Research Profile – A Prevention Paradox

Researchers explore how gender relates to suicide risk in youth.

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Suicide is the second leading cause of death in youth aged 15 to 24 in Canada. But boys account for about three out of four deaths, and researchers are now investigating whether males and females require different approaches to suicide prevention and intervention.

Researchers call it the 'gender paradox': while males are more likely to die by suicide, females make more attempts. According to Dr. Anne Rhodes, associate professor of psychiatry and epidemiology at the University of Toronto, we must learn more about this paradox to better understand the causes and prevention of suicide in youth.

"Gender differences, as they relate to suicide in adults, have been recognized a long time, but little attention has been paid to the fact this really takes off in youth. This is where the divergence between the sexes begins, that's where you need to intervene," she says.

Dr. Rhodes and her team are conducting a series of studies relating to the gender paradox in youth suicide.

In one study, her team examined health records of more than 1,200 youth, aged 10 to 25, who had died from suicide in Ontario between the years 2000 and 2007. The study confirmed that boys who died from suicide far outnumbered girls, even after taking into account potential errors made in classifying a death as a suicide.

Going further, Dr. Rhodes and her colleagues took an in-depth look at the health care services accessed by a subset of the same group of youths (more than 700) during the year prior to their suicides. Contact with the health care system represents a key opportunity to recognize suicide risk and intervene; therefore it is important to assess how well the current system is identifying at-risk individuals.

"We found that about 80% of these youth indeed had contact with the health care system in the year before their death, mostly in the form of visits to family physicians or visits to an emergency department (ED)," says Dr. Rhodes.

Of those seen in an ED, about two thirds of the girls had seen someone for mental health reasons compared to only about half of the boys. Also, girls were more likely to be admitted than boys. However, among those admitted, boys and girls were equally likely to have an inpatient mental health stay.

These findings suggest that boys arriving in an ED are less likely than girls to have their mental health needs recognized. However, more research is needed to understand why at-risk boys aren’t receiving the care they need.

The answer may lie in the different warning signs exhibited by boys and girls. For example, about 90% of youth who die from suicide had a mental disorder, but the kinds of mental disorders differ between genders, according to Dr. Rhodes.

In youth, the most common disorders associated with suicide are depression, substance-abuse and disruptive disorders (including attention deficit hyperactivity, conduct disorder and related problems).

But girls are more likely than boys to have depression and more internalized features people commonly recognize as potential risk for suicide.

"Boys may also have depression, but are more likely to exhibit disruptive or substance-related disorders. Their mental health problems are more externalized, and may influence how they are perceived and treated in the ED," she says.

A better understanding of the signs and symptoms of suicide risk in boys could provide leads on how to improve the system so both sexes get the interventions they need.

"Gender differences, as they relate to suicide in adults, have been recognized a long time, but little attention has been paid to the fact this really takes off in youth. This is where the divergence between the sexes begins, that's where you need to intervene."
– Dr. Anne Rhodes, University of Toronto