The gender differences in suicide risk present a unique picture in the Chinese cultural context, diverging significantly from the global norm. The deep-rooted origins of this phenomenon are embedded in the family order and gender role norms within Chinese culture. Although global epidemiological data show that male suicide rates generally exceed those of females—a phenomenon known as the “gender paradox” (Canetto and Sakinofsky, 1998)—China has long been a notable exception, with historical data showing higher female suicide rates than males. While this gap has narrowed over the past few decades, it still markedly differs from Western patterns (Zhang D. et al., 2022; Zhang J. et al., 2022). This “Chinese exception” may result from the interplay of multiple factors.

Firstly, under the influence of Confucian culture, family power structures and the pressures placed on women play a critical role. Confucian traditions emphasize hierarchical order and role obligations within the family, imposing strict norms on women. This often places women in a subordinate position within the power structure, leaving them vulnerable when facing intense marital conflicts, fertility pressures, or unmet societal expectations. Lacking effective buffering mechanisms and support resources, their suicide risk is significantly heightened (Zhang et al., 2011a).

Secondly, the “protective” and “stigmatizing” aspects of male roles offer insight. Patriarchal ethics grant men higher status and authority while simultaneously providing them with stronger identification with family responsibilities and access to social support networks, thus offering some degree of protection. More importantly, the Chinese cultural interpretation of suicide behavior contrasts sharply with that of the West. In Western contexts, suicide is often linked to notions of “masculinity” (Canetto, 2008), whereas Chinese culture tends to view it as an act of “weakness lacking masculinity” or “escaping responsibility.” This strong de-masculinization stigma creates significant cultural and psychological barriers for male suicides (Jia and Zhang, 2017).

Thirdly, meaning conflict and “the weapons of the weak” further explain the high vulnerability of Chinese women. Women are often caught between the conflicting demands of traditional roles and modern personal values. Perceived gender inequality has been shown to be positively correlated with suicidal ideation (Zhang et al., 2019). In extreme situations, suicide is sometimes seen by some women as a desperate means to express despair, protest injustice, or seek liberation (Zhang, 2010). This culturally embedded cognitive framework and stress mechanism continue to influence contemporary suicide ideation reports: comparative studies indicate that even amid a more balanced gender ratio, Chinese women still report significantly higher levels of suicidal ideation than men (Zhang D. et al., 2022; Zhang J. et al., 2022).

Therefore, we propose the hypothesis 2:

The economic conditions of the surveyed regions may also profoundly influence the association between MIL and SI. Early research indicates that economic environments not only shape individuals’ daily living standards but also, by affecting resource accessibility and opportunity structures, influence their pathways to fulfilling personal aspirations and the foundational construction of MIL (Pezirkianidis et al., 2016). Within China’s unique sociocultural context, this economic influence intertwines with rapid urbanization, modern cultural impacts, and the urban–rural dual structure, presenting a complex landscape.

In developed regions, modern culture spurred by reform and opening-up emphasizes personal achievement and market competition, leading individuals to anchor MIL more frequently in career advancement or material success. Conversely, in undeveloped regions experiencing delayed urbanization or cultural disruption, traditional rural ethics—though challenged by modernization waves—remains the core framework for MIL construction among many (Huang et al., 2023).

This economic-cultural embeddedness renders the impact of economic fluctuations on MIL potentially more acute in underdeveloped regions: when economic development lags or faces setbacks, it signifies not only material deprivation but also the potential failure to fulfill culturally rooted “life tasks,” thereby profoundly destabilizing individuals’ sense of meaning.

Therefore, we propose the hypothesis 3:

Compared to measurement tools for MIL, instruments assessing SI exhibit greater diversity, with different tools potentially emphasizing distinct conceptual dimensions of SI such as intensity, frequency, or specific content. Beck’s Suicide Ideation Scale (SSI) focuses primarily on evaluating ideation intensity, whereas Osman’s revised Suicide Behaviors Questionnaire-Revised (SBQ-R) emphasizes ideation frequency. The validity of these instruments is highly dependent on their developmental cultural context. Given Western countries’ pioneering advantage in SI research, many Chinese studies have directly translated and used these original tools. However, the core conceptual frameworks of Western scales—including their emphasis on individual autonomy, religious beliefs, or specific suicide methods—may fundamentally misalign with SI expression patterns within China’s collectivist cultural context (He et al., 2023). Specifically, this cultural mismatch manifests in two key aspects.

