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Open Access Research article

Risk factors for suicide in Hungary: a case-control study

Kitty Almasi1, Nora Belso1, Navneet Kapur2*, Roger Webb23, Jayne Cooper2, Sarah Hadley3, Michael Kerfoot4, Graham Dunn3, Peter Sotonyi5, Zoltan Rihmer16 and Louis Appleby2

Author Affiliations

1 In and Outpatient Department of Psychiatry, No III, National Institute for Psychiatry and Neurology, Budapest, Hungary

2 Centre for Suicide Prevention, University of Manchester, Manchester, M13 9PL, UK

3 Biostatistics/Health Methodology Research Group, University of Manchester, Manchester, M13 9PL, UK

4 Psychiatry Research Group, University of Manchester, Manchester, M13 9PL, UK

5 Department of Forensic Medicine, Semmelweis Medical University, Budapest, Hungary

6 Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary

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BMC Psychiatry 2009, 9:45  doi:10.1186/1471-244X-9-45

Published: 28 July 2009

Abstract

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 propects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants.

Conclusion

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.