Suicides in the former Soviet republics Varnik A, Wasserman D. Suicides in the former Soviet republics. Acta Psychiatr Scand 1992: 86: 76-78. 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.
In 1989 the USSR statistics on suicides, formerly classified as top secret, were published. A significant decline in the suicide rate in Estonia in the years 1986-1988 suggested the hypothesis that the phenomenon known worldwide as perestroika - which for the Estonians meant a renewed opportunity for self-organization as well as national and individual self-awareness and social optimism - had reduced the suicide rate (1). The Estonian Medical Association embarked on epidemiological studies in Estonia, and was able to initiate a survey on suicide in the USSR as well.
I
A. Varnik’, D. Wasserman’
’ Tallinn Psychiatric Hospital, Estonia, Karolinska Institute, Department of Psychiatry, Huddinge University Hospital, Stockholm, Sweden
Key words: epidemiology; suicide; USSR Danuta Wasserman, M.D. Ph.D., Karolinska Institute, Department of Psychiatry, Huddinge University Hospital and Center for Suicide Research and Prevention, Karolinska Hospital, Box 60210, S-104 01 Stockholm, Sweden Accepted for publication February 23, 1992
described in words without any code being used. If the death was violent, it had to be specified in detail. The diagnoses in death certificates were consequently coded by consultant doctors at the central statistical committees of the republics and constitute the basis for statistics. Figures on mortality from suicides, homicide and some infectious diseases were top secret until 1988. Suicide rates, i.e. the number of suicides per 100,000 inhabitants, are calculated on the basis of population censuses carried out in 1979 and 1989. Results
Material and methods
Data on suicides in the former USSR were derived from two sources: 0 a fairly comprehensive all-union statistical yearbook published in the USSR, in which data on suicides are mentioned for the first time (2); and 0 a collection of articles on suicidology, issued by the Ministry of Public Health of the Russian Soviet Federated Socialist Republic (RSFSR) and the Moscow Psychiatric Research Institute (3). The diagnosis of suicide was included in the USSR statistics in Class XVII, “accidents, poisonings, trauma”, under code 183 until 1982 and under code 173 since then. In the source cited here (2) there is no category for unknown causes of death. Suicide statistics in the USSR were based on death certificates issued by the medico-legal autopsy doctors. This procedure was used throughout the USSR. Official statistics were based on these death certificates. The cause of death in the death certificates was 76
During the stagnation period (1965- 1984), the suicide rate in the USSR was high. In 1965 the number of suicides was 39,550, and in 1984 it was 81,417. The incidence of suicide rose from 17.1 per 100,000 in 1965 to 29.6 in 1984. Suicide trends from 1984 to 1988 show a decreasing number of suicides in all republics. In 1988, 41,408 men and 14,111 women took their lives in the USSR. The fall in the suicide rate compared with 1984 ranges from 5.3% in Armenia (Asiatic region) to 37.9% in Byelorussia (European region (Table 1)). Table 1 shows the suicide rates of the former Soviet republics, which varied widely between different regions, from 1.9 to 37.9 in 1984 and 1.8 to 26.3 in 1988. Table 2 illustrates the lower suicide rates in some urban districts (cities, towns) compared with rural areas (villages). The statistical yearbook reveals the importance of suicide as a cause of violent death. The category of “accidents, poisonings, trauma” is subdivided in de-
Suicides in the former Soviet republics Table 1. Suicide rates per 100,000 inhabitants in the republics of the former USSR
Table 3. Causes of violent death in the USSR (Class XVII) per 100,000 inhabitants,
1988 1984
1985
1986
1987
1988
% change 1984-1988
Whole USSR
29.6
24.5
18.9
19.1
19.4
-34.5
Republics Russia Lithuania Latvia Estonia Byelorussia Ukraine Kazakhstan Moldavia Kirgizia Uzbekistan Turkmenistan Tadzhikistan Georgia Azerbaijan Armenia
