Suicide Rate In Hungary Research Articles

The impact of the COVID-19 pandemic on suicide rates in Hungary: an interrupted time-series analysis

From 2010 to 2019, suicide mortality fell steadily and substantially in Hungary: the declining trend remained stable, and the suicide rate decreased by more than one-third which was remarkable even from an international perspective. However, despite the declining trend, regional inequalities have always characterised the distribution of suicide mortality in Hungary. Following these favourable trends, COVID-19 appeared in Hungary on the 4th of March 2020 which might lead to an increase in suicides. We aimed to investigate this hypothesis in Hungary by gender, age, educational attainment, and region, as well. To test whether the pandemic changed the declining trend of Hungarian suicide rates, the observed number of suicides during March-December 2020 (pre-vaccination period) was compared with the expected numbers (without the appearance of COVID-19). An interrupted time-series analysis was conducted by negative binomial regression using monthly data from January 2010 to February 2020 (pre-pandemic period). Suicide mortality increased significantly compared to the trend during the pre-pandemic period: overall (by 16.7%), among males (18.5%), in the age group 35-49years (32.8%), and among vocational school graduates (26.1%). Additionally, significant growths in suicide rates were detected in the two regions (Central Hungary and Central Transdanubia) with the lowest COVID mortality rates (by 27.3% and 22.2%, respectively). Our study revealed reversed trend in suicide mortality during the pre-vaccination period compared to the pre-pandemic period in Hungary. There were significant differences in the pattern of suicide rates by gender, age group, educational attainment, and region during the pre-vaccination period in Hungary, which might be attributed to the socio-economic effects of the COVID-19 pandemic. These findings could prove useful in preventive strategies as the identification of groups at higher risk may be important for suicide prevention; however, further investigations are needed to explore the reasons.

Entrapment and escape: Exploring the relationship between suicide and emigration in a post-communist country.

Suicide rate in Hungary was nearly the highest in the world in the decades preceding the transition of the social system. Shortly after the transition in 1989, a radical decrease in fatal suicides occurred, parallel with a marked increase in emigration. We analyzed the data published by the Hungarian Central Statistical Office to detect if there was an association between the remarkable drop in suicide rates and the changes in emigration rates from 1995 to 2019. The results of a brief statistical analysis on the correlation between suicide rate and emigration confirmed a strong negative relationship (r = -.855, p = .00). For more precise results, we applied linear regression analysis, which showed that the emigration rate predicted 73.2% of suicide rate variances with a high predictive value (β = -.983). The study provides a possible explanation through a phenomenological analysis on major life transformations. Relating the arrested flight/cry of pain theory, the theory of rites of passage and double-bind communication resulted a comprehensive and coherent, but not exhaustive explanation on the relationship between suicide and emigration.

Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011.

From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of “Standardization and Decomposition (SDA)” was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.

Risk factors for multiple suicide attempts among Roma in Hungary.

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

Effects of Parliamentary Elections on Suicide Rates in Hungary.

Background: Phillips and Feldman reported a decline in suicides leading up to the American presidential elections, but Wasserman argued that elections had no impact on suicide. Aims: The present study explored the impact of elections on suicides in Hungary. Method: The study examined changes in the number of suicides in Hungary during the period 1990-2010 on the days of parliamentary elections, and in the weeks and months surrounding the elections. Results: There was no significant impact from the elections on the number of suicides. Conclusion: The data from Hungary replicated the results of Wasserman rather than those of Phillips and Feldman.

