From yonder sea
May his cold Trojan eyes discern the flames
That make me ashes! Be this cruel death
His omen as he sails!" She spoke no more.
But almost ere she ceased, her maidens all
Thronged to obey her cry, and found their Queen
Prone fallen on the sword, the reeking steel
Still in her bloody hands.
Virgil, Aeneid 4.663-70
Many studies have identified a strong link between suicide and diagnosable mental illness, especially depression. So because women suffer from depression at a much higher rate than men, they would seem to be at higher risk for suicide. But women actually commit suicide about one-fourth as often as men.
General Risk Factors
Six important risk factor domains for suicidal behavior have been identified:
1. A history of mental or addictive disorder: including mood disorders, which have a higher incidence among women, and substance abuse, which is more frequent in men.
2. Personality traits: aggressiveness, impulsiveness, hopelessness, cognitive rigidity and antisocial behaviors.
3. Psycho-social and environmental factors: physical or sexual abuse, decreased familial or social supports, parental loss, exposure to suicidal behavior, negative life events, chronic physical illness, pregnancy in adolescent females, or being a runaway.
4. A family history of suicidal behavior or mental illness.
5. Biological correlates including certain hormonal factors and a deficiency in the neurotransmitter serotonin.
6. High-risk epidemiologic and demographic factors: being male; being between the ages of 15 and 24 or over the age of 65; or being single, recently widowed, separated or divorced. It is the overlap of risk factors from several domains which increases the risk of suicide. In people who have a combination of these overlapping risk factors a humiliating life event is frequently the trigger to suicide; this precipitant is found in 90 percent of cases of suicide.
More women than men have dysthymia, seasonal affective disorder, and rapid-cycling bipolar disorder, for example, and women's higher rate of attempted suicide may be related to this elevated rate of mood disorder. However, it is the overlap of other factors that may account for men's higher rate of completed suicide, as men, more than women, experience the "lethal triad of suicide": the overlap of impulsive and aggressive personality traits, substance abuse, and depression.
Suicide and Suicide Attempts
Only 5-10% of women who attempt suicide do eventually kill themselves. Given the far greater number of suicidal attempts than completions by women, it becomes pivotal to understand the experience of the woman who attempts suicide as compared to the woman who completes suicide. Generally, the woman who attempts suicide is not of the same risk population as her sister who completes suicide. The prototypical or modal woman who attempts suicide is a young, white, unmarried, heterosexual woman. She comes from a chaotic family with whom she is still living and has a history of chronic interpersonal conflicts and previous suicidal attempts.
The prototypical person who completes suicide is an older, unemployed, married or widowed man, living alone. She is more likely to be alcoholic, to have made fewer suicidal attempts, to have more legal problems, and to have sought help less often. The precipitating event is often a humiliation sustained in the realm of employment or ill health.
Risk Factor for Middle-Aged Women
2011 report from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows a 49 percent increase in emergency department visits for drug-related suicide attempts for women aged 50 and older.
And women aged 40-69 are more at risk of killing themselves than other women, according to new research on age-specific suicide rates between 1998 and 2007. In 2007, this age group made up 60 percent of the 7,328 suicides reported among women.
But why middle-aged women?
It could just be a question of numbers: One in four adults in the U.S. has a treatable mental health condition, and middle-aged women are one of the fastest-growing populations in the country.
Or it may have something to do with baby boomers’ higher rates of substance abuse, an important risk factor in suicide, said Julie Phillips, Ph.D., a social demographer and associate professor at Rutgers University in New Jersey. Phillips calculated the age-specific rates from data from the National Center for Health Statistics and the Census Bureau. And during the nine-year time period she studied, suicide rates are fairly stable for women younger than 40, and for women older than 70, suicide rates are actually on the decline.
Women over 50 may also be in crisis because pain and sleep disorders — common problems with aging — can lead to an increased use of prescription drugs, according to Albert Woodward, Ph.D., the project director of SAMHSA’s Drug Abuse Warning Network. According to the SAMHSA report, suicide attempts involving drugs to treat anxiety and insomnia increased 56 percent. Woodward adds that older women may experience depression because of health changes and other negative life events.