37.9 35.8 33.7 32.4 29.6 26.5 26.1 23.3 14.8 8.8 8.6 6.2 4.8 4.5 1.9
31.0 33.7 29.0 31.5 23.1 22.3 22.2 20.7 11.6 8.2 7.5 5.9 4.6 3.7 2.2
23.0 25.1 24.9 27.3 17.7 18.5 16.5 18.8 9.2 7.6 8.8 5.3 4.5 3.5 1.8
23.2 28.7 23.0 25.3 19.0 19.6 16.2 17.1 11.3 6.9 8.0 4.4 4.3 3.7 2.4
24.3 26.3 22.5 24.3 18.4 19.0 16.8 17.0 11.2 6.3 7.7 4.0 4.3 3.3 1.8
-35.9 -26.5 -33.2 -25.0 -37.9 -28.3 -35.6 -27.0 -24.3 -28.4 - 10.5 -35.5 -10.4 -26.7 -5.3
Table 2. Suicide rates per 100,000 inhabitants in some regions of the USSR ~
~
~
Urban
Rural
1985
1986
1985
1986
-a
18.4
-
19.5
Russian SFSRb Udmurt ASSR' Mari ASSR' Kirov's district' Sverdlovsk district'
46.1 41.2 44.6 40.6
21.2 32.6 21.8 31.4 33.4
Estonia Uzbekistan Turkmenistan Tadshikistan
27.2 -
24.3 12.6 12.1 10.8
Whole USSR
100.8 89.5 61.3 60.7 42.3 -
-
27.6 60.6 71.5 48.6 46.4 34.8 6.1 5.7 2.4
a Data not available. Russian Soviet Federated Socialist Republic. Part of the Russian SFSR. Autonomous Soviet Socialist Republic.
tail (Table 3). Suicide comprises 18.3% of such deaths in men and 18.1% in women. Discussion Reliability of the data
Regarding the reliability of statistical data for 1988 in the all-union statistical yearbook (2), there is a discrepancy between the data on the total number of deaths in Estonia in this book and the original data collected by one of the authors from the Estonian Statistical Committee (1). In the Estonian data, there were 470 male deaths in the age group 0-9, whereas there are 259 according to the all-union yearbook. The difference - 21 1 children - is for some reason included in the 80-and-over age group. The numbers in other age groups (10-79) and the total number are similar.
Accidents, poisonings, trauma
Whole population Urban population
Rural population
Male
Female
Male
Female
Male
Female
Traffic accidents Accidental poisoning with alcohol Other accidental poisonings Accidental falls Accidents involving fire Drowning Accidents with firearms Suicide Murder
35.1
9.2
29.8
9.3
45.5
9.1
10.1 9.5 5.8 3.1 13.6 0.5 30.8 11.2
2.4 3.7 3.0 1.9 2.9 0.04 9.3 4.1
9.7 9.0 6.2 2.6 11.6 0.4 29.1 11.9
2.2 3.2 3.6 1.4 2.0 0.02 9.6 4.2
10.8 10.4 4.8 4.1 17.7 0.7 34.1 10.0
2.6 4.8 1.9 2.9 4.7 0.1 8.8 3.9
The 1987 statistics show the same tendency: children's deaths are added to the highest age group. Moreover, the total number of deaths among males, according to the Estonian Statistical Committee's tables, exceeds by 30 cases (0.4%) the number given in the all-union statistics. In the source available to us (2), the category of unknown causes of death, in which hidden suicides can be included, is not mentioned. Moreover, many cases of suicide may be concealed among cases classified as accidents, falls, drowning, etc. It is known that there were both written and oral instructions to keep statistics top secret, not only on suicides but also on, for example, cholera, murder, etc. We do not know with certainty how well these instructions were followed and how this affects the reliability of the data. However, personal contact with officials involved in this statistical work suggests that the primary goal was secrecy alone and that the data presented in the statistical yearbook (2) may be considered reliable. These existing data afford the only possibility of a survey of suicide in the country. In our ongoing study we are trying to clarify: 1) whether suicides can be hidden under other diagnoses, such as when other categories of violent death are diagnosed, and if so, how it affects suicide rates and trends; 2) how changes in the age distribution in the population, if any, affect suicide trends; and 3 ) how religious and cultural factors in the former USSR affect the reliability of statistics. Suicide rates in the various republics
Between 1965 and 1984, the total number of suicides in the USSR more than doubled. The suicide rate was high during the stagnation period (1965-1984), when individuality and creativity were systematically oppressed, independent thinking was severely punished and interpersonal contacts were replaced by a 17