The effect of the parliamentary election on suicide rate in Hungary

Elméleti háttér: Durkheim fogalmazta meg elsőként a társadalmi integráció és az öngyilkosság közötti összefüggést. Vizsgálatai során azt találta, hogy az az egyén, aki lazán kötődik a társadalomhoz, nagyobb öngyilkossági kockázatnak van kitéve. A társadalmi integráció egy sajátos része, aspektusa a közösség nagyobb eseményeiben, ünnepeiben való részvétel. A társadalomba stabilan integrálódott személy nem csak elfogadja, hanem gyakorolja is közössége ünnepeit, kiemelt eseményeit, mert egy-egy ilyen alkalommal is ki tudja nyilvánítani a társadalom iránti elkötelezettségét, a közösséghez tartozás érzését. Phillips szerint ilyen társadalmi integrációt erősítő esemény az USA-ban az elnökválasztási időszak. Megfigyelése szerint a választások éveinek két hónapjában (szeptember—október) az összhalálozási ráta alacsonyabb, mint a nem választási évek azonos hónapjaiban. Ezt a jelenséget „death-dip effect”-ként írta le, melyet később több szerző az elnökválasztások előtti időszak alatt tapasztalható öngyilkossági gyakoriságra is érvényesnek talált. Cél: A parlamenti választások és az öngyilkossági események számának alakulása közötti összefüggések vizsgálata magyarországi viszonyok között. Módszer: A szerzők a magyarországi országgyűlési választások évének három hónapjában az öngyilkossági események gyakoriságáról kapott adatokat összevetették a nem választási évek megfelelő hónapjainak adataival. Vizsgálták továbbá a választás napját megelőző és követő héten, valamint a választás napján történt öngyilkos cselekmények számát. A vizsgálat során varianciaanalízist (ANOVA), Poisson-modellt és idősoros megközelítést alkalmaztak. Eredmények: 1. A hazai parlamenti választási napokon az öngyilkosságok száma magasabb volt, mint a nem választási márciusi—áprilisi—májusi vasárnapokon, de a különbség nem bizonyult szignifikánsnak. 2. Nem jelentkezett az öngyilkosságok számának változása a választások előtti és utáni hét napjain sem. 3. Vizsgálatunk szerint nem volt kimutatható az öngyilkossági esetek számának csökkenése az országgyűlési választások két hónapjában (április—május) a többi, nem választási év azonos hónapjainak öngyilkossági eseményeivel összevetve sem. Következtetések: A vizsgálatok azt mutatták, hogy hazai viszonyok között nem bizonyítható a parlamenti választások társadalmi integrációt fokozó hatása, így a death-dip jelenség sem volt észlelhető. Figyelemre méltó eredmény ugyanakkor, hogy a választások vasárnapjain az országos öngyilkosságok számai magasabbak voltak a nem választási vasárnapokhoz képest, bár a különbség nem volt szignifikáns.

The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011.

Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods. Annual suicide rates per 100,000 population (>6years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011. Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups. Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.

Gender Differences in Deliberate Self-Poisoning in Hungary

The suicide rate in Hungary is one of the highest in the European Union, with a male-female ratio of 3.55:1. Suicide rates correlate positively with suicide attempts, for which depression is the most frequent underlying disorder. The aim of this qualitative study was to examine gender differences in suicide attempts, with a focus on the effect of precipitating factors on depression. Semistructured interviews were conducted among 150 suicide attempters. Data on circumstances, reason, and method of attempt were recorded. Patients completed the Shortened Beck Depression Inventory, the Beck Hopelessness Scale, the Sense of Coherence Scale, and the Social Support Questionnaire. Interpersonal conflict was found to be the most frequent precipitating factor. There were significant gender differences in depressive symptoms among patients with interpersonal conflicts. We found differences in depressive symptoms according to presence or absence of interpersonal conflicts among men, but not among women. Male suicide attempters who indicated interpersonal conflicts had lower levels of depression. Depressive symptoms are frequent among suicide attempters. However, a subgroup of male attempters reporting interpersonal conflicts are characterized by a lower level of depression. This subgroup of attempters would probably not be detected with depression screening programs and may have an unmet need for other forms of screening and prevention.

EPA-1023 - The 4-level approach to prevent suicides in Hungary: Results from EAAD and OSPI-Europe

The suicide rate in Hungary is high in international comparison. The four-level intervention program of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was evaluating the effectiveness of the EAAD on suicide rates in different areas. The program was implemented in Szolnok, a town in a region of Hungary with exceptionally high suicide rate and in Miskolc, a town in a region with high unemployment and also high suicide rate. Effectiveness was assessed by comparing changes in suicide rates before to after the start of the intervention in the intervention region to corresponding changes of national suicide rates. In addition, changes in suicide rates were compared to those in a control region (Szeged). In Miskolc also the number of suicide attempts was used to measure the effectiveness of the program. For the duration of the program and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p=.0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (-56.1%), 14.6 in 2006 (-51.4%) and 12.0 in 2007 (-60.1%). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in Hungary (p=.017). Men had the same decrease in suicide rates as women in Szolnok. In Miskolc we observed changes in the types of suicide attempts, especially among males.

