Culture matters in suicidal behavior patterns and prevention, psychologist says

"Everywhere, suicidal behavior is culturally scripted," said Silvia S. Canetto, PhD, of Colorado State University. "Women and men adopt the self-destructive behaviors that are expected of them within their cultures."

While the gender paradox of suicidal behavior is common, particularly in industrialized countries, it is not universal, she said. In China, for example, women die of suicide at higher rates than men. In Finland and Ireland, men and women engage in nonfatal suicidal behavior at similar rates. There are more exceptions to the gender paradox of suicidal behavior when one examines female/male patterns of suicidality by age or culture, she said.

In some cultures, particularly in industrialized countries, such as the United States and Canada, suicide is considered a masculine act and an "unnatural" behavior for women, Canetto said at a symposium entitled "New Perspectives on Suicide Theory, Research and Prevention."

"In these countries, the dominant view is that `successful, completed' suicide is the masculine way to do suicide. In the U.S., women who kill themselves are considered more deviant than men. By contrast, in other cultures, killing oneself is considered feminine behavior (and is more common in women)," she said, citing, among others, the Aguaruna people of Peru, who view suicide as an indication of a feminine inability to control strong emotions. Yet in other cultures, men's and women's suicidal behavior is similar. For example, in Sri Lanka, the same types of issues (problems with spouses, parents or in-laws) are typically associated with both women's and men's suicides.

"A broad cultural perspective shows that women and men do not consistently differ in terms of the kinds of suicidal behavior they engage in, or with regard to the circumstances or the motives of their suicidal behavior," she said. "When women and men differ with regard to some dimensions of suicidal behavior, the meaning and salience of these differences vary from one social group to another, one culture to another, one historical period to another, depending on local scripts of gender and suicidal behavior." The cultural variability in patterns and scripts of women's and men's suicidal behavior calls for "culturally situated suicidality research and prevention," Canetto said.

At the same symposium, James L. Werth Jr., PhD, of Radford University, discussed reasons why the suicide rate in rural America is consistently higher than it is in urban areas. In addition to general suicide risk factors, such as mental illness, a family history of suicide and feelings of hopelessness, rural residents may be more isolated, be less willing to ask for help and have increased access to lethal means such as guns and pesticides, he said.

"County by county or state by state, the top areas in terms of suicide are rural," Werth said. "The top five states are Alaska, Montana, New Mexico, Wyoming and Nevada, whereas D.C., New Jersey, New York Connecticut and Massachusetts have the lowest rates."

Some of the possible contributing factors to the higher rates in rural America are more poverty, higher unemployment and lack of access to treatment resources, Werth said. "People are not going to drive five hours to visit a counselor," he said.

In suggesting possible solutions to the rural suicide rate, Werth said greater access to broadband would help by increasing access to resources, as will integration of mental health practitioners into primary care.

"Even though people live farther apart, there may be stronger connections -- they need to rely on one another," he said. "There may be longstanding relationships among families and more religiosity …. we need to build on those existing qualities and strengths and beliefs."