Sex Differences in Suicide Mortality: Epidemiology, Modifying Factors, and Clinical Implications. A Narrative Review

In Western industrialized nations, the sexes differ in suicide mortality and the prevalence of diagnosed depression. Men have a higher mortality from suicide than women (figures for Germany, 2024: 18.2 vs. 6.9 per 100 000), but the 12-month prevalence of clinically diagnosed depression in women is double that in men (10-12% vs. 5-6%). This situation has been called the sex-suicide paradox. In this article, we present a structured analysis of the relevant sex-specific epidemiology and the modifying factors that account for these findings.

This narrative review was created according to the SANRA recommendations on the basis of publications retrieved by a selective search in the PubMed and Cochrane Library databases and the cause-of-death statistics of the German Federal Statistical Office (2000-2026).

In 2024, the suicide rate in Germany was 18.2 per 100 000 men (n = 7414) and 6.9 per 100 000 women (n = 2958). The relative risk for suicide in men is higher by a factor of 2.6 (95% CI: [2.5; 2.8]). Affective disorders are associated with ca. 90% of all suicides, although psychological autopsy studies are subject to methodological limitations, including recall bias. Men over age 85 are particularly vulnerable, with a suicide rate of 45.7 per 100 000. Modifying factors contributing to this sex disparity include the choice of more lethal means of suicide (e.g., hanging, which accounts for 50.5% of male suicides) and an often unrecognized, externalizing depression in men.

It may be possible to lower mortality from suicide in men through greater sensitivity for sex-specific symptomatic presentations, greater attention to somatic risk factors in old age, and implementation of low-threshold, sex-sensitive preventive measures.