28 Suicide during transition in the former Soviet Republics

Significant social, political, and economic changes in the countries of the former Soviet Union present a good model for investigation of the impact of environment on suicide mortality during times of transition. During the period of perestroika (1985–1990), when promising social changes were rapid, a significant decrease of suicide mortality was observed for both genders in all fifteen republics of the USSR. One of the factors which contributed to the decrease was the strict anti-alcohol policy implemented in 1985 and suspended by 1989. However, times of spiritual liberation, the aspiration of democracy, social optimism and hopes for higher living standards could also have attributed to the causality of suicide decrease. In the years 1990–1994, after the disintegration of the Soviet Union, the suicide rates in post-Soviet countries increased, with the exception of prevailingly Muslim central Asiatic, and the Caucasus countries which have a traditionally low level of suicides. The transitional period called for high adaptation capacity and the necessity of developing suicide-prevention programmes to increase social support and re-education measures.

Knowledge about the reasons of suicide, its risk factors and trigger mechanisms are necessary for effective suicide prevention. To work out local suicide prevention programmes, the organizers must know the specific local features of suicidal behaviour in a certain country or region. Psychological and medical problems (Mokhovikov and Donets 1999; Kopp et al. 2000; Mokhovikov and Donets 2000; Durkheim 2002/1897; Kopp et al. 2004; Baud 2005; Khmaruk and Gorbatkova 2005), as well as ‘genetic’ and other biological factors (Rozanov et al. 1999; Baud 2005; Marušič 2005), predispose people to suicidal behaviour. External social and environmental factors can enhance or diminish suicidal tendencies in people (Värnik 1993; Sosedko and Pustovalov 1994; Wasserman and Värnik 1994; Värnik 1997; Rancans 2001; Rancans et al. 2001a, b; Leister et al. 2003; Värnik et al. 2005; Panchenko and Gladyshev 2004). Sudden social changes cause problems, and can provoke suicidal ideation and behaviour in people who cannot adjust to new circumstances. The countries of the former Soviet Union, which have experienced significant social, political and economical changes beginning in 1985, present a good model for the investigation of sudden social changes' influence on suicide rates. A number of researchers have carried out studies on the features of suicide in these countries (Värnik 1993; Chuprikov et al. 1996; Ester 1996; Mokhovikov and Donets 1996a, b; Lester and Yang 1998; Värnik et al. 1998; Chuprikov et al. 1999; Lester 1999; Anokhin and Boyko 2000; Mäkinen 2000; Stone 2000; Leister et al. 2003; Khmaruk et al. 2005; Smirnov 2005).

The purpose of this review is to sum up the statistics of suicides in the countries of the former Soviet Union, during the transition period and in the present. Moreover, an analysis of the social and psychological consequences of the transition processes will follow, as well as a discussion of the suicide prevention measures that are taken and planned in these countries.

The following historical sketch will stand as a background to the researched reviewed and it is based on these sources: the Meyers Neues Lexicon (1971–1977); Hosking (1985); The Baltic States Reference Book (1991); The Encyclopedia Americana (1991); Estonia: A Reference Book (1993); The World Book Encyclopedia (1994); Värnik (1997).

The first step in the formation of the Soviet Union was the Bolshevist coup d'tat in October 1917, following the collapse of the Tsarist regime in February 1917. As a result of the October Revolution, the huge Russian Empire was disintegrated and, after the Civil War that followed, a large part of Russia went under the control of the communist regime. The Baltic republics managed to use the weakening of Russia's military to obtain independence in the period between the first and Second World Wars. The October Revolution ignited the civil war, in which several foreign powers participated, as well as the fight for freedom of many nations of the former Russian Empire (Podhoretz 2002). The Civil War lasted from 1918 to 1922, ending with the establishment of the Union of Soviet Socialist Republics (USSR) comprising the Russian Federation, Belarusian SSR, Ukrainian SSR and Transcaucasian Soviet Federated Socialist Republic. In 1936, this latter republic was divided into three separate republics: Georgia, Armenia and Azerbaijan. In 1925, the territories of the present Central Asian countries, Kazakhstan, Uzbekistan, Tajikistan, Kirgizia and Turkmenistan, were incorporated into the USSR. The Kazakh SSR and Kirgizian SSR were formed as separate republics in 1936.