Varnik and Wasserman kind of pseudocollectivism. There was nothing of permanent value, including life and death. Identity crises, in conjunction with total helplessness and mistrust, were common. The standard of psychiatric treatment was low, owing to the weakness of its theoretical and material basis. Pavlov’s neuropsychological conception was the sole psychiatric theory. People who sought psychiatric help were registered, and data on their cases might later be released to the authorities, with social restrictions imposed as a result. The suicide rate was particularly high in the Russian Soviet Federated Socialist Republic (RSFSR) and the Baltic States (Table 1). Besides the psychological causes mentioned above, there were specific circumstances in the Baltic States. These had previously experienced democracy during their period of independence (1918-1940), and the totalitarian system after 1940 was accordingly very difficult to tolerate. Another reason was large-scale immigration from the east and the danger of Russianization of the native population (1). Geographically, suicides were not homogeneously distributed in the RSFSR, since this area is multinational, with diverse languages, cultures, traditions, lifestyles and levels of development. In districts where social changes had been rapid and violent, suicide rates were fairly high. The highest rate in the RSFSR was in the Udmurt Autonomic Soviet Socialist Republic (ASSR): 46. l per 100,000, a region of rapid industrialization and hence immigration to provide factory labour, and the ousting or resettling of native inhabitants (Table 2). The lowest suicide rate in the RSFSR was 2.9 in northern Caucasus (Dagestan ASSR). Suicide rates in the neighbouring Caucasian republics (Armenia, Georgia and Azerbaijan) were also low, and they were also low in the central Asian republics (Tadzhikistan, Turkmenistan and Uzbekistan (Table 1)). The explanation may lie in stable traditions and lifestyles of long standing; large and strong families embracing several generations, with numerous children brought up at home, honouring and caring for the elderly; religion; high national self-awareness; and restrictions on alcohol consumption. Here, in contrast to the USSR on average (Table 2), another
factor possibly explaining the low rate among the rural population, besides the above-mentioned factors, is the relatively larger proportion of local people and small scale of migration. High suicide rates in rural regions of the RSFSR
The explanation for the very high suicide rates in rural areas compared with urban ones may possibly be the harmful impact of the Soviet regime on rural life. Collective farms were organized against people’s will; land, buildings and other property were nationalized. Some regions, regarded as having no prospects, were emptied and their inhabitants forcibly resettled. The countryside was beset by problems of inadequate food supply, medical care and social welfare. All in all, these factors exacerbated problems of adaptation, ethnic conflicts, alcoholism and other forms of deviant behaviour. Perestroika
Perestroika served as a positive social factor, reducing the number of suicides. It is hard to tell which contributed more, psychological freedom and hopes for the future or restrictions on the sale of alcohol. In our ongoing study we are following suicide trends in the republics affiliated with the Commonwealth of Independent States, which are of particular interest in view of great political changes. Acknowledgements This study was carried out with the support of the Estonian Ministry of Health, Statistical Committee and Registry Office and the Swedish insurance company Skandia.
References 1. VARNIKA. Suicide in Estonia. Acta Psychiatr Scand 1991: 84: 229-232. 2. Naselenie USSR 1988. Statisticzeskij jezjegodnik [Statistical yearbook]. Moscow: Goskomitet USSR, Finansy i Statistika, 1989. 3. Srawnitelno - wozrastn,vje isslodewanija w suicidologi - Moscow: Minzdraw RSFSR, Moskowskij NII psihiatrii, 1989: 2434.