First, Western instruments may overlook SI triggers critically significant in Chinese culture, such as intense “family shame” (from unfulfilled filial duties or ancestral dishonor), despair following failed major “life tasks,” or “altruistic relief” thoughts during intense family conflicts (Ma et al., 2022). Second, influenced by Confucian principles like avoiding public disclosure of family shame or the culture of endurance, Chinese individuals often prefer somatizing distress or using metaphorical language to report SI (e.g., “life feels meaningless” or “being a burden to the family”) rather than explicit “wanting to die” statements. Consequently, Western scales relying on direct phrasing may underestimate true risk (Lu et al., 2020). Therefore, researchers emphasize systematically adapting or redeveloping tools based on China’s unique sociocultural characteristics (Xia et al., 2002). Critically, such cultural adaptation has proven essential, as meta-analytic evidence confirms that SI measurement choice significantly moderates SI’s correlations with other variables (He et al., 2023). We thus reasonably infer that this culturally induced measurement “noise” similarly interferes with—or even distorts—capturing the true MIL-SI relationship.

Therefore, we propose the hypothesis 4:

The impact of public health emergency on the relationship between MIL and SI may exhibit significant specificity in terms of its pathways and intensity within China’s unique collectivist cultural context, warranting further investigation. The novel coronavirus strain SARS-CoV-2 was first identified at the end of 2019 and rapidly spread globally the following year, causing a worldwide pandemic (COVID-19). This health crisis not only disrupted individuals’ existential stability through universal stressors such as prolonged lockdowns, health anxiety, and social isolation (Trzebiński et al., 2020; Koştu et al., 2024), but also interacted complexly with cultural psychological factors in the Chinese context, including traditional sentiments of family and country, socialist culture’s sense of community, and trust in government.

Firstly, there is the “meaning-making” transformation of stressors: Compared to individualism countries that emphasize individual freedom restrictions and rights loss due to the pandemic, China’s collectivist values might lead some individuals to internalize strict epidemic prevention measures as a collective responsibility and act of dedication toward “protecting families and society,” even endowing it with a lofty sense of safeguarding “national security.” This, to some extent, helps buffer the loss of MIL (Aytekin et al., 2024).

Secondly, the strengthening of community bonds and the spirit of “solidarity in adversity”: The cultural tradition of “when one place is in trouble, help comes from all sides” has been widely activated during the pandemic. Neighborhood mutual aid, community-organized volunteer activities, and the state’s high emphasis on livelihood security have reinforced the sense of connection and belonging among social members, becoming an important cultural resource against isolation and maintaining MIL (Prati and Mancini, 2021).

Finally, the construction of institutional trust and the significance of “security provision”: The strong mobilization capabilities and resource investment demonstrated by the Chinese government under the principle of “people first, life first” might provide citizens with a deep sense of “security provision” and “order assurance.” This trust in institutional protective capacity can be transformed into a collective-level support for meaningfulness, partially offsetting individual panic in the face of uncertainty (Ma and Lyu, 2021).

However, the accumulation of long-term stress and the tension of cultural expectations should not be overlooked: Concerns about family livelihoods, the impact of strict quarantine policies on traditional family reunions, and the practical difficulties in fulfilling filial piety or parenting responsibilities may trigger unique “meaning conflicts” and ethical anxieties within the Chinese cultural context, becoming potential sources of SI risk (Zhao et al., 2024; Hao et al., 2024). Therefore, the impact of the pandemic on the MIL-SI relationship among the Chinese population could be a double-edged sword—providing protection through activating collectivism cultural resources and institutional trust while exacerbating risks due to the obstruction of core cultural needs.

Therefore, we propose the hypothesis 5:

All hypotheses are shown in Figure 2.

A comprehensive literature search was performed in primary Chinese academic repositories (including CNKI, Wanfang Data, and VIP Journals Database) alongside international databases (encompassing Wiley, Science Direct, ProQuest, Web of Science, and EBSCO). This investigation systematically integrated terminology related to meaning in life (specifically “meaning in life,” “life meaning,” “purpose in life,” “life purpose,” and “psychological coherence”) with suicide-related concepts (“suicidal ideation” and “suicide intention”) within the designated search parameters of titles, abstracts, and keywords. To address dissemination bias, supplementary search efforts incorporated general web search tools and bibliographic citations, encompassing pertinent review articles.

