Suicide-preventive effects of perestroika in the former USSR: the role of alcohol restriction.
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Biomedical subjects
Publications and source records attributed to A Värnik.
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The former USSR covered 22.4 million square kilometres and had a population of 288,362,296 in 1990. During 1984-1990 the former USSR consisted of 15 republics, which formed culturally, geographically and historically different regions. Yearly, approximately 45,000-50,000 males and 14,000-15,000 females committed suicide. Suicide rates in the former USSR during 1984-1990 varied greatly between different regions, from 3.5 cases per 100,000 inhabitants in the Caucasus (Georgia, Azerbaijan and Armenia) to 11.8 in Central Asia (Kazakhstan, Kirgizia, Turkmenistan, Uzbekistan and Tajikistan), 18.1 in Moldova, 25.6 in the Slavic region (Russia, the Ukraine and Belarus) and 28.0 in the Baltic region (Latvia, Lithuania and Estonia). The same pattern of great variation between different regions was observed for both men and women in the former USSR, with suicide rates for men ranging from 4.9 in the Caucasian region to 45.9 in the Baltics, and suicide rates for women ranging from 2.1 in the Caucasus to 12.3 in the Baltics.
At the same time as substantial and rapid socio-political and socio-economic changes took place during the period of perestroika, suicide rates in the former USSR decreased by approximately 32% for men and 19% for women. The decreases in the suicide rates of men in the former USSR were unlike the suicide rate decreases taking place in 22 other European countries, where rates decreased by approximately 8% for men and 17% for women during this time period. Declines in suicide rates from 1984 to 1986-1988 occurred in all republics, with the largest decreases in Russia and Belarus, at 42% for men and 20% for women. The decrease in suicide rates of men in the former USSR was most pronounced until 1986-1988, after which time an increasing trend was observed. Suicide rates for men in the former USSR decreased 3.8-fold more than they did for men in other parts of Europe, while decreases in the suicide rates for women in the former USSR were on the same level as in Europe.
Age-specific differences in suicide rates in the Baltic and Slavic regions of the former USSR were studied for the period 1984-1990, and were compared to those of 22 European countries. It was observed that suicide rates per 100,000 inhabitants in the Slavic and Baltic regions increased directly with age for women, and showed a bimodal distribution with peaks for the 45-54 and > or = 75 age groups for men. In most of the 22 European countries, the suicide rates of both men and women increased directly with age. In 1990 the suicide rates in the Slavic and Baltic regions ranged from 25.1 for the 15-24 age group to 86.9 for men aged 75 or older, and from 6.0 to 29.8 for women, while the suicide rates in Europe ranged from 13.0 to 64.8 for men and from 3.6 to 18.7 for women. Decreases in the suicide rates in the Slavic and Baltic regions during perestroika were largest for the 25-54 age group, averaging at drop of 45% for men and 33% for women between 1984 and 1986-1988. The pattern of age-specific suicide rates for women in the Slavic and Baltic regions remained similar to that in Europe throughout the period studied. This was in contrast to a distinct pattern of male suicide rates in the Slavic and Baltic regions in 1984, which converged with those found in other parts of Europe during 1986-1988. It appears that perestroika contributed to a unique pattern of male suicide mortality in the Slavic and Baltic regions, especially in the 25-54 age group.
The stability of the relationship between trends of violent deaths as a whole, suicides and death from undetermined causes was assessed by quantitative methods for the whole former USSR in the years 1970-1990 and for each of the 15 republics in the former USSR for the years 1984-1990. Semi-structured interviews during 1989-1996 were performed with 12 professionals involved in the diagnosis and coding of causes of death in the Baltic states and Russia. The quantitative analyses showed that mortality data were reliable for the Slavic (Russia, the Ukraine and Belarus) and Baltic (Estonia, Latvia and Lithuania) republics, and also for Kazakhstan, Kirgizia and Moldova. The Central Asian and Caucasian republics showed greater variation in trends and ratios, indicating a need for further investigations of the reliability of suicide statistics in these regions. It emerged from the interviews that no instructions to falsify data were given. The only instructions given were to treat the data on suicide and murder as 'top secret'. None the less, certain classification errors might arise in the statistics. The diagnosis 'undetermined cause of death' was permissible only as a preliminary diagnosis for 14 days, and there was a risk of criticism for poor-quality work if too many deaths were classified as being due to undetermined causes. Misclassifications could also occur in cases where there was a wish to conceal murder. Negative attitudes towards suicide, especially in Muslim regions, where suicide is taboo, might also have contributed to under-reporting of suicide.