The dictatorship of the Communist Party took shape throughout the 1920–1930s as the personality cult of Joseph Stalin was established. This cult was based on dictatorship and terror by a group of Communist Party leaders, and was executed by organs of state security such as the OGPU (United State Political Administration) and later by the NKVD (People's Commissariat of Internal Affairs). Between 1929–1932, compulsory collectivization of the rural economy was carried out, with all farmers forced to join collective farms (kolkhoz settlements). During the process of collectivization, 6–14 millions peasants were deported and imprisoned in labour or concentration camps in Siberia, constituting a large part of the so-called gulags (Solzhenitsyn 1974). The standard of living worsened significantly. Between 1932–1933, large territories were seized by famine and 3–7 million people died (Hosking 1985). At the same time, a heavy weapons industry was developed. Prisoner labour was largely used for the building of industrial and other grand strategic constructions (the Moscow–Volga Canal, White Sea–Baltic Sea Canal, Moscow underground). On a larger scale, massive repression of all classes of people, but especially many Communist Party members, intellectuals, army leaders and prosperous members of society, continued. Altogether, more than 42 million people died in Soviet concentration camps, between 1929–1953, according to Rummel (1995).

On the 23 August 1939, a non-aggression pact (known as the Molotow–Ribbentrop pact) was concluded with Nazi Germany. In a secret protocol attached to this pact, spheres of influence in Eastern and Central Europe were defined. After the beginning of the Second World War, in agreement with this pact, the Soviet Union assailed Finland, and occupied and annexed Estonia, Latvia, Lithuania, Bessarabia, Northern Bukovina and the eastern part of Poland. The People's Republic of Tannu Tuva was forcefully joined to the Soviet Union in 1944. In 1941, Germany attacked the Soviet Union, and during the war that continued until May 1945, the USSR lost 29.4 million people (Keegan 1989).

After the Second World War, the totalitarian political regime became even more severe. During the rebuilding of the economy, particular attention was paid to heavy industry. Political repressions were widespread in the USSR and especially heavy in the Baltic region. Intellectuals and leading persons were killed or deported to Siberia. A relatively large group from the Baltic countries escaped to the West. Immigration of Slavic people to the Baltic region was state-facilitated. Socialist realism was the only mode of art permitted during the Soviet times, glorifying the Communist Party and the Soviet Union. Both educational and other literature, as well as the press, was mainly written in Russian, with small regional exceptions (among others in the Baltic states). The Russian Cyrillic alphabet was forced upon many nations, which previously used other alphabets. Only after Stalin's death in 1953 did the situation begin to change.

Concomitantly, the USSR established satellite regimes that carried out similar modes of repression in practically all Eastern European Countries. The USA and most of the West European countries opposed this development and founded an antagonistic defence system, the North Atlantic Treaty Organization (NATO). The ensuing political antagonism and bilateral armament are known as the Cold War.

After the Stalinist reign of terror, a certain degree of emancipation took place under Nikita Khrushchev from 1953, especially after the 20th Party Congress in 1956. However, the 23rd Party Congress confirmed the return to highly centralized politics in 1966, after Leonid Brezhnev became the general secretary of the Communist Party (1964–1982). In internal politics, this meant continuing isolation from other countries, with stricter censorship and curbs on creative freedom. The USSR's attitude towards its satellite states were illustrated by the military intervention in Czechoslovakia, following the ‘Prague Spring’ in 1968.

The consequences of this repression were manifold, leading to problems of identity crises, mistrust and a developed system for double morality (one truth to be kept to oneself, another—accepted in Moscow—to be uttered out loud) arose. Low standards of psychiatric treatment and ethics deterred people from seeking help. Attention to, and respect for, individual integrity were superseded by ‘pan-collectivism’ (Värnik 1991). The members of society responded in a variety of ways, with passive resistance and alcoholism being widespread. Alcohol consumption was facilitated by the state, which obtained very high profits from the sale of alcohol. Moreover, alcohol was considered to be an important tool to solve the problem of leisure time, and to withdraw people's attention from politics (Värnik 1997).

The stagnation period, which ended in 1984 after the short leadership of Jurij Andropov (1982–1984) and Konstantin Chernenko (1984–1985), was succeeded by what is known as the period of reforms. The reforms were first of political concern and later also economic, beginning when Gorbachov came to power on 10 March 1985, continuing to different extents until and after the disintegration of the USSR. This process implied society's successive release from the Soviet system, with rapid changes calling for a high adaptive capacity. The period from 1985 until the moment of the disintegration of the USSR in 1991 was called perestroika—the restructuring of society. It was a period of hope for positive changes, for more honesty in human relations, aspirations for democracy, spiritual liberation, social optimism and even euphoria, as well as hopes for higher living standards and a better economic situation. Later, some of these hopes turned out to be unrealistic. The totalitarian regime gained some features of democracy; the ‘fresh wind’ of change (a line from one of the popular songs of that period) ventilated the human minds. One transformation of that time is especially pertinent to our thesis: Gorbachev introduced strict restrictions on the production and sale of alcohol as well as on the use thereof (Wasserman et al. 1994; Värnik 1997; Wasserman et al. 1998a, c; Värnik et al. 2007).

