The Gender Ratio of Chinese Suicide Rates: An Explanation in Confucianism

The gender (male to female) ratio of the Chinese suicide rates is different from those found in the rest of the world. None of the other societies with known suicide data has had female suicide rates higher than those for the males. While we investigate the factors that contribute to the relatively high suicide rates for Chinese women, we also need to ask what makes the relatively low suicide rates for Chinese men. In this study we try to examine some social and cultural variables in rural Chinese youths in order to identify the factors that account for the relatively low rate for men and relatively high rate for women. In rural China, 392 suicides (both men and women) aged 14–35 years consecutively sampled from 16 counties of three provinces were studied with 416 community living controls of the same age range and from the same locations. Case–control psychological autopsy method was used for the data collection. It is found that believing in Confucianism and being married are both protecting the rural young men from suicide, while the two same variables are either risk or non-protecting factors for the Chinese rural young women’s suicide. In rural China, social structure and culture may play an even more important role determining a society’s suicide rates as well as the gender ratios. Thus, suicide prevention may need to include culture specific measures.     

Suicide and Youth

The problem of suicide among young people is increasing at phenomenal rates. More young people die by suicide than from cancer and heart ailments combined. More than 4,000 young suicides are recorded each year, but no one knows how many suicide attempts fail. This article examines the problem of adolescent suicide and suicide attempts in relation to cultural factors, sex differences, and probable causes. Case studies help to identify symptomatic behavior. The importance of parents, teachers, and counselors in becoming alert to conflict and stress situations in youths is delineated. Community and school responsibility for leading youth to self-understanding and self-direction is crucial, and the article suggests several means of prevention through mental health and moral responsibility.     

Violent death in the West: suicide and homicide in New Mexico, 1958-1987

We examined New Mexico vital statistics data for suicides and homicides among the state's Hispanics, Native Americans, and non-Hispanic whites collected from 1958 to 1987. We found high age-adjusted rates for both suicides and homicides among Hispanic and Native American males, in comparison with rates for non-Hispanic white males. Suicide rates among Native American women were comparatively low, contrasting with their high homicide rates. Homicide rates for males in all three ethnic groups increased substantially over the 30-year study period. We conclude that death from violent causes, both suicide and homicide, is a major public health problem in New Mexico, and disproportionately affects minority males.     

Suicide in Batman, southeastern Turkey

The southeastern part of Turkey has comparatively high female suicide rates. We aimed to research social, economic, cultural, and psychiatric reasons of suicides in Batman in a case-controlled psychological autopsy study comparing suicides with matched community controls. The female suicide rate was 9.3 per 100.000 and the female/male ratio was 1.72/1. The suicides most frequently occurred in young females, mean age 20.7. The most frequent method (45%) was hanging. The most frequent stressful life events were health problems and family disruption. High suicide rates among females may be related to negative social status of females living in the region.     

Suicide mortality among Kentucky farmers, 1979-1985

Farmers may be at high risk for suicide because of their social environment and because of chemical exposure resulting in neurotoxic effects in the workplace. Age-specific suicide rates are compared for Kentucky white farmers, Kentucky white males, and U.S. white males. Data for suicides occurring in Kentucky represent the 7-year period between 1979 and 1985; data for the United States suicides represent the period 1980. Overall, suicide rates were highest for Kentucky farmers, followed by Kentucky males and then by U.S. males. All males were most likely to use firearms as the mode of suicide, but the farmers used firearms significantly more often than the U.S. males, as did the other Kentucky males. These findings and other evidence support the need to assess suicide rates in this occupational group in other states, to begin suicide prevention programs for Kentucky, and to work to identify risk factors contributing to the Kentucky farm suicides.     

Suicide and Homicide Rates in Canada and the United States

Suicide and homicide rates by age were analyzed for Canada and the United States, indicating that suicide is higher in Canada and that homicide is higher in the United States. Results indicated a positive association between homicide and suicide rates in the United States but these two rates of death were not significantly associated in Canada. Holinger (1987) had associated the relative size of the cohort to the rates of suicide and homicide in young people in the United States. The more current data in both countries did not support Holinger's results. Using the measure devised by Easterlin (1980) and Ahlburg and Schapiro (1984) –that is, the proportion of youths aged 15–24 relative to adults aged 25–64–the correlation between the size of the youth cohort and the suicide rate of youths aged 15–24 was negative. It is concluded that the two patterns in these two countries may be explained from a historical perspective.     

