Suicide and social stigma in women: understanding silence and building prevention

Talking about female suicide means addressing a complex topic, intertwined with biological, psychological and sociocultural aspects. Despite advances in mental health, suicide in women remains one of the most underestimated and stigmatized phenomena. Public narratives often focus on male suicide —statistically more frequent — but overlook the peculiarities of female suicidal experience, which require a specific and informed approach.

1. Epidemiological data and trends

Globally, over 700,000 people die every year by suicide, with a global average rate of 9 per 100,000 inhabitants (World Health Organization [WHO], 2021). Men account for about 75% of suicide deaths, but women make up to three times as many attempts (National Institute of Statistics [ISTAT], 2023).

This difference, called the “gender paradox of suicide”, is an internationally recognized phenomenon (Canetto & Sakinofsky, 1998). Women show a greater propensity to seek help, but encounter social, cultural, and psychological barriers that often prevent timely intervention.

2. Psychological and biological differences

The causes of suicide are multifactorial. However, emotional and relational specificities emerge in female subjects. The literature indicates a significant correlation between suicide and mood disorders, anxiety, post-traumatic disorders, and personality disorders (Chesney, Goodwin, & Fazel, 2020).

Women report higher levels of emotional rumination, self-blame, and shame (Nolen-Hoeksema, 2001), which may amplify suicidal risk. Biologically, hormonal fluctuations related to pregnancy, postpartum, and menopause can affect mood regulation and vulnerability to suicide (Bloch et al., 2003). These factors must not be understood in a deterministic sense, but as elements that interact with often non-protective relational and social contexts.

3. Stigma and suicide

One of the most significant problems related to suicide is stigma, which is a negative social brand associated not only with those who have attempted suicide, but also with those who have lost a loved one to this cause. Historically, society has responded to suicide with punishments and moral condemnations: in the past, the bodies of suicides were subjected to public humiliation, deprived of the funeral rite and burial in cemeteries, while families suffered confiscations and legal repercussions (Alvarez, 1973; Pompili & Tatarelli, 2007). These practices were intended to dissuade others from performing the same gesture, but in reality, they generated additional pain and isolation in the survivors.

Although today such sanctions no longer exist, subtle forms of marginalization and silence remain towards those affected by suicide. People who have survived an attempt or those who have lost a family member often experience reduced social contact, shame, and internalized guilt. This isolation, which manifests itself in tacit and everyday ways, further fuels suffering (Shneidman, 1972).

Every suicide not only affects the person who dies but also has profound repercussions on the family, the community, and the entire society. As the American Foundation for Suicide Prevention points out, “suicide is a personal act, but everyone feels the effects”. It is estimated that every year, around 180,000 individuals become survivors, i.e., people who have lost a loved one by suicide (Farberow et al., 1992a). In the United States, where there are about 31,000 suicides a year, at least six people for every victim are directly emotionally involved - a figure that leads to millions of survivors in recent decades (Shneidman, 1972).

bereavement by suicide represents one of the most traumatic experiences a person can face. The American Psychiatric Association calls it “catastrophic”, comparable to a concentration camp experience (quoted in Pompili & Tatarelli, 2007). Those who suffer a similar loss go through phases of shock, rejection, pain, anger, shame and desperation, often more complex than other types of mourning (Latham et al., 2004). Guilt is a central component: survivors constantly question whether they could have avoided the fatal act, thus fueling intrusive and self-blaming thoughts (Krysinska, 2003).

In addition to guilt, anger towards the deceased person is also common: the victim of suicide is, in a sense, also “the perpetrator” of the loss, and this makes it difficult to reconcile love and resentment. This emotional conflict hinders grieving and can lead to dissociative disorders, reactive psychosis, or major depression (Pompili et al., in press). Some survivors develop suicidal ideation, fueled by the unbearable mental pain that Shneidman (1993) identifies as the essential element of any suicidal gesture.

The loss of a loved one by suicide is not “overcome” in the traditional sense, but integrates over time, requiring a process of adaptation to the new reality without the loved one. Farberow et al. (1992 b) highlight that suicide bereavement takes longer than other types of loss, and only after about three years do differences in the processing process tend to narrow. However, the emotional impact remains profound and can resurface unpredictably, especially on significant dates or times of crisis.