The economic reforms implemented from 1989 and onward, especially in the later period (see below), necessitated new values, attitudes, professional expertise and completely different views of work and ethics. Gradually, after the disintegration of the USSR, a free market system was established, albeit lacking many essential controlling mechanisms, at least in most of the former Soviet republics. Forces of the free market imply a need for initiative taking, self-realization and responsibility, as well as the presence of sharp differences in income distribution. Controlling legislation as well as social security systems, expected to balance the forces of the free market, were not developed.

The rapid changes in these societies in transition required a high capacity for psychological adaptation. People who were used to a passive lifestyle in the past found it difficult to integrate into the new political and socio-economic framework. Their previous education—especially that of the elderly and those in the rural areas—did not enable them to cope with the new demands. Many people had unrealistically high expectations of the free market system. This new situation may be said to have caused an adaptation shock.

Several psychologists and sociologists have tried to analyse the consequences of the changes which took place in the countries of the former Soviet Union (Wasserman and Värnik 1994; Sartorius 1995; Mokhovikov et al. 1996; Mokhovikov and Donets 1996b; Värnik 1997; Lester 1998; Wasserman et al. 1998b; Värnik et al. 1998; Lester 1999; Kopp et al. 2000; Mäkinen 2000; Stone 2000; Kopp et al. 2004; Smirnov 2005). Many positive changes in society took place, such as: spiritual (religious) and social liberation, political freedoms, openness of communication with foreigners, the possibility to travel freely, more openness inside society, freedom and independence of mass media and the right to express one's opinions. Unfortunately, there were also negative consequences, such as economical instability, unemployment (which barely existed in the former USSR), pronounced stratification (polarization) of society, with some people rapidly becoming extremely rich, while others quickly sank below the poverty level, a wors-ened criminal situation, including organized criminal activity, and a system of pseudo-information or vacuum of information as a vestige of the Soviet regime. Some investigators called this situation ‘the general social disorganization’ (Lester 1999; Stone 2000; Rancans 2001; Skrabski et al. 2003, 2005; Smirnov 2005). Many people, who have been strictly governed and guided by the Soviet regime during 50–70 years, depending on the region, found themselves helpless when initiative-taking was needed. For the Baltic countries, popularly referred to as the most ‘Westernized’ part of the Soviet Union, the period of socio-economic crisis was shorter, and nowadays, the market economy is flourishing (in Estonia for example economic growth is more than 10 per cent per year) accompanied by its negative and positive features.

This chapter will focus on the negative outcomes of the transition period in relation to suicidal behaviour.

When Eastern Europeans gained their freedom people had high expectations that their lives would improve. For many, those hopes were dashed by bumpy transition to a market economy. Disillusionment led to stress and depression. And depression was a harbinger to death.

Stone (2000, p. 1732)

Rapid changes require a high capacity for psychological adaptation from the populations at stake. Namely, a change of lifestyle from more passive to more active, a re-education process because the previous education often was not sufficient. Further, there was a need to cope with very high demands and unrealistic expectations. What were the psychological reactions to this situation, especially among those people who could not answer to these demands? Several researchers tried to describe the psychological reactions of the population to the transition phenomena. First of all, one should underscore that a large portion of the Soviet population had certain general psychological features, which had developed because of their life in a totalitarian society, and thus made them less flexible and ready to change and adjust. Mokhovikov and colleagues (1996) described the complexity of these features as the ‘Soviet Syndrome’, the signs of which include:

One can also add the factor of the lack (and prohibition) of spirituality and religious faith in the Soviet Union; atheism was propagated as the main ‘religion’ and world outlook.

In this situation of transitional crisis, the main psychological reactions of the people with the above described ‘Soviet Syndrome’ turned out to be:

It is understandable that such negative responses caused an increase in premature health deterioration (morbidity), as well as the mortality rate during the phase of transition (Kopp et al. 2000; Skrabski et al. 2003; Kopp et al. 2004; Skrabski et al. 2005). They also influenced the rate of suicidal acts and attempts in these countries (Sartorius 1995; Lester 1998; Lester and Yang 1998; Wasserman et al. 1998b; Lester 1999; Värnik et al. 2005).

