The Gender Paradox in Suicide

In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.     

Improving the validity and reliability of medical-legal certifications of suicide

On a very basic level, those who study suicide are either explicitly or implicitly concerned with the certification of suicide deaths by coroners and medical examiners. Although many authors have questioned the reliability and validity of officially reported rates, these statistics continue to be quoted as fact--a potentially problematic practice for researchers who seek accurate and true causative factors for suicidal behavior. In relation to this topic, this article provides an overview of the existing vital statistics registry system and describes and proposes innovations that could ultimately improve the quality of officially reported suicide statistics.     

Double Jeopardy: Suicide Rates in Forensic Hospitals

While a number of studies have described high and increasing rates of completed suicide among psychiatric patients, the suicide risk of forensic hospital patients is virtually unknown. This paper reports on the suicides that have taken place in the country's oldest continually operating institution housing persons formerly labeled “criminally insane,” the Bridgewater State Hospital. The results show considerable variation in the suicide rate by historical period, with suicide prior to 1968 a considerably more infrequent event. By contrast, the post-′68 rate of 232 per 100,000 is comparable to data reported in a series of studies of psychiatric suicides, and significantly higher than that found in U.S. studies of correctional populations. These differences are discussed. The results strongly suggest that forensic hospital populations have suicide rates broadly comparable to other psychiatric populations.     

The Suicide of Seymour Glass

ABSTRACT: This paper explores the suicide of Seymour Glass, a major character in J. D. Salinger's fiction and utilizes the “psychological autopsy” technique as a framework for investigating the psychodynamics of Seymour's death. Based upon materials provided throughout Salinger's stories, the suicide is analyzed in terms of five major elements related to Seymour's emotional state and manifest behaviors: (1) details of the death; (2) personal history; (3) level of perturbation; (4) personality and life-style; and (5) intention and lethality of the act. Additionally, this essay posits various interpretations of the suicide and allows for insights into the psychodynamic functioning of a major literary character.     

A consideration of the validity and reliability of suicide mortality data

The question of the validity and reliability of suicide statistics may be considered at three levels: (1) Are suicide deaths misidentified or differentially identified across jurisdictions or over time? (2) To what degree are suicide deaths misidentified? and (3) Is the degree to which suicides are misidentified sufficient to threaten the validity of research based on suicide statistics? There is general agreement that suicides are likely to be undercounted, both for structural reasons (the burden-of-proof issue, the requirement that the coroner or medical examiner suspect the possibility of suicide) and for sociocultural reasons. There is also substantial anecdotal and empirical evidence suggesting that the mode of death for some true suicides is in fact certified as other than suicide. Overall, it does not seem that very many true nonsuicides are incorrectly certified as suicides. There is not, however, much agreement as to the degree to which true suicides are undercounted. At least some of the inconsistencies in the findings of different investigators arise because the validity of suicide certification seems to vary from place to place. But the source of apparent conflicts in many of the findings is undoubtedly the lack of a "gold standard" against which the verdicts of any given death certification process can be measured. At best, we can estimate that the sensitivity with which coroners and medical examiners certify true suicides varies from approximately 55% to 99%. A central question in estimating the sensitivity of suicide certification is this: What proportion of true suicides are either equivocal or likely to go unsuspected by the coroner or medical examiner? Very little has been done to investigate this issue. Yet the sensitivity of suicide certification clearly varies for equivocal versus unequivocal suicides. As shown in Table 1.2, specificity is also at issue when it comes to certifying equivocal cases. The final question--whether the degree of undercounting of suicide deaths is so great that it threatens the validity of research based on official statistics--is at the crux of the general concern about suicide certification. There are examples of studies in which conclusions based on crude comparisons of reported suicide statistics appear to be invalid. For the most part, these are comparisons among nations with substantially differing death certification procedures. When official statistics are interpreted with a degree of caution and an understanding of the source and direction of biases likely to affect the published rates, however, it seems unlikely that major conclusions based on these statistics will be in error.(ABSTRACT TRUNCATED AT 400 WORDS)     

