به سوی یک ارزیابی مجدد از نقش طلاق در نتایج خودکشی: شواهدی از پنج جمعیت حاشیه اقیانوس آرام

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 interdependence. Social welfare regimes in the four East Asian populations need to fill the vacancy left by retreating traditional family systems. Research implications are discussed.

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, unemployment, 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 illness, and alcohol or substance use disorders. Among them, marital status, an indicator of social integration, and socio-cultural changes seem to be linked together in exerting influences on suicide (Agerbo et al., 2011, Windfuhr and Kapur, 2011 and Yeh et al., 2008). Divorce rates have been found to have positive correlations with suicide rates over time in both western (Inoue, 2009a and Leenaars and Lester, 1999) and Asian populations (Chuang and Huang, 2007, Inoue, 2009b and Park and Lester, 2006). Divorced people are 1.5–3 times more likely to commit suicide than are married people (Corcoran and Nagar, 2010 and Griffiths et al., 2008; Kposowa, 2000; Masocco et al., 2008). However, the association between divorce and suicide seems to be less consistent across East Asian populations than across western populations. Two psychological autopsy studies conducted in China did not find that divorce increased the risk of suicide after adjusting for other variables (Phillips et al., 2002 and Zhang et al., 2010), while another conducted in Hong Kong found only a slightly higher risk for separated than married individuals (Chen et al., 2006). However, Yeh et al. (2008) recently analyzed a seven-year population-based dataset from Taiwan and found divorce to be the strongest predictor of suicide mortality among all marital status categories. East Asian countries are facing an exponential rise in divorce rates (Jones, 2010). Identified causes of this include demographic transitions, increased female labour participation, and changes in attitudes towards the family and marriage. A married couple’s threshold for deciding upon divorce may be lowering and their reasons for divorce changing, a phenomenon previously observed in the Netherlands (de Graaf & Kalmijn, 2006). Under such circumstances, it is important to inquire into the potential impact of divorce on suicide rates across history and cultures and its implication for suicide-prevention policy. Two theories may help increase understanding, from a macro perspective, of suicide among divorced people. In his theory of social integration/regulation, Durkheim (1897) described divorce as a condition of low social integration (‘anomie’) resulting in psychological distress and possibly suicide. This hypothesis has received strong support (Cutright et al., 2006 and Stack, 1990). Durkheim added that rapid social change (industrialization and urbanization) creates a collective state of ambivalence; older traditional social values become blurred and a new set of values are variably accepted. Park (2010) explains that this collective ‘cultural’ ambivalence is being experienced in East Asian societies today. The second theory of emotional interdependence was proposed by Kagitcibasi (1990), who argued that, in East Asian countries undergoing modernization, material interdependence may have weakened due to changed lifestyles but psychological/emotional interdependence is still compatible with and present in collectivistic societies today. Whether these theories hold true for East Asia in the context of divorce has not been determined. This paper examines five populations belonging to the ‘Pacific Rim’, with comparable socioeconomic profiles but important cultural differences, in order to gain a deeper understanding of suicide patterns among the divorced in East Asian populations. The five populations, namely Hong Kong, Taiwan, South Korea, Japan and the state of Victoria in Australia, are theorized to lie on a cultural (individualism—collectivism) spectrum, with Victoria at the individualism end, South Korea and Japan at the collectivism end, and Hong Kong and Taiwan positioned in between. To facilitate a basic understanding of how these five populations have developed historically, which is important for our theoretical interpretations of the divorce and suicide statistics, below we briefly depict cultural transitions as regards gender, family and social welfare in the five populations. Australia has a suicide profile comparable to those of western nations (De Leo & Evans, 2004). Previous studies have found that it scores high on indices of individualism: there is little emphasis on conforming to one’s own organization or on family-oriented self-construction (Parkes, Bochner, & Schneider, 2001). In the early days of British Colonial history, women were equal partners in business ventures (Rickard, 1988). A social welfare system supporting needy families was established in the 20th century and has been expanding ever since (Gray & Agllias, 2009). Lobbying by feminist activists has also led to the establishment of legal regulations in favour of gender equality and affirmative protection for women (Clancy, 2004). The local governing bodies of Victoria (which has a population of 5 million) have been more active in establishing such regulations than similar bodies of other Australian states (Murphy, 2006). Japan and Korea occupy the collectivism end of the spectrum because of a strong Confucian legacy in family matters. In the pre-modern era, the Yi Dynasty (1392–1910) of Korea gradually adopted a strict Confucian ideological and political system, thereby transforming into a typical family-based Confucian society that upheld filial piety and male dominance (Lee, 1998). Korean families shifted from being ‘matrifocal’ to ‘patrifocal’ in terms of formal power structures, while in reality wives and mothers constructed their own authority within families through social networking, rendering men dependent therein (Cho, 1998). When Korea became occupied by Japan in 1910, ‘familism’ (a term that describes when family interests are positioned above individual interests) was further strengthened. The country then passed through rapid political (from autocratic to democratic), economic (boom, crisis and recover) and socio-cultural (diminished number of extended families) changes after the Second World War (Ahn & Lee, 2005). In the Tokugawa era in Japan (1603–1867), there was vigorous governmental support for Confucianism, which was later carved deeply into the family structure and gender functioning throughout the Showa era (1926–1989). In the economic boom following the Second World War, husbands worked long hours for their companies (Lebra, 1998), while their wives were expected to take charge of their families (Lebra, 1998 and Nonoyama, 2000). In postmodern times, with the impact of globalization and economic recession, the idea of lifelong employment for married men no longer dominates corporate policies (Kono, 2005 and Ono, 2006). The traditional extended family support system has weakened in recent decades. In both South Korea (Ahn and Lee, 2005 and Park and Cho, 1995) and Japan (Kono, 2005), the government mindset at present is still heavily influenced by Confucian thinking, as can be witnessed by the emphasis placed on the family as the primary source of support in the social welfare regimes. Taiwan and Hong Kong have cultural histories and transitions quite different from those of Japan and Korea. Taiwan was ruled by the Qing Dynasty of China from 1683 to 1895 and was then ceded to Japan for another 50 years. Although strong Confucian traditions were established during these times, Taiwan also has a history of long-term dependence on the United States both politically and economically after the Second World War, during which time the American individualistic culture was imported. Similarly, Hong Kong was ceded, by the Qing Dynasty, to the UK and governed by the British for about 150 years until 1997 when China resumed sovereignty. Under British rule, Hong Kong internalized individualism. The economic boom of the late 1980s led to a decrease in the percentage of extended families in both Taiwan (Chen, Yang, & Wang, 2010) and Hong Kong (Chiu and Wang, 2005 and Koo and Wong, 2009). But during economic downturns, the Hong Kong government stressed traditional Confucian virtues of self-sacrifice and hard work. As Sullivan (2005) explains, a mixed identity influenced by both Confucianism and individualism has now emerged in Hong Kong. In Taiwan, a shift from authoritarian to democratic regimes and vigorous feminist legislation movements have given it a more gender-equal legal system regarding family matters than in South Korea and Japan (Kuo, 2007). Taiwanese women also have more freedom in the job market (Yu, 2006). Although the Taiwan government has emphasized family functions in its gradual expansion of social welfare packages, Taiwanese husbands are accustomed to depending less on their wives than their counterparts in South Korea and Japan. In Hong Kong, mutual support among children, parents and relatives has persisted, despite the fact that people conceive family life mainly in individualistic and self-reliant terms. Gender roles in families are no longer traditional in the Confucian sense (Koo and Wong, 2009 and Ng et al., 2009). Wives often actively seek divorce when they cannot tolerate the demands of marriage (Sullivan, 2005). For the aforementioned reasons, these two populations were placed between the more individualistic population in Victoria, Australia, and the collectivistic Japanese and Korean populations. In this study, we explored how the relationship between divorce and suicide risk is affected along this cultural spectrum. There are three specific hypotheses: (i) We hypothesized that the gap between suicide rates among the divorced and married in Victoria would be larger than the same gap in the other populations. This was based on a previous finding by Lloyd and Yip (2001): they compared Hong Kong and Australia in a time-series analysis from 1981 to 1993 and found protective effects of marriage as well as male–female difference in these effects to be larger in Australia. In an earlier time-series analysis (1950–1980) for Japan, which at the time was still very much a Confucian society, Stack (1992) also found that divorce did not have an impact on the suicide rate. Hence, it can be inferred that even during periods of cultural transformation, populations that are influenced by Confucianism have better social integration with, and familial support from, their kinship systems and hence would not be affected by divorce as much as those in Victoria. (ii) We also hypothesized that divorced men would show greater vulnerability to suicide than their female counterparts, as found in previous studies (Kposowa, 2003). In Confucian societies, husbands tend to be emotionally dependent on their wives, who are the domestic masters. Divorced men may thus be less able than women to handle the emotional stress accompanying divorce, especially when they do not have strong social support networks. (iii) Lastly, we hypothesized that there would be different age trends in the risk of suicide among the divorced across all the populations in view of the differing cultural influences across generations. Younger generations may not engage as much as older generations in traditional practices and networking; therefore, they might have fewer social support resources both during and after a divorce.

