of the gender difference in lifetime rates of major depression. Arch Gen Psychiatry 57:21–27PubMedCrossRef

35.

Hankin BL, Abramson LY (2001) Development of gender differences in depression: An elaborated cognitive vulnerability-transactional stress theory. Psychol Bull 127:773–796PubMedCrossRef

36.

Norman J (2004) Gender bias in the diagnosis and treatment of depression. Int J Ment Health 33:32–43

37.

Henrikksson MM, Hellivi MA, Marttunen MJ, Heikkinnen ME, Isometsa ET, Kuoppasalmi KI, Lonnqvist JK (1993) Mental disorders and comorbidity in suicide. Am J Psychiatry 150:935–940

38.

Martunnen MJ, Henriksson MM, Hillevi MA, Heikkinen ME, Isometsa ET, Lonnqvist JK (1995) Suicide among female youth: Characteristics and comparisons with males in age groups 13 to 22 years. J Am Acad Child Adolesc Psychiatry 34:1297–1307CrossRef

39.

Kposowa AJ, McElvain JP (2006) Gender, place, and method of suicide. Soc Psychiatry Psychiatr Epidemiol 41:435–443PubMedCrossRef

40.

Kaplan MS, Adamek ME, Geling O, Calderon A (1997) Firearm suicide among older women in the U.S. Soc Sci Med 44:1427–1430PubMedCrossRef

41.

Centers for Disease Control and Prevention (2009) WISQARS injury mortality reports. http://www.cdc.gov/injury/wisqars/. Accessed 3 Oct 2010

42.

Rawlinson C, Crews P (2003) Access to quality health services in rural areas. Emergency medical services. Rural Healthy People 2010: a companion document to healthy people 2010. The Texas A&M University System Health Science Center, School of Rural Public Health, Southwest Rural Health Research Center, College Station

43.

Menard SW (2002) Applied logistic regression analysis, 2nd edn. Sage, Thousand Oaks

44.

Altman DG, Bland JM (2003) Interaction revisited: the difference between two estimates. Br Med J 326:219CrossRef

45.

Kaplan MS, Geling O (1998) Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership. Soc Sci Med 46:1227–1233PubMedCrossRef

46.

Conwell Y, Duberstein PR, Connor K, Eberly S, Cox C, Caine ED (2002) Access to firearms and risk for suicide in middle-aged and older adults. Am J Geriatr Psychiatry 10:407–416PubMed

47.

Dahlberg LL, Ikeda RM, Kresnow M (2004) Guns in the home and risk of a violent death in the home: Findings from a national survey. Am J Epidemiol 160:929–936PubMedCrossRef

48.

Kellermann AL, Somes G, Rivara FP, Lee RK, Vanton JG (1998) Injuries and deaths due to firearms in the home. J Trauma 45:263–267PubMedCrossRef

49.

Kreitman N, Platt S (1984) Suicide, unemployment, and domestic gas detoxification in Britain. J Epidemiol Community Health 38:1–6PubMedCrossRef

50.

Lester D (1990) The effects of detoxification of domestic gas on suicide in the United States. Am J Public Health 80:1–2CrossRef

51.

Daigle MS (2005) Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Accid Anal Prev 37:625–632PubMedCrossRef

52.

Pomerantz JM (2008) FDA warning about suicidality: Balancing risk and benefit. Drug Benefit Trends 20:149–150

53.

Brent D (2007) Antidepressant and suicidal behavior: cause or cure? Am J Psychiatry 164:989–991PubMedCrossRef

54.

Isacsson G, Bergman U, Rich CL (1996) Epidemiological data suggest antidepressant reduce suicide risk among depressives. J Affect Disord 41:1–8PubMedCrossRef

55.

Spijker J, de Graaf R, ten Have M, Nolen WA, Speckens A (2010) Predictors of suicidality in depressive spectrum disorders in the general population: Results of the Netherlands Mental Health Survey and Incidence Study. Soc Psychiatry Psychiatr Epidemiol 45:513–521PubMedCrossRef

56.

Donovan S, Kelleher MJ, Lambourn J, Foster T (1999) The occurrence of suicide following the prescription of antidepressant drugs. Arch Suicide Res 5:181–192

57.

Mikula L, Bronson A, Reitman D (2007) Do antidepressant medications really increase suicide risk for adolescents? Reflections on the FDA’s black box warning. Behav Ther 30:99–103

58.

Stack S, Bowman B (2009) Suicide in movies: gender and choice of suicide method. In: Stack S, Lester D (eds) Suicide and the creative arts. Nova Science Publishers, New York, pp 57–61

59.

Oslin DW, Zubritsky C, Brown G, Mullahy M, Puliafico A, Ten Have T (2004) Managing suicide risk late in life: access to firearms as a public health risk. Am J Geriatr Psychiatry 12:30–36PubMed

60.

Rockett IRH, Wang S, Stack S, De Leo D, Frost JL, Ducatman AM, Walker RL, Kapusta ND (2010) Race/ethnicity and potential suicide misclassification: window on a minority suicide paradox? BMC Psychiatry 10:1–8CrossRef

61.

DeJong T, Overholser JC, Stockmeier CA (2010) Apples to oranges? A direct comparison between suicide attempters and suicide completers. J Affect Disord 124:90–97PubMedCrossRef

62.

Bradvick L (2007) Violent and nonviolent methods of suicide: different patterns may be found in men and women with sever depression. Arch Suicide Res 11:255–264CrossRef

63.

Sen B (2004) Adolescent propensity for depressed mood and help seeking: race and gender differences. J Ment Health Policy Econ 7:133–145PubMed

64.

Sussman L, Robins L, Earls F (1987) Treatment-seeking for depression by black and white Americans. Soc Sci Med 24:187–196PubMedCrossRef

65.

Hawton K, Appleby L, Platt S, Foster T, Cooper J, Malmberg A, Simkin S (1998) The psychological autopsy approach to studying suicide: a review of methodological issues. J Affect Disord 50:269–276PubMedCrossRef

66.

Pouliot L, De Leo D (2006) Critical issues in psychological autopsy studies. Suicide Life Threat Behav 36:491–510PubMedCrossRef

Title: Gender differences in suicide methods
Authors: Valerie J. Callanan
Mark S. Davis
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 6/2012
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-011-0393-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Gender differences in suicide methods

Abstract

Introduction

Methods

Results

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

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