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Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

A cross-national study on gender differences in suicide intent

Authors: Aislinné Freeman, Roland Mergl, Elisabeth Kohls, András Székely, Ricardo Gusmao, Ella Arensman, Nicole Koburger, Ulrich Hegerl, Christine Rummel-Kluge

Published in: BMC Psychiatry | Issue 1/2017

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Abstract

Background

Suicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country.

Methods

Data on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into ‘Non-habitual Deliberate Self-Harm’ (DSH), ‘Parasuicidal Pause’ (SP), ‘Parasuicidal Gesture’ (SG), and ‘Serious Suicide Attempt’ (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using χ2-tests, odds ratios, and regression analyses.

Results

Suicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where ‘Serious Suicide Attempts’ (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, ‘Serious Suicide Attempt’ (SSA) was rated significantly more often for males than females (p < .005).

Conclusions

Considering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.
Literature
1.
go back to reference Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study. 2010. Lancet. 2012;380:2095–128.CrossRefPubMed Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study. 2010. Lancet. 2012;380:2095–128.CrossRefPubMed
4.
go back to reference World Health Organisation. Preventing suicide. A global imperative. Geneva: World Health Organization. 2014;92. World Health Organisation. Preventing suicide. A global imperative. Geneva: World Health Organization. 2014;92.
5.
go back to reference O'Loughlin S, Sherwood J. A 20-year review of trends in deliberate self-harm in a British town, 1981-2000. Soc Psychiatry Psychiatr Epidemiol. 2005:446–53. O'Loughlin S, Sherwood J. A 20-year review of trends in deliberate self-harm in a British town, 1981-2000. Soc Psychiatry Psychiatr Epidemiol. 2005:446–53.
6.
go back to reference Canetto SS, Sakinofsky I. The Gender Paradox in Suicide. Suicide Life Threat Behav. 1998;28:1–23.PubMed Canetto SS, Sakinofsky I. The Gender Paradox in Suicide. Suicide Life Threat Behav. 1998;28:1–23.PubMed
7.
go back to reference Schrijvers DL, Bollen J, Sabbe BGC. The gender paradox in suicidal behaviour and its impact on the suicidal process. J Affect Disord. 2012;138:19–26.CrossRefPubMed Schrijvers DL, Bollen J, Sabbe BGC. The gender paradox in suicidal behaviour and its impact on the suicidal process. J Affect Disord. 2012;138:19–26.CrossRefPubMed
8.
go back to reference Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A, et al. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord. 2012;136:9–6.CrossRefPubMed Cibis A, Mergl R, Bramesfeld A, Althaus D, Niklewski G, Schmidtke A, et al. Preference of lethal methods is not the only cause for higher suicide rates in males. J Affect Disord. 2012;136:9–6.CrossRefPubMed
9.
go back to reference Värnik A, Kõlves K, Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol Community Health. 2008;62:545–51.CrossRefPubMedPubMedCentral Värnik A, Kõlves K, Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol Community Health. 2008;62:545–51.CrossRefPubMedPubMedCentral
10.
go back to reference Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders [ESEMeD] project. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders [ESEMeD] project. Acta Psychiatr Scand Suppl. 2004:21–7. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders [ESEMeD] project. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders [ESEMeD] project. Acta Psychiatr Scand Suppl. 2004:21–7.
11.
go back to reference Qin P, Agerbo E, Westergard-Nielsen N, Eriksson T. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000;177:546–50.CrossRefPubMed Qin P, Agerbo E, Westergard-Nielsen N, Eriksson T. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000;177:546–50.CrossRefPubMed
12.
go back to reference Tóth MD, Ádám S, Birkás E, Székely A, Stauder A, Purebl G. Gender differences in deliberate self-poisoning in Hungary analyzing the effect of precipitating factors and their relation to depression. Crisis. 2014;5(3):145–53.CrossRef Tóth MD, Ádám S, Birkás E, Székely A, Stauder A, Purebl G. Gender differences in deliberate self-poisoning in Hungary analyzing the effect of precipitating factors and their relation to depression. Crisis. 2014;5(3):145–53.CrossRef
13.
