Trigger warning: Due to the issues discussed such as mental health illness, self harm, and suicide, this article may trigger emotional distress in some readers.
A Facebook live went viral in Myanmar on 8th June 2020 and it isn’t any regular celebrity live or social media trends, but a tragic event where a man committed suicide in front of his child after having quarrel with his wife. This man had a record of substance abuse and depression. But no matter the record, just the idea of a child witnessing such a tragic event and the man himself becoming a victim of mental health illness is an issue that the society must never neglect.
Less than a week apart, Sushant Singh Rajput, a Bollywood star, passed away by the act of suicide on 14th June even though it is said that his life was extraordinary as the characters he portrayed. Despite unclear cause of suicide, the fact remains that mental health doesn’t choose their victim rich or poor, famous or otherwise.
This issue is even more pertinent when the global pandemic is involved. A recent study by the Center for Disease Control (CDC) reports that young people are experiencing more suicidal thoughts during this pandemic. For people ages 18-24 in the survey, 25% said that they seriously considered suicide.
The Global Burden of Disease Study in 2017 estimates that 792 million people lived with a mental health disorder, which comprises depression, anxiety, bipolar, eating disorders and schizophrenia. This amounts to slightly more than one in ten people globally (10.7%). The same study shows that every year, almost 800,000 people die from suicide. This makes it one of the leading causes of death globally. Around twice as many die from suicide as from homicide. Suicide is more common than homicide across most countries in the world – often as much as ten to twenty times higher.
Interestingly, gender-disaggregated data reveals surprising findings about gender differences in depression and suicide rate. While a higher proportion of women (4.1%) experience depression than men (2.7%), male to female age-standardized suicide rate in 2016 was 1.8. This finding is augmented by the WHO data in the same year which shows, nearly 40% of countries have more than 15 suicide deaths per 100,000 men; only 1.5% show a rate that high for women. The Tableau illustration below demonstrates age-standardised suicide rate estimate per 100,000 persons in 2016. In every continent, male suicide rate is higher than that of female’s. Take for example, in Eastern European countries, male suicide rates in Ukraine, Belarus, Lithuania, and Latvia are higher than female’s by at least 6-8 times. In the neighbouring Russia, a whopping 48.3 per 100,000 males committed suicide compared to 7.5 in females.
Despite low suicide rates in female globally, we must not neglect the trend over time. Death by suicide is still concerning, especially among young girls which see an uptick in some countries in the past decade. In the United Kingdom, the number of women and girls between the ages of 10 and 24 recorded as having taken their own lives has increased by 94 per cent since 2012. Tom Madders, director of campaigns at YoungMinds explained that traumatic experiences at a young age – such as bereavement, bullying or abuse – as well as school pressure, and difficult relationships with family or friends, among other things, could have a significant impact on girls’ and young women’s mental health.
So what caused males to commit suicide more despite having fewer depression rate than females?
While most people with depression do not die from suicide, having a major depression raises the risk of suicide relative to those without depression. The risk of suicide death can be related in part to the severity of the depression. New depression research that tracked people over long periods of time shows that about 2 percent of all people who have only been treated for depression in an outpatient environment would die from suicide. Among those ever treated for depression in an inpatient hospital setting, the rate of death by suicide is twice as high (4 percent). As for inpatients who were treated for depression following suicide ideation or suicide attempts, the likeliness to die by suicide is three times as likely to die by suicide (6 percent) as those who were only treated as outpatient.
Alcohol consumption gender role appropriate behavior: According to data, there is a strong link between alcohol dependence and depression in men, while depression can also be a consequence of alcohol abuse. A study reported a depression rate in patients with alcohol abuse that was 4 to 5 times higher than that in the general population, and in 55 % to 70 % of substance abusers who committed suicide, depression has been found as a comorbid condition (Murphy 1998).
Back in around 1990, alcohol consumption and suicide rates have been analysed in 13 countries (Belgium, Canada and some European countries) and the findings were that 10 out of 13 are directly related in alchohol consumption and suicides. However, suicide rate in Hungary had fallen over 30 percent even though there was a 25 percent rise in alcohol dependence rate and 6-fold increase in the unemployment rate. Even though the relation of suicide and alchohol dependences requires further research, recent studies claim possible relationships between them as alcohol use may cause suicidal ideation, behaviour and suicidal ideation can result on alchohol dependence. Therefore, it is safe to assume the two phenomena are related to each other.
