Suicidal Behavior in Young Women

doi:10.1016/j.psc.2008.01.002

Psychiatric Clinics of North America

Volume 31, Issue 2, June 2008, Pages 317-331

https://doi.org/10.1016/j.psc.2008.01.002 Get rights and content

This article provides an update on suicidal behaviors in young women. The rates of completed suicide and suicide attempts among young women are reviewed, and the impact of race and ethnicity on these rates is described. The risk and protective factors associated with suicidal behaviors in young women are discussed, including stressful life events, mental disorders, and hormonal factors. Finally, some considerations for treating suicidal young women are included.

Section snippets

Gender and Age Differences in Epidemiology of Suicidal Behaviors

Studies in different countries have consistently reported gender differences in the epidemiology of suicidal behaviors. Men seem to have higher rates of completed suicide than women, whereas women have higher rates of suicide attempts than men [2], [3], [4], [5], [13], [14], [15]. This pattern has been reported across different countries, cultures and ethnic groups, with just a few exceptions such as women in China, who have higher rates of completed suicide than men, although the difference

Risk Factors for Suicidal Behavior in Women

Suicidal behavior is complex and is probably caused by a combination of factors [32]. According to the stress–diathesis model, the risk for suicidal behaviors is determined by both a state-dependent trigger domain related to stressors (life events, states of depression or psychosis) and a threshold domain (diathesis), or trait-like predisposition to suicidal acts [32], [54]. Neither domain alone determines suicide risk, but the combination of risk factors across domains increases the likelihood

Protective Factors for Suicidal Behavior in Women

Protective factors act in the opposite way than risk factors: they decrease the probability of suicidal behaviors. In studies that compare suicide attempters with nonattempters, protective factors against suicidal behaviors are usually the opposite of risk factors.

Although most studies investigating variables associated with suicidal behaviors have focused on risk factors, only a few studies have examined protective factors [48]. The Practice Guideline for the Assessment and Treatment of

Considerations for Treating Young Women

Depression, suicide ideation, and attempts among the young are frequently undetected and untreated by health professionals [114], [115]. Although women are more willing than men to seek and accept help or treatment [22], young women have been reported to be more likely to receive care from nonspecialty mental health care providers [114].

Regarding pharmacologic treatments, although gender differences exist in the pharmacokinetics of several antidepressants, how they may affect clinical treatment

Summary

Suicide is one of the leading causes of death among young people, and suicide ideation and attempts are frequent in both general and clinical populations [8]. Clinicians assessing young patients must examine the presence of suicidal ideation, previous suicide attempts, factors that may interfere with treatment, and risk factors for suicidal behaviors, such as the presence of depression, drug or alcohol abuse, and access to firearms, to determine the level of risk [8], [22]. Public health