The epidemiology of suicide and attempted suicide

Since more than one century suicides have been registered in national statistics of death causes. They thus furnish one of the few parameters of psychiatrically relevant behaviour by means of which trends, cohort, age-group and period effects can be studied over longer periods. Since the second half of last century, the suicide rates for Swiss males--similar to those found in England and Wales--show a decrease in consecutive birth cohorts up to males born in the decade 1930-1940, and a continued decline in the total trend until about World War II. From then on the suicide rates of males in consecutive birth cohorts have been slowly increasing in the majority of European and North American countries--but not so in Sweden. Opposite to this, the predominantly low rates for females display little change. Further to the considerable differences between nations and the predominance of suicides committed by females in some Asian countries and Cuba, the changes indicate the significance of cultural and economic environmental factors. Typical period effects are mainly the result of changes in conception and conditions of life. In attempted suicide they proceed in a more sensitive and more rapid way and are about ten times higher. Such a period effect showing increases by about 300% in younger age-groups followed by a decline, attaining its peak about 1976, was ascertained in large cities of the Federal Republic of Germany. By the example of the effects of a television serial, the study of causal processes turning collective environmental factors into individual suicidal behaviour, proved that regularities are effective in learning by a process of modelling. Besides, the epidemiological data give essential hints how to treat suicidal behaviour.     

Suicide Prevention in Adults (Age 30–65)

Relatively little is known about midlife suicides, compared to adolescent and elderly suicides. A life-span model of suicidal behaviors is suggested as a heuristic conceptual tool. General midlife tasks and crises, as outlined by Levinson and Erikson, are reviewed. However, more than routine midlife developmental problems occur in most suicides. Some of the possible distinctive traits of midlife suicides (versus younger and older suicides) include: loss of spouse, years of heavy drinking, reaching the age of high depression risk, and occupational problems (including unemployment, inability to work, and retirement). Midlife suicide rates tend to be highest among white males, although female suicide rates peak in midlife. The paper concludes with a review of assessment and treatment issues related to a half-dozen high-risk midlife suicide types.     

Confucianism and Youth Suicide in Rural China

This study examined the relationship between core Confucian ethics and suicide. We used a proxy sample of youths randomly selected from rural areas of three provinces in China. The proxy sample consisted of 382 completed suicides and 414 community living controls, all aged 15–34 years. Logistic regression analyses showed that among the Chinese youths (1) the Confucian ethic of filial piety was negatively associated with suicide; (2) the Confucian ethic of harmony moderated the estimated net effect of negative life events on suicide; and (3) the Confucian ethic of female subordination was positively linked with suicide. We also discussed implications of our study for future research.     

Teen suicide and changing cause-of-death certification, 1953-1987.

This study examines whether the purported tripling in teenage suicides since the 1950s represents a real increase or is simply an artifact of the increased skill of medical examiners in distinguishing youth suicides from fatal accidents. This study examines firearms and poisoning deaths, which together account for 75% of all certified youth suicides, from 1953 through 1987, and concludes: (a) a past undercount of youth suicides is likely, (b) the increase in youth suicide that has occurred is less dramatic than reported and resembles increases in adult suicide, and (c) the suicide increase indicated among youths and adults occurred from 1964 to 1971 and has since stabilized.     

A demographic analysis of suicide among U.S. Navy personnel

Age-, sex-, race-, and employment-adjusted standardized mortality ratios (SMRs) were calculated for sailors committing suicide between 1990 and 1996 and compared with adjusted SMRs for civilians. Cluster analyses were conducted on annual rates from 1983 through 1995 to examine differences between comparison groups across time and location. Results showed fewer than expected suicides for Caucasian and African American males and a somewhat higher than expected suicide rate among other ethnic group males and among Caucasian women. The suicide rate showed an increase during the study period, with some evidence toward a clustering effect in time and space.     

Youth suicide: insights from 5 years of Arizona Child Fatality Review Team data

Data on 153 youth suicides in Arizona (1994-1999) were used to explore demographic, behavioral, and experiential factors that distinguish between firearm suicide and suicide by other means. In bivariate analyses, White youths were more likely than non-White youths to use a firearm to commit suicide as were youths who had not experienced a life crisis or expressed suicidal thoughts in the past, relationships that hold in multivariate analyses at the p < 0.2 level. Targeted suicide prevention activities should supplement interventions focused on restricting access to highly lethal means of suicide such as firearms.     

