Although suicide rates around the world are about three times higher for men than women, evidence is mounting that in developing countries in Asia, young women kill themselves more often than men do.
In a study outlined this week in The Lancet medical journal, researchers give the first picture of suicide among young people in India. In the region around Vellore in southern India, the average suicide rate for young women aged 10 to 20 was 148 per 100,000, compared with 58 suicides per 100,000 men.
Globally, the suicide rate for men is about 24 per 100,000, and about 6.8 per 100,000 for women.
Experts say the latest study was based on too few suicides to be certain that the observed rates are valid, but added that the research shows suicide is vastly underreported in the developing world.
"Almost everything we know about suicide comes from Western countries, particularly Europe. So far, we had not looked into other cultures," said Dr. Jose Bertolote, who heads the mental and brain disorders division at the World Health Organization and was not involved with the study.
"The more we look into those cultures we see that the difference between men and women is not as big as it happens to be in Europe, so there is a major cultural element here," he said.
The first evidence that suicide rates are higher among young women than among men in Asia emerged two years ago from a study conducted in rural China. Researchers there found rates of 30.4 suicides per 100,000 women compared with 23.8 suicides per 100,000 men.
The latest study, led by researchers at the Christian Medical College in Vellore is the second one to show a different gender pattern in Asian suicides.
"There is a very major trend here," Bertolote said.
One of the major differences between suicide in the West and in developing countries is the method. It is known from studies in the West that more women than men attempt suicide, but fewer succeed.
Usually, women in Western countries attempt suicide by slashing their wrists or swallowing pills, both methods which are treatable. In rural India, the methods are hanging, poisoning with lethal insecticides that are banned in many other parts of the world and setting oneself on fire. All three are difficult to survive.
Some of the pesticides, widely kept in rural homes, kill within three hours. For women trying to kill themselves in the countryside, where there is no transportation and sometimes no roads, it is often too late by the time they reach a hospital.
There are a few theories why young Asian women are committing suicide at such a high rate.
"It could be because of lack of education, conflicts surrounding the issue of arranged marriages, love failures, dowries and things like that," said Dr. Lakshmi Vijayakumar, who runs the Sneha Suicide Prevention Center in Chennai, in the Madras region of India.
Overall in India, male suicides outnumber the women as they get older, said Vijayakumar, who was not involved with the study.
Once the women have children, they become emotionally and psychologically stronger and the suicide rate comes down, she said.
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