Towards a reassessment of the role of divorce in suicide outcomes: Evidence from five pacific rim populations Paul S.F. Yip a, b , Ying-Yeh Chen c, d , Saman Yousuf a, b , Carmen K.M. Lee a, b , Kenji Kawano e , Virginia Routley f , B.C. Ben Park g , Takashi Yamauchi e , Hisateru Tachimori h , Angela Clapperton i , Kevin Chien-Chang Wu j, k, * a Department of Social Work and Social Administration, University of Hong Kong, Hong Kong b Hong Kong Jockey Club, Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong c Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan d National Yang-Ming University, Taipei, Taiwan e Center for Suicide Prevention, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan f Prevention Research Unit, Monash University, Department of Forensic Medicine, Victoria, Australia g Penn State University, Dubois, PA, USA h Department of Mental Health Administration, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan i Monash Injury Research Institute, Monash University, Victoria, Australia j Department of Social Medicine, National Taiwan University College of Medicine School of Medicine, Taipei, Taiwan k Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan article info Article history: Available online 19 April 2012 Keywords: Divorce Suicide Hong Kong Victoria Japan South Korea Taiwan Culture Confucianism abstract The connection between divorce and suicide risk in Asia is unclear. To understand the contribution of cultural transitions to suicide among the divorced, we compare age- and sex-specific suicide rates among divorced men and women from five Pacific Rim populations: Hong Kong, Taiwan, Japan, South Korea and the state of Victoria in Australia. On a cultural spectrum, we consider Hong Kong and Taiwan to lie between the more individualistic Australian culture and the more collectivistic Japanese and Korean cultures. Coefficients of aggravation (COA) are also compared. Suicide rates were found to be higher among the divorced than among other marital status groups in all five populations, but this difference was small in Victoria. The effect of divorce was significantly greater for men than for women only in Japan and South Korea. In the other populations, divorced men and women were at equal risk. Age trends in suicide rates for the divorced groups differed across populations. The COAs for the divorced group aged 40 or younger in the East Asian populations were higher than the COAs for older divorced groups, though this was not the case in the Victorian population. Suicide patterns among the divorced in the East Asian populations can be understood in terms of the legacy of Confucian traditions. Gender differences in Japan and South Korea may reflect either gender inequality (male dominance in formal interactions and emotional dependence in domestic life within a deteriorating Confucian family support system) or unique socio-cultural factors among married women. Divorced East Asian groups aged 40 or younger may be at a higher risk of suicide due to individual-level cultural ambivalence combined with a desire for systemic-level emotional interdepen- dence. Social welfare regimes in the four East Asian populations need to fill the vacancy left by retreating traditional family systems. Research implications are discussed. Ó 2012 Elsevier Ltd. All rights reserved. Introduction Myriad factors are associated with suicide. At the contextual level, factors related to suicide include macro-socioeconomic factors (e.g. social fragmentation, social integration, unemploy- ment, political regimes, socio-cultural transition), and temporal factors (e.g. seasonality). At the individual level, risk factors for suicide include male gender, older age, genetic factors, mental * Corresponding author. Department of Social Medicine, National Taiwan University College of Medicine School of Medicine, 2nd Floor, Medical Humanity Building, No. 1 Ren-Ai Road Sec. 1, Taipei 100, Taiwan. Tel.: þ886 2 23560029x14; fax: þ886 2 23935254. E-mail address: ccwu88@ntu.edu.tw (K.C.-C. Wu). Contents lists available at SciVerse ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed 0277-9536/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2012.03.009 Social Science & Medicine 75 (2012) 358e366