When discussing the statistics and specific features of suicide in the post-Soviet countries, one should take into consideration that these countries differ greatly in their geographic location, historical and cultural features, ethnicity, religion, etc. Because of this diversity, it would be inappropriate to give only the average suicide rates for all the republics together, merely due to the fact that some fourteen years ago they had belonged to one state—the USSR. The suicide rates in these countries differ significantly with respect to suicidality. In some studies, the post-Soviet countries were divided into ‘European’ ‘Asiatic’, or ‘Central Asiatic’ (Lester 1999). In other works (Sartorius 1995), they are classified according to the level of the suicide rates. In this chapter, using as a tool common cultural features and geographic location, the post-Soviet countries are divided into the four following groups, according to the division of the republics used in the former Soviet Union:

The Slavonic countries include Russia, Belarus and the Ukraine. The Republic of Moldova is close to them geographically and culturally, although the ethnic roots of the Moldovian people are lost to the Romanian group. All these countries are European, although a large part of Russia from the Ural Mountains eastward is situated in Asia. The ethnic majority in Russia, Belarus and Ukraine are Slavonic people, and the prevailing religion in all these countries is Eastern Orthodox. Russia is the most multi-ethnic country in this group. It is a federation including autonomous republics and regions, with populations of varied ethnic and cultural backgrounds. The culture of these countries has been formed by influences of their eastern and western (European) neighbours. In the Soviet period, their culture was subject to the enforcement of the communist culture ideology, for example, the so-called social realism in art and literature glorifying the Soviet Regime. Certain aspects of the Belarusian, Ukrainian and Moldovan culture have been lost due this policy and pronounced russification. The ethnic cultures of Russia were also suppressed and have lost some of their peculiar features.

The Baltic countries (Estonia, Latvia and Lithuania) have all had a rather smooth transition to a democratic society, and these countries are respectively the most independent from the influence of their former neighbours, especially Russia, of all former Soviet states. Their economic structures were well-functioning before being incorporated into the Soviet Union in 1939, and they are culturally and politically close to the central and northern European countries, such as Germany, Finland and Sweden. All the Baltic countries refused to join the Commonwealth of Independent States created by Russia after the disintegration of the USSR and are now members of the EU. The economic level of their populations is higher than in other post-Soviet countries. The prevailing religion is Christianity, in particular, the Lutheran church in Estonia and Latvia and Catholicism in Lithuania. Significant parts of the populations do not belong to any church, for exception for Lithuania, primarily because of the religious persecution in the former USSR, and also because of the ongoing secularization across Europe.

The Caucasian region includes Armenia, Azerbaijan and Georgia, which in spite of differences in ethnic roots and religions have much in common. They all have a rich historical and cultural heritage and are traditionally multinational. Their location on the border between Europe and Asia make them transcontinental nations. Because of their strategic location, they are within both the Russian and Western spheres of influence. Armenia and Georgia were the first nations to adopt Christianity as a state religion, in 301 AD and 327 AD respectively. The prevailing religion in Azerbaijan is Islam. In spite of the persecution of religions and the USSR communist culture policy, the populations of these countries managed to preserve much of their former national identities and religious faiths.

The Central Asiatic countries including Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan have more economical and political problems than the post-Soviet countries situated in Europe. All these states are republics, but they have governments with a strong autocratic presidency (e.g. Turkmenistan has a single-party system and was ruled by one president for life). The economy in all these countries is largely based on agriculture, although Kazakhstan and Turkmenistan possess major oil and gas fields, which are not exploited sufficiently due to the lack of adequate export routes for natural gas and oil. This in turn is caused by non-developed technology and international political rivalries. A large percentage of people live below the level of poverty, and there is a high level of unemployment. In all these countries, a large fraction of the population resides in rural areas. The prevailing religion in these countries is Islam. The people have largely preserved original national culture and customs, with roots in the Mongoloid ethnic group, with the exception of Tajikistan, which has an Indo-European population. In Kazakhstan, there is a very large proportion of Russians amounting to about 60 per cent of the whole population.

First, an effort will be made to analyse the dynamics of suicide rates during the decade, in which the social changes were especially fast, unpredictable and critical. Table 28.1 shows the average numbers of suicides per 100,000 of the total population between in the years 1985–1994, during perestroika, and directly after the disintegration of the USSR in 1991.