In 1989 the USSR statistics on suicides, formerly classified as top secret, were published. A significant decline in the suicide rate in Estonia in the years 1986-1988 suggested the hypothesis that the phenomenon known worldwide as perestroika - which for the Estonians meant a renewed opportunity for self-organization as well as national and individual self-awareness and social optimism - had reduced the suicide rate (1). The Estonian Medical Association embarked on epidemiological studies in Estonia, and was able to initiate a survey on suicide in the USSR as well.
I
A. Varnik’, D. Wasserman’
’ Tallinn Psychiatric Hospital, Estonia, Karolinska Institute, Department of Psychiatry, Huddinge University Hospital, Stockholm, Sweden
Key words: epidemiology; suicide; USSR Danuta Wasserman, M.D. Ph.D., Karolinska Institute, Department of Psychiatry, Huddinge University Hospital and Center for Suicide Research and Prevention, Karolinska Hospital, Box 60210, S-104 01 Stockholm, Sweden Accepted for publication February 23, 1992
described in words without any code being used. If the death was violent, it had to be specified in detail. The diagnoses in death certificates were consequently coded by consultant doctors at the central statistical committees of the republics and constitute the basis for statistics. Figures on mortality from suicides, homicide and some infectious diseases were top secret until 1988. Suicide rates, i.e. the number of suicides per 100,000 inhabitants, are calculated on the basis of population censuses carried out in 1979 and 1989. Results
Material and methods
Data on suicides in the former USSR were derived from two sources: 0 a fairly comprehensive all-union statistical yearbook published in the USSR, in which data on suicides are mentioned for the first time (2); and 0 a collection of articles on suicidology, issued by the Ministry of Public Health of the Russian Soviet Federated Socialist Republic (RSFSR) and the Moscow Psychiatric Research Institute (3). The diagnosis of suicide was included in the USSR statistics in Class XVII, “accidents, poisonings, trauma”, under code 183 until 1982 and under code 173 since then. In the source cited here (2) there is no category for unknown causes of death. Suicide statistics in the USSR were based on death certificates issued by the medico-legal autopsy doctors. This procedure was used throughout the USSR. Official statistics were based on these death certificates. The cause of death in the death certificates was 76
During the stagnation period (1965- 1984), the suicide rate in the USSR was high. In 1965 the number of suicides was 39,550, and in 1984 it was 81,417. The incidence of suicide rose from 17.1 per 100,000 in 1965 to 29.6 in 1984. Suicide trends from 1984 to 1988 show a decreasing number of suicides in all republics. In 1988, 41,408 men and 14,111 women took their lives in the USSR. The fall in the suicide rate compared with 1984 ranges from 5.3% in Armenia (Asiatic region) to 37.9% in Byelorussia (European region (Table 1)). Table 1 shows the suicide rates of the former Soviet republics, which varied widely between different regions, from 1.9 to 37.9 in 1984 and 1.8 to 26.3 in 1988. Table 2 illustrates the lower suicide rates in some urban districts (cities, towns) compared with rural areas (villages). The statistical yearbook reveals the importance of suicide as a cause of violent death. The category of “accidents, poisonings, trauma” is subdivided in de-
Suicides in the former Soviet republics Table 1. Suicide rates per 100,000 inhabitants in the republics of the former USSR
Table 3. Causes of violent death in the USSR (Class XVII) per 100,000 inhabitants,
1988 1984
1985
1986
1987
1988
% change 1984-1988
Whole USSR
29.6
24.5
18.9
19.1
19.4
-34.5
Republics Russia Lithuania Latvia Estonia Byelorussia Ukraine Kazakhstan Moldavia Kirgizia Uzbekistan Turkmenistan Tadzhikistan Georgia Azerbaijan Armenia
37.9 35.8 33.7 32.4 29.6 26.5 26.1 23.3 14.8 8.8 8.6 6.2 4.8 4.5 1.9
