Gender differences in death during hospitalization following a survived suicide attempt in Taiwan from 1998 to 2015: a cross-sectional study

Background: This study examines gender differences in death during hospitalization following a survived suicide attempt. The outcome of death during hospitalization following a survived suicide attempt and yearly rate of suicide attempts ending in hospitalization is examined. Methods: Data on 53,670 hospitalized patients injured by suicide attempt between January 1, 1998, and December 31, 2015, were collected from the National Health Insurance Database. From 1998 to 2015, 24,052 male patients and 29,618 female patients were screened and matched by age, gender, and filing date. Multinomial logistic regression was used to analyze the risk of death in terms of gender differences and suicide and hospitalization. p < 0.05 was considered statistically significant. Results: The risk of death during hospitalization after a survived suicide attempt of hospitalized male suicide patients was 1.694 times that of females (adjusted odds ratio (AOR) = 1.694, 95% confidence interval (CI) = 1.569–1.829). The risk of suicide and hospital death for male patients older than 65 years was 3.608 times that of male patients aged 10–24 years (AOR = 3.608, 95% CI = 2.914–4.468) and 6.648 times that of females (AOR = 6.648, 95% CI = 5.105–8.658). Every 1-point increase in the Charlson Comorbidity Index score of male suicide patients increased the risk of suicide hospital death by 5.6%, which indicates that the number or severity of the complications experienced by hospitalized male suicide patients was higher than that of women. Conclusions: Although men comprised a smaller proportion of hospitalized individuals following a survived suicide attempt, they also arrived in more critical condition and were more likely to die during their hospitalization. The increasing trend of female suicide attempt hospitalization rates is greater than that of males and yearly rate of suicide attempts ending in hospitalization is examined.

gender difference; suicide; epidemiology; long-term trend analysis

[1] World Health Organization. Suicide. 2021. Available at: http: //www.emro.who.int/health-topics/suicide/feed/atom.html (Ac-cessed: 25 October 2021).

[2] Suicide Prevention Center. Available at: http://tspc.tw/tspc/por tal/index/index.jsp (Accessed: 20 October 2021).

[3] World Health Organization. Global suicides in 2019. Avail-able at: https://www.who.int/publications-detail-redirect/ 9789240026643 (Accessed: 23 October 2021).

[4] Endendijk JJ, Groeneveld MG, Mesman J. The gendered fam-ily process model: An integrative framework of gender in the family. Archives of Sexual Behavior. 2018; 47: 877–904.

[5] Edinoff AN, Akuly HA, Hanna TA, Ochoa CO, Patti SJ, Ghaffar YA, et al. Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International. 2021; 13: 387–401.

[6] Jerzyński T, Stimson GV, Shapiro H, Król G. Estimation of the global number of e-cigarette users in 2020. Harm Reduction Journal. 2021; 18: 109.

[7] WHO. Age‘standardized rates, male:female ratio retrieved 10 Sep 2017. Available at: https://www.who.int/healthinfo/pap r 31. pdf (Accessed: 25 October 2021).

[8] Griffiths O, Hayes BK, Newell BR. Feature-based versus category–based induction with uncertain categories. Journal of Experimental Psychology. Learning, Memory, and Cognition. 2012; 38: 576–595.

[9] Holzer JC, Kohn R, Ellison JM, Recupero PR. Geriatric Forensic Psychiatry: Principles and Practice (pp. 284). Oxford University Press: Oxford. 2017.

[10] Chang BP, Tezanos K, Gratch I, Cha C. Depressed and suicidal patients in the emergency department: an evidence-based ap-proach. Emergency Medicine Practice. 2019; 21: 1–24.

[11] Chang X, Gong Q, Li C, Yue W, Yu X, Yao S, et al. Psychiatric disorders in China: strengths and challenges of contemporary re-search and clinical services. Psychological Medicine. 2021; 51: 1978–1991.

[12] Burrows S, Butchart A, Butler N, Quigg Z, Bellis MA, Mikton C. New WHO Violence Prevention Information System, an in-teractive knowledge platform of scientific findings on violence. Injury Prevention. 2018; 24: 155–156.