Conclusion The relationship between divorce and suicide rates in the four East Asian populations studied can be understood in terms of the legacy of Confucian traditions. Suicide patterns across gender and age in these populations are distinct from those in populations with western individualistic values; unique historical and socio-cultural transitions may be responsible. Gender differences in the effect of divorce in Japan and South Korea may reflect gender inequality or unique socio-cultural factors among married women. East Asians who are below 40 years of age are a particularly high-risk group. Cultural ambivalence at the individual level and continuing emotional interdependence at the systemic (family) level are possible explanations for this. In these populations, it is not sufficient for the wellbeing of divorced people to just pay lip service to the importance of traditional family values without parallel constructions of adequate social welfare regimes. Therefore, a community-based programme is called for to mitigate the stress among the divorced by providing more support groups and counselling services to those who are divorced or are seeking a divorce. It is recommended that large-scale studies be carried out to measure the effect of different cultural beliefs and practices on thoughts related to marriage in East Asian societies. Also, qualitative studies addressing the link between values and beliefs about marriage and divorce, and the demographics of East Asian societies could increase our understanding of cultural influences and the proportion of those influences that can be traced back to traditional Confucian teachings. Good family and socioeconomic policy, which is necessary for people’s wellbeing, could also have positive effects on suicide prevention. Nevertheless, further testing of our theoretical framework through suicide prevention focused on family and socioeconomic policy aspects is indicated.