Many studies have identified a strong link between suicide and diagnosable mental illness, especially depression. So because women suffer from depression at a much higher rate than men, they would seem to be at higher risk for suicide. But women actually commit suicide about one-fourth as often as men.

Writing in the journal Comprehensive Psychiatry, George E. Murphy, M.D., an emeritus professor of psychiatry at Washington University School of Medicine in St. Louis, says that women may be protected because of the way they think about problems and interact with others.

"Women process their experiences with friends. They discuss their feelings, seek feedback and take advice," Murphy says. "They are much more likely to tell a physician how they feel and cooperate in the prescribed treatment. As a result, women get better treatment for their depression."

That treatment may help protect them from suicide, but Murphy says there is more to it. The approach to problem-solving is what lands a woman in a psychiatrist's office in the first place. And that approach may be keeping female suicide rates lower than those of men.

Suicide vs. attempted suicide

There are roughly 30,000 suicides in the United States each year, and three-fourths of those are men. But the number of attempted suicides is at least 10 times that, and even that estimate may be low because many suicide attempts are euphemistically classified as lacerations or accidental poisonings when patients receive treatment in hospital emergency rooms.

Although suicide rates are lower among women, women lead men two to one in suicide attempts. So, Murphy says at least 200,000 women are involved in suicide attempts annually. But he points out that attempted suicide most often is not an attempt to actually end one's life. Its purpose, he says, is to survive with changed circumstances.

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"An attempted suicide is not really an attempt at suicide in about 95 percent of cases. It is a different phenomenon. It's most often an effort to bring someone's attention, dramatically, to a problem that the individual feels needs to be solved. Suicide contains a solution in itself," he says.

In attempted suicide, both men and women tend to use methods that allow for second thoughts or rescue. Murphy says that when people intend to survive, they choose a slowly effective, or ineffective, means such as an overdose of sleeping pills. That contrasts to the all-or-nothing means like gunshots or hanging used by actual suicides.

In the past, researchers who looked at the high rate of attempted suicide in women concluded that women were just not as efficient as men at taking their own lives. Murphy calls that "sexist baloney" and points to statistics that show that like men, women who commit suicide most often use guns. However, even as the number of women using the most lethal means increases, the suicide rate in women has slowly declined.

"So it really goes back to the same thing -- that women, when they intend to do it, can be just as effective as men in committing suicide. But they aren't so inclined," Murphy says.

Cognitive differences

Murphy believes women are less inclined to commit suicide because their thinking is more inclusive. While a man might tend to throw aside seemingly peripheral issues to get to the core of a problem, a woman might take more things into account. She may continue to seek input and process problems long after the point where men decide on a course of action.

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"She'll consider not just her feelings but also the feelings of others -- her family, the children, even acquaintances, and how those people will be affected by a decision like suicide," Murphy says. "A man is much less likely to take those things into account. He makes his decision, and it's about him, so he doesn't feel the need to share it with anyone else."

But before they ever get to the point of considering suicide, Murphy says, women are much more likely to seek help with their problems. The classic example is asking for directions when driving. Many men refuse to do that, perhaps seeing it as an admission of weakness. They believe they are supposed to be competent in all areas. Because they are not, they are at risk. Women, on the other hand, are much more likely to seek advice and take it.

Even though depressed or alcoholic men are less likely to look for help, it still may be possible to prevent many suicides, Murphy believes. He says alert physicians might be able to pick up on risk factors and refer men into treatment to help them look for ways to solve their problems without ending their lives.

"Half of all people who commit suicide have seen a physician within a month of their fatal act," he says. "Mostly they didn't get diagnosed, and if they did, they didn't get treated very vigorously."

That requires recognition that depressed men may understate their pain or their difficulty with a particular problem. Murphy says such recognition is essential if men are ever to benefit from the treatments that protect women from suicide. Murphy and the late Eli Robins, M.D., conducted the first comprehensive study of suicide 40 years ago, studying every suicide that occurred in St. Louis and St. Louis County during a one-year period.