[13] Steeg S, Quinlivan L, Nowland R, Carroll R, Casey D, Clements C, et al. Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data. BMC Psychiatry. 2018; 18: 113.

[14] Demkowicz O, Panayiotou M, Humphrey N. Cumulative risk exposure and emotional symptoms among early adolescent girls. BMC Women’s Health. 2021; 21: 388.

[15] Kern DM, Cepeda MS, Wiegand F. Treatment patterns of pa-tients diagnosed with major depressive disorder and suicidal ideation or attempt: a U.S. population-based study utilizing real-world data. BMC Psychiatry. 2021; 21: 608.

[16] Babicka-Wirkus A, Wirkus L, Stasiak K, Kozłowski P. Univer-sity students’ strategies of coping with stress during the coro-navirus pandemic: Data from Poland. PLoS ONE. 2021; 16: e0255041.

[17] Ibrahim N, Amit N, Che Din N, Ong HC. Gender differences and psychological factors associated with suicidal ideation among youth in Malaysia. Psychology Research and Behavior Manage-ment. 2017; 10: 129–135.

[18] Health and Welfare Data Science Center, Ministry of Health and Welfare. Available at: https://dep.mohw (Accessed: 25 October 2018).

[19] Santos García D, Suárez Castro E, Expósito I, de Deus T, Tuñas C, Aneiros A, et al. Comorbid conditions associated with Parkinson’s disease: a longitudinal and comparative study with Alzheimer disease and control subjects. Journal of the Neurological Sciences. 2017; 373: 210–215.

[20] Bilsen J. Suicide and youth: Risk factors. Frontiers in Psychiatry. 2018; 9: 540.

[21] Harmer B, Lee S, Duong TVH, Saadabadi A. Suicidal ideation. In: StatPearls. StatPearls Publishing: Treasure Island (FL). 2021.

[22] Michaud L, Brovelli S, Bourquin C. The gender paradox in sui-cide: Some explanations and much uncertainty. Revue Medicale Suisse. 2021; 17: 1265–1267. (In French)

[23] Jain B, Kalesnikava V, Ibrahim JE, Mezuk B. Places of living and places of dying: the case for preventing suicide in residential long-term care. Ageing and Society. 2021; 41: 1945–1960.

[24] Köhler J, Heinz I, Mergl R, Elsner A, Hegerl U 2021. The Ger-man Alliance Against Depression and suicide rates: A retrospec-tive analysis. PLoS ONE. 2021; 16: e0254133.

[25] Hajek A, Sabat I, Neumann-Böhme S, Schreyögg J, Barros PP, Stargardt T, et al. Prevalence and determinants of probable de-pression and anxiety during the COVID–19 pandemic in seven countries: Longitudinal evidence from the European COVID Survey (ECOS). Journal of Affective Disorders. 2021; 299: 517–524.

[26] Lombardo F, Daly M. Analyzing suicide life stories on Wikipedia with Highway_star and other textual visualization tools. SN Social Sciences. 2021; 1: 268.

[27] Tóth MD, Ádám S, Zonda T, Birkás E, Purebl G. Risk factors for multiple suicide attempts among Roma in Hungary. Tran-scultural Psychiatry. 2018; 55: 55–72.

[28] Balt E, Mérelle S, van Bergen D, Gilissen R, van der Post P, Looijmans M, et al. Gender differences in suicide–related com-munication of young suicide victims. PLoS ONE. 2021; 16: e0252028.

[29] Höhn A, Oksuzyan A, Lindahl-Jacobsen R, Christensen K, Sea-man R. Gender differences in time to first hospital admission at age 60 in Denmark, 1995–2014. European Journal of Ageing. 2021; 18: 443–451.

[30] Adzrago D, Osaghae I, Ananaba N, Ayieko S, Fwelo P, Anikpezie N, et al. Examining differences in suicidality between and within mental health disorders and sexual identity among adults in the United States. AIMS Public Health. 2021; 8: 636–654.