Questions of culture,age and gender in the epidemiology of suicide

Cultural values were examined as predictors of suicide incidence rates compiled for men and women in six age groups for 33 nations for the years 1965, 1970, 1975, 1980, and 1985. Hofstede's cultural values of Power-Distance, Uncertainty Avoidance, and Masculinity (i.e., social indifference) were negative correlates of reported suicide, and Individualism was a strong positive correlate. The proportion of variance in suicide reports generally related to these four cultural values was R2 = 0.25. Suicide by women and by middle-aged people was most related to cultural values, even though international variance in suicide is greater for men and for the elderly. Suicide incidence for girls and young women showed unique negative correlations with Individualism. For all age groups, Individualism predicted a greater preponderance of male suicides, and Power-Distance predicted more similar male and female suicide rates. Social alienation and Gilligan's feminist theory of moral judgment were hypothesized to explain some gender differences.     

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.     

A Century of Suicide in Italy: A Comparison between the Old and the Young

This study analyzes suicide rates from 1887 to 1993 in the Italian population between the ages of 15 and 24 years old and over 65 years of age, based on official data published in the Health Statistics Year Book. The rates of death by suicide (per 100,000) subjects) are calculated for each year and for 10-year periods, as are the mortality rates relative to each method of suicide, standardized by gender. The latter analysis was possible starting from 1951 only, when it became customary to record method. The findings indicate an increase in the suicide phenomenon in the elderly population in Italy over the test period. Rates are at least 3 times higher for men than for women. The highest rates are reported for elderly men, but there appears to have been a greater proportional increase in the number of suicides committed by elderly women. The rise was statistically significant in both males and females. By contrast, a rather constant decrease in suicide rates in young people emerges from the beginning of the century through to the present date. This decrease is more marked in females, although suicide rates are lower for females than for males. Over the study period, substantial changes have come about in the suicide methods used by both young and old people. There was an increase in poisoning by care exhaust fumes, jumping from heights, hanging, and firearms.     

Bringing the Public Health Approach to the Problem of Suicide

Suicide and suicidal behavior are public health problems that should be addressed through a systematic public health approach. The need for such an approach can be found, for example, in Pierre, SD, where the suicide rate is 13 times the national rate; in the African American community, where the suicide rate among Black youths more than doubled between 1980 and 1995; and across the United States, where suicides outnumbered homicides in 1995. The U.S. Public Health Service is applying the public health approach to suicide by preparing the first-ever Surgeon General's Report on Mental Health, and by holding an October conference in Reno aimed at advancing a national strategy for suicide prevention.     

Zusammenhang zwischen Art der strafbaren Handlung und Suizid in Haftanstalten der USA

Does the nature of the criminal charge or conviction influence whether a jail or prison inmate will take his life? In the United States several nationwide surveys provide relevant information for answering this question. Studies of jail suicides in 1979, 1985 and 1986 respectively indicated that most inmates who committed suicide were charged with nonviolent offenses including drug related or minor offenses. In more recent national surveys the rate of suicide among jail inmates charged with violent offenses was triple that for those charged with nonviolent offenses. Offenses with the highest rates of suicide were kidnapping, rape and homicide. In prisons, where the rate of suicide is much lower than in jails, the rate of suicide for violent prisoners was twice that for nonviolent prisoners. Violent offenses with the highest rates of suicide in prisons included kidnapping, homicide, sexual assault and assault. Discussion addresses the discrepant results between the early surveys of jail suicides and the more recent surveys of suicides in jails and prisons. Further explored are possible explanations for the earlier predominance of nonviolent offenses among suicide victims, the recently elevated rates among violent offenses, and the elevated rates among specific criminal offenses. Commentary is also given to the practical implications of these findings.     

The Growing Use of Firearms by Suicidal Older Women, 1979–1992: A Research Note

Suicide among older women (65 +) has received very little attention despite increasing numbers of suicides in this population. An examination of national mortality data from the National Center for Health Statistics for the years 1979 through 1992 shows an increasing trend in rates of suicide among older women and a declining trend among women under 65. Over the 14-year period, firearms replaced poisoning as the most prevalent method of suicide by women 65 and over. The results seem consistent with the assertion that the availability, familiarity, and cultural acceptability of firearms may play a role in the choice of suicide method among older women. Although violent death and the use of firearms are generally associated with males in our society, the trends reported here indicate that greater attention to firearm suicides among older women is warranted.     

Characteristics of Completed Suicides: Implications of Differences Among Methods

Approximately 30% of suicides in New York City are the result of jumping from a height. After describing jumping suicides and jumping sites, we used polychotomous logistic regression to compare the characteristics of suicides by jumping to those of individuals committing suicide by hanging, ingestion, or shooting. Method used was significantly associated with sociodemographics, occupation, and mental health status, even after adjustment for individual access to the means of committing suicide. Our finding of an independent association between personal characteristics and method used provides strong evidence for the hypothesis that controlling access to an agent of suicide can influence overall suicide rates, at least in the short term. Study results support the introduction of preventive programs to control access to commonly employed agents of suicide.