Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries

Abstract

BackgroundOver 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors. MethodsData on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product. ResultsBoth continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0–5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4–3.3) and Asia (2.7, IQR: 1.8–3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7–4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3–3.8).The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (–0.30, p < 0.0001). ConclusionThere are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.