Sex and Gender Differences in Suicide and Suicidal Tendencies/Introduction
Sex differences in the frequency of suicides are documented worldwide: men are up to three times more likely to commit suicide than women. For example, 2603 women and 7287 men committed suicide in Germany in 2012. For both sexes, the suicide rate increases with age, but for men it increases significantly more.  The underlying causes often lie in social and emotional isolation. Suicide attempts, on the other hand, are more likely to be observed in the younger generation. The sex ratio is reversed here: younger women are more frequently affected than young men. 
The greatest risk factor for suicide is mental illness. Depression in particular, but also schizophrenic or addictive disorders increase the risk of suicide dramatically. 90 percent of all suicides are associated with mental illness, primarily depression (up to 70 percent).  Although depression is diagnosed about twice as often in women as in men, the proportion of men who commit suicide as a result of depression is significantly higher than women at 60 to 70 percent. It is reasonable to conclude that depression in men is associated with a higher risk of suicide than in women.  With regard to schizophrenia, younger men have a particularly high risk of suicide. Additional influencing factors for suicide include a educational background, knowledge about the disease and its possible course, and a considerable degree of suffering. 
In contrast to the general population, there is no sex difference in the suicide rate among physicians. Overall, physicians commit suicide more frequently than non-physicians, with female physicians committing suicide about as often as their male colleagues. For both sexes, the exceptionally heavy workload, as well as social isolation, appear to be contributory factors.  For women with children, it is particularly the persistent dual burden and the feeling of not being able to fulfil the role of mother and professional that can lead to severe states of exhaustion and depressive symptoms.  
The gender paradox
The significantly higher suicide rate with a lower suicide attempt rate for men compared to women is scientifically discussed as a sex paradox.  A particular phenomenon seems to be that suicide attempts are considered the strongest predictor of future suicides and that women should therefore have a higher suicide rate than men.  An explanation for this paradox can be found in gender stereotypes. With the socially influenced gender role, suicide in men is much easier to reconcile with "failed suicide" in the sense of a suicide attempt.   In addition, men choose more aggressive suicide methods on average, which are more likely to lead to death. Men who are mentally ill also show a significantly lower propensity to seek help than women who are affected, are less likely to verbalize their suffering and generally have a lower willingness to seek medical treatment.  It is therefore necessary to rethink male gender roles in order to promote the acceptance of mental illness among men, to increase the number of men seeking help and ultimately to prevent suicide.  Prevention programs that recognize and take into account social gender roles are urgently needed. One way to increase access to preventive measures for men (and women) could be prevention programs in the workplace. 
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