Risk factors for male and female suicide decedents ages 15-64 in the United States - Results from the 1993 National Mortality Followback Survey

Background Few controlled studies have examined possible gender differences in risk factors for suicide. This paper examined the associations of certain risk factors with suicide among males and females aged 15-64, and the variation in the associations by gender. Methods A case-control study was constructed from the 1993 National Mortality Followback Survey in the United States. Information concerning age, race, education, living arrangement, marijuana use, excessive alcohol consumption, access to a firearm, depressive symptoms, and mental health service utilization was collected via death certificate and proxy respondent. Decedents between the ages of 15 and 64 who died by suicide were compared with those who died of natural causes. Logistic regression analysis was used to examine the associations between risk factors and suicide in males and females. Results In comparison to those who died of natural causes, we found that marijuana use, excessive alcohol consumption, and access to a firearm increased the odds of suicide for both genders. For male decedents, the presence of depressive symptoms was more frequently reported for the suicide decedents in the 45-64 age group, and the proportion of mental health service use was higher among suicide decedents who did not complete high school. For female decedents, depressive symptoms were related to suicide in all age groups, and the use of mental health services was more frequent in the suicides of the 15-29 and 45-64 age groups. Conclusions The risk factors of marijuana use, excessive alcohol use, and firearm accessibility in the last year of life increased the odds of suicide in both genders. When compared to natural deaths, depressive symptomatology was common in female suicide decedents, whereas it was only associated with older age among male suicide decedents. The interactions of mental health service use with demographic factors suggested possible gender differences in suicide risk associated with severity of mental disorders, as well as the likelihood of treatment seeking.