Suicide in Estonia

Varnik À. Suicidein Estonia. Acta PsychiatrScand 1991:84: 229-232. À, Varnik Ta"innPsychiatric Hospital,Estonia,USSR Data îï the suicide rate from 1922 to 1935 and from 1965 to 1988 are obtained from annua1jouma1s and origina1 documents compi!ed Üó the Estonian State Committee for Statistics. During the period of Estonian independence (1922-1935 under consideration), the suicide rate was 16.7 per 100,000 inhabitants at the beginning of the period. During the Great Depression, this figure temporarily rose to 30 and dec!ined to 20.6 in the year 1935. From 1965 to 1985 the suicide rate remained constantly high: îï average 33 per 100000 inhabitants. À dec!ine in the mà1åsuicide rate from 55.2 to 36.8 has occurred since 1986. The effects of sociopo!itica1 changes and of limitations îï the sa1eof a1coho!îï suicide rates are discussed. Suicide is the extreme expression of psychological crisis. It is seldom an instantaneous event. Suicide is usually à process (1), i.e. it is preceded Üó à ðåriod of crisis of either shorter or longer duration, when it is still possible to interrupt it. ÒÜåEstonian Medical Association, which was forced to ceaseits activities in 1940and was revived in 1988,has started epidemiological research to ascertain the various risk groups and factors leading to suicide. This research is the first of its kind to embrace the whole of Estonia permitted since 1940. Up to 1988, suicide statistics were classified as top secret. ÒÜå official line was that suicides, alcoholism and other personal problems are à manifestation of the capitalist system and of ïî importance for the Soviet people, and that the Soviet system and the Communist Party guarantee everyone's personal happiness. Suicide was treated in psychiatric textbooks in à cursory fashion, as à symptom of mental illness only. Materialand methods Data îï the suiciderate [rom 1922to 1935have Üååïtaken [rom the statisticalannuals[rom the ðåriod î[ Estonian independence,summarizedin à publication î[ the Central Statistical Bureau. The C1assificationî[ Diseases,class ÕÓII "Mors violenta et accidentalis",includes suicidesunder the code 163-171(2). Wå have not Üååï àÛå to get anó in[ormation about 1936-1964becauseduring the first years î[ the Sovietregimein Estoniaòanó printed materials from the independenceperiod were destroyedand the statisticsfrom the beginningî[ the Sovietîññèpation period are present in à very sophisticated form and need[urther work [or comparability. The data for 1965-1988are compiledinto tables Êåó words: suicide; longitudinal study; Estonia Airi Varnik, M.D.,Ph.D,TallinnPsychiatric Hospital, Paldiski Rd. 52, Tallinn 200109, Estonia, USSR Accepted for puÛication April 5, 1991 ..Annual report of natural migration of population in Estonia, ...year." Statistics îï suicide are based îï certificates of death issued Üó the medico-legal àètopsy doctors. During the Soviet period the shortened Classification of Diseases of the USSR was used in Estonia. Class ÕÓII, ..Accidents, poisonings, trauma" includes suicidesunti11981 under code 183 and from then under code 173 (Å950-Å959 Üó ICD). Calculations per 100,OOOinhabitants arebased îï demographic data of the population. Results During the period of Estonian independence(19181940), the suicide rate was comparatively low: from 16.7 per 100,000in 1922to 20.6 in 1935. Duringthe Great Depression, this figure temporarily rose to 30 (Fig. 1) and than declined again. The first data ofthe Soviet period begin only from 1965, and from 1965 to 1985the suicide rate remained constantly high: îï average 33.0 per 100,000 (Fig. 1). ÒÜå suicide rate has significant declined since 1986. Âó 1988, the suicide rate had fallen to 24.3. W å investigated for which groups changes in the suicide rate occurred; for decades, the suicide rate has remained relatively constant for women, whereas the suicide graph for òåï gives us à vivid picture of the influence of the sociopolitical factors that ñàï causemental crisis. The impact has Üååï most abrupt among òåï: during the Great Depression, suicides in this group doubled and then declined. During the period of Soviet occupation, the suicide rate remained high for òåï (in 1965-1985 îï average55.2 per 100,000),followed Üó à rapid decline (to 36.8 per 100,000 in 1988). Next, we looked at men's suicide rate according to different age groups for the period marked Üó the 229 Varnik YEAR Fig.1. Suicidesin Estonia 1922-1935and 1965-1988, rapid decline in the suicide rate (Fig. 2), i.e. in 1984 (the final year ofthe stagnation period), in 1986(the beginning of perestroika, and the enforcement of the strict limitations îï the sale of liquor) and in 1988 (the awakening of national self-consciousness). À marked gradual decline has occurred among måï 25-55 years old: måï in the prime of their lives. À very rapid increase in the suicide rate has occurred in those > 80 years. Discussion The sèicide rate for women dèring these periods remained òîãå îã less the same. The peaks and troèghs in the overall sèicide graph resèlt primarily Ñãîò the incidence îÑ sèicide among òåï. The cèrves correlate with historical events in Estonia. Since òåï are socially òîãå active in Estonia, this correlation woèld lend evidence to the claim that the incidence îÑ sèicide is directly related to social èpheaval (3). Dèring the Great Depression, there