go back to reference Hasley JP, Ghosh B, Huggins J, Bell MR, Adler L, Shroyer LW. A review of “Suicide intent” within the existing suicide literature. Suicide Life Threat Behav. 2008;38(5):576–91.CrossRefPubMed Hasley JP, Ghosh B, Huggins J, Bell MR, Adler L, Shroyer LW. A review of “Suicide intent” within the existing suicide literature. Suicide Life Threat Behav. 2008;38(5):576–91.CrossRefPubMed
14.
go back to reference Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Level of suicide intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry. 2004;4:1–7.CrossRef Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Level of suicide intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study. BMC Psychiatry. 2004;4:1–7.CrossRef
15.
go back to reference Harriss L, Hawton K, Zahl D. Value of measuring suicide intent in the assessment of people attending hospital following self-poisoning or self-injury. Br J Psychiatry. 2005;186:60–6.CrossRefPubMed Harriss L, Hawton K, Zahl D. Value of measuring suicide intent in the assessment of people attending hospital following self-poisoning or self-injury. Br J Psychiatry. 2005;186:60–6.CrossRefPubMed
16.
go back to reference Hawton K. Sex and suicide. gender differences in suicidal behaviour. Br J Psychiatry. 2000;144:484–5.CrossRef Hawton K. Sex and suicide. gender differences in suicidal behaviour. Br J Psychiatry. 2000;144:484–5.CrossRef
17.
go back to reference Hawton K, Fagg J. Suicide, and other causes of death, following attempted suicide. Br J Psychiatry. 1988;152:359–66.CrossRefPubMed Hawton K, Fagg J. Suicide, and other causes of death, following attempted suicide. Br J Psychiatry. 1988;152:359–66.CrossRefPubMed
18.
go back to reference Denning D, King D, Cox C. Method choice, intent, and gender in completed suicide. Suicide Life-Threat Behav. 2000;30:282–8.PubMed Denning D, King D, Cox C. Method choice, intent, and gender in completed suicide. Suicide Life-Threat Behav. 2000;30:282–8.PubMed
19.
go back to reference Moscicki EK. Gender differences in completed and attempted suicides. Ann Epidemiol. 1994;4:152–8.CrossRefPubMed Moscicki EK. Gender differences in completed and attempted suicides. Ann Epidemiol. 1994;4:152–8.CrossRefPubMed
20.
go back to reference Strosahl K, Chiles JA, Linehan M. Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Compr Psychiatry. 1992;33:366–73.CrossRefPubMed Strosahl K, Chiles JA, Linehan M. Prediction of suicide intent in hospitalized parasuicides: Reasons for living, hopelessness, and depression. Compr Psychiatry. 1992;33:366–73.CrossRefPubMed
21.
go back to reference Kumar CTS, Mohan R, Ranjith G, Chandrasekaran R. Gender differences in medically serious suicide attempts. A study from South India. Psychiatry Res. 2006;144:79–86.CrossRef Kumar CTS, Mohan R, Ranjith G, Chandrasekaran R. Gender differences in medically serious suicide attempts. A study from South India. Psychiatry Res. 2006;144:79–86.CrossRef
22.
go back to reference Aghanwa H. The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study. Gen Hosp Psychiat. 2004;1:63–9.CrossRef Aghanwa H. The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study. Gen Hosp Psychiat. 2004;1:63–9.CrossRef
23.
go back to reference Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, et al. Optimizing suicide prevention programs and their implementation in Europe [OSPI Europe]: an evidence-based multi-level approach. BMC Pub Health. 2009;23:1–8. Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, et al. Optimizing suicide prevention programs and their implementation in Europe [OSPI Europe]: an evidence-based multi-level approach. BMC Pub Health. 2009;23:1–8.
24.
go back to reference Hegerl U, Wittman M, Arensman E, Audenhove C, Bouleau JH, Feltz-Cornelis C, et al. The European Alliance Against Depression [EAAD]: a multifaceted, community-based action programme against depression and suicidality. World J Biol Psychiatry. 2008;9:51–9.CrossRefPubMed Hegerl U, Wittman M, Arensman E, Audenhove C, Bouleau JH, Feltz-Cornelis C, et al. The European Alliance Against Depression [EAAD]: a multifaceted, community-based action programme against depression and suicidality. World J Biol Psychiatry. 2008;9:51–9.CrossRefPubMed
25.
go back to reference Hegerl U, Rummel-Klue C, Värnik A, Arensman E, Koburger N. Alliances against depression - A community based approach to target depression and to prevent suicidal behaviour. Neurosci Biobehav Rev. 2013:2404–9. Hegerl U, Rummel-Klue C, Värnik A, Arensman E, Koburger N. Alliances against depression - A community based approach to target depression and to prevent suicidal behaviour. Neurosci Biobehav Rev. 2013:2404–9.
