Almasi Kitty, Belso Nora, Kapur Navneet, Webb Roger, Cooper Jayne, Hadley Sarah, Kerfoot Michael, Dunn Graham, Sotonyi Peter, Rihmer Zoltan, Appleby Louis
In and Outpatient Department of Psychiatry, No III, National Institute for Psychiatry and Neurology, Budapest, Hungary.
BMC Psychiatry. 2009 Jul 28;9:45. doi: 10.1186/1471-244X-9-45.
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.
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.
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.
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.
匈牙利曾是世界上自杀率最高的国家之一，但自1990年起经历了重大的社会和经济变革。我们旨在调查匈牙利自杀行为的诱因。我们假设匈牙利的自杀行为既与西方研究中确定的自杀风险因素有关，也与社会和经济结构调整相关的经历有关。
我们开展了一项对照心理解剖研究。临床医生使用详细的调查表对194例病例（2002年至2004年布达佩斯和佩斯州的自杀死亡病例）和194名对照者的 informant 进行了访谈。
在其他环境中与自杀相关的许多人口统计学和临床风险因素在匈牙利也与自杀有关；例如，未婚或目前没有恋爱关系、缺乏其他社会交往、教育程度低、有自残史、目前被诊断为情感障碍（包括双相情感障碍）或人格障碍，以及近期经历重大不良生活事件。一些反映经济结构调整后经历的变量也与自杀有关；例如，失业、对工作前景的担忧、生活水平的变化、宗教信仰活动。在死亡时有抑郁症证据的病例中，只有20%接受过抗抑郁药治疗。
匈牙利的自杀率正在下降。我们的研究确定了一些与个体层面的人口统计学和临床特征以及近期社会变革可能相关的风险因素。改善精神疾病和自残行为的管理可能会进一步降低自杀率。