31.0 33.7 29.0 31.5 23.1 22.3 22.2 20.7 11.6 8.2 7.5 5.9 4.6 3.7 2.2
23.0 25.1 24.9 27.3 17.7 18.5 16.5 18.8 9.2 7.6 8.8 5.3 4.5 3.5 1.8
23.2 28.7 23.0 25.3 19.0 19.6 16.2 17.1 11.3 6.9 8.0 4.4 4.3 3.7 2.4
24.3 26.3 22.5 24.3 18.4 19.0 16.8 17.0 11.2 6.3 7.7 4.0 4.3 3.3 1.8
-35.9 -26.5 -33.2 -25.0 -37.9 -28.3 -35.6 -27.0 -24.3 -28.4 - 10.5 -35.5 -10.4 -26.7 -5.3
Table 2. Suicide rates per 100,000 inhabitants in some regions of the USSR ~
~
~
Urban
Rural
1985
1986
1985
1986
-a
18.4
-
19.5
Russian SFSRb Udmurt ASSR' Mari ASSR' Kirov's district' Sverdlovsk district'
46.1 41.2 44.6 40.6
21.2 32.6 21.8 31.4 33.4
Estonia Uzbekistan Turkmenistan Tadshikistan
27.2 -
24.3 12.6 12.1 10.8
Whole USSR
100.8 89.5 61.3 60.7 42.3 -
-
27.6 60.6 71.5 48.6 46.4 34.8 6.1 5.7 2.4
a Data not available. Russian Soviet Federated Socialist Republic. Part of the Russian SFSR. Autonomous Soviet Socialist Republic.
tail (Table 3). Suicide comprises 18.3% of such deaths in men and 18.1% in women. Discussion Reliability of the data
Regarding the reliability of statistical data for 1988 in the all-union statistical yearbook (2), there is a discrepancy between the data on the total number of deaths in Estonia in this book and the original data collected by one of the authors from the Estonian Statistical Committee (1). In the Estonian data, there were 470 male deaths in the age group 0-9, whereas there are 259 according to the all-union yearbook. The difference - 21 1 children - is for some reason included in the 80-and-over age group. The numbers in other age groups (10-79) and the total number are similar.
Accidents, poisonings, trauma
Whole population Urban population
Rural population
Male
Female
Male
Female
Male
Female
Traffic accidents Accidental poisoning with alcohol Other accidental poisonings Accidental falls Accidents involving fire Drowning Accidents with firearms Suicide Murder
35.1
9.2
29.8
9.3
45.5
9.1
10.1 9.5 5.8 3.1 13.6 0.5 30.8 11.2
2.4 3.7 3.0 1.9 2.9 0.04 9.3 4.1
9.7 9.0 6.2 2.6 11.6 0.4 29.1 11.9
2.2 3.2 3.6 1.4 2.0 0.02 9.6 4.2
10.8 10.4 4.8 4.1 17.7 0.7 34.1 10.0
2.6 4.8 1.9 2.9 4.7 0.1 8.8 3.9
The 1987 statistics show the same tendency: children's deaths are added to the highest age group. Moreover, the total number of deaths among males, according to the Estonian Statistical Committee's tables, exceeds by 30 cases (0.4%) the number given in the all-union statistics. In the source available to us (2), the category of unknown causes of death, in which hidden suicides can be included, is not mentioned. Moreover, many cases of suicide may be concealed among cases classified as accidents, falls, drowning, etc. It is known that there were both written and oral instructions to keep statistics top secret, not only on suicides but also on, for example, cholera, murder, etc. We do not know with certainty how well these instructions were followed and how this affects the reliability of the data. However, personal contact with officials involved in this statistical work suggests that the primary goal was secrecy alone and that the data presented in the statistical yearbook (2) may be considered reliable. These existing data afford the only possibility of a survey of suicide in the country. In our ongoing study we are trying to clarify: 1) whether suicides can be hidden under other diagnoses, such as when other categories of violent death are diagnosed, and if so, how it affects suicide rates and trends; 2) how changes in the age distribution in the population, if any, affect suicide trends; and 3 ) how religious and cultural factors in the former USSR affect the reliability of statistics. Suicide rates in the various republics
Between 1965 and 1984, the total number of suicides in the USSR more than doubled. The suicide rate was high during the stagnation period (1965-1984), when individuality and creativity were systematically oppressed, independent thinking was severely punished and interpersonal contacts were replaced by a 17
