A Comparison of Physician-Assisted/Death-With-Dignity-Act Death and Suicide Patterns in Older Adult Women and Men.

OBJECTIVE: To examine Oregon's Death-with-Dignity-Act (DWDA) death and suicide patterns among women age 65 and older, relative to patterns among same-age men, as a way to assess DWDA's impact on older adult women, a group considered vulnerable. DESIGN: Oregon's 1998-2018 DWDA- and suicide-mortality rates and confidence intervals were calculated. RESULTS: Between 1998 and 2018 women age 65 and older represented 46% of DWDA deaths and 16.3% of suicides in their age group. Among women age 65 and older DWDA and suicide mortality increased whereas among same-age men DWDA deaths increased and suicides declined. DWDA deaths were the most common form (52.7%) of self-initiated death for older adult women, and firearm suicides (65.7%) for older adult men. CONCLUSION: Legalization has a substantial impact on older adult women's engagement in self-initiated death. In Switzerland and in Oregon, where assisted suicide/medical-aid-in-dying (MAID) is legal and where assisted-suicide/MAID and suicide comparative-studies have been conducted, older adult women avoid self-initiated death except when physician-approved. Older adult women's substantial representation among assisted-suicide/MAID decedents, relative to suicide, may be a clue of their empowerment to determine the time of their death, when hastened-death assistance is permitted; or of their vulnerability to seeking a medicalized self-initiated death, when in need of care.

Caregiving as suicide-prevention: an ecological 20-country study of the association between men's family carework, unemployment, and suicide.

PURPOSE: Suicide rates are generally higher in men than in women. Men's higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men's suicide vulnerability is also related to their private-life behaviors, particularly men's low engagement in family carework, this ecological study explored the association between men's family carework, unemployment, and suicide. METHODS: Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men's engagement in family carework and suicide rates by sex was estimated, with OECD's unemployment-benefits index and United-Nations' Human Development-Index (HDI) evaluated as controls. The moderation of men's carework on the unemployment-suicide relationship was also assessed. RESULTS: Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country's HDI. Unemployment benefits were not associated with suicide rates. Men's family carework moderated the association between unemployment and suicide rates. CONCLUSION: This study's findings that higher levels of men's family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men's family carework. They are consistent with evidence that where gender equality is greater, men's and women's well-being, health, and longevity are greater.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Permissive beliefs and attitudes about older adult suicide: a suicide enabling script?

OBJECTIVES: In the United States, suicide rates are highest among European American older adults. This phenomenon calls attention to cultural factors, specifically, the suicide beliefs and attitudes of European Americans. Beliefs and attitudes matter in the vulnerability to suicide. As predicted by cultural scripts of suicide theory, suicide is most likely among individuals and in communities where it is expected and is most acceptable. This study examined beliefs about the precipitants of, and protectors against older adult suicide, as well as suicide attitudes, in a predominantly European American community. DESIGN AND METHODS: Two hundred and fifty-five older adults (86% European American) and 281 younger adults (81% European American) indicated what they thought were the most likely older adult suicide precipitants and protectors, and their opinion about older adult suicide, depending on precipitant. RESULTS: Health problems were the most endorsed older adult suicide precipitants. Suicide precipitated by health problems was also rated most positively (e.g., rational, courageous). Older adults, persons with more education, and persons who did not identify with a religion expressed the most favorable attitudes about older adult suicide, across suicide precipitants. Men viewed older adult suicide as more admissible, and women, with more sympathy. Perceived suicide protectors included religiosity among older adults, and supportive relationships among younger adults. CONCLUSIONS: The belief, in this study's predominantly European American community, that older adult suicide is triggered by health problems, together with favorable attitudes about older adult suicide, suggest an enabling older adult suicide script, with implications for suicide risk and prevention.

A systematic review of physical illness, functional disability, and suicidal behaviour among older adults.

OBJECTIVES: To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. METHOD: Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. RESULTS: Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. CONCLUSION: Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.

Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan.

OBJECTIVE: Female labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years. METHODS: Annual national labor-participation rates for women ages 25-64, and female and male suicide-rates, for 1980-2020, were obtained from Taiwan's Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects. RESULTS: Higher FLFP rates were associated with lower female suicide-rates (ß = -0.06, 95% CI (Credibility Interval) = [-0.19, -0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]). CONCLUSION: This study's findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers' support. Therefore, this study's findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men's disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.

Female labor-force participation (FLFP) has been theorized to increase suicide.Over time higher FLFP was associated with lower suicide, particularly in women.Higher FLFP was associated with widening male-to-female suicide-rate ratios.

The long-lasting impact of adolescents' deviant friends on suicidality: a 3-year follow-up perspective.

