Caroline Lehman
Sociology 164: Death and Dying
Professor Gold
December 8th, 2011
Cultural Attitudes Toward Suicide: A Comparison of Europe, the Middle East, and Asia
Introduction
Suicide. Self-murder. Self-immolation. No matter the phrasing one uses, the mention of
the word “suicide” in conversation often makes people uncomfortable because among most
every culture, suicide is considered taboo. While hardly ever spoken about, suicide is one of the
leading causes of death throughout the world. It is hard to believe that suicide rates worldwide
have skyrocketed sixty percent in the past 45 years. Additionally, researchers predict that by the
year 2020, global suicide figures will reach almost 1.4 million deaths per year (Pompili et al.,
2011). Sadly, the grief that family members face when a loved one commits suicide often goes
unacknowledged by society; however, this disenfranchised grief will hopefully become a thing
of the past as suicide awareness increases worldwide.
While researchers have thoroughly studied the effects of social factors such as sex, age,
and race on suicide rate as well as personal, interpersonal, and economic social factors, cultural
attitudes toward suicide are harder to define and characterize. Social factors often play a role
later in life in changing one’s attitude toward suicide while culture is continually present in one’s
life from upbringing until death. Religion also plays an instrumental part in an individual’s
thoughts on an afterlife, death, and suicide. Culture and religion are intertwined in more ways
than one and are therefore very hard to separate into two completely different categories, as
culture encompasses religion. An individual’s upbringing also shapes one’s beliefs and thoughts
towards death and dying and culture greatly influences this environment in which one was
raised. For these reasons, nations around the world report very different suicide statistics in terms
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of suicide rates among the two sexes or different age groups, and these statistical trends are often
inversely related to other nations that share similar economic development or religious beliefs.
These extreme differences among suicide trends and patterns among different geographical areas
and racial and ethnic groups strongly suggest cultural influences. The way in which people
respond to and view mental health and suicide is incontrovertibly linked to society and culture.
What are the ways in which attitudes toward suicide differ by culture?
Literature Review
Europe
A study by Jukkala et al. (2011) examined the attitudes toward suicide in Russia through
determining suicide acceptance and its determinants. 1,190 Muscovites were surveyed. The
sample contained people living in the Greater Moscow ages 18 years or older. The sample was
taken at random from each of the 125 municipal districts of Greater Moscow, each of which was
divided into 10 administrative districts. Each sample aimed to match the same sex and age
distribution of the district population. The only source of bias was that the highly educated were
overrepresented in the sample. The research obtained revealed the relationships between
demographic, personal, social, economic, and religious variables and suicide acceptance as well
as the relationships in attitudes toward other disputable behaviors compared to suicide.
The study concluded that 10.6% of men and 6.1% of women living in Moscow were
accepting of suicide while 78% and 81.6% were condemnatory, respectively. Suicide was often
grouped into the same category as other “disputable behaviors” such as homosexuality and
prostitution. The youngest age group was three times more accepting of suicide than the
reference group (ages 45 to 54 years). Non-religious and higher educated people were also more
accepting of suicide while marital and economic status had little effect on acceptance. This data
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highlights the significance of the environment in which one is raised as well as socialization for
suicide attitudes. The strongest predictor to suicide acceptance was general tolerance overall.
Another study done by Renberg et al. (2003) measured attitudes toward suicide and the
correlation to suicidal behavior by surveying a Swedish population in the years of 1986 and
1996. A randomly selected sample of 700 people aged 18 to 65 were surveyed in a county in
northern Sweden in 1986 but the sample size analyzed was only 510. In 1996, 1,000 people with
similar demographics were surveyed but only 650 surveys were used. The sample matched the
overall population of Sweden quite well, but there was a higher proportion of females as well as
cohabiting people in the study. People surveyed were asked to answer questions regarding eight
different factors of suicide and how accepting they were of each factor.