Varnik and Wasserman kind of pseudocollectivism. There was nothing of permanent value, including life and death. Identity crises, in conjunction with total helplessness and mistrust, were common. The standard of psychiatric treatment was low, owing to the weakness of its theoretical and material basis. Pavlov’s neuropsychological conception was the sole psychiatric theory. People who sought psychiatric help were registered, and data on their cases might later be released to the authorities, with social restrictions imposed as a result. The suicide rate was particularly high in the Russian Soviet Federated Socialist Republic (RSFSR) and the Baltic States (Table 1). Besides the psychological causes mentioned above, there were specific circumstances in the Baltic States. These had previously experienced democracy during their period of independence (1918-1940), and the totalitarian system after 1940 was accordingly very difficult to tolerate. Another reason was large-scale immigration from the east and the danger of Russianization of the native population (1). Geographically, suicides were not homogeneously distributed in the RSFSR, since this area is multinational, with diverse languages, cultures, traditions, lifestyles and levels of development. In districts where social changes had been rapid and violent, suicide rates were fairly high. The highest rate in the RSFSR was in the Udmurt Autonomic Soviet Socialist Republic (ASSR): 46. l per 100,000, a region of rapid industrialization and hence immigration to provide factory labour, and the ousting or resettling of native inhabitants (Table 2). The lowest suicide rate in the RSFSR was 2.9 in northern Caucasus (Dagestan ASSR). Suicide rates in the neighbouring Caucasian republics (Armenia, Georgia and Azerbaijan) were also low, and they were also low in the central Asian republics (Tadzhikistan, Turkmenistan and Uzbekistan (Table 1)). The explanation may lie in stable traditions and lifestyles of long standing; large and strong families embracing several generations, with numerous children brought up at home, honouring and caring for the elderly; religion; high national self-awareness; and restrictions on alcohol consumption. Here, in contrast to the USSR on average (Table 2), another
factor possibly explaining the low rate among the rural population, besides the above-mentioned factors, is the relatively larger proportion of local people and small scale of migration. High suicide rates in rural regions of the RSFSR
The explanation for the very high suicide rates in rural areas compared with urban ones may possibly be the harmful impact of the Soviet regime on rural life. Collective farms were organized against people’s will; land, buildings and other property were nationalized. Some regions, regarded as having no prospects, were emptied and their inhabitants forcibly resettled. The countryside was beset by problems of inadequate food supply, medical care and social welfare. All in all, these factors exacerbated problems of adaptation, ethnic conflicts, alcoholism and other forms of deviant behaviour. Perestroika
Perestroika served as a positive social factor, reducing the number of suicides. It is hard to tell which contributed more, psychological freedom and hopes for the future or restrictions on the sale of alcohol. In our ongoing study we are following suicide trends in the republics affiliated with the Commonwealth of Independent States, which are of particular interest in view of great political changes. Acknowledgements This study was carried out with the support of the Estonian Ministry of Health, Statistical Committee and Registry Office and the Swedish insurance company Skandia.
References 1. VARNIKA. Suicide in Estonia. Acta Psychiatr Scand 1991: 84: 229-232. 2. Naselenie USSR 1988. Statisticzeskij jezjegodnik [Statistical yearbook]. Moscow: Goskomitet USSR, Finansy i Statistika, 1989. 3. Srawnitelno - wozrastn,vje isslodewanija w suicidologi - Moscow: Minzdraw RSFSR, Moskowskij NII psihiatrii, 1989: 2434.
