Research paperShifts in gender equality and suicide: A panel study of changes over time in 87 countries
Introduction
Gender equality is defined as the equal rights, responsibilities and opportunities of women and men, and girls and boys (European Institute for Gender Equality, 2019). This definition acknowledges that the interests, needs and priorities of both women and men should be taken into consideration, and recognises the diversity of different groups of women and men (European Institute for Gender Equality, 2019). Gender equality is seen as critical to the enactment of the sustainable development goals, central to which is the importance of greater equality of welfare, vresources, roles and lifestyles between women and men (United Nations, 2015). Hence, the World Bank, along with other international organisations (such as the United Nations Development Programme) have been tracking the progress in achieving gender equality in economics, political life, educational attainment and health since the 1990s.
Aside from its importance as a social goal, there is growing recognition that gender equality has impacts on population level health (King et al., 2020), but there has been little examination of how gender equality is associated with suicide outcomes.
Suicidal behaviours in most parts of the world are patterned by gender. In most countries, a ‘gender paradox’ is observed, whereby women and girls exhibit higher rates of suicidal ideation and behaviour, but have lower suicide mortality than boys and men (Canetto and Sakinofsky, 1998). Some cross-sectional research has demonstrated a relationship between gender equality and suicide (Chang et al., 2019; Mayer, 2000). Mayer and colleagues (Mayer, 2000) found that gender equality (as measured using the Gender Equality Measure, known as the GEM) was associated with increased suicide rates for both women and men, while Shah et al. (2008) found that gender equality (measured using the Gender Development Index; GDI, and the GEM) showed no association with suicide rates. A more recent cross-sectional study by Chang and colleagues (Chang et al., 2019) reported lower ratios of male to female suicide in countries with greater gender inequality (lower gender equality). The authors suggested a reduction in gender inequality may result in better general well-being for women in particular, but argued that it is particularly important to pay attention to both suicide and gender equality as they are socially patterned within countries. This emphasises the importance of controlling for a wider range of country-specific factors in analyses to more accurately capture the relationship between gender equality and suicide.
Several theoretical frameworks have been deployed to explain associations between gender equality and health outcomes. According to role expansion theory, gender equality should particularly benefit women because holding multiple life roles or identities is associated with better health outcomes than holding fewer roles (Backhans et al., 2007; Nordenmark, 2004). The convergence theory posits that as gender equality increases in a society, there is a convergence in gender roles between men and women, as well as behaviours and exposures, and these in turn lead to a convergence in health outcomes between men and women (Backhans et al., 2007). It is theorised that women may benefit from the positive effects of role-expansion but may experience the detrimental effects of poor working conditions, while men may benefit from the adoption of less masculinized beliefs and behaviours (Backhans et al., 2007).
Previous research has been cross-sectional and is thus unable to provide insight regarding within-country changes in gender equality in relation to suicide rates. In light of this, the current study drew on 11 years of gender equality and suicide data from 87 countries, and carried out the first study of within-country changes in suicide rates in relation to within-country gender equality. Importantly, this approach enabled us to hold potentially important time-invariant country-specific factors stable. Applying the convergence theory, and given that males are more likely to die by suicide in most parts of the world, we hypothesised, that increasing gender equality would be associated with: a) an increase in female suicide rates, and; b) a decrease in male suicide rates.
Section snippets
Data sources
We used publicly available data collected by the World Health Organization and electronically extracted annual suicide rates for males and females across the world (World Health Organization, 2018). Information on the Gender Gap Index (GGI) was drawn from the World Economic Forum (World Bank, 2019a). Information on confounders used to adjust analytic models were drawn from the World Bank, World Development Indicators (World Bank, 2019b), and the United Nations, Department of Economic and Social
Results
The highest average suicide rates between 2006 and 2016 for men were in Lithuania, Guyana, and Suriname, and for women in South Korea, Suriname, and Guyana. The lowest rates for men were in Egypt, Oman, and the Maldives, and for women in Oman, Egypt, and Barbados. These results by individual country can be seen in Fig. 1. Fig. 2 presents GGI score by country. The Gender Gap Index for the period between 2006 and 2016 was highest in Iceland, Norway, and Finland, and lowest in Iran, Egypt, and
Discussion
Our results demonstrate that increasing gender equality, as measured by the GGI, is associated with a significant reduction in within-country suicide rates for women. We hypothesised that increasing gender equality would also be significantly associated with a reduction in the suicide rate for males: while increasing gender equality did appear to be associated with a reduction in the suicide rates for men, this did not reach statistical significance and there was insufficient evidence to
Author statement
AM conceived the aim of the paper, completed the data analysis and wrote much of the first draft of the paper; AJS compiled the data, assisted with the data analysis, and contributed to the writing of the paper, BH assisted with the data analysis and contributed to the writing of the paper, HM contributed to the writing of the paper, LR contributed to the writing of the paper, TLK completed the first draft of the paper and oversaw the final draft. All authors approved the final article.
Funding
This work was funded by an Australian Research Council (ARC) Linkage Grant (LP180100035). AM was supported by a Victorian Health and Medical Research Fellowship. AJS is supported by an NHMRC Postgraduate Scholarship (#1191061) and the Australian Government RTP Scheme. TLK is supported by an ARC DECRA Fellowship (DE200100607). The funding bodies did not have any involvement in the preparation of this paper.
Declaration of Competing Interest
The authors declare no conflicts of interest.
Acknowledgements
Tragically, Associate Professor Allison Milner died during the final revisions of this paper. The authorship team wishes to honour the memory of Allison, whose intellect, wit, and passion for research will never be forgotten.
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