The study found that the level of acceptance toward the right to commit suicide across all
age groups studied increased from 1986 to 1996, which also coincided with a decline in suicide
rates during this 10-year period. However, in 1986 when the suicide rate in females was four
times lower than that of males, women were found to be less permissive of suicide. Young
people held strong beliefs that it is possible to help a suicidal person while older age groups
believed that people who committed suicide are mentally ill. Young women and men living in
urban areas held the most accepting views toward suicide. The oldest men studied, on the other
hand, were most resigned about suicide. Additionally, suicidal women believed suicide to be a
right, were more sympathetic toward those who attempted to kill themselves, and considered
suicidal behavior more normal and more relation-caused.
An additional study by Renberg et al. (2008) assessed the relationship between European
nations’ outlooks on suicide and suicidal behavior by analyzing data collected from three
different countries. The sample was taken from three different regions in Sweden, Norway, and
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Russia, each region reporting quite different suicide rates. 627 Swedes, 466 Norwegians, and 508
Russians participated in study. The sample was randomized and consisted of people ranging
from 18 to 65 years of age. Participants were asked about their experience with suicide among
significant others, their attitudes toward suicide, their life satisfaction, as well as any suicidal
thoughts they had previously held.
Results showed that experience with suicidal problems among significant others and
suicidal expressions early in life predicted attitudes toward suicide and that these outlooks on
suicide, in turn, predicted current suicidal thoughts. Swedish women who experienced early
suicidal expressions were very non-condemning of suicide. Norwegian men and women as well
as Swedish men also followed this pattern. On the contrary, Russian men and women who
reported early suicidal expressions were more condemning than those who did not have previous
suicidal expressions. Attitudes toward suicide were also influenced by experience with suicide
among family and the data differed by culture and gender. Overall, Russian attitudes toward
suicide played a more important role in suicidal behaviors than did Swedish or Norwegian
attitudes, as Russia has one of the highest suicide rates in the world.
The Middle East
A qualitative study by Keyvanara et al. (2010) explored the sociocultural contexts of
suicide attempts among women in Iran. In 2006, fifty women from Isfahan, Iran who had been
admitted to a hospital for suicide attempt related injuries were interviewed. The women were
between the ages of 15 and 46 and had attempted suicide, on average, between one and four
times. About half of the participants were married and half lived in urban areas. A majority
attempted to overdose while 16 attempted to use self-immolation.
At the conclusion of the study, many major themes presented themselves in the
qualitative data such as family problems, marriage and love, social stigma, pressure of high
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expectations, as well as poverty and unemployment. The family problems included strains in the
relationships between mothers and daughter-in-laws, husbands and wives, children and parents
as well as siblings. Many young women sited parental discrimination, social restrictions such as
gender inequality, and pressures to perform well academically as reasons to commit suicide.
Notable conflicts emerging in Iranian society and culture are those between traditional and
modern values of different generations, especially on the topic of arranged marriage, as well as
the change in social and gender roles.
Another study by Koronfel (2002) reviewed the numerous aspects of deaths by suicide
that took place in Dubai, United Arab Emirates between the years of 1992 and 2000. 362 cases
were examined and data on sex, age, nationality, religion, psychological illness, as well as
method of suicide was collected from the Forensic Medicine department of the Dubai Police.
The samples were classified into two religious categories: Muslim and non-Muslim and were
separated by citizens, expatriates from the Indian subcontinent, and expatriates from other
nations.
Eighty five percent of the suicidal deaths were males and ninety four percent of the
victims were expatriates. There was also a significant increase over the 8 years in the number of
non-Indian female expatriate suicides. A vast majority of victims were between the ages of 21
and 40 while the highest suicide rate was among 26-30 year olds and the lowest was among
people over the age of 50. Three fourths of the victims hung themselves and females preferred
methods of jumping from a tall building and self-poisoning. Age had nothing to do with the
choice of method used to commit suicide. Twenty eight percent of people who committed
suicide tested positive for alcohol and all of these cases but one were in men. Surprisingly,
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religious beliefs had little correlation with suicide. Motives for suicide included unemployment,
breakdown of a relationship, death of a spouse, drug addiction, and terminal illness.
