Gender and risk factors for suicide: Evidence for heterogeneity in predisposing mechanisms in a psychological autopsy study

Objective: It is unclear whether clinical and behavioral suicide risk factors, identified primarily among men, can be extended to women. We therefore explored sex differences in psychopathology and personality variants among suicide completers. Method: Using the psychological autopsy method, we compared personality variants and the prevalence of psychopathology as a function of sex among 351 consecutive suicides in a large, urban community. Psychiatric diagnoses were obtained using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and measures of impulsive aggression, temperament, and character were administered. Subsequently, we carried out secondary analyses between male and female suicides matched 2:1 for age, current depression, and number of lifetime depressive episodes. The study was conducted from late 2000 to 2005. Results: Females were less likely to meet criteria for current and lifetime alcohol abuse, but those who did were less likely than males to have concurrent depression. On average, females were less impulsive, yet similar proportions of males and females were highly impulsive and impulsivity was associated with alcohol abuse irrespective of gender. Females were more likely to meet criteria for lifetime anxiety disorders; these were associated with nonviolent suicide methods, irrespective of gender. Conclusions: Despite a lower prevalence among females, high levels of impulsivity and alcohol abuse appear to be valid risk factors for both sexes. Researchers should focus on females for the identification of other suicide mediators.