[31] Hong M, Ha TH, Lee S, Oh S, Myung W. Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder. Psychiatry Investigation. 2019; 16: 926–932.

[32] Lee J, Chang SJ, Kim H, Kim M, Ahn J, Park K, et al. Prolonged Risk of Suicide Reattempts in Patients with Alcohol Use Disor-der and Acute Alcohol Use: a Register-Based Follow-up Study (2010–2015). Psychiatry Investigation. 2019; 16: 145–153.

[33] Miller NS, Mahler JC, Gold MS. Suicide Risk Associated with Drug and Alcohol Dependence. Journal of Addictive Diseases. 1991; 10: 49–61.

[34] Huikari S, Miettunen J, Korhonen M. Economic crises and sui-cides between 1970 and 2011: time trend study in 21 developed countries. Journal of Epidemiology and Community Health. 2019; 73: 311–316.

[35] Khazaie H, Najafi F, Hamzeh B, Chehri A, Rahimi-Movaghar A, Amin-Esmaeili M, et al. Cluster analysis of risky behaviors among the youth in Western Iran: Determining correlates and comparing clusters based on severity of disability and attitude toward mental health help-seeking. Indian Journal of Psychiatry. 2021; 63: 424–432.

[36] Kim G, Shin J, Kim J. The mediating role of internalizing and externalizing symptoms in the relationship between childhood trauma and suicidality among adolescents: a structural equa-tion model. Child and Adolescent Psychiatry and Mental Health. 2021; 15: 79.

[37] Nock MK, Han G, Millner AJ, Gutierrez PM, Joiner TE, Hwang I, et al. Patterns and predictors of persistence of suicide ideation: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Journal of Abnormal Psy-chology. 2018; 127: 650–658.

[38] Chen R, Zhu X, Wright L, Drescher J, Gao Y, Wu L, et al. Suici-dal ideation and attempted suicide amongst Chinese transgender persons: National population study. Journal of Affective Disor-ders. 2019; 245: 1126–1134.

[39] McGillivray L, Shand F, Calear AL, Batterham PJ, Rheinberger D, Chen NA, et al. The Youth Aware of Mental Health program in Australian Secondary Schools: 3- and 6-month outcomes. In-ternational Journal of Mental Health Systems. 2021; 15: 79.

[40] Crawford MJ, Thana L, Parker J, Turner O, Carney A, McMur-ran M, et al. Structured Psychological Support for people with personality disorder: feasibility randomised controlled trial of a low-intensity intervention. BJPsych Open. 2020; 6: e25.

[41] Singh J, Lou A, Green M, Keely E, Greenaway M, Liddy C. Evaluation of an electronic consultation service for transgender care. BMC Family Practice. 2021; 22: 55.

[42] Rojas G, Martínez P, Guajardo V, Campos S, Herrera P, Vöhringer PA, et al. A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic dis-ease at primary care: protocol for a cluster randomized con-trolled trial. BMC Psychiatry. 2021; 21: 418.

[43] Calati R, Ferrari C, Brittner M, Oasi O, Olié E, Carvalho AF, et al. Suicidal thoughts and behaviors and social isolation: a nar-rative review of the literature. Journal of Affective Disorders. 2019; 245: 653–667.

[44] Tucker RP, Hagan CR, Hill RM, Slish ML, Bagge CL, Joiner TE, et al. Empirical extension of the interpersonal theory of suicide: Investigating the role of interpersonal hopelessness. Psychiatry Research. 2018; 259: 427–432.

[45] Brådvik L. Suicide Risk and Mental Disorders. International Journal of Environmental Research and Public Health. 2018; 15: 2028.

[46] Faraji J, Metz GAS. Aging, Social Distancing, and COVID-19 Risk: who is more Vulnerable and why? Aging and Disease. 2021; 12: 1624–1643.