An additional study by Rezaeian (2007) examined data on suicidal deaths from 2000 on
22 different countries in the Eastern Mediterranean Region. The countries were divided into two
subgroups, high income and low/middle income. Of these countries, only four were considered
high income. The suicide cases were split into 5 age groups, ranging from 5 years old to 60 years
and older.
The study found that overall, the rates of suicide for females were higher than for males.
The highest rate of suicide occurred between 15 to 29 years of age for women and the rate for
men rose continuously with age. The highest rate of suicide for men occurred above the age of
60. Low and middle-income countries had similar rates of suicide while females in the highincome countries had the lowest rates of suicide and males had lower rates of suicide overall
compared to males living in lower income countries. The region studied is about 90% Islamic,
which may contribute to the lower recorded suicide mortality rate compared to western regions.
Asia
A study by Zhang et al. (2011) observed the correlations between Chinese culture and
suicide by testing the strain theory of suicide with data collected throughout China. The strain
theory identifies psychological strains as the predecessor to suicide. The study used both
psychiatric and social predictors of suicide. In 2008, 392 suicide cases (178 females and 214
males) were sampled and 416 living cases (214 females and 202 males) were used as controls.
Both samples were between the ages of 15 and 34 years of age from 16 rural countries in China.
Four different strain sources were tested for among the suicide cases and controls. These
included value strain, when two conflicting social values are competing in a person’s life,
aspiration strain, when there is a inconsistency between an individual’s goal in life and reality,
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deprivation strain, when an impoverished person realizes other people of the same economic
status are better off, and coping strain, when a life crisis occurs and the individual is unable to
handle the pressure. The value strain is especially relevant to Chinese culture as it pertains to the
Confucian traditional gender values.
Researchers found that suicides scored significantly higher on all four strains than the
controls. Coping skills were only second to psychiatric diagnosis as the strongest predictor of
suicide. Interestingly, the value strain was not as significantly observed in association with
suicide, as were the other three strains. Making more money and job security were among the top
four failed aspirations in the suicide sample. Religion tended to be positively associated with
suicide among the rural youth of China.
Another study by Lau et al. (2001) examined how a predominantly Asian tradition of
respecting elders related to suicide rates by comparing statistics from 1995, specifically focusing
on people 75 years or older in forty different countries throughout the world. The ratio between
suicide rates in the older population and total population were analyzed and the statistics for the
different countries were compared.
Overall, the suicide ratios for older generations were actually worse in Asian cultures
than those found in western cultures. Urban China, Singapore, Rural China and Hong Kong had
the highest male suicide ratios and the worst female suicide ratios. Rural China had both the
highest suicide rate among females as well as among older people. The significant statistical
differences between Asian societies and western cultures can possibly be explained by the
different values held by Asian cultures, such as placing men higher up in society than women or
the rapidly changing social system. Another factor may be that Asian cultures are placing more
value in the nuclear family, which is reducing the traditional veneration of old people.
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An additional study by Lester et al. (1999) investigated the epidemiology of suicide in
India from 1975 to 1994 by examining data on gender, methods used for suicide, and motives.
Data was collected from the 25 states as well as the 23 major cities in India. This data was
compared to the corresponding data for the 48 continental states of the US.
The study concluded that in 1991, the suicide rate among Indians was 9.2 per 100,000 per
year with the male ratio slightly higher than the female rate. The most common methods for
suicide were poisoning and hanging. While the suicide rate in India is quite low, it has been
rising in recent years. Self-immolation is a more popular method for women than for men, as this
type of sacrifice for women has a long history in Indian tradition and the majority of the public
approves of these practices. The most common motives for male suicides were failures in exams,
poverty, or disputes over property. Suicide rates were found to be higher in more densely
populated Indian states but in less densely populated areas of the US. High suicide rates in India
could be predicted by high female participation in the labor force and low fertility. The low
suicide rates as compared to China and other Asian nations reveals that Indian society is not
tolerant of suicide as it is viewed as cowardly and an act of betrayal.