BACKGROUND: During adolescence, friends are increasingly important for support and values. Do friends also have a long-term impact on suicidality? This study explored the role of friendship problems (e.g., social isolation) and deviant friends during late adolescence on suicidal ideation and behavior 3 years later. METHOD: Participants were 295 community adolescents (59% Mexican-American; 41% European-American) from the United States. Information about their suicidal ideation and behavior, depression, friendship problems, and deviant friends was collected at baseline and at a 3-year follow-up. RESULTS: Having deviant friends was a better predictor of suicidality than having friendship problems, with variability by sex and ethnicity. Having deviant friends predicted suicidal ideation among Mexican-American adolescents. Having friends who were disconnected from school was a risk factor for suicidal ideation among European-American adolescents but a protective factor for suicidal behavior among Mexican-American adolescents, especially boys. Depression played more of a mediating role between friendship factors and suicidality for European-American than for Mexican-American adolescents. CONCLUSIONS: This study's findings suggest an influence of adolescents' deviant friends on suicidality 3 years later. They also call for the cultural and gender grounding of suicide theory, research and prevention.

Suicide Scripts in Italian Newspapers.

Background: There is substantial variability, by culture, in suicide rates, and also in suicide beliefs and attitudes. Suicide beliefs and attitudes predict actual suicidality. They also are elements of cultural scripts of suicide. Most suicide-scripts research has been conducted in Anglophone countries. Aims: This study investigates women's and men's suicide scripts in Italy. Methods: Italy's suicide scripts, including beliefs about what causes suicide, were explored via analyses of newspaper stories (N = 923) of women's and men's suicides. Results: Italian newspapers mostly featured men's suicide stories, consistent with Italian men's higher suicide mortality. Women's suicide was narrated as an unexpected act signaling personal (e.g., emotional and private-relationship) problems. By contrast, men's suicide was framed as relatively understandable response to serious public-life/social adversities (e.g., an economic downturn), and as a death of legitimate despair. Limitations: Social media suicide stories were not included in this study. Conclusion: In Italy, as in several countries with higher male suicide mortality, female suicide is psychologized and considered irrational while male suicide is viewed as a symptom of serious public-life/social problems, and therefore as deserving respect and empathy. The preference for social explanations of male suicide, together with the empathic attitudes, may contribute to male suicide being relatively more permissible and less stigmatized, and therefore also to men's higher suicide mortality.

Studying Scripts of Women, Men and Suicide: Qualitative-Method Development and Findings from Nepal.

Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has been mostly epidemiologic and hospital-based. Little is known about how suicide is understood by Nepali people in general-including dominant suicide attitudes and beliefs in Nepal. Suicide attitudes and beliefs, which are elements of a culture's suicide scripts, predict actual suicidality. Drawing on suicide-script theory, we developed and used a semi-structured survey to explore Nepali beliefs about female and male suicide. The informants were adult (Mage = 28.4) university students (59% male). Female suicide was believed to be a response to the society-sanctioned oppression and abuse that women are subjected to, in their family and community. The prevention of female suicide was viewed as requiring dismantling ideologies, institutions, and customs (e.g., child marriage, dowry) that are oppressive to women, and ensuring that women are protected from violence and have equal social and economic rights and opportunities. Male suicide was believed to be a symptom of societal problems (e.g., unemployment) and of men's psychological problems (e.g., their difficulties in managing emotions). The prevention of male suicide was viewed as requiring both societal (e.g., employment opportunities) and individual remedies (e.g., psychological counseling). This study's findings suggest that a semi-structured survey can be a fruitful method to access the suicide scripts of cultures about which there is limited research.

Women's Suicide in the First-Year Postpartum: A Population-based Study.

BACKGROUND: In dominant suicidology there is a long traditionof theorizing that women are protected from suicide, particularly when mothers and during the postpartum. Studies have mostly confirmed the postpartum suicide-protection theory, with low suicide mortality generally observed among postpartum women. A limitation of these studies is that most were conducted in majority European-descent-population countries. A challenge to the more general maternal suicide-protection theory is that in East-Asia women of childbearing age exhibit substantial suicidality, nonfatal and fatal. This study evaluated whether suicide is less likely in first-year postpartum women as compared to women past the first-year postpartum. METHODS: This population-based, nested case-control study focused on women whose live birth was between 2001 and 2016 in East-Asian Taiwan. To ascertain suicide outcomes, the women were followed until 2017. For each suicide case, four control cases were randomly selected from the Birth Certificate Application dataset, with a 1:4 matching ratio based on age of last live-delivery and parity (one delivery record vs. two or more records) (cases N = 1571; controls N = 6284). Conditional logistic regression analyses were conducted to assess whether suicide was less likely in women in the first-year postpartum relative to women past the first-year postpartum. RESULTS: The odds ratios of suicide were elevated at 42 days postpartum [Odds Ratio (OR) = 2.06; 95% Confidence Interval (CI) = (1.04, 4.16)], six-months postpartum [OR = 2.28; 95% CI = (1.60, 3.29)] and one-year postpartum [OR = 2.26; 95% CI = (1.76, 2.96)], when controlling for sociodemographic and mental-disorder variables. Suicide was more likely in women who were single at index birth, had lower socioeconomic status, or had a mental disorder history. CONCLUSION: Our findings suggest that the postpartum stage is not suicide-protective per se. Whether the postpartum stage is associated with suicide protection or suiciderisk appears to depend on context and culture.

Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors.

Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.

Language, culture, gender, and intersectionalities in suicide theory, research, and prevention: Challenges and changes.

Over the decades suicidology has experienced many challenges and changes. Language, culture, gender, and intersectionalities of experience have been domains of challenge and change. In this article I document my contributions to suicidology's transformation in these domains. These contributions include challenging stigmatizing and biased suicide-language (e.g., expressions like "successful" and "failed" suicide); questioning gender myths of suicidal behaviors (e.g., the myth that women and men are opposites in terms of suicide motives); the gender-paradox-of-suicide idea; and suicide-scripts theory and research. I then describe the evolution of suicide-scripts theory. Suicide-scripts theory builds on evidence that in each culture there are unique situations when suicidal behavior is expected from specific people, using specific methods, and with specific social consequences. The theory posits that these scripts contribute to variations in suicidality across cultures, and within cultures, across sociodemographic groups, intersectionally. Studies using a diversity of methodologies and focusing on a diversity of sociodemographic groups and cultures point to the role of suicide scripts in suicidality. The article concludes with a discussion of the implications, for suicide prevention, of suicide-scripts theory and evidence.

Women's suicide in low-, middle-, and high-income countries: Do laws discriminating against women matter?

BACKGROUND: Women's suicide is a serious public health issue in low- and middle-income countries (LMIC). This study explored whether institutional discrimination against women, as manifested in formal and informal laws, is relevant to country's income-level variability in women's suicide mortality. It also examined which discriminatory laws are associated with LMIC women's suicides. METHODS: Scores on laws discriminating against women, across 176 countries, were obtained from the Gender, Institutions and Development Database. Male-to-female (M/F) 2017 suicide ratios were the index of women's propensity for suicide. The mediating role of laws discriminating against women on the association between country's income level and M/F suicide ratio was analysed by bootstrapping method. Regression analyses examined which discriminatory laws were associated with LMIC women's suicide rates. RESULTS: LMIC had significantly smaller M/F suicide ratios than high-income countries. Institutional discrimination mediated the association between country's income-level and M/F suicide ratio (total effect: ß = -0.13, 95% CI [ -0.26, -0.01]; direct effect: ß = -0.06, 95% CI [ -0.20, 0.08]; indirect effect: ß = -0.07, 95% CI [ -0.15, -0.02]). In LMIC, higher levels of discrimination against women in laws about access to productive and financial resources (ß = -0.69, p < 0.001), civil liberties (ß = -0.60, p < 0.001), and in family law (ß = -0.57, p < 0.001) were associated with smaller M/F suicide ratios after controlling for male suicide rates and sex ratios at birth. CONCLUSIONS: The relatively high suicide rates recorded among women in LMIC might be related to the higher level of institutional discrimination women experience in these countries. In LMIC, where, by law, women had restricted access to productive and financial assets and to justice, and/or unequal rights with regard to citizenship, household-responsibilities, divorce, and inheritance, M/F suicide ratios were lower-that is, women's suicide rates were higher. Suicide theory, research, and prevention targeting women should incorporate social-context and social-justice perspectives.

Suicidal as Normal - A Lesbian, Gay, and Bisexual Youth Script?

Background: Lesbian, gay, and bisexual (LGB) youth are more likely to report suicidal thoughts and/or behavior (STB) than heterosexual youth. The elevated suicidality of LGB youth is not fully accounted for by sexual-minority stress, according to a meta-analysis. A less-tested explanation is that suicidality has become an expected idiom of LGB youth distress. This explanation is consistent with suicide script theory and evidence that suicidal behavior is most likely when it is relatively acceptable. Aims: Building on suicide script theory and evidence, two studies were designed: one of LGB youth attitudes about suicidal behavior, and the other of LGB youth attitudes about suicidal individuals. Method: Surveys of LGB and heterosexual youth (total N = 300; M age = 20; 51% female) were conducted. Results: LGB youth were more accepting of and empathic toward suicidal behavior than heterosexual youth. They also viewed suicidal individuals as more emotionally adjusted. Limitations: Attitudes were not examined by sexual-minority subgroups. Conclusion: LGB youth's understanding attitudes may translate into less judgmental behavior toward suicidal peers, but also into normalizing suicidality as a way to express distress and cope with life problems. There may be utility in evaluating LGB youth suicide attitudes in suicide prevention initiatives.