Demystifying the gender differences in suicide rates
One method theory is that it is commonly believed suicide, as a violent act, is masculine and that is why it happens more in males than in females (Steffensmeier 1984). Therefore, even among suicide victims, males are more likely to end their lives through violent means (guns, jumping, hanging, etc.), while females primarily use less violent methods such as overdosing on medications (Callanan and Davis 2011, 2012). A detailed explanation has not been found yet, but the factors include gender-role oriented, male social status, Postmodern individuality and guilt on unemployment according to the research “ Why are men so vulnerable” by Anne Maria Moller-Leimkuhler.
Postmodern individuality: Traditional gender role expectation is reinforced by individualism such as social isolation from family, community whereas it has a positive effect for women who perceive themselves as interdependent, thus remaining socially connected. But for males, in this postmodern era, they try to cope alone which causes this individuality that in a way, leads to suicidal ideation.
Male social status: Adolescent males often respond to mental health issues with ‘excessive’ masculinity (risk-taking, aggression, violence) to validate their male social status. As boys are taught to be stoical and to ignore symptoms (“boys don’t cry”) (Grossman, Wood 1993; Traue 1998). This is presumably one core problem that males are facing, one reason that leads to the higher male suicide rates. And thus the aggression, the so-called male social status has so much impact for the implementation of the suicidal ideation of males.
Women seek help – men die: This conclusion was drawn from a study of suicide prevention in Switzerland (Angst, Ernst 1990). 75 % of those who sought professional help in an institution for suicide prevention were female, and 75 % of those who committed suicide in the same year were male. Wrapping up, most of the factors related to each other, males are the most likely to die than ask for help.
Exceptional cases
Not all countries have a high males-female suicide ratio, such as China, one would be that women in a very traditional Confucian family are discouraged from participating in social activities, cultivating talents, along with many other factors that pressured women to have depression and thus a higher suicide ratio than males.
But there are still exceptional cases in the change of male to female suicide ratio that needs to be put into consideration. An example is that in-between (1950-1960) females’ suicide rates increased due to dramatic changes of female roles in that time, such as the increase of divorce, changing attitude towards fertility, education and labour engagement. After 1970, female sucide rate decreased having adapted to those situations while males suicide rates increased disproportionately which caused the gap to widen alot.
How to prevent future tragedies - Useful resources for suicide prevention
For people who have quite a good mental health condition, it can be a mystery when it comes to dealing with people who have suicidal thoughts. Contrary to popular belief, asking about suicide will not put the thought of a suicidal person. According to QPR Institute, just as talking about physical pain helps diminish it, talking about suicide with someone willing and able to listen, reduces psychological pain almost immediately. Even if you do not know how to converse with someone about suicide, trying to be aware of the behaviours change or signs of your friends, your family or anyone close and getting them help could actually save a life.
Now with the pandemic, more people are seeking help because of social isolation. Online therapy company Talkspace reported a 65 percent jump in clients since mid-February to May this year. So especially in this period, for reaching out for help, below are the online resources and help if you or someone in your community requires help.
- All in the family counseling ( South East Asia )
- Safe Space ( From Singapore ) Both online and offline
- Call me today, a non-profit org ( From Myanmar, for locals )
- Talk Space ( Therapy session )
- Pride counselling ( for LGBT community )
- Teen Counselling ( For Teens )
Gatekeeper training for those who might require more help and use the self-care tools like self-care wheel. The self-care wheel developed by Olga Phoenix helps individuals to manage every-day stress, and increase contentment and life satisfaction. There are over 80 exercises that can be used to learn about which areas of your life need improvement. Practicing effective self-care means finding a balance between the six sectors, each of which requires daily attention. Additionally, the self-care application Samaritan provides free online call.
September 10th of every year is World Suicide Prevention Day. But as the statistics in this article explicitly advocates for, we need more than one day to raise awareness on the alarming rate of suicide in not just men, but also women, especially among people in their 20s. Every day, we must do our part to fight mental health stigma so that those with mental health illness can seek the help they need in time without fear of discrimination. Suicide is the most preventable kind of death and your action can save a life. If you don’t know where to begin, the QPR Institute advise that saying “I want you to live” or “I’m on your side. We’ll get through this” will cut through isolation and hopelessness of people with suicidal thoughts. Your willingness to listen and to help can rekindle hope and make all the difference.