Discussion
Among most every region and culture studied, views on suicide as well as suicide rates
differed based on religion, sex, and age. A general denunciation of suicide in a culture did not
necessarily correlate with lower suicide rates. Therefore, it is very difficult to generalize an entire
culture’s acceptance or condemnation of suicide as many other factors play a role in an
individual’s attitude toward such a traditionally taboo subject.
Overall, research on suicide in European culture and society is extensive and European
attitudes toward suicide have been carefully documented. With Russian suicide rates being
among the highest in the world, one would think they would have very accepting views on
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suicide. However, the study done by Jukkala et al. (2011) proved otherwise. Interestingly, while
suicide is generally condemned in Moscow, many people believe that suicide should be a free
personal choice. The study conducted by Renberg et al. (2008) ponders whether or not these
criticizing attitudes of Russians towards suicide is just a coping mechanism to deny and suppress
their true suicidal problems. Similar to the research in Russia, the study in Sweden by Renberg et
al. (2003) concluded that Swedes who are young and well educated were more likely to be
permissive of suicide. An overall increase in permissive attitudes toward suicide corresponded
with a decline in suicide rate in Sweden, contradicting the general trend in Russia. One would
think that a more open-minded society and culture would allow people to express their suicidal
thoughts more freely, allowing the suicidal individual to get help before it’s too late. However,
an increase in the acceptance of suicide in young women correlated with an increase in suicide
rates among young women in Sweden. Interestingly, Russian men who have had a suicide in the
family are less condemning of the act while Swedish men who have had similar experiences are
more condemning. These differing attitudes probably reflect the huge gap in suicide rates
between these two groups. While these two nations exhibit similar western traditions and values,
it is almost impossible to group them together as one culture with one singular, similar attitude
toward suicide.
Since Islam is the largest religion in the Middle East, accounting for the religion of about
90% of the people in the region, religion and culture are very intertwined. The Qur’an states that
it is a sin to kill oneself; therefore, we can assume that the heavy emphasis on Islam correlates
with the Middle East having one of the lowest suicide rates in the world as well as a general
negative attitude toward the act of killing oneself. Unlike in other areas of the world, suicide is
not one of the top leading causes of death in the Middle East, in fact, it was estimated to be the
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25th leading cause of death in the year 2000. Because of these factors, very little research has
been done in terms of attitudes toward suicide and statistics on suicide rates may be skewed, as
suicides are likely to be documented as an “unknown cause of death”. While one can assume that
suicide is widely condemned throughout the region, there is very little statistical data to prove
this attitude toward suicide. However, through the studies presented, we can analyze some
suicide trends and compare and contrast them to those of Europe and Asia. The study by
Keyvanara et al. (2010) reveals how cultural factors in Iran lead to women having almost twice
the annual suicide rate as men. Iranian culture places heavy emphasis on family honor as well as
arranged marriages for women. Gender inequality and the pressure of high expectations in school
can be too much to handle and suicide is seen as the only way out for women. Additionally, the
culture in Iran is becoming more modernized, with a higher literacy level and a growing
economy. Younger generations are beginning to have greater aspirations for freedom and
equality, often causing tensions between parents and children. On the other hand, the United
Arab Emirates, one of only four countries in the region classified as a high-income country, has a
significantly greater suicide rate among males than among females according to the study by
Koronfel (2002). However, the study by Rezaeian (2000) concluded that throughout the entire
Middle Eastern region, overall rates of suicide are higher for females than in males, contradicting
the trend in the UAE, but corresponding to the trend in Iran. Overall, while these studies do not
directly answer the ways in which people of the Middle East view suicide, they give us important
insights on how suicide rates are related to gender, economic prosperity, and religion. As in
Europe, the statistics vary greatly from country to country in the Middle East; therefore it is very
hard to generalize attitudes people in the region have toward suicide or even trends in data for
the entire region.