An important dimension to consider concerns the active prevention of suicide, which cannot ignore the fight against stigma. As pointed out in an interview conducted with Prof. Giuseppe Bersani published by UPMC Italy, ask a person directly «Are you thinking of killing yourself?» or «Have you done anything to end your life?» it can represent an act of care and openness that reduces isolation, as long as it is accompanied by empathy and not judgment (UPMC Italy, 2024). The article highlights how stigma is an obstacle to the recognition of warning signs —for example, thoughts of death, seeking information about «dying» or behavioural changes — and how direct questioning can instead foster the activation of a support and help network (UPMC Italy, 2024). Such an integrated approach —reducing stigma + early recognition — reinforces prevention and helps reduce the negative impact on survivors.

A further crucial aspect concerns professional training and open communication as fundamental tools for reducing the stigma associated with suicide. As Turchi and Righini (2020) highlight, in an article published in State of Mind, “talking about it openly and training adequately can help reduce stigma and break silence” (p. —). The authors point out that specific training allows health professionals to ask direct questions about suicidal ideation — without fear of “instigating” the gesture — and promotes the use of a common language that strengthens the connection between the sufferer and the care context (Turchi & Righini, 2020). This approach not only aims to counteract the isolation of those experiencing deep mental pain, but also intervenes preventively on the terrain of social stigma, placing knowledge and empathy at the center of the strategy.

Finally, several studies have observed how suicide can generate clusters of similar events within families or communities, where despair and identification with the deceased become contagious elements (Pompili et al., in press). This phenomenon underscores the importance of offering immediate psychological support to survivors, not only to grieve but also to prevent further suicides. Understanding and reducing stigma, therefore, represent not only an act of empathy but a real form of prevention.

4. The cultural dimension: stigma and gender stereotypes

On a sociological level, female suicide is strongly influenced by the cultural context and social representations of women. In many cultures, women are still associated with roles of care, moral strength, and emotional resilience. Showing fragility is perceived as a “role break”, and this fuels shame and guilt (De Leo, 2020).

Public storytelling also tends to romanticize or pathologize female suicidal gestures: on the one hand, it reduces them to expressions of “sentimental drama”; on the other, it labels them as “emotional exaggerations”. Both readings dehumanize pain and prevent real understanding. Stigma, as highlighted by Chesney et al. (2020), reduces the probability of a woman asking for help promptly by up to 40%. Self-stigmatization, or the belief that you are “wrong” to experience suffering, becomes a risk factor as powerful as the trauma itself.

5. Specific risk factors

Among the most frequent risk factors in female suicide, we find:

• Domestic violence and sexual abuse (Oram et al., 2017)

• Postpartum depression and perinatal mood disorders

• Eating disorders and anxiety disorders

• Relationship conflicts and loss of social role

• Chronic care burden (for children, elderly, or sick family members)

• Isolation and a poor support network

The intersection of these elements often creates a cumulative vulnerability: it is not a single event that generates suicidal risk, but the sum of micro-wounds and expectations internalized over time.

6. The “double invisibility” of female suicide

Female suicide is “double silence”: on the one hand, because suicide is taboo; on the other, because women, by cultural norm, should “resist”. When a woman attempts suicide, the gesture is often read in a moral or relational key, not as an expression of authentic psychological suffering (Canetto, 2015). This invisibility also extends to public policies: most prevention programs are gender neutral, and rarely consider the specificities of female life — violence, caregiving, precariousness, discrimination.

7. The role of language and communication

Language builds reality. Terms such as “attention-seeking” or “emotional weakness” create a frame that blames pain and perpetuates the idea that female emotions are excessive or not legitimate. Adopting respectful and non-judgmental language is part of cultural suicide prevention. As the guidelines of the Istituto Superiore di Sanità (ISS, 2022) suggest, speaking openly and empathetically about suicide does not increase the risk but favors the early emergence of distress.

8. Prevention strategies: from the clinic to society

Prevention of female suicide requires multilevel interventions:

• Training of professionals on gender reading of psychological distress.

• Accessible territorial support networks, integrated with anti-violence centers and social services.

• Educational campaigns that reduce stigma and normalize the call for help.

• Promotion of psychological well-being in critical phases of the female life cycle (adolescence, motherhood, menopause).

• Scientific research that includes gender as a structural variable, not an accessory one.

Furthermore, informal support — between friends, family, colleagues — can be decisive. Feeling listened to and recognized reduces the risk of suicide (Joiner, 2005). Connection saves lives.

9. Conclusions

Talking about female suicide means talking about the right to fragility. It means recognizing that strength does not consist in suffering in silence, but in being able to say “I can't do it” without fear of being judged. Every gesture of listening, every non-stigmatizing word, every welcoming space contributes to prevention. Suicide is not an act of weakness, but a desperate cry from those who no longer have any perception of alternatives. Making this reality visible is an act of professional, ethical, and social responsibility.

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