The suicide rates in the prevailing majority of the Soviet Union republics decreased during the perestroika period, the years with the lowest suicide rate being 1986–1988. This decrease was especially prominent in the republics with high suicide rates and high alcohol consumption as in the Slavonic and Baltic republics. One can assume that one of the factors that contributed to the decrease of suicides during the first years of perestroika was the strict anti-alcohol policy implemented in 1985 and ceased by 1989 (Wasserman et al. 1994, 1998a, c; Värnik et al. 2007). However, spiritual liberation, aspiration of democracy, social optimism and hope for higher living standards, all mentioned in the historical outline above, could also have influenced the causality of suicide decrease.

Age-specific differences in suicide rates observed in the Slavic and Baltic regions during perestroika (1985–1990) showed direct increase with age for women, and bimodal distribution for the 45–54 age groups and 75 and older for men. In 1990, suicide rates in the Slavic and Baltic regions ranged from 25.1 for the 15–24 age group to 86.9 for men 75 years and older, and from 6.0 to 29.8 for women, while suicide rates in Europe ranged from 13.0 to 64.8 for men and 3.6 to 18.7 for women (Värnik et al. 1998).

Several researchers (Stolyarov et al. 1990; Razvodovskiy 2003, 2004; Kõlves et al. 2006) have shown that alcohol consumption plays a negative role in suicidal behaviour. Alcohol intoxication precipitates suicidal tendencies, and may act as a factor in rendering behaviour more impulsive and less regulated by logic. Thus, the strict control of alcohol use in the USSR in 1980s had the following consequences:

The preceding figures in Table 28.1 show that between the years 1990–1994, especially after the disintegration of the Soviet Union, suicide rates in the post-Soviet countries began to increase. The highest numbers of suicides could be observed in Russia and all the Baltic countries. Different authors explain these changes in relation to different political and social conditions. According to Sartorius (1995), suicide increased due to the stress caused by an unforeseeable future, economic decline and unemployment. These factors contributed greatly to increased alcohol consumption and depression. Lester (1998, 1999) lists the following explanatory factors among others: disappointment in the change of regime, lack of dictatorship to blame for misery, and economic decline. Both Sartorius and Lester mention shortage in health care leading to poor or lack of treatment of suicidal persons.

In some countries of the former USSR, the suicide rates did not increase or decrease after 1991 (Lester 1999). This concerns the prevailingly Muslim central Asiatic countries and the Caucasus region, as well as Moldova. The majority of these countries belong to regions with a traditionally low level of suicides, with the exception of Moldova, formerly a part of Romania, in which the level of suicides is above the average for Europe. Azerbaijan, Tajikistan, Turkmenistan and Uzbekistan are Muslim countries. These figures lead to the assumption that being part of a predominantly Muslim society is a protective factor against suicidal behaviour.

Multi-ethnic Russia has great diversity in suicide rates in different regions. The lowest suicide rates are observed in the northern Caucasus region (Ingushetia, Chechnya, North Ossetia and other districts), and the highest in north-western Siberia, where they exceed 150 per 100,000 of population (Polozhiy 2002, 2004; Nevmayatulin 2005). These differences are probably due to cultural, religious, demographic, economic and other factors.

However, according to Boris Polozhiy, suicide largely depends on the ethnic grouping of people (Polozhiy 2002, 2004). Analysing suicide rates in different countries, he concluded that three ethnic groups: the Finno-Ugric, the Baltic and the Germanic group belong to high suicide risk ethnicities. The Finno-Ugric group is composed of Finns, Hungarians, Estonians as well as the Finno-Ugric peoples of Russia: Mordvins, Udmurts, Permian-Komis, Maris, Karelians, Ostyaks, Voguls. Latvians and Lithuanians represent the Baltic ethnic group. Finally, Germans, Austrians, the German-speaking Swiss, Danes and Swedes represent the Germanic group. This theory seems to be rather speculative and based on static and conventional notions of ethnicity, not taking into account its fluctuating construction and cross-section with other identities, such as economic class, religion, gender, sexuality, social status, etc. In fact, Polozhiy does not consider that people might not favour ethnic belonging over some of the above-mentioned distinctive identities. Moreover, no genetic research has been performed to sustain these findings.

