Risk factors for suicide in Hungary: a case-control study.
BACKGROUND
Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring.


METHODS
We carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002-2004) and 194 controls were interviewed by clinicians using a detailed schedule.


RESULTS
Many of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personality disorder, and experiencing a recent major adverse life event. A number of variables reflecting experiences since economic restructuring were also associated with suicide; for example, unemployment, concern over work prospects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants.


CONCLUSIONS
Suicide rates in Hungary are falling. Our study identified a number of risk factors related to individual-level demographic and clinical characteristics, and possibly recent societal change. Improved management of psychiatric disorder and self-harm may result in further reductions in suicide rates.
Almasi
Kitty
K
In and Outpatient Department of Psychiatry, No III, National Institute for Psychiatry and Neurology, Budapest, Hungary. almasi@externet.hu
Belso
Nora
N
Kapur
Navneet
N
Webb
Roger
R
Cooper
Jayne
J
Hadley
Sarah
S
Kerfoot
Michael
M
Dunn
Graham
G
Sotonyi
Peter
P
Rihmer
Zoltan
Z
Appleby
Louis
L
D000328:Adult; D000928:Antidepressive Agents / Q000600:supply & distribution / Q000627:therapeutic use; D016022:Case-Control Studies; D002423:Cause of Death / Q000639:trends; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D012069:Religion and Psychology; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D012922:Social Change; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D014478:Unemployment
D000928:Antidepressive Agents