period of mid-life crisis, and the third local maxi- mum of the diagram is the old age group (about 80 years old), at the end-of-life period. In the groups of young ...
Croat Med J 2005;46(2):288-293
CLINICAL SCIENCE
Gender Differences in Suicide Attempters in Hungary: Retrospective Epidemiological Study Sandor Fekete, Viktor Voros, Peter Osvath Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
Aim Methods
Results
Conclusion
To determine gender differences in suicidal behavior and investigate the factors associated with suicide attempts. In the framework of the WHO/Euro Multicenter Study on Suicidal Behavior, 1,158 suicide attempts have been registered and analyzed retrospectively in Pécs center, Hungary. Descriptive statistics and logistic regression analysis were performed to compare the characteristics of male and female suicide attempters. A “typical” female suicide attempter could be characterized as follows: retired or economically inactive (OR=2.38), widowed (OR=6.55), divorced (OR=1.64), or with depression in her personal history (OR=1.27). Female attempters were mainly repeaters, using the method of self-poisoning, mostly with benzodiazepines. Among men, unemployment, living alone, never having been married, and problems with addiction were the main risk factors, while violent methods characterized the typical attempt In the cases of self-poisoning, men were more likely to take meprobamate or carbamazepine. Significant differences were found in the risk factors for suicide attempts between men and women. Since suicide is a multi-causal phenomenon, its therapy and prevention should be complex and gender differences should be taken into consideration while building up our helping strategies.
Since gender is regarded as one of the most important risk factors for suicide, gender differences in suicidal behavior have been analyzed in a number of recent studies (1-3). According to these, several socio-economic, demographic, psychiatric, familial, and help-seeking differences can be recognized between men and women in protective and risk factors (4-5). In most countries, with the exception of China (6), there are more completed suicides among men than women (male:female ratio=2-5:1). However, as it is known from gender paradox (2), there are more attempted suicides among women (female:male ratio=5-10:1). In the last couple of years, most countries have experienced a decrease in the overall
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suicide rates (mainly in older women), despite the slight increase in the rates of younger age groups, particularly among men (7,8). Social factors – mainly linked to changes in gender roles and the fact that men respond more strongly to changes in social and economic conditions, seem to be the most probable explanations of the phenomenon (9). Regarding socio-economic factors, unemployment, retirement, single life, and extended illness are significant risk factors for suicide, especially among younger men (10). Several studies and summarized clinical impressions have suggested that the compliance for the therapy and prevention is poorer in male than in female patients (1). Among men, marriage seems to be a protective factor in its own right whereas for women, having a small child could explain the protective effect of
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marriage (10). Another study identified pregnancy as a protective factor for women (11).
Given the fact that gender is one of the most important risk factors for suicide, and that previous suicide attempts occur in the anamnesis of many completed suicides, we find it important to study suicide attempters in relation to gender differences. Reliable data are available mainly on the characteristics of suicide victims, so our aim was to detect differences in suicidal behavior between men and women in a large sample of medically treated suicide attempters in Hungary, a country with one of the highest suicide rates in the world. This analysis was performed within the framework of the WHO/Euro Multicenter Study on Suicidal Behavior (13,14). The aim of the European collaborative study was to identify epidemiological and socio-demographic features of suicide attempters to find protective and risk factors for suicide attempts. Personal and social characteristics predictive for future suicidal acts and psychological background or life events were also detected. Patients and Methods Within the framework of this multicenter study, 1,158 monitored suicide attempts were collected in the Pécs Center, Hungary from July 1, 1997 to June 30, 2001, within geographically defined catchment areas comprising populations of 190,000.
The registration of attempted suicides was carried out on consecutive episodes at university clinics in Pécs. We detected and analyzed all suicide attempters who were treated in our psychiatric in-patient department and in our outpatient service in the given period. The recorded events included only the cases of medically treated suicide attempters; suicide attempters who were not brought to the attention of health care system (approximately 20-30% of all the attempters) were not included. We assessed the rate of suicide attempters who were not brought to the attention of health care system by asking present attempters about medical treatments after their previous attempts. We concluded that approximately 3 of 4 attempts were treated by health personnel in this area.
Gender Differences in Suicide Attempters
Concerning the differences in suicide methods, it is recognized that men tend to use violent methods of both suicide and attempted suicide more often than women, who are more likely to choose self-poisoning.
In this analysis, we used our local database in Pécs Center containing data on 1,158 suicide attempters to determine gender differences in suicide attempters.
Fekete et al:
Mental illnesses are the most consistent predictors for suicide in both genders, especially among women. In a longitudinal study, hospitalized mental illnesses (particularly a recent discharge from a psychiatric hospital) appeared to be the most prominent risk factor for suicide. Affective disorders carry the highest risk, both to men and women, and often co-morbidly with personality disorders and other mental disorders. Rates of schizophrenia and addictions are higher among men, whereas eating disorders, especially anorexia nervosa, are more common in female suicide victims (5,12).
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In data collection, we used a standardized monitoring form developed for the multicenter study. This structured interview, conducted by psychiatrists, contains items about age, gender, date and time of the suicide attempt, the method, details of the attempt, clinical diagnosis of the patient according to ICD-10 (diagnosed by two trained psychiatrists at the discharge from hospital), details of previous suicide attempts, and various medical and socio-demographic variables (e.g. medication, level of education, and family status). In the statistical comparison, descriptive statistics (c2 test) and logistic regression analysis were performed using the procedures available in Statistical Package for Social Sciences for Windows, version 10.0 (SPSS, Inc., Chicago. IL, USA). Results Of 1,158 medically treated suicide attempters, 63% (n=728) were women. The mean age of the patients was 36.4±15.2 years (mean± standard deviation; range 14-89). Women were older than men (37.4±16.4 years vs 34.7±13.3 years, F=8.441, df=1; P=0.004). There were more suicide attempts among women in most age groups (except the 25-29, 36-39, 55-59, 75-79, and 85-90 age groups); the highest rates were in the adolescent
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2005;46(2):288-293
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Gender Differences in Suicide Attempters
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Figure 1. Suicide attempts by age groups. Data from Pécs center of the WHO/Euro Multicenter Study on Suicidal Behavior, 2001. Open bars – women, closed bars – men.
Fekete et al:
and middle-aged population in both genders (Fig. 1) More than half of the attempts were repeated suicide attempts, both in men (53.3%) and women (52.1%). The most common diagnosis was adjustment disorder (55.3% in women, 50.2% in men, P=0.074) in both genders, which in fact corresponded to an emotional crisis situation. It was followed by depressive disorder in women (18.78% in women, 11.14% in men, P