Advancing prevention research on the role of culture in suicide prevention.

Despite evidence of considerable racial/ethnic variation in adolescent suicidal behavior in the United States, research on youth of European American descent accounts for much of what is know about preventing adolescent suicide. In response to the need to advance research on the phenomenology and prevention of suicidal behavior among ethnic minority populations, NIMH co-sponsored the "Pragmatic Considerations of Culture in Preventing Suicide" workshop to elicit through interdisciplinary dialogue how culture can be considered in the design, development, and implementation of suicidal behavior prevention programs. In this discussion paper we consider the three ethnic minority suicide prevention efforts described in the articles appearing in this issue, along with workshop participants' comments, and propose six major areas where issues of culture need to be better integrated into suicidal behavior research.

Women and suicidal behavior: a cultural analysis.

Around the world girls and women have higher rates of suicidal ideation and behavior but lower rates of suicide than boys and men. There is, however, significant variability in gender patterns and meanings suicidal behavior within and across cultures. For example, in the United States, suicide is most common among older "White" men, and is typically considered masculine behavior. Women who kill themselves are viewed as acting like men, and therefore deviant. By contrast, in other societies, including China, suicide is viewed as an act of the powerless, and is most frequent in young women. In these societies, men who kill themselves are considered weak and effeminate. The cultural diversity in gender patterns and interpretations of suicidal behavior challenges essentialist perspectives on gender and suicidal behavior. It also challenges the assumption, common in industrialized countries, that women are protected from suicide as long as they stay "feminine" and subsumed within the family. This cultural diversity also points to the pitfalls of theorizing about clinical phenomena as if they were culture-free, and calls for culturally grounded theory, research, and practice.

Suicidal Behaviors Among Muslim Women. Patterns, Pathways, Meanings, and Prevention.

BACKGROUND: The literature on Muslim women's suicidality has been growing. Comprehensive reviews are, however, unavailable, and theory needs development. AIMS: This article reviews and integrates theories and findings about Muslim women's suicidality. METHOD: Two databases (PsycINFO and Web of Science) were searched for publications about Muslim women's suicidality. RESULTS: There is significant variability in Muslim women's patterns of suicidality across Muslim-majority communities and countries. Muslim women represent half to nearly all cases of nonfatal suicidal behavior. According to the official records of Muslim-majority countries, women's suicide mortality is lower than that of men. Community studies, however, show that in some areas, Muslim women have significantly higher suicide rates than Muslim men. Both nonfatal and fatal suicidal behaviors are most common among uneducated and poor rural young women. Muslim women's typical suicide methods vary by locale, and include self-burning, hanging, and poisoning. With regard to contexts and meanings, a recurring female script is that of suicidality as protest against and desperate escape from the oppressive regulation as well as the abuse many women endure within their families and societies. CONCLUSION: Understanding and preventing Muslim women's suicidality, and the socially sanctioned oppression it is often a response to, require system-level - not just individual-level - analyses and interventions as well as a human rights perspective.

Phyllis Bronstein (1939-2012).

This article memorializes Phyllis Bronstein (1939-2012). Bronstein was a feminist scholar, social and clinical psychologist, and activist for social justice. At the University of Vermont, she engaged almost 100 undergraduates in her research teams, mentored the research and professional development of 43 graduate students, and trained over 90 clinical psychology students in the feminist family therapy program she developed. Bronstein published over 45 chapters and journal articles, and three edited books. One stream of her scholarship focused on sociocultural factors in parenting, child and adolescent development, with studies conducted in the United States and Mexico. Bronstein is perhaps best known for two volumes on the integration of multicultural and gender issues into the psychology curriculum, coedited with Kathryn Quina and published by the American Psychological Association. Bronstein's third stream of scholarship addressed sexist, racist, and ageist practices in academic and clinical professions.

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents.

Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.

Love and achievement motives in women's and men's suicide notes.

It is often assumed that women kill themselves because of love and men because of achievement problems. The authors evaluated the suicide notes of 56 U.S. adult women and men with regard to love and achievement motives. Love themes were significantly more common than achievement themes, independent of sex and age. This suggests that, at least for U.S. adults who leave suicide notes, relationship concerns may be a dominant component of the motivation for suicide.