How to Decrease Suicide Rates in Both Genders? An Effectiveness Study of a Community-Based Intervention (EAAD)

BackgroundThe suicide rate in Hungary is high in international comparison. The two-year community-based four-level intervention programme of the European Alliance Against Depression (EAAD) is designed to improve the care of depression and to prevent suicidal behaviour. Our aim was to evaluate the effectiveness of a regional community-based four-level suicide prevention programme on suicide rates.MethodThe EAAD programme was implemented in Szolnok (population 76,311), a town in a region of Hungary with an exceptionally high suicide rate. Effectiveness was assessed by comparing changes in suicide rates in the intervention region after the intervention started with changes in national suicide rates and those in a control region (Szeged) in the corresponding period.ResultsFor the duration of the programme and the follow-up year, suicide rates in Szolnok were significantly lower than the average of the previous three years (p = .0076). The suicide rate thus went down from 30.1 per 100,000 in 2004 to 13.2 in 2005 (−56.1 %), 14.6 in 2006 (−51.4 %) and 12.0 in 2007 (−60.1 %). This decrease of annual suicide rates in Szolnok after the onset of the intervention was significantly stronger than that observed in the whole country (p = .017) and in the control region (p = .0015). Men had the same decrease in suicide rates as women. As secondary outcome, an increase of emergency calls to the hotline service (200%) and outpatient visits at the local psychiatry clinic (76%) was found.ConclusionsThese results seem to provide further support for the effectiveness of the EAAD concept. Whilst the majority of suicide prevention programs mainly affect female suicidal behaviour, this programme seems to be beneficial for both sexes. The sustainability and the role of the mediating factors (social service and health care utilization, community attitudes about suicide) should be key points in future research.

National trend of antidepressant consumption and its impact on suicide rate in Hungary

The aim of this study was to analyse the changes in the amount and structure of Hungarian antidepressant consumption at national and regional level, furthermore to investigate the possible relationship between antidepressant sales and trends in suicide rates using regional data. Retrospective analysis of antidepressant sales data was performed on a 12 years period (1993-2004), applying the ATC/DDD methodology developed by WHO. Linear regression model was set up to investigate the trends in antidepressant utilisation. The association between antidepressant consumption and suicide rates was measured by Pearson correlation. The nationwide utilisation of antidepressants revealed more than five-fold increase in the studied 12 year period. The usage of tricyclic antidepressants (N06AA) decreased to one third of the previous value, while the usage of selective serotonin reuptake inhibitors (N06AB) multiplied by 21. The consumption of 'other antidepressants' (N06AX) was found very low (3.66 DDD/1000 inhabitants/day in 2004). There was not found any significant correlation between increased antidepressant consumption and decreased suicide rates at regional level by our statistical analysis (r (min) = -0.160; r (max) = -0.314). Further investigation is required to identify determinants that have contributed to recent decline in suicide rate in Hungary.

Trends in suicidology: personality as an endophenotype for molecular genetic investigations.

