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Original research
Gender difference in suicide in Taiwan over a century: a time trend analysis in 1905–1940 and 1959–2012
  1. Yi-Han Chang1,2,
  2. David Gunnell3,4,
  3. Chia-Yueh Hsu5,6,7,
  4. Shu-Sen Chang1,5,8,
  5. Andrew Tai-Ann Cheng9,10
  1. 1Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
  2. 2Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
  3. 3Population Health Sciences, University of Bristol Medical School, University of Bristol, Bristol, UK
  4. 4National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
  5. 5Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  6. 6Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  7. 7Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  8. 8Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
  9. 9Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
  10. 10Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
  1. Correspondence to Shu-Sen Chang, Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City 100, Taiwan; shusenchang{at}ntu.edu.tw

Abstract

Background Suicide rates are higher in men than in women in most countries, although the gender ratios vary markedly worldwide. We investigated long-term trends in suicide rates and the male-to-female ratios in relation to age, method and economic factors in Taiwan during the Japanese colonial (1905–1940) and postwar (1959–2012) periods.

Methods Suicide data were from the Statistical Reports of Taiwan Governor’s Office (1905–1940), Vital Statistics (1959–1970) and cause-of-death mortality data files (1971–2012). Annual age-standardised and age-specific/method-specific suicide rates by gender and the gender ratios were calculated and examined graphically. The associations between trends in economic indicators, suicide and suicide gender ratio were investigated using Prais-Winsten regression.

Results The male-to-female suicide rate ratio increased from below 1 in the 1900s to around 2 by 2000; the reversal was mainly due to a marked reduction in suicide rates in young women coupled with a rise in male suicide between 1905 and 1940. The gender ratio increased again from the 1980s onwards. Poisoning was the most common method in the 1970s–1980s, but its use decreased afterwards, more in women than in men proportionally. The use of gassing for suicide increased markedly in the 2000s and contributed to the rises in overall suicide and the gender ratio. Unemployment rates were more strongly associated with male suicide than female suicide in 1959–2012. Unemployment rates and gross domestic product per capita were positively associated with suicide gender ratios.

Conclusions Gender differences in suicide changed remarkably in Taiwan over the past century; such change may be related to cultural, socioeconomic and method-specific factors.

  • SUICIDE
  • MENTAL HEALTH
  • PSYCHIATRY
  • PUBLIC HEALTH
  • TIME-SERIES

https://doi.org/10.1136/jech-2020-214058

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    Footnotes

    • Contributors Literature review: Y-HC, S-SC. Study design: Y-HC, DG, S-SC, ATAC. Data preparation: Y-HC, S-SC. Data analysis: Y-HC, S-SC. Data interpretation: Y-HC, DG, C-YH, S-SC, ATAC. Wrote the first draft of the manuscript: Y-HC, S-SC. Approved the final article: Y-HC, DG, C-YH, S-SC, ATAC.

    • Funding The study was supported by the Chiang Ching-kuo Foundation for International Scholarly Exchange (grant number RG014-p-12 to S-SC and AC) and National Taiwan University (grant number NTUCC-107L891603; NTUCC-108L891603; NTUCC-109L891503 to S-SC). DG is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, England. C-YH was supported by Wan Fang Hospital (grant number 109-wf-swf-04). S-SC was supported by the Ministry of Sciences and Technology, Taiwan (grant number MOST 105-2628-B-002-039-MY4). AC was supported by China Medical University, Taiwan (grant number CMU107-Z-06). The funding sources have no role in the data collection, analysis, interpretation or writing of the manuscript or the decision to submit the paper for publication. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.