The research strictly adhered to PRISMA (Page et al., 2021) reporting standards, with methodological implementation depicted in Figure 3. This involved dual-phase screening of article headings and summaries for thematic congruence, followed by in-depth assessment of candidate publications against predefined eligibility thresholds. Furthermore, bibliographies of complete-text publications were systematically examined to identify pertinent research, with dual-reviewer verification (XL and LYM) implemented to maintain selection validity.

The present study adopted the following inclusion criteria: (1) an empirical paper; (2) the study reported the correlation coefficient between MIL and SI or provided data that could be converted into a correlation coefficient; (3) The samples between studies were independent. In instances of overlap or repetition of samples between studies, the study with more detailed data or a larger sample size was selected. (4) The study reported the measurement tools for SI.

Papers were excluded if: (1) the study incorporated content about SI yet lacked data on the subject; (2) it did not incorporate measurement of MIL.

The study collected information on four domains: (1) publication information: author and year of publication, journal; (2) demographic information: gender ratio of the participants; (3) The study characteristics: time of study conduct, region, and the measurement tools; (4) The variables: sample size (N) and the correlation coefficient (r) between MIL and SI. In studies that reported correlation coefficients in two distinct dimensions, the correlation coefficient was obtained by calculating the weighted average of the two. The third author (XJD) independently verified all collected datasets, and discrepancies were eliminated by achieving consensus through team consultations.

The gender ratio of the samples was derived from self-reported data. For samples that did not directly report the gender proportion, the ratio was derived computationally using the quotient of female subjects count over total participant population. The statistical evaluation revealed that gender (the proportion of females within the sample) did not exert a statistically meaningful moderating influence on the MIL-SI association coefficient [r = −0.389, 95% CI (−0.427, −0.349), p = 0.708].

Thirty-nine samples were entered into sub-sample analysis (Table 5). A mixed effects model indicated that the correlation between MIL and SI was- 0.391 [95% CI (−0.431, −0.350)] in females and −0.363 [95% CI (−0.495, −0.214)] in males.

Based on the division of developed and undeveloped regions by Su and his colleagues (2021), 21 samples were conducted in developed regions, eight were conducted in undeveloped regions, and 10 were cross-regional. As indicated in Table 5, the analytical results reveal that the economy exerts a pronounced moderating impact on the MIL-SI association within the Chinese context [r = −0.346, 95% CI (−0.385, −0.307), p < 0.001].

Analysis of a mixed-effects model revealed that the MIL-SI association measured −0.481 [95% CI (−0.624, −0.339)] in less-developed regions, whereas this value attenuated to −0.303 [95% CI (−0.350, −0.255)] in highly-developed regions. Marked variability in association strengths was observed across less-developed and highly-developed regional groupings. The correlation between MIL and SI, as measured by surveys conducted in undeveloped regions, is stronger than the correlation obtained from surveys conducted in developed regions.

The SI measurement tools utilized in the studies encompassed by this study were categorized based on the sample reports into two distinct types: Chinese-revised tools and foreign original tools. In sub-sample analysis, 28 samples employed Chinese-revised tools, while 11 utilized foreign original tools. As demonstrated in Table 5, we found that tools significantly moderate the relationship between MIL and SI in the Chinese context [r = −0.346, 95%CI (−0.385, −0.307), p < 0.001].

A mixed effects model indicated that the correlation between MIL and SI was −0.387 [95% CI (−0.433, −0.342)] in Chinese-revised tools samples, while it was −0.314 [95% CI (−0.392, − 0.235)] in foreign original tools samples. Significant correlation heterogeneity was found in Chinese-revised and original foreign tools samples. The correlation between MIL and SI, as measured by surveys using Chinese-revised tools, is stronger than the correlation obtained from surveys using foreign original tools.

In sub-sample analysis, 25 samples were conducted before the pandemic, while 14 were conducted after. As demonstrated in Table 5, we found that public health emergency (COVID-19) significantly moderated the relationship between MIL and SI in the Chinese context [r = −0.346, 95% CI (−0.385, −0.307), p < 0.01].

A mixed-effects model demonstrated that the MIL-SI correlation measured −0.356 [95% CI (−0.412, −0.302)] in pre-pandemic samples, whereas this value declined to −0.338 [95% CI (−0.410, −0.272)] in post-pandemic samples. Significant correlation heterogeneity was found in samples before and after the pandemic. The correlation between MIL and SI, as measured before COVID-19, is stronger than the correlation obtained from surveys after COVID-19.

