Suicide at very advanced age: The extremes of the gender paradox
Suicide figures are declining globally. Most recent estimates suggest 788,000 deaths in 2015 as representative of the global mortality due to suicide (World Health Organization [WHO], 2017). Rates also appear to be decreasing remarkably, with older adults (65 years and over) witnessing the most relevant decrease (Bertolote & De Leo, 2012). Reasons for this welcome phenomenon are not too clear, although general improvements in the quality of life of older citizens and ameliorated health assistance conditions are reported as the most convincing explanations (WHO, 2014). Despite these changes, older adults continue to represent the segment of population most exposed to the risk of suicide nearly everywhere in the world. The gender paradox in suicide rates (i.e., the difference between sexes that sees a greater prevalence of fatal acts among male individuals) is often explained by the more developed skills in help-seeking behavior of female subjects, and the use of more lethal suicide methods in males (such as the use of firearms and hanging; Kõlves, McDonough, Crompton, & De Leo, 2017; Schriivers, Bollen, & Sabbe, 2012). In high-income countries, it is generally noted that the suicide rates ratio between males and females stands at around 3:1. In low- and middle-income countries, this ratio averages around 1.5:1 (WHO, 2014). However, with advancing age these ratios change profoundly, with rates greatly increasing among men. A study of centenarians by Shah, Zarate-Escudero, Bhat, De Leo, and Erlangsen, using data from 17 countries (those able to provide data for the oldest-olds), showed the existence of a ratio of 8:1 between males and females, a fact that seems to suggest the accumulation of multiple risk factors among men and an apparently better adaptation of women at such advanced age (Shah et al., 2014).
Crisis: The Journal of Crisis Intervention and Suicide Prevention