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In China, like in the Middle East, religion plays a role in traditional culture. Buddhism
and Taoism are based heavily on belief in the afterlife and supernatural being as well as
incarnation. In China, there is a lack of a social support system and coping mechanisms that are
very much present in western religions because Buddhists and Taoists do not congregate on a
regular basis. According to the study by Zhang et al. (2011), very religious Chinese youth living
in rural areas tend to have higher rates of suicide. Interestingly, China is a predominantly atheist
country now due to the rapid Westernization of its culture which creates more strains in society
among the religious minority. This cultural tension increases the likelihood of suicide among the
religious in China. China is also known for venerating its elders. One would assume that this
protects elders from suicidal thoughts. Fascinatingly, suicide in people over 75 is higher in
countries with cultural values attached to Christianity and extended family values than in more
secular societies. In the study by Lau et al. (2001), Asian cultures were found to have aged
suicide ratios worse than those in the west. Cultural tradition in Asian societies is slowly eroding,
as is emphasis on family, which has greatly affected the suicide rate of the older generation in
China. India, in contrast to Eastern Asia, has a much lower suicide rate according to the study by
Lester et al. (1999). Research reveals that Indian society is not as tolerant of suicide despite the
fact that the sacrificial self-burning of widows is commonly accepted in Indian culture. The
Indian suicide rate is higher in men than in women, which is completely opposite to the suicide
statistics in China and the Middle East. Again, while these studies do not give us direct statistics
on the ways in which attitudes on suicide differ throughout Asia, we are able to see that cultural
views and values do play an important role in determining suicide rates among different cultures.
Therefore, culture greatly affects the way in which people view suicide, however, these cultural
attitudes are very hard to statistically determine through research. In the future, researchers
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should examine more thoroughly the ways in which cultural attitudes in Middle Eastern and
Asian societies differ from the views and opinions of suicide throughout the rest of the world.
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Works Cited
Jukkala, T. & Makinen, I.H. (2011). Acceptance of suicide in Moscow. Social Psychiatry &
Psychiatric Epidemiology, 46(8), 753-765.
Keyvanara, M. & Haghshenas, A. (2010). The Sociocultural Contexts of Attempting Suicide
Among Women in Iran. Health Care for Women International, 31(9), 771-783.
Koronfel, A.A. (2002). Suicide in Dubai, United Arab Emirates. Journal of Clinical Forensic
Medicine, 9, 5-11.
Lau, B. & Pritchard, C. (2001). Suicide of older people in Asian societies: an international
comparison. Australasian Journal on Ageing, 20(4), 196-202.
Lester, D., Agarwal, K., & Natarajan, M. (1999). Suicide in India. Archives of Suicide Research,
5, 91-96.
Renberg, E.S., Hjelmeland, & H. Koposov R. (2008). Building Models for the Relationship
Between Attitudes Toward Suicide and Suicidal Behavior: Based on Data from General
Population Surveys in Sweden, Norway, and Russia. Suicide and Life-Threatening
Behavior, 38(6), 661-675.
Renberg, E.S. & Jacobsson, L. (2003). Development of a Questionnaire on Attitudes Towards
Suicide (ATTS) and Its Application in a Swedish Population. Suicide and LifeThreatening Behavior, 33(1), 52-64.
Rezaeian, M. (2007). Age and sex suicide rates in the Eastern Mediterranean Region based on
global burden of disease estimates for 2000. Eastern Mediterranean Health Journal,
13(4), 953-959.
Zhang, J., Wieczorek, W.F., Conwell, Y., & Tu, X.M. (2011). Psychological strains and youth
suicide in rural China. Social Science & Medicine, 72(12), 2003-2010.
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