What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries

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dc.contributor.author Mergl, Roland
dc.contributor.author Koburger, Nicole
dc.contributor.author Heinrichs, Katherina
dc.contributor.author Szekely, Andras
dc.contributor.author Toth, Monika Ditta
dc.contributor.author Coyne, James C.
dc.contributor.author Quintao, Sonia
dc.contributor.author Arensman, Ella
dc.contributor.author Coffey, Claire
dc.contributor.author Maxwell, Margaret
dc.contributor.author Vaernik, Airi
dc.contributor.author Van Audenhove, Chantal
dc.contributor.author McDaid, David
dc.contributor.author Sarchiapone, Marco
dc.contributor.author Schmidtke, Armin
dc.contributor.author Genz, Axel
dc.contributor.author Gusmão, Ricardo
dc.contributor.author Hegerl, Ulrich
dc.date.accessioned 2016-02-17T10:07:57Z
dc.date.available 2016-02-17T10:07:57Z
dc.date.issued 2015
dc.identifier.citation Mergl R, Koburger N, Heinrichs K, Székely A, Tóth MD, Coyne J, et al. (2015) What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS ONE 10(7): e0129062. doi:10.1371/journal.pone.0129062
dc.identifier.volume 10 en
dc.identifier.issued 7 en
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10468/2302
dc.identifier.doi 10.1371/journal.pone.0129062
dc.description.abstract Background: In Europe, men have lower rates of attempted suicide compared to women and at the same time a higher rate of completed suicides, indicating major gender differences in lethality of suicidal behaviour. The aim of this study was to analyse the extent to which these gender differences in lethality can be explained by factors such as choice of more lethal methods or lethality differences within the same suicide method or age. In addition, we explored gender differences in the intentionality of suicide attempts. Methods and Findings: Methods. Design: Epidemiological study using a combination of self-report and official data. Setting: Mental health care services in four European countries: Germany, Hungary, Ireland, and Portugal. Data basis: Completed suicides derived from official statistics for each country (767 acts, 74.4% male) and assessed suicide attempts excluding habitual intentional self-harm (8,175 acts, 43.2% male). Main Outcome Measures and Data Analysis: We collected data on suicidal acts in eight regions of four European countries participating in the EU-funded "OSPI-Europe"-project (www.ospi-europe.com). We calculated method-specific lethality using the number of completed suicides per method * 100 /(number of completed suicides per method + number of attempted suicides per method). We tested gender differences in the distribution of suicidal acts for significance by using the chi(2)-test for two-by-two tables. We assessed the effect sizes with phi coefficients (phi). We identified predictors of lethality with a binary logistic regression analysis. Poisson regression analysis examined the contribution of choice of methods and method-specific lethality to gender differences in the lethality of suicidal acts. Findings Main Results: Suicidal acts (fatal and non-fatal) were 3.4 times more lethal in men than in women (lethality 13.91% (regarding 4106 suicidal acts) versus 4.05% (regarding 4836 suicidal acts)), the difference being significant for the methods hanging, jumping, moving objects, sharp objects and poisoning by substances other than drugs. Median age at time of suicidal behaviour (35-44 years) did not differ between males and females. The overall gender difference in lethality of suicidal behaviour was explained by males choosing more lethal suicide methods (odds ratio (OR) = 2.03; 95% CI = 1.65 to 2.50; p < 0.000001) and additionally, but to a lesser degree, by a higher lethality of suicidal acts for males even within the same method (OR = 1.64; 95% CI = 1.32 to 2.02; p = 0.000005). Results of a regression analysis revealed neither age nor country differences were significant predictors for gender differences in the lethality of suicidal acts. The proportion of serious suicide attempts among all non-fatal suicidal acts with known intentionality (NFSAi) was significantly higher in men (57.1%; 1,207 of 2,115 NFSAi) than in women (48.6%; 1,508 of 3,100 NFSAi) (chi(2) = 35.74; p < 0.000001). Main Limitations of the Study: Due to restrictive data security regulations to ensure anonymity in Ireland, specific ages could not be provided because of the relatively low absolute numbers of suicide in the Irish intervention and control region. Therefore, analyses of the interaction between gender and age could only be conducted for three of the four countries. Attempted suicides were assessed for patients presenting to emergency departments or treated in hospitals. An unknown rate of attempted suicides remained undetected. This may have caused an overestimation of the lethality of certain methods. Moreover, the detection of attempted suicides and the registration of completed suicides might have differed across the four countries. Some suicides might be hidden and misclassified as undetermined deaths. Conclusions: Men more often used highly lethal methods in suicidal behaviour, but there was also a higher method-specific lethality which together explained the large gender differences in the lethality of suicidal acts. Gender differences in the lethality of suicidal acts were fairly consistent across all four European countries examined. Males and females did not differ in age at time of suicidal behaviour. Suicide attempts by males were rated as being more serious independent of the method used, with the exceptions of attempted hanging, suggesting gender differences in intentionality associated with suicidal behaviour. These findings contribute to understanding of the spectrum of reasons for gender differences in the lethality of suicidal behaviour and should inform the development of gender specific strategies for suicide prevention. en
dc.description.sponsorship European Commission (Seventh Framework Programme Grant Agreement No. 223138); Universität Leipzig, Germany (Open Access Publishing program) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Public Library of Science en
dc.rights © 2015 Mergl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject Case fatality rates en
dc.subject Behavior en
dc.subject Deaths en
dc.subject Multicenter en
dc.subject Depression en
dc.subject Alliance en
dc.subject States en
dc.title What are reasons for the large gender differences in the lethality of suicidal acts? An epidemiological analysis in four European countries en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Ella Arensman, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: earensman@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.wokid WOS:000358157600018
dc.contributor.funder Seventh Framework Programme
dc.contributor.funder Deutsche Forschungsgemeinschaft
dc.contributor.funder Universität Leipzig
dc.description.status Peer reviewed en
dc.identifier.journaltitle PLOS ONE en
dc.internal.IRISemailaddress earensman@ucc.ie en
dc.identifier.articleid e0129062
dc.relation.project info:eu-repo/grantAgreement/EC/FP7::SP1::HEALTH/223138/EU/Optimizing suicide prevention programs and their implementation in Europe/OSPI-EUROPE


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© 2015 Mergl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Except where otherwise noted, this item's license is described as © 2015 Mergl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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