Program in Public Health, University of California, 653 E. Peltason Drive, Irvine, CA, 92617, USA.
College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
Soc Psychiatry Psychiatr Epidemiol. 2021 Oct;56(10):1751-1759. doi: 10.1007/s00127-021-02054-4. Epub 2021 Mar 15.
Indian states at greater levels of economic development report more suicides. This relation appears stronger among women relative to men. We test the hypothesis, suggested in the literature, that conflict between rapid economic growth and inadequate female autonomy (approximated using total fertility rate) varies positively with female suicides.
We used state-level data on female suicides for all 35 Indian states and union territories, from 2001 to 2011, from the National Crime Records Bureau. We specified, as our outcome, age-adjusted female suicides per 100,000 population per state-year. We retrieved data on key covariates, namely, gross state domestic product (GSDP) per capita, total fertility rate (TFR), and other control variables from multiple national surveys and publicly available data sources. We examined whether and to what extent age-adjusted female suicides (per 100,000 population) correspond with total fertility rate (lower TFR indicates greater female autonomy and vice versa) within the context of greater economic development (GSDP per capita). Linear longitudinal mixed effect regressions controlled for state-specific random intercepts, son preference (male:female sex ratio at birth), literacy gap (percentage difference between literate males and females), access to health systems (institutional deliveries), female to male employment ratio, and linear time trends.
At constant levels of GSDP per capita, a one unit decline in TFR corresponds with 0.27 fewer female suicides per 100,000 population (P value = 0.008). Sensitivity tests indicate that this relation does not hold for male age-adjusted suicides (per 100,000 population).
Our findings, if replicated, indicate that at constant levels of economic development, lower TFR (indicating greater female autonomy) may reduce suicide risk among women.
经济发展水平较高的印度邦报告的自杀人数较多。这种关系在女性中相对于男性更为明显。我们检验了一个假设，即文献中提出的经济快速增长与女性自主权不足之间的冲突（通过总生育率来近似）与女性自杀率呈正相关。
我们使用了来自国家犯罪记录局的 2001 年至 2011 年期间印度所有 35 个邦和联邦属地的女性自杀州级数据，作为我们的结果，我们指定了每个州年每 10 万人中年龄调整后的女性自杀率。我们从多项全国性调查和公开数据来源中检索了关键协变量的数据，即人均国内生产总值（GSDP）、总生育率（TFR）和其他控制变量。我们考察了在经济发展水平较高（人均 GSDP）的情况下，年龄调整后的女性自杀率（每 10 万人）与总生育率（较低的 TFR 表示女性自主权较大，反之亦然）之间是否以及在何种程度上存在对应关系。线性纵向混合效应回归控制了州特定的随机截距、儿子偏好（出生时的男女比例）、识字差距（男性和女性识字率之间的百分比差异）、获得卫生系统的机会（机构分娩）、女性与男性的就业比例和线性时间趋势。
在人均 GSDP 水平不变的情况下，TFR 下降一个单位与每 10 万人中女性自杀人数减少 0.27 人相对应（P 值=0.008）。敏感性测试表明，这种关系不适用于男性年龄调整后的自杀率（每 10 万人）。
如果得到证实，我们的研究结果表明，在经济发展水平不变的情况下，较低的 TFR（表示女性自主权较大）可能会降低女性的自杀风险。
