In Western countries depression and suicide attempts are more prevalent among women, and completed suicides among men; but in China women die more often than men by suicide. How can we interpret these contrasting findings?

Prospective studies of population cohorts.

The Zurich Study found that suicidal ideation was equally prevalent in women and men but suicide attempts more frequent in women. Suicidality was associated with multiple risk factors: both men and women with a depressive personality and severe punishment in childhood were more at risk. Furthermore, women more often reported a broken home, sexual trauma and a lower education level and men that they grew up in a tense family atmosphere.

In another study of 2768 19-year old Swiss army conscripts followed up until age 36, higher external aggression scores were found in the 46 men who died by suicide than in controls. In the Zurich Study women scored lower in external aggression than men.

Men generally choose more violent and women softer methods of suicide. Following the detoxification of gas in England and Wales, women's suicides fell sharply. In country areas in China women's free access to pesticides is considered to explain the high female suicide rates.

The findings call into question the hypothesis that suicide attempts in women are more of an appeal for help. Restricting the availability of weapons and toxic substances can prevent suicide.