[47] Mulvey B, Bhatti DL, Gyawali S, Lake AM, Kriaucionis S, Ford CP, et al. Molecular and Functional Sex Differences of Nora-drenergic Neurons in the Mouse Locus Coeruleus. Cell Reports. 2018; 23: 2225–2235.

[48] Cleary A. The gendered landscape of suicide: Masculinities, emotions, and culture. Palgrave Macmillan: Cham. 2019.

[49] Naghavi M. Global, regional, and national burden of suicide mortality 1990–2016: Systematic analysis for the global burden of disease study 2016. British Medical Journal. 2019; 364: 194.

[50] Kasaju SP, Krumeich A, Van der Putten M. Suicide and deliber-ate self-harm among women in Nepal: a scoping review. BMC Women’s Health. 2021; 21: 407.

[51] Andoh-Arthur J, Knizek BL, Osafo J, Hjelmeland H. Suicide among men in Ghana: the burden of masculinity. Death Studies. 2018; 42: 658–666.

[52] Naghavi M. Global, regional, and national burden of suicide mortality 1990–2016: Systematic analysis for the Global Bur-den of Disease Study 2016. British Medical Journal. 2019; 364: l94.

[53] Fattah KN, Camellia S. Gender Norms and Beliefs, and Men’s Violence against Women in Rural Bangladesh. Journal of Inter-personal Violence. 2020; 35: 771–793.

[54] Pirkis J, Spittal MJ, Keogh L, Mousaferiadis T, Currier D. Mas-culinity and suicidal thinking. Social Psychiatry and Psychiatric Epidemiology. 2017; 52: 319–327.

[55] Struszczyk S, Galdas PM, Tiffin PA. Men and suicide preven-tion: a scoping review. Journal of Mental Health. 2019; 28: 80–88.

[56] Stoychev K, Dimitrova E, Nakov V, Stoimenova-Popova M, Chumpalova P, Veleva I, et al. Socio-demographic and clini-cal characteristics of psychiatric patients who have committed suicide: Analysis of Bulgarian regional suicidal registry for 10 years. Frontiers in Psychiatry. 2021; 12: 665154.

[57] King TL, Shields M, Sojo V, Daraganova G, Currier D, O’Neil A, et al. Expressions of masculinity and associations with sui-cidal ideation among young males. BMC Psychiatry. 2020; 20: 228.

[58] Yang X, Lau JTF, Wang Z, Lau MCM. Prevalence of binge drinking and relationships between masculine role discrepancy and binge drinking via discrepancy stress among Chinese men. Drug and Alcohol Dependence. 2019; 196: 57–61.

[59] Mahalik JR, Backus Dagirmanjian FR. Working Men’s Con-structions of Visiting the Doctor. American Journal of Men’s Health. 2018; 12: 1582–1592.

[60] Hiebert B, Leipert B, Regan S, Burkell J. Rural Men’s Health, Health Information Seeking, and Gender Identities: a Concep-tual Theoretical Review of the Literature. American Journal of Men’s Health. 2018; 12: 863–876.

[61] Lai AY, Sit SM, Wu SY, Wang MP, Wong BY, Ho SY, Lam TH. Associations of delay in doctor consultation with COVID-19 re-lated fear, attention to information, and fact-checking. Frontiers in Public Health. 2021; 9: 797814.

[62] Miranda-Mendizabal A, Castellví P, Parés-Badell O, Alayo I, Almenara J, Alonso I, et al. Gender differences in suicidal be-havior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies. International Journal of Public Health. 2019; 64: 265–283.

[63] River J, Flood M. Masculinities, emotions and men’s suicide. Sociology of Health & Illness. 2021; 43: 910–927.

[64] Nascimento MAFD, Uziel AP, Hernández JG. Young men in ju-venile detention centers in Rio de Janeiro, Brazil: Gender, sex-uality, masculinity and health implications. Cadernos de Saúde Pública. 2018; 34: e00177916.

[65] Khan AR, Ratele K, Arendse N. Men, suicide, and Covid-19: Critical masculinity analyses and interventions. Postdigital Sci-ence and Education. 2020; 2: 651–656.