Loneliness and depression are also suicide risk factors. "Older women especially in the U.S. are more isolated and separated from daily human contact outside of work and the internet," says Ellyn Kaschak, Ph.D., emeritus professor of psychology at San Jose State University and the editor of the journal Women & Therapy.
Dr. Leslie Beth Wish, a psychologist and licensed clinical social worker in Sarasota, Fla., has found through her online surveys, lectures and focus groups a startling increase in suicide attempts with women ages 45 to 54. Women are susceptible to depression but older women may also be suffering from pre-menopause hormone fluctuations that can affect mood changes and depression. Also, existing long-term illnesses such as lupus or multiple sclerosis can worsen and breast cancers and other cancers might be diagnosed.
Dr. Wish also says middle-aged women are more aware of their mortality and may be disappointed and disillusioned that it’s too late for happiness. Transitioning to becoming an empty nester can also be stressful for women.
“Mental illness is a real debilitating illness,” Farhat says. “But unlike someone who is physically disabled, no one holds the door open for a person on the street having hallucinations.”
Biological Factors and Suicidal Behavior in Women
Changes in brain chemistry and hormonal factors may contribute differently to suicidal behavior in men and women. Studies of pregnant adolescents find an increase in their suicidal behavior, and unwanted pregnancy has long been thought a precipitating factor in suicide, but pregnancy is more often a protective factor against both suicide and mental illness. While the elevated levels of brain neurotransmitters and hormones that occur in pregnancy may protect women against depressions caused by deficiencies in these compounds, the falling levels of neurotransmitter and gonadal hormones after delivery may contribute to the high frequency of postpartum depression.
Studies confirm this drop in the incidence of severe mental illness during pregnancy, and its dramatic rise during the postpartum period to two or four times the expected rate. Many women who suffer from manic-depressive illness experience their first episode in the postpartum period. In fact, during the postpartum period 60 to 80 percent of women experience transient depression, 10 to 15 percent of women develop clinical depression, and one out of every 1,000 women develops psychosis.
It should also be noted that the postpartum period carries with it sleep deprivation, increased stress, strains and disruptions in interpersonal relationships, and other changes that accompany caring for a new baby. The influence of pregnancy and childbirth on women's mental health and the impact of these events on women's suicidal behavior is an area that warrants further study.
Hormone cycles may also play a role in protecting women against suicide. Parry suggests that, "The cyclicity of estrogen, progesterone, and other female reproductive hormones may destabilize or sensitize neuro-chemical and biologic clock mechanisms, setting the stage for development of cyclic mood disorders." While the cyclicity of women's endocrine milieu may increase their vulnerability to episodic depressions, it may also protect women against the development of many chronic illnesses, such as heart disease and, possibly, certain mental disorders.
These hormones have significant effects on mood and behavior. Estrogen, for example, has been used as a treatment for refractory depression, but the mechanism of its antidepressant effect is unknown. Women's higher levels of estrogen may have particular effects on the regulation of the neurotransmitter, serotonin -- and low levels of serotonin have been implicated in the aggressiveness and impulsivity associated with violent suicidal behavior.
Gender Differences in Suicide Methods
The gender difference in suicide methods is usually attributed to one of three reasons. The most common perception is that women are more likely to use less lethal approaches because they really do not want to kill themselves in most cases. According to this line of reasoning, women who attempt suicide are crying for help and are not really motivated to die. Therefore, women are more likely to ingest pills or other toxic substances which increases the probability of intervention.
The second perspective argues that gender socialization decreases the probability that women may own, or have access to the firearms to the same extent as the men are. Therefore, women turn to other methods, like poisoning or drowning, which appear to be less lethal.
The third explanation for observed gender dissimilarity of approaches in the use of the suicide methods is related to the women’s concern over the possible physical disfigurement of the body. Women prefer to remain a “beautiful corpse” because of the society stereotypes for female physical appearance importance. There is a different line of thoughts, suggesting that women are more concerned over their loved feelings, preferring to avoid leaving highly mutilated corpse. Thus, women are more likely to use methods that do not disfigure the face, such as drug poisoning.
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