LAUSR

BACKGROUND To assess whether gender inequality determines the patterns of suicide gender ratios. METHODS Using suicide data obtained from the World Health Organization Statistical Information System, 2012, suicide gender ratios were calculated and a world map of the ratios constructed. Forest plots were utilized to assess whether gender inequality (indicated by the Gender Inequality Index ["GII"] and male to female sex ratios at birth) moderated the worldwide patterns of suicide gender ratios. Regression analyses were then performed to estimate the extent to which gender inequality affects suicide gender ratios before and after controlling for human development level ("HDI"). RESULTS Gradient relationships of suicide gender ratios across 3 tertiles of GII were observed (ratios = 2.03, 2.54, 3.51, respectively for high, moderate and low GII, P = 0.03). High sex ratio at birth was significantly associated with lower suicide gender ratio (ratio = 1.64 vs. 2.75, P = 0.00). Regression analyses showed that highest tertile of GII and high sex ratios at birth were significantly associated with lower suicide gender ratios (P = 0.00 and P = 0.00, respectively). When the level of human development level was controlled, high sex ratio at birth remained to be a significant determinant of suicide gender ratios (P = 0.00), whereas the significance of GII disappeared (P = 0.19). LIMITATIONS The cross-sectional data do not allow for causal inferences. CONCLUSIONS Male to female suicide ratios were higher in countries with more egalitarian gender norms. Strategies to eliminate culturally embedded gender discrimination have the potentials to prevent suicides.