Suicide in Former Eastern Bloc States and the Church’s Response
About one million people die from suicide worldwide each year. Of the 10 nations with the highest suicide rates, five are in the former Soviet Union (FSU): Lithuania—1st; Kazakhstan–3rd; Belarus–4th; Russia–6th; and Ukraine–8th. Three other FSU republics have suicide rates among the highest worldwide: Latvia–11th; Estonia–17th); and Moldova–19th (Initiative for Mental Health, 2010). While suicide rates increased worldwide in the 20th century, the rise in suicide rates in former Soviet republics has been unprecedented. Ten of the former republics had extraordinary rises in suicide rates in the period 1990-1995. (See table.)
Sociologist Emil Durkheim (1858-1917) wrote that society-wide instability would necessarily lead to a state of alienation and uncertainty, which he named anomie. Great changes in conditions of life lead to uncertainty and anxiety on individual and national levels.
Many well-known factors contribute to suicide risk including individual personality factors, access to lethal means (medications, firearms), low levels of life satisfaction, low levels of religious practice, alcohol consumption, mental disorders, divorce, unemployment, poverty, a family history of suicide, and previous suicide attempts (Suicide Prevention Resource Center, 2001). Other research shows gender, age, latitude, and seasons associated with suicide risk (Windfuhr & Kapur, 2011).
The highest rates of suicide in the FSU are in the Baltic republics and the western republics (Russia, Belarus, and Ukraine). Suicide rates in the Central Asian republics and the Caucasus republics are lower with the exception of Kazakhstan, a Central Asian republic with a high Slavic population (Vamik, Tooding, Palo & Wasserman, 2000).
From 1980 to 1990, suicide rates in 12 of the 15 republics declined, attributable in large part to Gorbachev’s anti-alcohol campaign begun in 1985 (Värnik & Mokhovikov, 2009). Alcohol consumption, especially binge drinking, is associated with higher suicide rates in Belarus during the period 1980-2005 (Razvodovsky, 2011). Regulation of alcohol could be an effective intervention in reducing suicide rates.
Islam, the major religion in Central Asian republics, is associated with low levels of suicide, both due to the tenets of Islam, and the fact that many Muslim countries under-report the number of suicides (Nafees, 2010). Armenian, Azerbaijan, and Georgian suicide rates are as low as or even lower than those of Central Asian republics.
The three large Slavic republics, Belarus, Russia, and Ukraine, saw sharp increases in suicide rates (of 52, 56, and 37 percent respectively) immediately after 1990. The Baltic republics saw even higher increases in suicide rates between the years 1990 and 1995 (Estonia, 48; Latvia, 56; and Lithuania, 74 percent). In these countries Durkheim’s anomie appeared in increasing unemployment, uncertainty, increased poverty (Mäkinen, 2000), and “general hopelessness in segments of the population” (Vågerö, Ferlander, Leinsalu, Mäkinen & Stickley, 2005, 42). Suicide rates in Central and East European states have not been uniform. Rates of suicide declined in the Czech Republic, Hungary, and Slovakia between 1990 and 1995, while Bulgaria, Poland, and Romania saw dramatic increases in suicide rates during the same period.
Certain demographic and personality factors mediate and protect individuals from risk of suicide. These factors include: having young children, utilizing mental health services, religious practice, possession of coping skills, employment (New Zealand Ministry of Health, 2005), as well as limiting access to lethal means, decreasing substance abuse, crisis intervention, and improved mental health services (Beautrais, Fergusson, Coggan, 2007).
Deficient Health Systems
The health systems in the FSU had been deteriorating since before perestroika. Mortality rates, especially in the westernmost republics, had been increasing since 1970. By 1974, the average age of death for men in Russia had declined to 57.6 years. Health systems were inflexible and suffered in overstressed economies. Today former Eastern Bloc countries face the need to decrease dependence on large bureaucratic mental health services centered primarily around psychiatric hospitals. Soviet era health care legacies that continue to linger include underfunding, unwieldy and overly centralized direction, and politicized psychiatry.
Eastern Bloc autocratic states encouraged passivity in relationship to authority and people behaved passively in relation to health care as well. Piko wrote that in these countries, “There is a need for converting learned helplessness. . . into learned optimism” (2004, 112). Improvement in health, whether in relation to suicide, tuberculosis, or HIV, cannot be realized simply by fine-tuning the systems currently in existence. Effective health care overhaul must involve community engagement, nationwide policies, and a reorientation of health systems toward primary, secondary, and tertiary prevention agendas (Robles, 2004).
Specific proposals for suicide prevention must include a revamping of health care systems. Three former Eastern Bloc states were part of a recent 21-nation investigation of suicide and health care systems that revealed that only 40 percent of those considering suicide had received any medical or psychiatric treatment. Citizens of poorer nations had even less contact with health care systems. Few contemplating suicide felt the need to seek help, and many held unfavorable attitudes toward the health care system (Bruffaerts, Demyttenaere, Hwang, 2011).
Community-wide prevention programs have been shown to be effective in reducing suicide rates. One such program conducted on Gotland Island in Sweden focused on education and treatment by medical practitioners who had been specially trained in suicide prevention. Suicides decreased by 60 percent during the years the program ran. However, the suicide rate returned to previous levels when the program ended (Rutz, 2001).