During 1984-1990, a decline in suicide rates of 32% for males and 19% for females took place in the former Soviet Union. The observed annual decrease in mortality from suicide was most marked for men in 1984-1986 and for women in 1984-1988. This article illuminates the hypothesis that the restrictive anti-alcohol campaign initiated by Gorbachev on 1 June 1985, in which prices of alcoholic beverages were raised substantially, had an impact on female mortality from suicide in the former Soviet Union. Data regarding alcohol consumption, female violent death (n = 451,537), suicide (n = 94,149), death due to accidental alcohol poisoning (n = 28,078), and undetermined death, whether accidental or self-inflicted (n = 23,982) were analysed for three Slavic (Russia, Belarus and the Ukraine), three Baltic (Lithuania, Latvia and Estonia) and two Central Asian republics (Kazakhstan and Kirgizia). Regression analyses with alcohol consumption as the independent variable and female suicide rates and female violent-death rates as dependent variables showed that suicide and alcohol consumption, as well as violent death and alcohol consumption, were positively correlated. However, alcohol seems to have a lower explanatory value for female suicides and female violent deaths compared with male suicides and male violent deaths. The attributable fraction of alcohol for female suicides in the whole USSR (27%) is estimated at approximately half of that for male suicides (50%).
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A significant decline (34.5%) in the suicide rate occurred in 1984-1988 throughout the USSR. The decline was observed shortly after the introduction of strict restrictions on the sale of alcohol. We tested the hypothesis that the restrictive alcohol policy in the first years of perestroika (June 1985) caused the fall in suicide rates in the former USSR. Data on alcohol consumption, violent death caused by external injury and poisoning (n = 916,315), death due to accidental alcohol poisoning (n = 77,837), suicide (n = 192,305) and death undetermined whether accidentally or purposely (n = 54,253) were analyzed for all former Soviet republics for 1984, 1986, 1988 and 1990. Men were chosen for the analysis, since men are more prone to abuse alcohol than women. Regression analysis with alcohol consumption as the independent variable and suicide rates and violent death rates as dependent variables shows that suicide and alcohol consumption were positively correlated as were violet death and alcohol consumption. In the republics with high alcohol consumption (Slavic and Baltic), suicide rates were also high. In the Caucasian republics, low alcohol consumption was associated with low suicide rates. For most republics, alcohol seems to explain more than 50% of suicides. Alcohol also has considerable explanatory value for violent death. Thus, a restrictive alcohol policy might be a way to reduce suicide and violent death.
Trends of male and female suicides in the Baltic countries--Estonia, Latvia and Lithuania--in the years 1968-90 were studied. As throughout the former USSR, suicide rates declined sharply from 1986, the year marking the onset of turbulent social change. During the "period of stagnation" from 1968 to 1984, the mean value of male suicide rates per 100,000 males were 55.7 in Estonia, 52.5 in Latvia and 51.7 in Lithuania. The figures for female suicide rates were 14.3, 14.3 and 10.4, respectively. Suicide rates remained consistently high in Estonia and Latvia, while in Lithuania the male suicide rate rose gradually from 33.0 to 61.3 and the female rate from 8.0 to 13.1 during the stagnation period. In conjunction with perestroika in the former USSR (including a restrictive alcohol policy and the first tentative steps towards democracy), annual male suicide rates per 100,000 in the years 1986-90 fell considerably below those in the stagnation period. Mean values of male suicide rates decreased by 26.6% in Estonia, 26.6% in Latvia and 14.4% in Lithuania in the period 1986-90 compared with the mean values for the period 1968-84. Female suicide rates were relatively stable and the male-female ratio was accordingly lower in 1986-90 (Estonia and Latvia 3.1, Lithuania 4.2) than in 1968-84 (Estonia 3.9, Latvia 3.7 and Lithuania 5.0).
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The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984. In regions of long-standing traditional lifestyles, strong religious faith and multi-generation families (the Caucasus and central Asia), the suicide rate was low, whereas in regions with sociopolitical antagonisms (Baltic States) and forced social changes (Russia), it was high. A significant decline in the suicide rate (34.5%), from 29.6 to 19.4 per 100,000 inhabitants, occurred in 1984-1988 throughout the Soviet Union, in the hopeful period of social democratization and stiff restrictions on the sale of alcohol. Rates varied widely between different republics - from 1.8 in Armenia to 26.3 in Lithuania and 24.3 in the Russian Soviet Federated Socialist Republic (RSFSR) in 1988. In contrast to the pattern in several countries in western Europe, the suicide rates in the Russian SFSR were much higher in the rural regions than in the urban ones.
Data on the suicide rate from 1922 to 1935 and from 1965 to 1988 are obtained from annual journals and original documents compiled by 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 declined to 20.6 in the year 1935. From 1965 to 1985 the suicide rate remained constantly high: on average 33 per 100,000 inhabitants. A decline in the male suicide rate from 55.2 to 36.8 has occurred since 1986. The effects of sociopolitical changes and of limitations on the sale of alcohol on suicide rates are discussed.