Explaining Gender Differences in Non-fatal Suicidal Behaviour Among Adolescents

From BMC Public Health Explaining Gender Differences in Non-fatal Suicidal Behaviour Among Adolescents A Population-based Study Michael Kaess; Peter Parzer; Johann Haffner; Rainer Steen; Jeanette Roos; Martin Klett; Romuald Brunner; Franz Resch Posted: 09/27/2011; BMC Public Health. 2011;11(597) © 2011 BioMed Central, Ltd. Background While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents. Methods A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female. Results Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R2 of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained. Conclusions The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age. Background Suicide and non-fatal suicidal behaviour are both well-recognized public health problems in young people.Whereas the prevalence of suicide and suicidal behaviour remains relatively low before puberty, adolescent suicide is one of the leading causes of death in the teenaged group.In Europe, suicide is the second leading cause of death in male and female adolescents. In the USA, suicide is reported to be the third leading cause of death after accidents and homicides.According to the findings of a WHO multi-centre study conducted in young people 15 to 24 years of age, the increase in suicide has been shown to be associated with an increase in suicide attempts. Results of a systematic review of 128 studies on the prevalence of suicidal phenomena in adolescents revealed that, on average, 9.7% (95% CI 8.5 to 10.9) of adolescents reported to have attempted suicide while even 29.9% (95% CI 26.1 to 33.8) of these adolescents indicated having thought about suicide at some point in their life. One of the strongest predictors of completed suicide or further suicide attempt has been found to be a previous suicide attempt. Therefore, suicide attempts and also suicidal thoughts in adolescents must always be taken seriously, in spite of the fact that for every death of a young person from suicide, many suicide attempts have already been undertaken, especially by girls. In most western countries, females are more likely to engage in suicidal behaviour, but are less likely to die as a result of a suicidal act than males. This "gender paradox" is known to be extremely distinctive in adolescents; during this period of life suicide attempts are 3–9 times more common in girls while completed suicides rates are 2–4 times higher in adolescent males. Many epidemiological studies so far have reported higher rates of non-fatal suicidal behaviour in females which could indicate a gender-specific predisposition for the experience of suicidal thoughts and suicide attempts during this life-period. As regards mental illness as one of the strongest risk factors for suicidal behaviour, depression and anxiety in particular seem to function as mediators of adolescent suicidal behaviour. But drug abuse, risk behaviours and other types of externalizing psychopathological behaviours are also associated with an increased risk of suicide among adolescents. There is only little empirical research which investigated the reasons underlying the correlation of being female and showing higher rates of suicidal thoughts and suicide attempts during adolescence. One theory is that gender differences in psychopathology could play an important role in this issue, suggesting that different types and characteristics of emotional and behavioural problems may primarily lead to unequal rates of suicidal behaviour in female and male individuals. Therefore, our hypothesis was that gender differences in non-fatal suicidal behaviour among adolescents could mainly be explained by the gender differences in emotional and behavioural problems.