Suicide in Eastern Europe, the Commonwealth of Independent States, and the Baltic Countries International Institute for Applied Systems Analysis Schlossplatz 1, A-2361 Laxenburg, Austria Tel: +43 2236 807 Fax: +43 2236 71313 I I A S A www.iiasa.ac.at I I A S A Suicide in Eastern Europe, the CIS, and the Baltic Countries: Social and Public Health Determinants A Foundation for Designing Interventions Summary of a Conference Leslie Pray, Clara Cohen, Ilkka Henrik Mäkinen, RR-13-001 RR-13-001 Airi Värnik, and F. Landis MacKellar, Editors RR-13-001 ISBN 978-3-7045-0149-3 February 2013 Suicide-cover.indd 1-2 2/5/2013 9:54:12 AM The International Institute for Applied Systems Analysis is an interdisciplinary, nongovernmental research institution founded in 1972 by leading scientific organizations in 12 countries. Situated near Vienna, in the center of Europe, IIASA has been producing valuable scientific research on economic, technological, and environmental issues for over three decades. IIASA was one of the first international institutes to systematically study global issues of environment, technology, and development. IIASA’s Governing Council states that the In- stitute’s goal is: to conduct international and interdisciplinary scientific studies to provide timely and relevant information and options, addressing critical issues of global environ- mental, economic, and social change, for the benefit of the public, the scientific community, and national and international institutions. Research is organized around three central themes: – Energy and Climate Change – Food and Water – Poverty and Equity The Institute now has National Member Organizations in the following countries: Australia Japan Commonwealth Scientific and Industrial The Japan Committee for IIASA Research Organization (CSIRO) Korea, Republic of Austria National Research Foundation of The Austrian Academy of Sciences Korea (NRF) Brazil Malaysia Center for Strategic Studies and Academy of Sciences Malaysia Management in Science, Technology Netherlands and Innovation (CGEE) Netherlands Organization for China Scientific Research (NWO) National Natural Science Foundation Norway of China The Research Council of Norway Egypt Pakistan Academy of Scientific Research and Pakistan Academy of Sciences Technology (ASRT) Russia Finland Russian Academy of Sciences The Finnish Committee for IIASA South Africa Germany National Research Foundation Association for the Advancement of IIASA Sweden The Swedish Research Council for India Environment, Agricultural Sciences Technology Information, Forecasting and Spatial Planning (FORMAS) and Assessment Council (TIFAC) Ukraine Indonesia Ukrainian Academy of Sciences Indonesian National Committee for IIASA United States of America The National Academy of Sciences Suicide-nmo.pdf 1 2/5/2013 2:18:35 PM Suicide in Eastern Europe, the Commonwealth of Independent States, and the Baltic Countries: Social and Public Health Determinants A Foundation for Designing Interventions Summary of a Conference Leslie Pray, Clara Cohen, Ilkka Henrik Makinen,¨ Airi Varnik,¨ and F. Landis MacKellar Editors International Institute for Applied Systems Analysis (IIASA) Health and Global Change Unit, Laxenburg, Austria Stockholm Centre on Health of Societies in Transition (SCOHOST) Sodert¨ orn¨ University, Stockholm, Sweden Estonian-Swedish Mental Health and Suicidology Institute (ERSI) Tallinn, Estonia RR-13-001 February 2013 Suicide-body.pdf 1 2/5/2013 2:22:26 PM International Standard Book Number 978-3-7045-0149-3 Research Reports, which record research conducted at IIASA, are independently reviewed before publication. Views or opinions expressed herein do not necessarily represent those of IIASA, its National Member Organizations, or other organizations supporting the work. Copyright c 2013 International Institute for Applied Systems Analysis ZVR-Nr: 524808900 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without permission in writing from the copyright holder. Printed by Remaprint, Vienna. Suicide-body.pdf 2 2/5/2013 2:22:27 PM Contents Preface ix Executive Summary xiii 1 Introduction 1 1.1 Suicide in Eastern Europe . 1 1.2 The Social Basis of Suicidal Behavior . 3 2 Suicide Mortality in Eastern Europe 8 2.1 Suicide Trends in Estonia, 1965–2009 . 8 2.2 Suicide Trends in Latvia . 12 2.3 Suicide Trends in Lithuania, 1988–2008 . 17 2.4 Suicide Trends in Belarus, 1980–2008 . 21 2.5 Suicide Trends in Russia, 1956–2008 . 28 2.6 Suicide Trends in Ukraine, 1988–2010 . 31 2.7 Suicide Trends in Hungary, 1920–2007 . 34 2.8 Suicide Trends in Poland, 1979–2008 . 39 3 Gender, Age, and Rurality/Urbanity Patterns in Suicidal Behavior 50 3.1 Gender, Age, and Suicide . 50 3.2 Rural-Urban Variation in Suicide Rates . 54 4 Social and Public Health Determinants of Suicide 65 4.1 Culture, Attitudes, and Suicide . 