The analysis of moderators on the relationship between MIL and SI in the Chinese context demonstrates that there is no significant influence in the relationship between MIL and SI across different genders. Therefore, hypothesis 2 of this study is not supported.

As a crucial psychological resource, MIL can effectively buffer suicidal ideation in both men and women. However, its protective mechanism demonstrates unique cultural adaptability against the backdrop of China’s social gender role transformation.

Firstly, modern societal development in China, alongside the transformation of gender roles, weakens the traditional gender-based segregation in meaning construction. With the acceleration of urbanization, the spread of education, and the rise in the proportion of working women, the traditional social division of labor where “men work outside, women manage inside” has been broken. Research shows that the percentage of urban women in China deriving life meaning from professional achievements has increased by 32% compared to 20 years ago (Wang and Wang, 2023). Meanwhile, men’s increasing participation in childcare and housework has brought them closer to women in terms of deriving meaning from family roles (Zhang D. et al., 2022; Zhang J. et al., 2022). This fluidity in social roles reduces the one-way constraint of traditional gender norms on the sources of meaning.

Secondly, policy-driven gender equality strengthens the cross-gender protective effects of MIL. Policies such as the Anti-Domestic Violence Law (2016) and the revised Women’s Rights Protection Law (2022) provide institutional support to reduce structural pressure differences through systemic intervention. This allows both genders to access social support resources more equally, thereby enhancing the risk-resilience efficacy of MIL.

Finally, the deep cultural resilience of normative meaning construction mediates gender differences. Despite changes in social roles, the core value placed on family by traditional culture continues to profoundly influence both genders. Data indicates that 76% of Chinese men and 82% of women rank “family responsibility” as the primary source of life meaning (Zhang et al., 2011b). This consensus results in the protective mechanisms of MIL exhibiting cross-gender stability.

Moreover, gender differences may indirectly influence the relationship between MIL and SI through mediating variables such as social support and coping strategies, rather than directly moderating this relationship. Although women face greater psychological stress, their stronger social support networks may mitigate risks (Caetano et al., 2013; Shye et al., 1995), while men’s reluctance to seek help might exacerbate the accumulation of stress (Möller-Leimkühler, 2003; Oliffe et al., 2020). However, these pathways may not have been incorporated into the analytical framework.

The heterogeneity in sample size and research methods within the meta-analysis may have diluted the signal of gender differences. Characteristics of the sample (such as a predominant student population), variations in measurement tools, or differences in study design among included studies may obscure actual gender effects, rendering them statistically non-significant in aggregated analyses. Future research should optimize sample representation and refine analytical models to comprehensively elucidate the potential role of gender in the relationship between MIL and SI.

Preliminary evidence suggests that the relationship between MIL and SI varies depending on economic conditions within the Chinese context. Surveys conducted in undeveloped regions show a stronger correlation between MIL and SI compared to those in developed regions, which supports hypothesis 3.

This finding is similar to the results reported by Li and colleagues. One possible explanation for this result is that people living in undeveloped regions place greater importance on material conditions that improve their quality of life (Batson and Stocks, 2004; McLeod, 2007). Their MIL is associated with the pursuit of these material conditions, forming a clear and enduring sense of life meaning in the process (King and Hicks, 2009; Stephens et al., 2013).

China’s rapid urbanization has created an economic gradient between urban and rural areas, which is actually a spatial imprint of traditional agricultural civilization and industrial civilization (Wang and Hui, 2018). This reshapes the cultural construction logic of MIL, leading to profound spatial heterogeneity in the relationship with SI. In undeveloped regions, Confucian filial piety ethics have been distorted into a materialistic survival competition, residents anchor MIL on rigid material goals (Jeung et al., 2019), tying their MIL to material achievements that improve family economic conditions (Batson and Stocks, 2004), forming a condition-dependent MIL (King and Hicks, 2009). A collapse in the economy can trigger a breakdown in the MIL. In contrast, developed regions experience rapid economic development, and sources of MIL shift toward non-material dimensions such as personal value realization and social participation (Li et al., 2024). However, the “996 work schedule” and the “identity split of new citizens” still create semi-modern dilemmas (Li, 2017). Durkheim’s theory of anomie presents an urban–rural fractal here: the dual dilemma of the disintegration of traditional cultural support networks in rural areas and the absence of new social norms in cities (Durkheim, 2005), making the meaning systems of materially deprived groups more prone to collapse (McLeod, 2007).

