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Association between parity and risk of suicide among parous women
Authors:Chun-Yuh Yang
Institution:From the Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
Abstract:

Background

There are limited empirical data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. I conducted this study to examine whether there is an association between parity and risk of death from suicide among women.

Methods

The study cohort consisted of 1 292 462 women in Taiwan who had a first live birth between Jan. 1, 1978, and Dec. 31, 1987. The women were followed up from the date of their first birth to Dec. 31, 2007. Their vital status was ascertained by means of linking records with data from a computerized mortality database. Cox proportional hazard regression models were used to estimate hazard ratios of death from suicide associated with parity.

Results

There were 2252 deaths from suicide during 32 464 187 person-years of follow-up. Suicide-related mortality was 6.94 per 100 000 person-years. After adjustment for age at first birth, marital status, years of schooling and place of delivery, the adjusted hazard ratio was 0.61 (95% confidence interval CI] 0.54–0.68) among women with two live births and 0.40 (95% CI 0.35–0.45) among those with three or more live births, compared with women who had one live birth. I observed a significantly decreasing trend in adjusted hazard ratios of suicide with increasing parity.

Interpretation

This study provides evidence to support Durkheim’s hypothesis that parenthood confers a protective effect against suicide.Childbearing is considered to have long-term effects on women’s health.1 However, little is known about the relation between parity and mortality among women except for cancers of the reproductive organs.2In his book on suicide published in 1897, Durkheim concluded that the rate of death from suicide was lower among married women than among unmarried women because of the effect of parenthood and not marriage per se.3 Three studies since then have explored Durkheim’s hypothesis. In the first, published almost 100 years later, Hoyer and Lund conducted a prospective study in Norway involving 989 949 married women aged 25 years or older who were followed up for 15 years.4 They reported a negative association between suicide-related mortality and number of children. In a nested case–control study in Denmark involving 6500 women who committed suicide between Jan. 1, 1981, and Dec. 31, 1997, and 130 000 matched control subjects, Qin and Mortensen found a significantly decreased risk of suicide with increasing number of children.5 In the third study, 12 055 pregnant women in Finland were followed up from delivery in 1966 until 2001; the authors found a decreasing trend in suicide-related mortality with increasing parity.1One reason for the limited empirical evidence exploring Durkheim’s hypothesis may have to do with sample size and study design.4 Only studies involving representative suicides from the general population could make it possible to achieve sufficient power to detect the effect of parity on rare events such as suicide.1,4,5 Even in the prospective study involving 989 949 women followed for 15 years, only 11 deaths from suicide occurred among women with six or more children.4In Taiwan, suicide is the eighth leading cause of death among men and the ninth among women. The age-adjusted rate of death from suicide was 19.7 per 100 000 among men and 9.7 among women in 2007.6 Suicide rates in Western countries have been generally lower than those in Asian countries.7 A consistent increase in the suicide rate since 1999 has been found in Taiwan.6 However, most Western countries have had stable or slightly decreasing rates during the 1990s.8,9 The male:female ratio of suicide is frequently greater than 3:1 in Western countries,7 whereas it is 2:1 in Taiwan.10 High suicide rates among Chinese women have been well documented.11 One explanation is that Chinese women do not benefit from marriage as much as their male counterparts.12 The sex difference in suicide rates is largely driven by a high rate of suicide among women in Chinese societies.11 In many Western countries, the trend over the past several years has been in the opposite direction: rates among women have been stable or decreasing, whereas rates among men have been increasing.12 Furthermore, in an epidemiologic study of suicides in Chinese communities, the prevalence of mental illness among people committing suicide was much lower in those communities than in Western societies.13Because the previous studies that related parity and suicide-related mortality were carried out in economically developed countries and because different cultural settings might influence suicide patterns,3 I undertook the present study in Taiwan, using a cohort of women who had a first and singleton live birth between Jan. 1, 1978, and Dec. 31, 1987, to explore further Durkheim’s hypothesis.
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