Gender differences in risk factors for attempted suicide among young adults: findings from the Third National Health and Nutrition Examination Survey
Introduction
Suicide is the third leading cause of death among young adults aged 15 to 34 years; more young adults died of suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza, and chronic lung disease combined (1). Suicide has been identified as one of the top public health concerns in the United States today (2). The excessive mortality following suicide attempts, the precursor of suicide, has also emerged from many follow-up studies 3., 4., 5., 6., 7., 8.. An attempted suicide implies a higher risk than having a mental disorder such as major depression, personality disorder, or dependence on alcohol (6). The rate of completed suicide is 100 times higher in the attempters than that in the general population (6), indicating the urgent need for research to identify the risks of attempted suicide.
Gender has been well documented as a socio-demographic correlate significantly associated with suicidal behavior. In contrast to completed suicide, the prevalence of attempted suicide is much higher in women than that in men. Although none of the explanations for this paradox has been widely accepted, it is generally agreed that the gender paradox is a real phenomenon, not an artifact of data collection (9). The question of whether the gender differences for suicidal behavior are due to differential exposure to the known risk factors, or other factors inseparable from gender, however, remains a puzzle 9., 10.. An answer to this question is crucial for both clinical research and suicide intervention. Many studies have investigated the gender differences in risk factors associated with completed suicide 10., 11. but there have been few such examinations for those who attempted suicide. Focusing on young adults, using a large population-based national sample, the aims of this study are to identify the significant factors associated with attempted suicide among men and women, and determine whether socioeconomic status (SES) and social support indictors, health risk factors, and lifetime history of medical and psychiatric illnesses can explain gender differences in attempted suicide.
Section snippets
Subjects and study design
NHANES III was designed to obtain nationally representative information on the health and nutritional status of the civilian, non-institutionalized US population through interviews and direct physical examinations (12). The survey began in the fall of 1988 and was completed in the fall of 1994. The sampling scheme was a stratified, multistage probability design with over-sampling of young children, older persons, blacks, and Mexican Americans to allow more precise estimates of health and
Results
Table 1 presents the selected characteristics of the weighted study population by gender. There were significant differences between men and women for most characteristics selected. Approximately, 4.99% (SE, 0.45) of men and 5.13% (SE, 0.67) of women had attended school for fewer than 8 years. Men were more likely not to attend churches and to be heavy smokers and heavy alcohol drinkers at the time of interview. However, men were more physically active during leisure-time, and had a
Discussion
Two findings emerge from the present study. First, the associations between attempted suicide and selected risk factors differed between genders. Low income and smoking were associated with attempted suicide in men, while attempted suicide in women was associated with lower educational attainment, smoking, drug use, and a poor self-evaluated health status. A history of medical and psychiatric illnesses was associated with attempted suicide for both genders, but this association was
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