Suicide: The Psychosocial Dimension

ABSTRACT: This paper explores the relationships among culture, character, and suicide. It draws on the author's research in Scandinavia and his studies of suicide among United States urban blacks and college students. The differences in motivation and significance of suicide in Sweden and Denmark are illustrated. The United States is an amalgam of subcultures which must be studied separately to identify the psychosocial determinants of behavior. The varying rates and motivations for suicide in different cultures and subcultures, the differences between men and women, between young and old, differences in ways of coping with love and loss, life and death make clear that suicide is part of a culture's possibilities. The varying psychodynamic ways in which the suicidal individual in differing cultures and subcultures conceives of, uses, and absorbs death also has much to tell us about how we live.     

Suicide of Japanese Youth

ABSTRACT: The uniquely intense stress due to the Examination Hell (shiken jigoku) not only generates a basic drive for Japan's economic success but also contributes to a high rate of young people's suicide. This paper discusses the major factors in the intensity of Japanese stress on both institutional and psychological levels. The social structural factors which convert stress to suicide are analyzed in terms of weak ego; restraint on aggression; a lack of social resources; and views of life, death and suicide. Japanese views of life, death and suicide are treated in terms of Absolute phenomenalism, the original form of Shintoism, to which Buddhism and Confucianism have been adjusted in Japan. Japanese phenomenalism affects suicide through its three aspects: animism, present-time oriented small groupism, and the absolute acceptance of the established social order. Confusion and conflict since World War II have increased anomic suicides; however, elements of fatalistic suicide (due to excessive formal or informal social regulations) and altruistic suicide (due to strong social integration) are evident. Suicide is still a highly institutionalized adjustment mechanism in Japan.     

The Scandinavian Suicide Phenomenon—Myth or Reality?

ABSTRACT: This paper reexamines the “Scandinavian Suicide Phenomenon,” the observation that reported suicides are typically high in Denmark and Sweden and typically low in Norway even though these three countries seem otherwise similar. It has been suggested that in Norway more suicides are reported as accidental death or as death due to unknown causes. This paper explores this possibility by means of a detailed examination of causes of death. Nine other countries are included in the comparisons to facilitate interpretation of the findings. It was found that there were significantly higher rates of accidental and unclassified deaths in Norway than in Denmark or Sweden; if it is assumed that many of these are suicide, this could account for the reported differences in suicide rates.     

Suicide in Japan: socioeconomic effects on its secular and seasonal trends

Changes in male and female suicide death rates for 33 years following the end of World War II in Japan were analyzed. The death rates for men and women decreased during periods of economic prosperity and then increased during the years preceding economic depression; that for men also increased after economic depression. When examined by profile analysis, the seasonal variation was slightly but significantly different in the four time periods (1950-1955, 1955-1967, 1967-1974, and 1974-1982) in both sexes except between the last two periods (p less than .05). We suggest that death by suicide and its seasonal variation in Japan were affected by changes in socioeconomic conditions.     

The Effectiveness of Suicide Prevention Centers: A Review

This article reviews 14 studies examining whether suicide prevention centers have a preventive effect on suicide rates. Seven studies were identified that provide some support for a preventive effect, one found an increase in the suicide rates, and six failed to find any significant effects (either preventive or facilitative). The studies' different methodologies are reviewed, and limitations on the authors' conclusions pointed out. The conclusion of this article is that the evidence provides support for a preventive effect from suicide prevention centers, albeit small and inconsistently found.     

Suicide bereavement and recovery patterns compared with nonsuicide bereavement patterns

This study compared bereavement experiences of suicide survivors with those of other survivors. The primary focus of investigation was upon grief reactions suggested to be unique to suicide bereavement and upon quality of grief resolution 2-4 years after death. Fifty-seven women and men, between the ages of 24 and 48, who had experienced the death of a marital partner were interviewed. Subjects were assigned to one of four groups by mode of death (suicide, accident, unanticipated natural, and expected natural). Analyses of variance and Scheffe procedures indicated no significant differences among survivors on frequencies of grief reactions considered common to all bereavements. The suicide survivors were significantly different from all others on certain grief measures, including rejection and unique grief reactions. On various other grief measures, significant differences were indicated among the groups of survivors. Four primary conclusions, implications of the findings, and limitations of the study are discussed.     

