Women have poorer mental health and engage in more suicidal behaviours than men, and all indications are that the Coronavirus and responses to it have exacerabated this mental health gap. Today’s analysis takes a deep dive into global trends to understand whether gender equality may correlate to rates of suicide. Tania King (@TaniaLKing) of University of Melbourne (@unimelbMSPGH), one of the authors of Shifts in gender equality and suicide: An panel study of changes over time in 87 countries, provides a summary of their findings.

Gender equality and suicide

In addition to the its importance in terms equity and justice, there is growing recognition that gender equality has impacts on population-level health, but there has been little examination of how gender equality is associated with suicide outcomes.

In almost all parts of the world, suicidal behaviours are patterned by gender. In most countries, we see a ‘gender paradox’: women and girls exhibit higher rates of suicidal ideation and behaviour, but they have lower suicide mortality than boys and men (Canetto and Sakinofsky, 1998). Of the small number of studies that have looked at the relationship between gender equality and suicide, results have been mixed. One study found that gender equality was associated with higher suicide rates for men and women. Another found lower ratios of male to female suicide in countries with greater gender inequality (lower gender equality). But none of these studies have looked at how this might change over time.

What we did

In this study, we investigated the relationship between gender equality and the rates of suicide for men and women in 87 countries around the world, across a period of 11 years. For our gender equality measure we used the World Economic Forum’s Gender Gap Index (GGI). The GGI comprises 14 measures across four major domains: economic participation and opportunity; education attainment; health and survival; and political empowerment (World Economic Forum, 2014). We then obtained suicide data from the World Health Organization.

We used some statistical methods called fixed effects regression models to assess the relationship between gender equality and suicide over 11 years. These fixed effects methods enabled us to examine the way that within-country changes in gender equality are associated with within-country changes in suicide. To control for bias due to confounding, we included some other variables in our models such as Gross Domestic Product per capita, total population number, the ratio of population living in urban/rural areas of a country, number of children per person, percentage of the population who were unemployed, and year.

What did we find?

We found that the highest average suicide rates between 2006-2016 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.

The Gender Gap Index for the period between 2006-2016 was highest in Iceland, Norway, and Finland (meaning, highest levels of gender equality), and lowest in Iran, Egypt, and Oman.

Country ratings for the Gender Gap Index. The darker the colour, the higher the country is rated for gender equality.

When we looked at how gender equality and suicide were related, we found that as gender equality increased, there was a significant reduction in suicide for women (-7.08, 95% CI -12.35 to -1.82, p= 0.009). This is equivalent to about 7 women per 100,000. For men, greater gender equality appeared to be associated with lower suicide rates, but the association was not significant (b-Coef -5.76, 95% CI -19.40 to 7.86, p= 0.403). This means that there was insufficient evidence that greater gender equality was associated with reduced suicide rates for men.

Making sense of these results

The results show that increasing gender equality within a country, as measured by the GGI, is associated with a within-country reduction in suicide rates for women.

It could be that increasing gender equality decreases suicide rates for women by providing them with more opportunities to take up diverse social roles. Photo by Ketut Subiyanto from Pexels — It could be that increasing gender equality decreases suicide rates for women by providing them with more opportunities to take up diverse social roles. Photo by **Ketut Subiyanto** from **Pexels**

The accumulation of multiple identities is thought to lead to a more meaningful existence and sense of purpose and value, and contribute to improved psychological well-being (Thoits, 1983). Having multiple social roles also develops and consolidates economic and social resources that provide satisfaction and can be drawn on in adversity (Nordenmark, 2004). These multiple roles also enable engagement and connection across different contexts that anchor and support individuals, and according to Sieber (1974), they can be leveraged and transacted to gain further benefits.

Thinking about this in relation to our results, it is possible that as gender equality within a country increases, the suicide risk of women is reduced through their ability to acquire and accumulate multiple social roles. This may operate through various specific mechanisms such as labour force participation: as women enter the labour force (or remain in the labour force), they acquire (or retain) an identity tied to their role as an employee, which, in addition to their identities associated with other roles (such as mother, friend, volunteer), provides them with an accumulated set of rewards and resources that positively impacts on their mental health and lowers their suicide risk.

Around the world, men are at substantially greater risk of suicide than females (World Health Organization, 2014). Given that the mental health of boys and men appears to benefit from gender equality (King et al., 2020) and gender egalitarian attitudes (King et al., 2019), we expected that suicide rates for men may have reduced as gender equality within a country increased. While it was clear that gender equality did not increase the suicide risk for males, There was however, no clear evidence that within country changes in gender equality is associated with within-country changes in suicide rates.

We know that certain masculine norms can be disadvantageous for men. While it is logically assumed that gender equality is associated with an erosion of traditional masculine norms, it is possible that this process is somewhat out of step. The process of dismantling some damaging norms may lag behind the process of increasing gender equality. While it is feasible that some pressures on men may be relieved by initiatives and policies designed to progress gender equality, the pressure (and associated suicide risk) may be higher for men who are particularly attached to the male breadwinner role.

In summary, these results are good news; they show that increases in gender equality within a country is associated with reduced suicide rates for women. We have argued elsewhere that COVID-19 provides a prime opportunity to make progress on gender equality measures.

This post is part of the Women's Policy Action Tank initiative to analyse government policy using a gendered lens. View our other policy analysis pieces here.

Posted by @SusanMaury

Providing the big picture on gender equality and suicide rates