Analyzing the Association of Gender-Based Violence on National Suicide Rates - A Multinational Ecological Study.

Gender-based violence (GBV) is a global concern impacting women irrespective of age, origin, or socioeconomic background. Globally, one in three women experiences physical and/or sexual violence during her life. Such experiences are postulated to increase the risk of developing psychiatric disorders and suicidal behavior. However, ecological multinational studies of this phenomenon remain scarce. Consequently, this study aimed to investigate the association between the degree of reported GBV and female suicide rates within a comprehensive multinational study. The effect of GBV - operationalized by the Violence against Women Index (VAWI) - on national female suicide rates in 37 countries of the WHO European Region was examined in form of a multinational ecological analysis using cross-sectional national-level data with spline-based regression models correcting for multiple factors: male suicide rate, gross domestic product (GDP) per capita, unemployment rate, percentage of population ≥65 years of age, number of mental health hospital beds per population and homicide and robbery rates. The analyses revealed a significant U-shaped association between VAWI and female suicide rates (p = .007). Whereas in the lower ranges of VAWI scores (0-0.16), a negative association with the female suicide rate was found, this relationship reversed after an inflection point (around 0.17), thereafter exhibiting a positive association. Significant associations with total VAWI scores were also found for the covariates male suicide rate (p < .001) and gross domestic product (GDP) (p = .04). This is the first multinational ecological study to investigate the association between GBV and female suicide rates, revealing a nonlinear relationship with a positive association from medium VAWI levels upwards. These results highlight the urgent need for more thorough data collection with respect to GBV and a reduction of barriers and stigma in reporting of GBV and help-seeking of affected women.