Association between parity and risk of suicide among parous women

In his book on suicide published in 1897, Durkheim concluded Figure Eight pendant 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 suiciderelated 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.1

In 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 Coin Edge disc pendant 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.13

One study emphasized a higher reduction in suicide-related mortality for each additional child among postmenopausal women (26% reduction per child) than among premenopausal women (18% reduction per child).4 The evidence suggests that the protective effect from children may differ at various stages during a woman's life. The Danish study showed a trend of decreasing risk of suicide with increasing number of children: relative to nulliparous women, the odds ratios were 1.02 for one child, 0.97 for two children, 0.84 for three to four children, and 0.62 for five or more. My study found a 39% decrease in suicide-related mortality among women with two live births and a 60% decrease among women with three or more births compared with women with one child. The protective effect of parity on risk of Paloma's X pendant from suicide was much stronger than previously reported