title: Gender distribution of suicide attempts among immigrant groups in European countries--an international perspective.
abstract: BACKGROUND
  Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe.
  
  
  METHODS
  Data on 64 native and immigrant groups, including 17,662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups.
  
  
  RESULTS
  The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curaçao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants.
  
  
  CONCLUSIONS
  The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategies.
authors.affiliation: National Prevention of Suicide and Mental Ill-Health, Karolinska Institute and Stockholm County Council's Centre for Suicide Research and Prevention, WHO Lead Collaborating Centre of Mental Health Problems and Suicide across Europe, Sweden. cendrinebursztein@gmail.com
authors.forename: Cendrine
authors.initials: C
authors.lastname: Bursztein Lipsicas
authors.forename: Ilkka Henrik
authors.initials: IH
authors.lastname: Mäkinen
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
authors.forename: Ad
authors.initials: A
authors.lastname: Kerkhof
authors.forename: Konrad
authors.initials: K
authors.lastname: Michel
authors.forename: Ellinor
authors.initials: E
authors.lastname: Salander Renberg
authors.forename: Kees
authors.initials: K
authors.lastname: van Heeringen
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
authors.forename: Armin
authors.initials: A
authors.lastname: Schmidtke
mesh_terms: D000293:Adolescent; D000328:Adult; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013406:Suicide, Attempted / Q000208:ethnology* / Q000523:psychology