Psychopathology, especially depression, is the most important risk factor for suicidal behaviour [ 1, 2] with between 25% and 40% of depressed patients attempting suicide [ 3] and about 3.4% completing suicide eventually [ 4]. Given recent figures suggesting that the lifetime prevalence of a major depressive episode among the US population is 32.6–35.1 million [ 5], it is no surprise that suicide ranks among the top ten causes of death in many other countries [ 6]. Understanding the aetiology of a significant public health issue such as suicide is important but difficult because of its complex and multifactorial origins. Although most suicidal behaviour occurs within the context of a mood disorder, most depressed individuals never attempt suicide. Furthermore, no linear relationship between the severity of the depressive episode and the likelihood of suicide has been forthcoming [ 7], highlighting the importance of other factors in addition to psychiatric illness. These factors include substance abuse or alcoholism, a head injury, a dysfunctional family or childhood abuse [ 8], high rates of gun ownership [ 9], smoking [ 10], socioeconomic adversity [ 11], and personality factors [ 12]. Genetic factors may also be very important [ 13, 14]. Marusic and Farmer [ 15] argue that the variation in the suicide rate across European countries (7–43 per 100,000 inhabitants per year) cannot be explained by sociocultural factors alone and is probably due to shared genetic vulnerability. A case in point is the high suicide rate in Hungary and Finland, two populations with a common genetic origin but with divergent cultural and political trajectories [ 15]. Colours of Depression At the family level, the risk of suicide is higher in individuals with a family history of suicide [ 16, 17], and the suicide rate of adolescents is highly correlated with the suicide rate among their relatives [ 18]. Even studies that have controlled for levels of psychopathology have shown that relatives of suicide completers and attempters are at an increased risk for suicidal behaviour [ 19, 20]. Twin studies indicate that this familial clustering of suicidal behaviour has a partly genetic basis with heritability estimates of 17%–55% for suicidal behaviour [ 21, 22] and 20% for suicide [ 23] reported. The only adoption study we are aware of suggested that as far as suicidal behaviour is concerned, adoptees resemble their biological parents more than the adoptive family [ 24]. These data have catalysed the search for genes that predispose to suicidal behaviour, with more than 100 studies now published [ 25]. Post-mortem studies of people who committed suicide have led to the general consensus that a disturbance of the serotonergic system is associated with suicidal behaviour. Therefore, it is no surprise that most of the genes implicated in suicidal behaviour—the serotonin transporter (SERT), tryptophan hydroxylase (TPH), monoamine oxidase A (MAO-A), and the serotonin receptors, 5-HTR1A, 5-HTR2A, and 5-HTR1B—modulate central serotonergic function (see Table 1). As is the case with most complex traits, however, success tends to plateau at a point where good candidate genes are identified but conclusive causal inferences remain elusive because of replication failures. Table 1 Association Analyses of Genes Predisposing to Suicide or Suicidal Behaviour The unequivocal identification of genes related to psychiatric disorder is retarded by a complex interplay of latent environmental influences or gene–environment interactions; genetically and phenotypically heterogeneous samples; the possible effects of numerous loci of small effect size; and the difficulty of adequately correcting for multiple testing. Faced with these frustrations, the use of endophenotypes as an aid to molecular genetic investigations has become almost de rigueur. In the case of suicide, a number of researchers have advocated the use of personality traits as endophenotypes [ 12, 26].

Reduced completed suicide rate in Hungary from 1990 to 2001: Relation to suicide methods

Background and method Changes in the rate of completed suicides and in the suicide methods used in Hungary between 1990 and 2001 were evaluated using the database of the Hungarian Central Statistical Office. Results During this period of time, the suicidal mortality rate decreased by 27.9%. A major part (62%) of this decrease was due to the less frequent use of poisonous substances and drug overdose, particularly of psychotropics. Conclusion Beside the more widespread treatment of depression and other mental disorders, the improved safety of pharmacotherapy and the removal of the most toxic pesticides and chemicals from everyday use might have contributed to the reduction of the suicide rate in Hungary.