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Given that SAs were reported for the entire period of their lives to date, one would expect that opportunities for SA would increase with age. However, consistent with our findings, research has previously shown that young women have the highest rates of SA and the highest ratio of attempted suicides versus death by suicide among all age groups (Baca-Garcia et al., 2008). Over the last 10–20 years, there has been an increasing trend in elevated SA in women under 40 (CDC, 2020; Have et al., 2009; Hedegaard and Warner, 2021; Milton et al., 2020).
Although men are more likely to die by suicide, women experience a greater and more rapidly increasing rate of suicidal ideation (SI) and are 3 times more likely to attempt suicide than men. Despite this increased risk, little is known about factors that contribute to SI or suicide attempts (SA) among women. We examined factors associated with SI and SA among women and identified mood-related symptoms that differentiate women who reported attempting suicide from those who did not. Women at elevated risk for depression from across the U.S. (N = 3372; age 18 to 90) completed a survey regarding depression, anxiety, sociodemographic and reproductive status, behavioral/mental health history, and exposure to adversity. Structural equation modeling and logistic regression were used to analyze the data. Variables with the most significant relationships to SI were severity of depression (OR = 5.2, p = 0.000) and perceived stress (OR = 1.18, p = 0.000) while frequency of suicidal thoughts (OR = 3.3, p = 0.000), family history of a depression diagnosis (OR = 1.6, p = 0.000) and exposure to violence (OR = 1.9, p = 0.000) had the strongest association with SA. Childhood abuse/trauma was associated with SA (OR = 1.13, p = 0.000) but not SI. ‘Feeling bad about themselves, a failure, or having let themselves or their family down’ was the symptom that most clearly differentiated women who attempted suicide from women who reported suicidal ideation but no SA. The salience of childhood abuse and domestic/community violence to women's risk for a suicide attempt reinforces previous findings that these adversities may differentiate suicide risk for women versus men. Continued research is essential to understand varied paths that may lead to suicidal behavior among women, some which appear unrelated to the frequency or intensity of their suicidal thoughts.
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When working with teens, it is important to keep in mind adolescent neurocognitive development. In earlier adolescence, before age 20, the majority of teens experience heightened emotions and interest in engagement in novel behaviors without the complete development of relevant coping skills that are associated with later neurocognitive maturation [56,57]. This gap often contributes to poorer coping skills such as difficulty coping with intense emotions, difficulty planning for the future, and difficulty with impulse control—all skill deficits that may place adolescents at higher risk for suicidality.
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Suicidal Behavior in Young Women

Section snippets

Gender and Age Differences in Epidemiology of Suicidal Behaviors

Risk Factors for Suicidal Behavior in Women

Protective Factors for Suicidal Behavior in Women

Considerations for Treating Young Women

Summary

Lancet

J Am Acad Child Adolesc Psychiatry

Ann Epidemiol

J Affect Disord

J Affect Disord

Biol Psychiatry

Compr Psychiatry

Am J Prev Med

Lancet

Schizophr Res

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Psychosom Res

Biol Psychiatry

Neuropsychopharmacology

Brain Res Mol Brain Res

Summary of National Strategy for Suicide Prevention: Goals and Objectives for Action

Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey

Arch Gen Psychiatry

Clinical epidemiology of suicide

J Clin Psychiatry

Suicide attempts in the Epidemiologic Catchment Area Study

Yale J Biol Med

Suicide acts in 8 states: incidence and case fatality rates by demographics and method

Am J Public Health

Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003

JAMA

Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland

Psychol Med

Factors in the assessment of suicidality in youth

CNS Spectr

Suicide trends among youths and young adults aged 10–24 years—United States, 1990–2004

MMWR Morb Mortal Wkly Rep

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents

Arch Gen Psychiatry

Worldwide trends in suicide mortality, 1955–1989

Acta Psychiatr Scand

Prevalence of suicide ideation and suicide attempts in nine countries

Psychol Med

Suicide rates per 100,000 by country, year and sex

The ecological fallacy and the gender ratio of suicide in China

Br J Psychiatry

Global suicide rates among young people aged 15–19

World Psychiatry

Data and statistics web page. Quality of cause-of-death information: a challenge in large part of the world

A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts

J Clin Psychiatry

Practice guideline for the assessment and treatment of patients with suicidal behaviors

Web-based Injury Statistics Query and Reporting System

Youth risk behavior surveillance—United States, 2005

MMWR Surveill Summ

Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Acta Psychiatr Scand Suppl

Lifetime prevalence of specific psychiatric disorders in three sites

Arch Gen Psychiatry

Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors?

Acta Psychiatr Scand

Toward a clinical model of suicidal behavior in psychiatric patients

Am J Psychiatry

Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US

Psychol Med

Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey

Am J Public Health

Gender differences in adolescents and young adults with suicidal behaviour

Acta Psychiatr Scand

Ethnic and sex differences in suicide rates relative to major depression in the United States

Am J Psychiatry

Suicide and serious suicide attempts in youth: a multiple-group comparison study

Am J Psychiatry

Coping, meaning in life, and suicidal manifestations: examining gender differences

J Clin Psychol

Lethality of firearms relative to other suicide methods: a population based study

J Epidemiol Community Health