was an abrèpt rise îÑ short dèration in the sèicide rate, which declined again after the Great Depression ended. Dèring the period îÑ Soviet occèpation, the sèicide rate ?1n for 1965-1985 remained constantly high and even higher than during the ðåì of the depression years. Under Stalin and bls successors and during the period of stagnation, individua1ity was systematically oppressed. Dominated Üó à continuous existential fear, people's personalities were homogenized, independent thinking was severely punished, and actual contacts between people were weakened and replaced Üó some sort of pseudocollectivism. Identity crisis arose, coupled with total helplessness and mistrust; the result was à one-dimensional person. Books and art ofthe independenceperiod were destroyed, churchgoing was forbidden, atheism was actively propagated and former organizations, including even temperance associations and sports clubs, were banned. As à last resort, many people turned to alcohol. The state-facilitated alcohol abuse to à great extent and, moreover, derived enormous profits from the saleof alcohol. Finally, alcohol abuse dulled the minds of the people. Such fields as genetics, cybernetics, sociology, psychology, theology and statistics were perverted. Pavlov's concept of neurophysiology was the only theory allowed in psychiatry. The theories of Freud Suicidein Estonia 140 î î 0î î ..à: ø àø ~ à: ø î ~ ~ u) ;; Q7 715: ~o ' ?; ~ 7 Fig.2. Suicidesin Estonia~, .g ~15: 7 (j3 <:i!<- õ?; ~ tj) 6'<- 6) 6'15: '<;?/ '0'<2 u'- ~ Q ~ Q<- U'-<- 'O~ \9 7 I.r.,9 9'9' 9'.,9 u9' u.,9 u9' J3-~_<i..l.~~.~. .>. ";"15: '6) °'..;1. '.>. \9 7 .g <90 õ (male. female). and his successors,as well as psychodynamic trends, were not taught; they were not allowed to Üå used, nor could they Üå used because of the lack of literature, not to mention the inadequate knowledge of the languages. We lived behind the Iron Cèrtain. Researchîï the casesof parasèicide hospitalized at the Tartè University Clinic (4) also stresses the significance of sociopsychological and political [àñtors: it has Üåñîmå apparent what à debilitating influence the homogenization of persona1itiesand the weakening of ethics and ethnic identity, the discrepancies between words and deeds, the threat of loss of national identity and the loss of God has had îï people. Since 1986 the sèicide rate has continèoèsly and abrèptly declined. This can Üå explained Üó perestroika, which meant, for the Estonians, à renewal of the opportènity to organize things for themselves, national and individèal self-consciousness and social optimism. ÒÜå strict limitations placed îï the sale of alcohol also probably played an essential role in this trend. In 1988 à confidential crisisline was allowed. ÒÜå anonymoès talks show that people have sèffered silently, while at the same time trying to pèt èð passive resistance to the events taking place aroènd them. ÒÜåaggression it has caèsed has been channelled into àn individèal's own aggression.ÒÜåðåîple were not ñàðàÛå of overcoming their crises. Moreover, they did not believe that treatment might Üå èsefèl. Sèch so-called social depressions are indeed difficèlt to treat. The standard of psychiatric treatment is 10W, owing to the weakness of its theoretical and material basis. In addition (this activity has ended now), if ðåîðlå did consult help, they were registered and data îï their cases,which àñåelsewherekept strictly confidential, might later Üå released to the authorities. This might Üå followed Üó social restrictions: prohibitions îï working in certain fields, the right to possess à driver's license or à hunting ïÂå or travelling abroad. Most of the other conditions have remained the sameèð to now, but the spiritualliberation and hope for à better future seemto have reduced the suicide rate for òåë, and especially among those in the ðïòå of their lives, Üó one-fourth. The abrupt rise in the suicide rate among those 80 years in 1988, at the height of our national reawakening, still requires àn explanation and further relevant sociological research is needed. Conclusion The suicide rate depends îï sociopolitical, psychological, psychiatric and economic factors. This is especiallymarked in Estonia among men in the prime of their lives. The democratization of society and the freedom ofthe individual for self-development seem to Üå important factors that ñàï prevent suicide. Estonia needsthe world's support in this regard. We also need help in arranging individual psychological and psychiatric treatment, and in training: we need 231 ~ Varnik I moreliterature,more guestlecturersand more student and academicexchanges. Acknowledgements This study was supported Üóthe Estonian Ministry of Hea1thand the State Committee for Statistics. 1 would like to thank Mr. Matti Mandre, who helped òå in the statistical ana1ysisand in obtaining data, and associate professor Danuta Wasserman. for professiona1help. 2~2 References 1. ÀÑÍÒÅ Ê, UNDFORS Î, LÁNNQVISÒ J, SALOKARI Ì. Suomalainen Itsemurha. Helsinki: Yliopistopaino: 1989. 2. Estonia åï chitTresresumeretrospectif de 1920-1935. Tallinn: Bureau Central de statistique de I'Estonia, 1937. 3. DURKHEIM Å. Le Suicide, 1887. 4. NOOR Í, MEHILANE L. Sociopsychological situation and parasuicide in Estonia. Psychosomatic disorders. Acta Ñîòmentationes Universitatis Tartuensis 1990: 891: 137-161.