+ How is suicide culturally constructed?: An example from China June Lam & Juveria Zaheer 2016 IDC February 6, 2016

+ The impact of suicide worldwide 804,000 suicide deaths worldwide in 2012 For every one suicide death, 10 – 20 attempt Second leading cause of death in year-olds Suicide rate almost twice for males HICs: 3x male suicide deaths vs. female LMICs: 1.5x male suicide deaths vs. female *WHO “Preventing suicide: a global imperative”

+ “Over 90% of suicide victims or suicide attempters have a diagnosable psychiatric illness, most commonly a mood disorder.” Mann JJ Neurobiology of suicidal behaviour. Nature Reviews Neuroscience 4:

+ The “ Gender Paradox ” In almost every country in the world, women have higher rates of suicidal ideation and behaviour, but lower rates of death by suicide than men Canetto & Sakinofsky (1998) labeled this phenomenon the gender paradox of suicidal behaviour Most marked in industrialized nations, specifically English-language countries such as the US, Great Britain, and Australia (Canetto, 2008)

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+ Suicide in China China's suicide rate 2 to 3 x global average No national death reporting system Phillips et al. (2002, 2003) developed an estimate by adjusting for unreported deaths Annual number 287,000 suicide deaths

+ Suicide in China: Gender World Health Organization Statistics Source: WHO Data, 1995

+ Suicide in China: Gender Rate of suicide in females 25% higher than males Very high rate in young rural women Suicidal behaviour in young women characterized by high impulsivity, little effort to seclude themselves, and low rates of mental illness (Pearson et al, 2002) 29% took poisons in front of someone; 65% found within five minutes of the attempt Common interpersonal stressors include unhappy marriage, financial problems, spousal abuse, changed routines, conflict with mother-in-law, and large loan

+ Suicide in China: Mental Illness National Psychological Autopsy Study (Phillips et al, 2002) 38% suffered from a mental illness 62% identified with mental illness with culturally appropriate expanded probes Low rates of substance abuse (almost non-existent in females but increasing in males) Borderline Personality Disorder as seen in the West rarely described in China

+ Suicide in China: Means National Psychological Autopsy Study (Phillips et al, 2002) 58% died by ingesting pesticides (especially in rural communities) Pesticides responsible for 150,000 deaths per year by suicide (easy access dangerous for impulsive acts) 75% used pesticides in the home 62% received medical treatment but died

+ Culture Does Not Exist in a Vacuum Chinese culture is not monolithic Urban and rural differences Globalization Sociopolitical factors Rapid economic change Theories should be built from data

+ Culture Does Not Exist in a Vacuum Canada is a culturally and ethnically diverse country, with large populations of visible minorities and high rates of immigration. Approximately half of population in the GTA is foreign-born Over one million residents born in Asia and the Middle East 10.4% of the population of the GTA identifies as ethnically Chinese (Statscan, 2006) An understanding of cultural conceptions of gender and suicidal behaviour can be beneficial in designing suicide prevention strategies geared to culturally diverse groups

+ Cross-cultural Suicide Prevention Immigration and Suicide Canadian born: 13.3 suicides per Non-Native born: 7.9 suicides per However: “ Healthy Immigrant ” effect? Rates matched those in the immigrants' countries of birth more closely than those of Canada The gap between suicide rates between men and women is narrower in immigrants Statscan, 2004

+ Cross-cultural Suicide Prevention WHO/EURO multi-center study on suicidal behaviour found that geographic boundaries and distances have a much weaker correlation with suicide rates than do regions sharing similar cultures, languages and religion (Schmidtke et al, 2004)

+ What can we learn from studying suicide through cultural lens? Question Western-centric knowledge: Who? More women, more rural, younger How? Pesticides account for >50% of deaths Why? Less mental illness, more interpersonal, impulsive; 60% due to mental illness vs. 90+% How sociocultural context affects mental health, including place of origin, gender, and immigration Cross-cultural collaborative study: gender and cultural factors in suicidal behaviour of Chinese and Chinese-Canadian women

+ Exploring As a Learner Mental Health on the Margins Interdisciplinary resident-initiated discussion group exploring topics in global mental health and cultural psychiatry, and the tension between Safe space to discuss marginalized topics with other learners informally, over food If there is a gap in a field of interest, find friends and create your own learning opportunities Join us!

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