26.
go back to reference Värnik P, Sisask M, Värnik A, Laido Z, Meise U, Ibelshäuser A, et al. Suicide registration in eight European countries: a qualitative analysis of procedures and practices. Forensic Sci Int. 2010;202(1–3):86–92.CrossRefPubMed Värnik P, Sisask M, Värnik A, Laido Z, Meise U, Ibelshäuser A, et al. Suicide registration in eight European countries: a qualitative analysis of procedures and practices. Forensic Sci Int. 2010;202(1–3):86–92.CrossRefPubMed
27.
go back to reference van der Feltz-Cornelis CM, Sarchiapone M, Postuvan V, Volker D, Roskar S, Grum AT, et al. Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. Crisis. 2011;32:319–33.CrossRefPubMedPubMedCentral van der Feltz-Cornelis CM, Sarchiapone M, Postuvan V, Volker D, Roskar S, Grum AT, et al. Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. Crisis. 2011;32:319–33.CrossRefPubMedPubMedCentral
28.
go back to reference Maloney J, Pfuhlmann B, Arensman E, Coffey C, Gusmão R, Poštuvan V, et al. Media recommendations on reporting suicidal behaviour and suggestions for optimisation. Acta Psychiatr Scand. 2013;128:314–5.PubMed Maloney J, Pfuhlmann B, Arensman E, Coffey C, Gusmão R, Poštuvan V, et al. Media recommendations on reporting suicidal behaviour and suggestions for optimisation. Acta Psychiatr Scand. 2013;128:314–5.PubMed
29.
go back to reference Platt S, Bille-Brahe U, Kerkhof A, Schmidtke A, Bjerke T, Crepet P, et al. Parasuicide in Europe I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand. 1992;85:97–104.CrossRefPubMed Platt S, Bille-Brahe U, Kerkhof A, Schmidtke A, Bjerke T, Crepet P, et al. Parasuicide in Europe I. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand. 1992;85:97–104.CrossRefPubMed
30.
go back to reference Feuerlein W. Selbstmordversuch oder parasuizidale Handlung? Tendenzen suizidalen Verhaltens. Nevenartz. 1971;3:127–30. Feuerlein W. Selbstmordversuch oder parasuizidale Handlung? Tendenzen suizidalen Verhaltens. Nevenartz. 1971;3:127–30.
31.
go back to reference Hjelmeland H, Nordvik H, Bille-Brahe U. A cross cultural study of suicide intent in parasuicide patients. Suicide Life-Threat Behav. 2000;30:295–303.PubMed Hjelmeland H, Nordvik H, Bille-Brahe U. A cross cultural study of suicide intent in parasuicide patients. Suicide Life-Threat Behav. 2000;30:295–303.PubMed
32.
go back to reference Nordentoft M, Branner J. Gender differences in suicide intent and choice of method among suicide attempters. Crisis. 2008;29:209–12.CrossRefPubMed Nordentoft M, Branner J. Gender differences in suicide intent and choice of method among suicide attempters. Crisis. 2008;29:209–12.CrossRefPubMed
33.
go back to reference Rapeli CB, Botega NJ. Clinical profiles of serious suicide attempters consecutively admitted to a university-based hospital: a cluster analysis study. Rev Bras Psiquiatr. 2005;27:285–9.CrossRefPubMed Rapeli CB, Botega NJ. Clinical profiles of serious suicide attempters consecutively admitted to a university-based hospital: a cluster analysis study. Rev Bras Psiquiatr. 2005;27:285–9.CrossRefPubMed
34.
go back to reference Dyer JA, Kreitman N. Hopelessness, depression and suicide intent in parasuicide. Br J Psychiatry. 1984;144:127–3.CrossRefPubMed Dyer JA, Kreitman N. Hopelessness, depression and suicide intent in parasuicide. Br J Psychiatry. 1984;144:127–3.CrossRefPubMed
35.
go back to reference Hamdi E, Amin Y, Mattar T. Clinical correlates of intent in attempted suicide. Acta Psychiatr Scand. 1991;83:406–11.CrossRefPubMed Hamdi E, Amin Y, Mattar T. Clinical correlates of intent in attempted suicide. Acta Psychiatr Scand. 1991;83:406–11.CrossRefPubMed
36.
go back to reference Lewinsohn PM, Rohde P, Seeley JR, Baldwin CL. Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry. 2001;40:427–34.CrossRefPubMed Lewinsohn PM, Rohde P, Seeley JR, Baldwin CL. Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry. 2001;40:427–34.CrossRefPubMed
37.
go back to reference Wunderlich U, Bronisch T, Wittchen HU, Carter R. Gender differences in adolescents and young adults with suicidal behaviour. Acta Psychiatr Scand. 2001;104:332–9.CrossRefPubMed Wunderlich U, Bronisch T, Wittchen HU, Carter R. Gender differences in adolescents and young adults with suicidal behaviour. Acta Psychiatr Scand. 2001;104:332–9.CrossRefPubMed
38.
go back to reference Michel K, Valach L, Waeber V. Understanding deliberate self-harm: the patients’ views. Crisis. 1994;15:172–8.PubMed Michel K, Valach L, Waeber V. Understanding deliberate self-harm: the patients’ views. Crisis. 1994;15:172–8.PubMed
