Outside Factors Contributing to Suicide Rate Differ by Sex, Study Finds
Contextual factors such as health expenditure, homicide rate, unemployment rate, and alcohol use were associated with sex-specific suicide rates in North America, according to study results recently published in The Lancet Regional Health – Americas.
“Although there was some overlap, the contextual factors that significantly impacted the suicide mortality rate among males and females were largely different, which mirrors the current literature on individual-level risk factors for suicide,” lead author Shannon Lange, MPH, Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON, Canada, and co-authors noted. “Taken together, our data supports that sex should be considered when adapting and testing suicide risk reduction interventions and when developing national suicide prevention strategies.”
Related: Suicidal Behavior Increasing in US Youth, Meta-Analysis Finds
While suicide rates worldwide have been steadily decreasing for the last few years, the rate in North America continues to increase. The World Health Organization (WHO) Global Health Estimates database provided sex-specific suicide mortality estimates from 2000 to 2019. Researchers conducted joinpoint regression analysis to examine the suicide rate trend over time. Then, a linear mixed model was applied to investigate the effects of specific contextual outside factors compiled from the Global Burden of Disease Study 2019 covariates and The World Bank.
The mean country-level suicide mortality rate in men in North America was found to decline as health expenditure per capita rose and increased when the homicide rate, the prevalence of intravenous drug use, and alcohol use increased. Results showed North American men have a higher suicide mortality rate than women.
In women, the mean country-level suicide mortality rate decreased as the number of employed doctors increased but rose concurrently with education inequality surges. The suicide rate in North American women, though still lower than in men, steadily increased by an average of 1.25% every year between 2000 and 2019 (95% CI: 0.73%, 1.78%).
Suicide rates in both men and women rose as the unemployment rate increased then declined as the proportion of the country with a moderate population density increased. Suicide rates increased faster in rural areas than in metropolitan areas between 1999 and 2016, “suggesting that rural areas may be more sensitive to the impact of social deprivation than more metropolitan counties.”
“Although increasing the population density of a country is not a realistic public health strategy for reducing the suicide mortality rate,” researchers then noted, “improving social connectedness, and civic opportunities may be worth exploring as potential suicide prevention strategies.”
Researchers hypothesized that the difference in the influencing factors between the sexes was, in part, due to the differences in behavior, vulnerabilities, and gender norms and expectations between the 2 groups. For example, men are more likely to engage in risky or unhealthy behavior, such as heavy alcohol or drug use, than women.
Differences in suicide rate influencers such as those listed emphasize the importance of including multiple factors in suicide prevention research and further prove that effective suicide prevention initiatives are not one-size-fits-all.
“Although an in-depth review of each risk factor and their sex-specific mechanism is beyond the scope of this paper, the current study is intended to evoke hypotheses and spark further investigation into sex-specific risk relationships for suicide mortality, and their etiology.”