67 4.2 Socioeconomic Status and Suicide . 69 4.3 Social Change, Civil Society, and Suicide: Psychosocial Risk Fac- tors Associated with Suicidal Behavior in Hungary . 72 4.4 Religion/Religiosity as a Determinant of Suicide: Risk or Protection? 76 4.5 Alcohol Consumption as a Determinant of Suicidal Behavior . 83 iii Suicide-body.pdf 3 2/5/2013 2:22:27 PM iv 5 Suicide Prevention Policies and Programs: Accomplishments and Gaps 94 5.1 Health Care Approach to Suicide Prevention: What Works? . 94 5.2 Public Health Approach to Suicide Prevention: What Works? . 98 5.3 Suicide Prevention in Adolescents . 99 5.4 The World Health Organization (WHO) and Suicide Prevention . 100 5.5 Suicide Prevention in Hungary: More on the Importance of Social Protection . 106 5.6 Practitioner’s Perspective: A Successful Local Nongovernmental Organization (NGO) . 106 5.7 Suicide Through a Social Lens: Implications for Prevention . 109 6 Next Steps for the Scientific Community: Research and Data Needs for Designing Effective Suicide Prevention Strategies 121 6.1 Some General Approaches for Moving Forward . 121 6.2 A Role for Historians . 123 6.3 A Role for Economists . 123 6.4 Alcohol Consumption . 125 6.5 Religiosity . 127 6.6 Social Change . 127 6.7 Unemployment . 129 6.8 Depression . 130 6.9 Conclusion . 130 Appendix A 133 Scientific Program . 133 Appendix B 138 Speaker Biographies . 138 Appendix C 145 List of Participants . 145 Suicide-body.pdf 4 2/5/2013 2:22:27 PM List of Figures 1.1 Map of suicide rates worldwide, based on most recently available data (2009). 2 2.1 Suicide crude mortality per 100,000 population, in Estonia, 1970– 2009. Males, females, and total population. 9 2.2 Age-specific suicide mortality rates (deaths per 100,000 population), selected age groups for male and female population over time. 10 2.3 Proportion of total age-specific mortality rate (ASMR) attributed to suicide, by age and gender. 10 2.4 Suicide death rates per 100,000 population by sex, Latvia. 14 2.5 Male excess suicide mortality in rural vs. urban populations across Latvia. Calculations based on a 3-year moving average. 15 2.6 Trends in suicide mortality among urban vs. rural males and females (b = average annual change). 18 2.7 Suicide mortality per 100,000 population in Belarus, 1980–2005. 22 2.8 Male–female ratios in suicide mortality in Belarus, 1980–2008. 23 2.9 Age-standardized male and female suicide rates (per 100,000 popu- lation) in Belarus, 1990–2005. 24 2.10 Female and male suicide mortality in Russia, 1956–2008. 29 2.11 Age distribution of suicide mortality in Russia, 2008. 30 2.12 Blood alcohol concentration (BAC)-positive suicides vs. BAC- negative suicides in eight regions of Russia, before (1981–1984), dur- ing (1985–1990), and after Gorbachev’s anti-alcohol campaign. 30 2.13 Suicide mortality (per 100,000 population) in six main geographic areas of Ukraine, 1988–2009. 33 2.14 Historical trends in suicide rates and suicide proportion of total mor- tality in Hungary, 1920–2007. 35 2.15 Age-specific male suicide mortality rates (per 100,000 population) for selected periods, 1980–2008, in Hungary. 36 2.16 Age-specific female suicide mortality trends (per 100,000 popula- tion) for selected periods, 1980–2008, in Hungary. 37 2.17 Major ways of committing suicide among Hungarian men, 1970–2008. 38 v Suicide-body.pdf 5 2/5/2013 2:22:27 PM vi 2.18 Major ways of committing suicide among Hungarian women, 1970– 2008. 39 3.1 Male–female suicide rates in select European countries, averaged over last five years available. 51 3.2 Male and female suicide rates (per 100,000 population) in the Baltic and Slavic states, 1981–2005. 52 3.3 A comparison of male suicide rates (all ages), 1981–2007, between the Baltic and Slavic states vs. the EU-15 states. 52 3.4 Historical urban and rural suicide rates (per 100,000 population) across Russia. 56 3.5 Urban and rural suicide rates in the Baltic and Slavic states during the transition (i.e., 1986–2001). 57 4.1 Suicide rates (per 100,000 population) by religion. 78 4.2 Suicide rates (per 100,000 population) in the former Soviet states. 79 4.3 Annual and alcohol-related suicide mortality in Russia, 1956–2002. 84 5.1 The effect of social protection spending on the association between unemployment and suicide. 102 5.2 The impact of social welfare spending on suicide rates in Sweden vs. Spain. 102 Suicide-body.pdf 6 2/5/2013 2:22:27 PM List of Tables 1.1 Changes in suicide mortality over time in four East European vs. four West European countries. 4 2.1 Poland: Suicide by provinces (voivodeships) in 2004 . 41 3.1 Mean male–female ratios of suicide mortality rates in urban and rural areas by age and country. 58 4.1 Correlations between aggregated means of religious variables and suicide mortality (1990–1995 average) in 12 European countries.