Depression and Suicidal Behavior

Letters to the EditorDepression and Suicidal BehaviorTamás ZondaTamás ZondaHungarian Association for Suicide PreventionSearch for more papers by this authorPublished Online:January 01, 2005https://doi.org/10.1027/0227-5910.26.1.34PDFView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMore References Apter, A., Bleich, A., King, R.A., Kron, S., Fluch, A., Jotler, M., Cohen, D.J. (1993). Death without warning?. Archives of General Psychiatry, 30, 138–142 First citation in articleCrossref, Google ScholarBronisch, T. (2003). Depression and suicide behavior (Letter to the Editors). Crisis, 24, 179–180 First citation in articleLink, Google ScholarCheng, A.T.A. (1995). Mental illness and suicide. Archives of General Psychiatry, 52, 594–603 First citation in articleCrossref Medline, Google ScholarIsacsson, G. (2000). Suicide prevention - a medical breakthrough?. Acta Psychiatrica Scandinavica, 102, 113–117 First citation in articleCrossref Medline, Google ScholarMarttunen, M.J., Aro, H.M., Henriksson, M.M., Lönnqvist, J.K. (1991). Mental disorder in adolescent suicide. Archives of General Psychiatry, 48, 834–839 First citation in articleCrossref Medline, Google ScholarOravecz, R., Czigler, B., Leskosek, F. (2003). Correlation between suicide rate and antidepressant use in Slovenia. Archives of Suicide Research, 7, 279–285 First citation in articleCrossref, Google ScholarSchrader, E., Meier, B., Brattström, A. (1998). Hypericum treatment of mild-moderate depression in a placebo-controlled study. Human Psychopharmacology, 3, 163–169 First citation in articleCrossref, Google ScholarZonda, T. (2001). A magyarországi öngyilkossági ráták csökkenése mögött feltételezhet&odblac; okok vázlatos elemzése. [The possible causes beyond the decrease of Hungarian suicide rates] Szenvedélybetegségek, IX(1), 26–30 First citation in articleGoogle ScholarZonda, T., K&abreve;vári, E., Tokody, A. (2000). How to reduce suicide? (A repeated Gotland-study in Hungary). 8th European Congress of Suicide and Suicidal Behavior. Bled, IX, 6–9 First citation in articleGoogle ScholarFiguresReferencesRelatedDetailsCited bySeasonal variation of mortality from external causes in Hungary between 1995 and 20146 June 2019 | PLOS ONE, Vol. 14, No. 6Suicide and mental disorders: A discourse of politics, power, and vested interests23 May 2017 | Death Studies, Vol. 41, No. 8Mental disorder and suicide: A faulty connection19 August 2014 | Australian & New Zealand Journal of Psychiatry, Vol. 49, No. 1Psychological Autopsy Studies as Diagnostic Tools: Are They Methodologically Flawed?Death Studies, Vol. 36, No. 7 Volume 26Issue 1January 2005ISSN: 0227-5910eISSN: 2151-2396 Published online2005 InformationCrisis (2005), 26, pp. 34-35 https://doi.org/10.1027/0227-5910.26.1.34.© 2005Hogrefe & Huber PublishersPDF download

Suicide Rates in Hungary Do Not Correlate Negatively with Reported Rates of Depression and with the Number of General Practitioners

The author re-examined the theory published in several papers in Hungarian and English which attempt to explain the striking regional (geographical) differences in Hungarian suicide rates. According to this theory the differences are due to the fact that in counties with a high suicide rate the number of diagnosed (registered) depression cases is low and vice versa. Thus there is a negative correlation between the suicide rate and the "diagnosed depression" rate of the different regions. The explanation given is that the number of general practitioners is lower in regions (counties) with high suicide rates. Assessing a more reliable database and a much longer time period (1985-1998) the author did not find any confirmation of this theory. Since the Hungarian suicide situation has many specific features with deep historical, cultural and traditional roots, the explanation of the high Hungarian suicide rates and regional differences requires a much more complex approach.

Testing Durkheim's theory of suicide in Hungary.

Measures of domestic social integration which have been found to account for the time-series suicide rate in Hungary quite well also accounted for the time-series suicide rates of each province and for villages, towns, and cities.

Suicide rates in Hungary correlate negatively with reported rates of depression

Regional variations across Hungary in suicide rate and in rate of treated depression were examined. Regional differences in suicide rate as well as psychiatric morbidity were consistent over the 3 years examined (1985, 1986 and 1987). The suicide rate showed a significant negative correlation with the rate of treated depression in each of the 3 years, and weaker negative correlations with perinatal mortality and divorce rate. No correlation between suicide rate and rate of schizophrenia was found. The results suggest that underdiagnosis of depression may contribute to Hungary's very high suicide rate. The implications of this for medical education and psychiatric practice are discussed.