Physicians View Death and Suicide*

ABSTRACT: Comparisons were made between physicians' attitudes toward death and suicide and those of a nonphysician control group. Results of the analysis revealed significant differences that may offer some insights as to why physicians have an elevated suicide rate.     

Suicide: A decade review of the sociological literature

Major works on suicide are reviewed and classified into four analytic categories according to their theoretical emphasis: cultural, economic, modernization, and social integration perspectives. The research under these paradigms is assessed in terms of four themes. First, attention is drawn to research evidence that questions traditional theories. An example is Durkheim's position on social class and suicide. Second, the review notes several new theories including Phillips’ imitation thesis and the author's own model of migration's effects on suicide. Third, the paper observes and reviews explanations of new trends in suicide rates such as the rapid increase in youth suicide and the decline in suicide among the elderly. Finally, the review calls attention to explanations of suicide, such as that linking suicide to low marital solidarity, that have withstood the test of the more rigorous empirical testing of recent times.     

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.     

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.     

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self‐reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence‐based components—entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre‐suicidal mental state, regardless of their self‐reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.     

Preliminary Validation of a Korean Version of the Acquired Capability for Suicide Scale‐Fearlessness About Death

The interpersonal‐psychological theory of suicide proposes that the desire for suicide must be accompanied by the capability to do so in order for an individual to engage in suicidal behavior. The Acquired Capability for Suicide Scale‐Fearlessness about Death (ACSS ‐FAD ) measures fearlessness about death, a core component of the capability for suicide. This study aimed to validate a Korean version of the ACSS ‐FAD in a college student sample. We administered the ACSS ‐FAD and measures of suicide ideation, fear of suicide, death anxiety, pain anxiety, and depression in a sample of Korean college students (N  = 301) and analyzed its reliability, factor structure, invariance across genders, convergent validity, and discriminant validity. The one‐factor model achieved satisfactory model fit. Across genders, partial metric invariance and partial scalar invariance were established. The results also revealed that the ACSS ‐FAD has good internal consistency, convergent validity (positive correlations with fear of suicide, death anxiety, and pain anxiety), and discriminant validity (no relation with depression). The Korean version of the ACSS ‐FAD presents adequate psychometric properties and may be considered to be a promising instrument for measuring fearlessness about death in college students.     

The Evolution of Epidemic Suicide on Guam: Context and Contagion

Thirty years of suicide rates for Guam were analyzed by age, sex, period, and cohort. Youth suicide increased rapidly in the 1990s; certain cohorts have higher rates. Four explanatory factors are discussed, including ecological factors and migration from the Federated States of Micronesia. Direct and indirect suicide contagion followed the death by suicide of a respected politician, strongly influencing period and cohort patterns. Suicide pacts inflated suicide among young people. These factors acted in combination to produce epidemic levels of suicide in the 1990s.     

Risk Factors Proximate to Suicide and Suicide Risk Assessment in the Context of Denied Suicide Ideation

Health care providers have significant opportunities to identify individuals at near‐term risk for suicide, but lack empirical data on near‐term risk factors. This study aimed to identify dynamic, state‐related risk factors observed by clinical practitioners within the last 30 days of life of 157 patients who died by suicide and to compare these near‐term risk factors among patients who denied versus responded positively to having suicide ideation (SI ) when last asked by a clinical practitioner prior to their death. Risk factors charted for the majority of all decedents were a history of prior suicide ideation and/or suicide attempt, current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, and a family history of mental disorder. Two‐thirds of patients denied having SI when last asked and one‐half of these patients were dead by suicide within 2 days. Decedents who denied having SI were quite similar in charted diagnoses, symptoms, behaviors, and environmental circumstances to decedents who responded affirmatively to having SI . Reliance on verbalized or reported SI as a gateway to a suicide risk assessment is questioned and the need for better understanding near‐term risk for suicide, particularly in the absence of stated SI , is highlighted.