Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
BMJ Open. 2022 Feb 17;12(2):e049425. doi: 10.1136/bmjopen-2021-049425.
In the last half of the 20th century, many countries have already abolished antisuicide laws; however, more than 20 countries still adopt them. This paper is the first to systematically explore the association between criminalisation of suicide and national suicide rates in 171 countries/regions to examine the deterring effects of the antisuicide laws.
A cross-sectional ecological study.
171 countries in the world.
In 2012, 25 countries were identified to carry antisuicide laws. A linear regression analysis was adopted to explore the association between national suicide rates (log transformed) and criminalisation of suicide in the world in 2012, having controlled for the Human Development Index (HDI), majority religious affiliations and the national unemployment rate.
Sex-specific age standardised suicide mortality rates.
Criminalisation of suicide was associated with slightly increased national suicide rates (β estimate=0.29, 95% CI -0.04 to 0.61). Stronger association was found in women (β estimate=0.40, 95% CI 0.06 to 0.74), connecting criminalisation of suicide and higher suicide rates. The harmful effect of antisuicide laws on women was particularly prominent in non-Muslim countries and countries with lower HDI.
Laws penalising suicide were associated with higher national suicide rates and even more so in the female population in the low HDI, non-Muslim countries. The non-supportive patriarchal culture with laws penalising suicide may render women vulnerable to suicidality. Instead of criminalising suicide, alternative approaches such as providing good mental healthcare and adjusting the socioeconomic, legal and cultural factors that contribute to suicide should be considered.
在 20 世纪下半叶，许多国家已经废除了自杀法；然而，仍有 20 多个国家采用自杀法。本文首次系统地探讨了 171 个国家/地区的自杀刑事化与国家自杀率之间的关系，以检验自杀法的威慑作用。
横断面生态学研究。
世界上的 171 个国家。
2012 年，确定了 25 个国家实行自杀法。采用线性回归分析探讨了 2012 年世界各国自杀率（对数转换）与自杀刑事化之间的关系，同时控制了人类发展指数（HDI）、主要宗教信仰和国家失业率。
性别特异性年龄标准化自杀死亡率。
自杀刑事化与国家自杀率略有上升相关（β估计值=0.29，95%CI-0.04 至 0.61）。在女性中发现了更强的关联（β估计值=0.40，95%CI0.06 至 0.74），将自杀刑事化与更高的自杀率联系起来。在非穆斯林国家和 HDI 较低的国家，自杀法对女性的有害影响更为显著。
惩罚自杀的法律与更高的国家自杀率相关，在低 HDI、非穆斯林国家的女性中更为明显。惩罚自杀的非支持性父权制文化可能使女性更容易产生自杀倾向。与其将自杀刑事化，不如考虑提供良好的精神卫生保健和调整导致自杀的社会经济、法律和文化因素等替代方法。
