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dc.contributor.author Roland Mergl
dc.contributor.author Nicole Koburger
dc.contributor.author Katherina Heinrichs
dc.contributor.author Székely, András
dc.contributor.author Tóth, Mónika Ditta
dc.contributor.author James Coyne
dc.contributor.author Sónia Quintão
dc.contributor.author Ella Arensman
dc.contributor.author Claire Coffey
dc.contributor.author Margaret Maxwell
dc.contributor.author Airi Värnik
dc.contributor.author Chantal van Audenhove
dc.contributor.author David McDaid
dc.contributor.author Marco Sarchiapone
dc.contributor.author Armin Schmidtke
dc.contributor.author Axel Genz
dc.contributor.author Ricardo Gusmão
dc.contributor.author Ulrich Hegerl
dc.date.accessioned 2016-06-21T10:28:26Z
dc.date.available 2016-06-21T10:28:26Z
dc.date.issued 2015
dc.identifier.citation pagination=e0129062; journalVolume=10; journalIssueNumber=7; journalTitle=PLOS ONE;
dc.identifier.uri http://repo.lib.semmelweis.hu//handle/123456789/2095
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 χ2-test for two-by-two tables. We assessed the effect sizes with phi coefficients (φ). 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) (χ2 = 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.
dc.relation.ispartof urn:issn:1932-6203
dc.title What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries
dc.type Journal Article
dc.date.updated 2015-07-31T09:02:23Z
dc.language.rfc3066 en
dc.identifier.mtmt 2919055
dc.contributor.department SE/AOK/I/Magatartástudományi Intézet
dc.contributor.institution Semmelweis Egyetem


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