Furthermore, public awareness of mental health results in people being sensitive to those at risk for suicide. Screening for depression and suicide risk can be conducted. Mass media can also play an important role by educating themselves and by depicting mental health issues in a responsible manner (New Zealand Ministry of Health, 2005).
Comparing Nationwide Prevention Measures
Armenia, Azerbaijan, and Tajikistan have articulated no national mental health policies. In contrast, Kyrgyzstan, Russia, and Uzbekistan all have national mental health policies, plans, and legislation. Other FSU republics have policies, but are only now developing concrete plans and implementation.Russia has no nationwide suicide prevention program, although some regions (Omsk, Sverdlovsk, Tomsk, and Irkutsk) have created integrated systems for care and prevention of suicidal behavior (Lyubov, 2011). A three-year project is underway in Belarus to provide physicians with training in the diagnosis and treatment of depression (Karolinska Institutet, 2010).
In Ukraine, suicide was one of the leading causes of death among soldiers. In response, the military command initiated a successful prevention program based on education of officers and representatives of the most vulnerable risk groups and distribution of informational materials to all personnel (Rozanov, Mokhovikov, Stiliha, 2002). In Estonia a current project, “Estonia Free from Depression,” sponsors training of school personnel to recognize depression and to intervene to prevent suicide. Families of students also receive published materials on suicide prevention (ESSI, n.d.). In addition, Estonia offers local suicide survivor support services, as do Lithuania and Russia (IASP, 2011). A number of international organizations operate telephone suicide help hotlines using call centers outside the FSU. In the former Soviet Union the greatest concentration of help hotlines is found in the Baltic, the Caucasus, and western regions.
Christian Help Hotlines
Christian ministries sponsor telephone hotlines for spiritual questions and for problems such as addiction, loneliness, and family conflict. Some ministries in the FSU include suicide in their list of concerns, but it appears that no Christian helplines exist exclusively for suicide prevention. Christian counselors confirm that they are not aware of the existence of telephone resources specifically for those contemplating suicide.
One ministry that operates a telephone helpline is the Emmanuel Association, part of the Christian Broadcast Network. Emmanuel provides telephone numbers for material help, adoption services, and a 24-hour spiritual helpline. Toll-free Russian-language calls may be made from Russia, Ukraine, Israel, and the United States. Emmanuel receives several thousand calls per month, but only a few dozen per year come from individuals considering suicide.
The Ufa Diocese of the Russian Orthodox Church hosts an internet site dedicated exclusively to the topic of suicide (http://www.k-istine.ru/suicide/suicide.htm). Several dozen articles written by priests and others present Orthodox positions on various aspects of suicide. The site also provides telephone numbers for local and regional government-sponsored 24-hour hotlines offering social and psychological help. A similar website “Pobedish,” meaning “You Will Overcome” (http://pobedish.ru/), features articles by clergy and other professionals on various aspects of suicide, such as overcoming suicidal thoughts, the meaning of life, coping with losses, suffering, depression, and anxiety. This site has links and an email address for the Church of the Mother of God of Sorrows in St. Petersburg.
Recommendations for Further Christian Intervention
Given the need for transition to a comprehensive reformation of the health care system, Christian health professionals should take a leading role where possible. Believers with a vision for more responsive health services could model proactive and preventative care.
Soviet psychiatry, psychology, and medicine were suspect in the past, and for good reason. All three served to suppress political dissidents by means of forced hospitalization and mind-altering drugs. As a result church leaders and church members are wary of many non-Christian professionals and their resources. Distrust of the health care system is particularly serious in the case of suicide. As no Christian ministries currently offer direct suicide help, such as suicide hotlines, churches must rely on secular systems for assistance. Church leaders therefore must encourage their members to utilize secular services when they are available in their communities.
Church leaders also need to have an understanding of risk factors for suicide. Pastors and church leaders should receive training in suicide symptoms, mental illness, and crisis intervention. General practitioners have proven invaluable in successful suicide prevention programs, and churches should and could be proactive as well.
To educate the church at large, informational pamphlets and books could be produced to alert believers regarding suicide symptoms. Christian internet sites could do the same and at less cost. Ideally, pastors, lay leaders, and laity could attend seminars that would provide overviews of mental illness and how the church can extend help and care for fellow citizens suffering from debilitating psychological conditions including suicidal tendencies.
Could a Christian organization or coalition of congregations and organizations work together to create an effective response to suicide in former East Bloc states? Yes, it is possible. Although a church or ministry can consider a direct ministry such as a hotline, this type of outreach requires trained staff who are knowledgeable on topics related to psychiatry, psychology, and medicine. Probably, at this point, the best option for the church would be to become better informed, not only about suicide prevention, but about a range of mental health issues, substance abuse, and treatment options. Whatever action the church takes, the goal should be to more effectively serve as salt and light in its community.
Source: WHO, 2009.
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Dennis O. Bowen, Psy.D., serves as director of the Vos’ozhdenie Center, Kyiv, Ukraine, under the auspices of Reachglobal of the Evangelical Free Church of America.