The present meta-analysis showed that the moderating effect of tools on the relationship between MIL and SI was significant and supported hypothesis 4. The samples included in this study utilized SI measurement tools that were either Chinese-revised or original SI measurement tools. The selection of tools has a substantial impact on the study of the correlation between MIL and SI.

This phenomenon can be explained from three perspectives. First, the cross-cultural validity of measurement tools is itself culturally constrained. A typical example is the Western-developed “Depression Symptoms-Suicide Subscale” (DSI-SS), which bundles the measurement of depression and suicidal symptoms based on the theoretical assumption (that suicide is primarily driven by psychological disorders) rooted in the Western medical model. However, the prevalence of psychological disorders in Chinese suicide cases is significantly lower than in the West (Phillips et al., 2002). This core cultural specificity difference means that when DSI-SS is applied to Chinese populations, it may overestimate the explanatory power of depression on Suicidal Ideation (SI) due to cultural mismatch (Zhang et al., 2016). Second, the process of localizing scales is itself a form of cultural adaptation and semantic reconstruction. For instance, the Chinese version of the “Beck Scale for Suicide Ideation” (BSI) deliberately replaces the original term “suicidal intent” with “thoughts of self-harm.” This adjustment in wording is not a simple translation but deeply aligns with the widespread taboo against directly discussing death and the tradition of euphemistic expression in Chinese culture (Xu, 2021), directly reflecting the influence of cultural norms on measurement language. Lastly, there are also differences in the weight of core dimensions for assessing suicide risk across different cultural backgrounds, as evidenced by the focus of scale design: The commonly used Western “Suicidal Behaviors Questionnaire-Revised” (SBQ-R) places more emphasis on observable behavior frequency, whereas the Chinese domestically developed “Self-Rating Idea of Suicide Scale” (SIOSS) focuses more on the authenticity of individual self-reports and inner experiences. This difference reflects how deep cultural value orientations shape the construction logic and core concerns of assessment tools.

The present study demonstrated that the moderating effect of public health emergency on the relationship between MIL and SI was significant. Moreover, the correlation between MIL and SI, as observed in surveys conducted before COVID-19, exhibits a stronger association compared to that found in surveys conducted after COVID-19, partly supporting hypothesis 5.

This result could be explained from two perspectives. On the one hand, the prolonged nature of the Pandemic has subjected individuals to chronic stress, leading to the gradual depletion of psychological resources (e.g., social support, emotional energy). According to the Conservation of Resources Theory (COR, Hobfoll, 1989), long-term resource loss weakens individuals’ ability to buffer suicide risk through MIL—when individuals fall into an “existential vacuum” (Frankl, 1985), the ambiguity of goal perception and the rupture of value connections may exacerbate SI (Trzebiński et al., 2020). This is reflected in the weakened negative correlation between MIL and SI in post-pandemic samples compared to pre-pandemic cohorts.

On the other hand, in the process of responding to the COVID-19 crisis, the Chinese government has constructed a globally unique path to enhance psychological resilience through institutional meaning provision and the deep activation of collectivism cultural genes. This model is first embodied in the institutional practice of the governance philosophy of “people first” – universal free vaccination, material supply systems, and precise prevention and control measures. By providing “security provision,” the protective power of the state is transformed into an existential anchor point for citizens’ “national community identity,” gaining extremely high support for epidemic prevention policies (Zhai, 2023). Secondly, relying on social mobilization advantages, community volunteer actions transform the ethical norm of “respecting one’s own elders and extending that respect to others’ elders” in Chinese culture into “micro-practices of protecting home and country.” During lockdown management, numerous residents participated in mutual aid, allowing individuals to reconstruct “helping behaviors” as “crisis-driven missions” (Liu et al., 2021; Martela and Steger, 2023). This dynamic balance of resilience wisdom ultimately forms a real-time transformation mechanism of “loss control-meaning creation” (Van Bavel et al., 2020), enabling individuals to maintain the Confucian life realm of “peaceful existence and meaningful life” under pressure. The resulting structural effect is that institutional meaning provision partially replaces the anti-suicide function of individual MIL, leading to an abnormal weakening of the negative correlation between MIL and SI during strict prevention and control periods, highlighting China’s uniqueness in reshaping suicide prevention strategies during the pandemic through cultural factors.