WHO/EURO MULTICENTRE STUDY ON PARASUICIDE FACTS AND FIGURES Second edition, 1999 World Health Organization Regional Office for Europe Copenhagen EUR/ICP/HPSA 01 06 03 ENGLISH ONLY UNEDITED EUROPEAN HEALTH21 TARGET 6 IMPROVING MENTAL HEALTH By the year 2020, people’s psychosocial wellbeing should be improved and better comprehensive services should be available to and accessible by people with mental health problems (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) ABSTRACT When carrying out collaborative multinational research – or studying results from such research – it is often useful to have at hand some general information on the areas and nations involved in the study and also some general knowledge on relevant conditions in those areas. It is the aim of this publication to provide those interested in the WHO/EURO Multicentre Study on Parasuicide with such information. The catchment areas under study by the twenty-eight centres involved in the Study differ to varying degrees as a result of differences in political and economic factors, in cultures, traditions, lifestyles and so forth. Each centre was asked to describe its catchment area – its demography, history and other general and specific characteristics. The characteristics of the centres participating in the first wave of the Study were described in the first version of Facts & Figures (WHO, 1993). In this edition, new centres are included and information on the “old” centres is updated. Keywords SUICIDE STATISTICS SOCIOECONOMIC FACTORS HEALTH SERVICES EUROPE EUROPE, NORTHERN EUROPE, EASTERN EUROPE, SOUTHERN © World Health Organization – 1999 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. Editor: Unni Bille-Brahe, Denmark WHO Collaborating Centre for Prevention of Suicide Centre for Suicidological Research Odense, Denmark Contributors: Jouko Lönnqvist, Helsinki, Finland Unni Bille-Brahe, Odense, Denmark Danuta Wasserman, Stockholm, Sweden Heidi Hjelmeland, Sør-Trøndelag, Norway Ellinor Salander-Renberg, Umeå, Sweden Konrad Michel, Bern, Switzerland Margaret Kelleher, Cork/Limerick, Ireland Werner Felber, Dresden/Weisseritz, Germany Cees van Heeringen, Gent, Belgium Christian Haring, Innsbruck, Austria Keith Hawton, Oxford, England Ella Arensman, Leiden, The Netherlands Agnès Batt, Rennes, France Armin Schmidtke, Würzburg, Germany Ludmila Kryzhanovskaya, Kiev, Ukraine Onja Grad, Ljubljana, Slovenia Slavica Selakovic-Bursic, Novi Sad, Yugoslavia Alexander N. Mokhovikov, Odessa, Ukraine Sandor Fekete, Pecs, Hungary Santa Zeibote, Riga, Latvia Airi Värnik, Tallinn, Estonia Danute Gailiene, Vilnius, Lithuania Alan Apter, Holon/Bat-Yam, Israel Isik Sayil, Mamak, Turkey Diego De Leo, Padua, Italy CONTENTS Page Preface FACTS AND FIGURES Introduction 1 The background of the WHO/EURO Multicentre Study on Parasuicide 1 Participants of the Multicentre Study 2 A general description of the areas under study 5 The Northern European Centres 9 Centres in Mid-Western Europe 15 Centres in Central-Eastern Europe 23 Southern-Mediterranean Europe 29 Indicators of social conditions and social instability 32 Housing conditions 32 Family life 36 Standard of living 38 Social security and welfare 38 Social problems: crime and substance abuse 44 Health and health care 53 Suicidal behaviour and the treatment of suicidal people 70 The frequency of suicide 70 The frequency of parasuicide 74 Treatment of suicide attempters 76 Concluding remarks 83 Annex Publications from the participants in the WHO/EURO Multicentre Study on Parasuicide PREFACE Suicidal Behaviour - the WHO/EURO perspective Suicidal patterns are a growing concern and somewhat confusing issue throughout Europe: some countries show increasing suicide and depression figures, others increasing depression and constant or decreasing suicidality, a few others again show a decrease both in the prevalence of depression and the number of suicides. Some countries seem resistant to transition, at least in certain sectors of the population, others are afflicted “in toto”, to a degree where national authorities warn of a risk of "depopulation". The complex patterns and background of suicide make multifactorial, process-related thinking highly necessary, even if specific links such as that to depression and/or alcoholism can be identified. Intervention to prevent suicide should consequently take into consideration the complexity as well as the more specific causalities which characterize the suicidal process. What is needed today, is the development of comprehensive, holistic and process-related approaches, as well as practicable, evidence-based and feasible intervention. To exemplify: in addition to improving access to effective recognition and management of depressive conditions, multifactorial and sociological approaches are demanded to intervene in the process of becoming depressed and consequently suicidal, as this process is characterized by an interaction of social, psychological and existential factors against a background of individual biological vulnerability. Thus, the suicidal process can be seen as a typical one, reflecting human processes of development, empowerment, breaking down and reorientation and linked to other stress- related morbidity and mortality. To study these complex interactions, identifying the salutogenic, strengthening, as well as pathogenic, weakening factors in suicidality, as well as in society and life, should today be considered one of the most exciting and advanced challenges in the field of prevention and mental health promotion. Life expectancy in East Europe is decreasing, especially in males. The dramatically increasing suicidality and stress-related mortality there, has to be seen in a greater context of other risk taking behaviour, such as violence, abuse and premature death, due to all sorts of sensation seeking and risk taking life-styles. In the policy of the newly re-emerged Mental Health programme, as well as in its HEALTH21 paper, WHO/EURO has chosen to expose the problem of increasing suicide as one of the most important focuses in its mental health policy. The costs of depression and suicide are, in an increasing number of countries, identified as one of the most important burdens in health care, considering that suicidal behaviour represents an incommensurable amount of morbidity, mortality and suffering, not only in the suicidal individual, but also amongst relatives, friends, and other persons belonging to his social network. Since its start, the European Multicentre Study on Parasuicide has developed into a most important and influential source of knowledge and scientific development in suicidology in Europe, with a strong and valuable network, where essential data collection and important research has been carried out. This network incorporates some of the most important European national centres on suicide research today. This new WHO publication presents data mirroring the demographic, socioeconomic, psychosocial and health care situation with respect to suicidality, in different and diverse countries of Europe. It reflects the need for comprehensive and holistic thinking as above and is most welcome as a basis for the dissemination of relevant knowledge and the development of feasible suicide prevention strategies in the European region. The last WHO publication on “Suicide in Europe in the mid-90’s”, published in 1998, reviews the state of the work being done and reveals the substantial epidemiological knowledge developed by the group here. We strongly hope that the ultimate interest of WHO, to further improve the suicidal situation throughout Europe and to counteract the dramatic developments in some of its countries, can be facilitated with the help of this work. Wolfgang Rutz, M.D., Ph.D. Regional Adviser, Mental Health WHO Regional Office for Europe 1 INTRODUCTION When carrying out collaborative multinational research - or studying results from such research - it is often useful to have at hand some general information on the areas and nations involved in the study and also some general knowledge on relevant conditions in those areas. It is the aim of this publication to provide those interested in the WHO/Euro Multicentre Study on Parasuicide with such information. THE BACKGROUND OF THE WHO/EURO MULTICENTRE STUDY ON PARASUICIDE In 1977, the World Health Organization and its Member States adopted as their goal the attainment of health for all by the year 2000. The Member States of the European Region of WHO turned this very broad goal into 38 specific targets, which the Member States accepted in September 1984. One of these targets, namely target 12, concerns suicidal behaviour and states that "By the year 2000, the current rising trends in suicides and attempted suicides in the Region should be reversed". Increasing rates of suicide and attempted suicide had for long caused great