Suicide in the Baltic countries and in the former republics of the USSR

Background: Suicide was a prohibited topic in the former USSR. During Gorbachev'sperestroika data on suicide mortality were released in 1989, for the first time inthe history of the USSR. The USSR then consisted of 15 republics, forming culturally,geographically and historically disparate regions. Aim: The aim of this study was to examine suicide rates in different regionsof the former USSR, which although comprising various ethnic groups and cultures weresubject to the same laws and uniform routines for classifying and registering causesof death. Nationwide changes in 1984-90 provided the opportunity for observing theinfluence of sociopolitical and economic factors on suicide trends in the 15 constituentrepublics. Comparison of changes in suicide rates among men and women in differentage groups in the USSR in 1984-90 was also feasible. Material and method: The periods studied were 1922-35 and 1965-68 for Estonia,1968-90 for the three Baltic states, and 1984-90 for all 15 republics. The studyperiod 1965 to 1984 is known as the period of stagnation. The ensuing period, perestroika,may be divided into the phases of political reform (1985-88) and economic reform(from 1989). A database containing figures on violent causes of death, suicides,undetermined causes of death and deaths from alcohol poisoning, for males and females,for the entire population of the USSR in the years 1970-90 and for different agegroups in all 15 republics in 1984-90, was established using original sources inMoscow. Suicide data for Estonia 1922-35 and 1965-83, as well as for 22 Europeancountries 1984-90, and population data for all periods studied, were also obtained.Particular attention was paid to the reliability of the material from the USSR usedin the study. Results: Quantitative and qualitative studies have shown that the reliabilityof suicide statistics in the former USSR is good. Suicides constituted approximately18% of all violent deaths in the USSR. Analysis of suicide distribution shows thatsuicide rates varied widely between different regions with lowest suicide rates observedin the Caucasus and highest in the Baltic and Slavic republics. The suicide ratefor males aged 15 and over in the entire USSR was 2.4 times higher than that of themale suicide rate for 22 European countries (69.2 and 28.9 respectively) in 1984,and 1.8 times higher in 1990. Suicide rates for females in the USSR were 1.3 timeshigher than those in Europe, in both 1984 and in 1990. Suicide rates in the USSRrose directly with age for women (from 5.5 to 31.5). For men, a bimodal distributionwas observed with peaks at ages 45-54 (76.3) and 75 and older (90.3). For men, between1984 and 1990. suicide fell by 31.8% in the USSR and 8.4% in the 22 European countriescombined. For women, the corresponding figures were 19.3% and 17.0%. The largestdecreases in suicide rates in the Slavic and Baltic regions were observable in the25-54 age group. Alcohol seems to have a considerable explanatory value for decreasein suicide rates during perestroika. The estimated attributable fraction of alcoholfor male suicides in the whole USSR in the period studied is approximately 50%, andfor female suicides 27%. Conclusions: Suicide rates in the former USSR varied widely between therepublics, due to national and cultural differences, with the highest rates in theBaltic and Slavic regions, and the lowest in the Caucasus and Central Asia. The markeddownward trend of male suicide rates in the USSR was unique and coincided with sociopoliticaland economic events, including governmental anti-alcohol policy. during perestroika. Key words: suicide; sex; age; alcohol; epidemiology; USSR; Slavic region;Baltic region; Central Asia; Caucasus; perestroika. ISBN: 91-628-2750-2 Stockholm, 199