cent data from the Chinese government for 2000 show a significant fall in suicide rate from 23 per 100,000 to 17 per 100,000.

CHALLENGES

Cross-National Differences: Real or Artifact?

Interpretation of cross-national suicide rates are subject to several limitations. First, different countries may assign different meaning and classification to the acts. Kelleher et al. (1998) report that countries with religious sanctions against suicide were less likely to report their suicide rates to the World Health Organization, and on average, their reported rates were lower than for countries without sanctions.2 In India, suicide rates may be misrepresented due to traditional and unique cultural practices such as “dowry death,” which is a category of deaths of young married women including both homicide and suicide following from intense coercion for payment of unpaid or additional dowry. It may be difficult to differentiate homicide from suicide in the investigation of such deaths (Khan and Ray, 1984; Leslie, 1998). Second, difference among countries may reflect the capacity of the emergency health care system to respond rather than differences in the intent of the individuals. For example, the high rate of suicide among young Chinese women may result from the lethality of available means in the face of limited treatment availability. Women living on farms in China often have ready access to extremely toxic pesticides. It is often not possible to obtain emergency treatment after these chemicals are ingested in an impulsive moment. Thus, cases that might end up as suicide attempts in the United States are fatal in China. Difference in the demographics of suicide attempts and completions between counties may reflect these artifacts of infrastructure rather than psychological or biological differences (Ji et al., 2001). Third, the organization and functioning of medico-legal officials across countries has long been thought to produce artifactual differences even between similar countries such as Britain and Scotland (Barraclough, 1972). Most developing societies lack registries and expertly trained officials to record suicide. Further, there are cross-national differences in the underlying logic of classifications systems. In India, for example, the classification scheme focuses on social stressors rather than psychopathology. In 1997, only 4.9 percent of all suicides were attributed to mental disorders, while other causes were cited for the remaining 95.1 percent (e.g., family problems (18.4 percent), love affairs (3.7 percent), poverty (3.4 percent)) (Gov-

2  

It is uncertain whether the rates are low because of the protective effects of religion or because of misrepresentation of cause of death.



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