39.
go back to reference James D, Hawton K. Overdoses: explanations and attitudes in self-poisoners and significant others. Br J Psychiatry. 1985;146:481–5.CrossRefPubMed James D, Hawton K. Overdoses: explanations and attitudes in self-poisoners and significant others. Br J Psychiatry. 1985;146:481–5.CrossRefPubMed
40.
go back to reference Boergers J, Spirito A, Donaldson D. Reasons for adolescent suicide attempts. Associations with Psychological Functioning. J Am Acad Child Adolesc Psychiat. 1998;37:1287–3.CrossRef Boergers J, Spirito A, Donaldson D. Reasons for adolescent suicide attempts. Associations with Psychological Functioning. J Am Acad Child Adolesc Psychiat. 1998;37:1287–3.CrossRef
41.
go back to reference Hjelmeland H, Hawton K, Bille-Brahe U, De Leo D, Fekete S, Grad O, et al. Why people engage in parasuicide: a cross-cultural study of intentions. Suicide Life Threat Behav. 2002;32:380–93.CrossRefPubMed Hjelmeland H, Hawton K, Bille-Brahe U, De Leo D, Fekete S, Grad O, et al. Why people engage in parasuicide: a cross-cultural study of intentions. Suicide Life Threat Behav. 2002;32:380–93.CrossRefPubMed
42.
go back to reference Haw C, Casey D, Holmes J, Hawton K. Suicidal intent and method of self-harm: a large-scale study of self-harmpatients presenting to a General Hospital. Suicide Life Threat Behav. 2015; [Epub ahead of print] Haw C, Casey D, Holmes J, Hawton K. Suicidal intent and method of self-harm: a large-scale study of self-harmpatients presenting to a General Hospital. Suicide Life Threat Behav. 2015; [Epub ahead of print]
43.
go back to reference Möller-Leimkühler A. The gender gap in suicide and premature death or: why are men so vulnerable? Eur Arch Psychiatry Clin Neurosci. 2003;253:1–8.CrossRefPubMed Möller-Leimkühler A. The gender gap in suicide and premature death or: why are men so vulnerable? Eur Arch Psychiatry Clin Neurosci. 2003;253:1–8.CrossRefPubMed
44.
go back to reference Pallis DJ, Sainsbury P. The value of assessing intent in attempted suicide. Psychol Med. 1976;6:487–92.CrossRefPubMed Pallis DJ, Sainsbury P. The value of assessing intent in attempted suicide. Psychol Med. 1976;6:487–92.CrossRefPubMed
45.
go back to reference Niméus A, Alsén M, Traskman-Bendz L. High suicidal intent scores indicate future suicide. Arch Suicide Res. 2002;66:211–9.CrossRef Niméus A, Alsén M, Traskman-Bendz L. High suicidal intent scores indicate future suicide. Arch Suicide Res. 2002;66:211–9.CrossRef
46.
go back to reference Haw C, Hawton K. Life problems and deliberate self-harm: associations with gender, age, suicide intent and psychiatric and personality disorder. J Affect Disord. 2008;109:139–48.CrossRefPubMed Haw C, Hawton K. Life problems and deliberate self-harm: associations with gender, age, suicide intent and psychiatric and personality disorder. J Affect Disord. 2008;109:139–48.CrossRefPubMed
47.
go back to reference Beck AT, Schuyler D, Herman I. Development of suicidal intent scales. In: Beck AT, Resnik HLP, Lettieri DJ, editors. The prediction of suicide. Charles Press: Philadelphia; 1974. p. 45–56. Beck AT, Schuyler D, Herman I. Development of suicidal intent scales. In: Beck AT, Resnik HLP, Lettieri DJ, editors. The prediction of suicide. Charles Press: Philadelphia; 1974. p. 45–56.
48.
go back to reference Dorpat T, Boswell J. An evaluation of suicide intent in suicide attempts. Compr Psychiatry. 1963;4:117–5.CrossRef Dorpat T, Boswell J. An evaluation of suicide intent in suicide attempts. Compr Psychiatry. 1963;4:117–5.CrossRef
49.
go back to reference Cooper J, Steeg S, Bennewith O, Lowe M, Gunnell D, House A, et al. Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ. 2013;3:1–9. Cooper J, Steeg S, Bennewith O, Lowe M, Gunnell D, House A, et al. Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ. 2013;3:1–9.
50.
go back to reference National Institute for Health and Clinical Excellence. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. 2004. Clinical Guideline 16. National Institute for Health and Clinical Excellence. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. 2004. Clinical Guideline 16.
Metadata
Title
A cross-national study on gender differences in suicide intent
Authors
Aislinné Freeman
Roland Mergl
Elisabeth Kohls
András Székely
Ricardo Gusmao
Ella Arensman
Nicole Koburger
Ulrich Hegerl
Christine Rummel-Kluge
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1398-8

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