Review
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World J Psychiatr. Dec 22, 2014; 4(4): 120-132
Published online Dec 22, 2014. doi: 10.5498/wjp.v4.i4.120
Antecedents and sex/gender differences in youth suicidal behavior
Anne E Rhodes, Michael H Boyle, Jeffrey A Bridge, Mark Sinyor, Paul S Links, Lil Tonmyr, Robin Skinner, Jennifer M Bethell, Corine Carlisle, Sarah Goodday, Travis Salway Hottes, Amanda Newton, Kathryn Bennett, Purnima Sundar, Amy H Cheung, Peter Szatmari
Anne E Rhodes, Institute for Clinical Evaluative Sciences, Toronto M4N 3M5, Ontario, Canada
Anne E Rhodes, Mark Sinyor, Corine Carlisle, Amy H Cheung, Peter Szatmari, Department of Psychiatry, University of Toronto, Toronto M5T 1R8, Ontario, Canada
Anne E Rhodes, Jennifer M Bethell, Suicide Studies Unit, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
Anne E Rhodes, Sarah Goodday, Travis Salway Hottes, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Ontario, Canada
Michael H Boyle, Kathryn Bennett, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton L8N 3K7, Ontario, Canada
Michael H Boyle, Kathryn Bennett, The Offord Centre for Child Studies, Hamilton L8S 4K1, Ontario, Canada
Jeffrey A Bridge, The Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, United States
Jeffrey A Bridge, The Ohio State University College of Medicine, Columbus, OH 43210, United States
Mark Sinyor, Amy H Cheung, Sunnybrook Health Sciences Centre, Toronto M4N 3M5, Ontario, Canada
Paul S Links, Department of Psychiatry, University of Western Ontario, London N6A 5W9, Ontario, Canada
Lil Tonmyr, Robin Skinner, The Injury and Child Maltreatment Section, Public Health Agency of Canada, Ottawa K1A 0K9, Ontario, Canada
Corine Carlisle, Peter Szatmari, The Centre for Addiction and Mental Health, Toronto M6J 1H4, Ontario, Canada
Amanda Newton, Department of Pediatrics, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
Kathryn Bennett, The Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton L8S 4K1, Ontario, Canada
Purnima Sundar, The Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa K1G 0Z1, Ontario, Canada
Peter Szatmari, The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada
Author contributions: Rhodes AE, Boyle MH and Bridge JA contributed to the conception and design; Rhodes AE, Bridge JA and Szatmari P contributed to the acquisition of data, and the analysis and interpretation of data (all authors); Rhodes AE contributed to the drafting of the article, and its critical revision for important intellectual content; all authors contributed to the analysis, critical revision for important intellectual content and interpretation of data gave their final approval of the version to be published.
Supported by The Canadian Institutes of Health Research, No. 319379
Conflict-of-interest: The authors have no conflict of interests.
Open-Access: This article is an open-access article which selected by an in-house editor and fully peer-reviewed by external reviewers. It distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anne E Rhodes, PhD, Suicide Studies Unit, St. Michael’s Hospital, 30 Bond Street, Toronto M5B 1W8, Ontario, Canada. rhodesa@smh.ca
Telephone: +1-416-8646099 Fax: +1-416-8645996
Received: September 27, 2014
Peer-review started: September 28, 2014
First decision: October 21, 2014
Revised: November 13, 2014
Accepted: November 27, 2014
Article in press: December 1, 2014
Published online: December 22, 2014
Abstract

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this “gender paradox” in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others’ or one’s own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one’s ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

Keywords: Suicide, Attempted suicide, Sex, Gender, Child, Adolescent, Review

Core tip: Previous research has demonstrated clear and consistent sex-/gender-specific patterns in the continuum of suicidal behaviour. Here, we review epidemiologic, genetic, neurodevelopmental and psychopathological research to identify and discuss explanations for these findings. We propose antecedents to youth suicide and highlight the importance of early intervention. Understanding the mechanisms underlying sex/gender differences in youth suicidal behaviour could help identify strategies to reduce suicide risk across the lifespan.