Gender Inequality and Crude Suicide Rates in Türkiye: A Nationwide Retrospective Ecological Study.

Introduction: Suicide is a serious public health problem worldwide, with most suicides occurring in low- and middle-income countries. This nationwide ecological study aimed to explore the relationship between crude suicide rates of the sexes and gender inequality. Method: The data on age and gender-stratified crude suicide rates in all 81 provinces of Türkiye were retracted from the Turkish Statistical Institute database. Gender inequality was measured using Türkiye's provincial-level Gender Equality Index (GEI). Additionally, the following variables were considered gender inequality indicators: early marriages, fertility rate, and marriage/divorce rates; data were obtained from the Turkish Statistical Institute database. Data from 2019 were used to avoid the confounding effect of the COVID-19 pandemic. Results: The associations between gender inequality and crude suicide rate differed between women and men. There was a positive correlation between crude suicide rate and GEI in men aged 45-64 (r=0.294 p<0.01), but no correlations were found in other groups of age and gender. Early marriage rates (r=0.341 p<0.01) and fertility rate (r=0.333 p<0.01) were positively associated with crude suicide rates in women aged 15-44, while divorce/marriage rate (r=-0.256 p<0.05) was negatively related to these rates. Divorce/marriage rate was associated with an increase in men's suicides in both the 45-64 (r=0.452 p<0.01) and 65 and over (r=0.290 p<0.01) age groups. Conclusion: Gender inequality indicators were related to suicide. That relationship may vary across different age and gender groups. The findings may be limited to low- and middle-income countries. Suicide prevention interventions should be designed to account for age group, gender, and cultural characteristics of the place of residence concerning gender.