Investigating the incidence of suicides in Russia, Polozhiy found the highest suicide rates in the Koryak autonomous area (suicide rate 133.6 per 100,000), the Komi-Permyak autonomous area (suicide rate 124.4), the Nenets autonomous area (suicide rate 95.7) and the Republic of Buryatia (suicide rate 87.6). Although the peoples of these areas belong to different ethnic groups, they have much in common, due to traditional beliefs of Shamanism, not viewing suicide negatively and even implying its admissibility, viewing human life as a series of sufferings. Polozhiy suggests a particular approach to suicide prevention taking ethnic belonging into account (Polozhiy 2002, 2004).

The gender distribution of suicide rates during the Perestroika period varied greatly between different regions, with suicide rates of men ranging from 4.9 in the Caucasian region to 45.9 in the Baltic, and suicide rates of women from 2.1 in Caucasus to 12.3 in the Baltic region (Wasserman et al. 1998b). The data from the WHO database presented in Table 28.2 show that the Slavonic countries have the highest suicide rates among the post-Soviet countries, with male:female ratios also being high. Male and female suicide rates in Lithuania rank among the highest in the world.

Interestingly, the suicide rates for males and females in Kazakhstan approach the levels in the Slavonic countries, which one can assume is due to the large Slavonic population in Kazakhstan. Besides ethnicity, of course, one cannot exclude other reasons more specific to the Slavonic people living in Kazakhstan.

Research focusing on the transition period strongly suggests that negative social factors cause more stress reactions with increased suicidal tendencies in men rather than women. Males are more vulnerable in terms of unemployment and decreased income, as well as to the inequality of income and the loss of social status. Studies across the world show that men are less likely to seek psychological support than women, and have weaker trust in receiving help from official and private sources (Moller-Leimkuhler 2003; Skrabski et al. 2003). In addition, men in the former USSR countries consume more alcohol than women, and it has been demonstrated that alcohol abuse increases suicidal risk (Kõlves et al. 2006). All these circumstances make males more susceptible to suicidal risk than females in situations of sharp social change.

Moreover, there are some specific features in the age distribution of suicides. It was shown that in contrast to other age groups, the suicide rates in elderly people, 75 years and older, did not increase one year after the disintegration of the USSR, and in some regions even decreased, according to the division of the republics used in the former Soviet Union (Sartorius 1995). This decrease of suicide rates for the elderly, shortly after the disintegration of the USSR, is interpreted by Sartorius as giving them a sense of being needed: they are not as exposed to unemployment and job insecurity as younger people, they rarely abuse alcohol and are often religious, which may give them a sense of security. Finally, many of them had learned survival skills during the Second World War.

The increase of suicide rates in post-Soviet countries, after perestroika and the disintegration of the USSR, highlighted the necessity of developing suicide prevention programmes. In most cases, the initiative of developing such programmes did not come from governmental bodies, but rather from specialists in the health services. Individual foreign specialists, in particular, members of the WHO network on suicide prevention as well as other suicidological services of the European countries, rendered great help in organizing suicide prevention in the post-Soviet countries (Pilyagina 1998; Chuprikov and Pilyagina 2002; Panchenko and Gladyshev 2004; Panchenko et al. 2004).

Experiences from the former USSR, regarding suicide prevention during transition periods show that the focus should be on the male population. It is important to increase social support and re-education measures, to involve those with low educational achievement in new economic developments and allow them to benefit from economic changes, and also to be aware of the role of alcohol consumption on mental and physical health. It is also important to detect mental problems, especially depression, to bear in mind specific features of male depression (Wasserman 2006) and to promote modernized comprehensive health care systems equally accessible for all.

The specific features of suicidal behaviour in the period of transition in post-Soviet countries lead us to numerous conclusions and questions for further research. The statistics and research performed illustrate a decrease of suicide rates during the 5-year period of perestroika, followed by a significant increase in the majority of the countries studied after the disintegration of the Soviet Union. Today, the distribution of suicide rates in the former USSR is extremely uneven, with the highest rates found in Lithuania and Russia, and the lowest in the countries of the Caucasus region. When analysing the general suicide rates in specific regions, it is important to keep in mind that multiple factors are at stake, the interaction of biological, hereditary and sociocultural features are closely related to political, socio-economic, and other environmental circumstances. Suicide rates in the transition period have been strikingly gender-related: men being more vulnerable than women towards unfavourable social changes such as unemployment, relative income inequality and loss of social status.

In conclusion, the following aspects are important to focus on when implementing suicide prevention programmes during times of transition: the involvement of those with less education or no education at all in new economic development, and allowing them to benefit from economic changes. Further, an increased awareness of the role of alcohol consumption on health needs to be emphasized, alongside the early detection and treatment of mental problems, especially depression, and particularly in males.