BMJ  2005;330:176-177 (22 January), doi:10.1136/bmj.38328.454294.55 (published 15 December 2004)

Paper

Suicide among Russians in Estonia: database study before and after independence

¹ Estonian-Swedish Institute of Suicidology, Hariduse 6, Tallinn 10119, Estonia, ² Swedish National and Stockholm County Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm

Introduction

Migration has been reported as an important risk factor for suicide. Immigrants have a higher risk than exists in their countries of origin and than among the native population of their new country.^{1 2} According to the 1934 population census, before the second world war native Estonians constituted 88.1% of the total population of Estonia. By 1989, however, because of geopolitical changes related to the incorporation of Estonia into the Soviet Union, the Russian minority had grown to about 30%. We examined how the radically changed sociopolitical status of the Russian minority after the dissolution of the Soviet Union was reflected in their suicide rates.

Methods and results

We compared suicide rates of Russians in Estonia, Estonians in Estonia, and inhabitants of Russia from before (1983-90) and after the dissolution of the Soviet Union during Estonian independence (1991-8). We collected data from the World Health Organization reports on age adjusted suicide rates for the Russian Federation. We derived data on the population in Estonia by nationality from the Estonian Statistical Office. The nationality of those who committed suicide was specified on the death certificates.

According to the 1989 census, Estonian-Russians include Russians (78.7%), Ukrainians (8.1%), Belorussians (4.7%), and others (8.5%). We termed inhabitants of Russia "Russians" in the study. In the Russian Federation 82.6% of inhabitants were native Russians.

Means of age adjusted suicide rates were high for the three nationalities during 1983-90 (table). The rates of suicide were lower among Russians in Estonia than Estonians (P = 0.061). During the transition period (1991-8), suicide rates increased for all three nationalities (by 39.2% for Russians in Estonia, 25.9% for Russians in Russia, and 17.1% for Estonians) (table). Thus, the Estonian Russians had a significantly higher suicide rate than Estonians (P = 0.005) and Russians in Russia (P = 0.032). Of the total numbers of suicides during both periods studied, 80% were in men.

View this table: [in this window] [in a new window]   Mean age adjusted suicide rates per 100 000 and paired samples t tests by nationality in two time periods for Estonia and Russia

 

Comment

During the Soviet era Russians had the lowest suicide rate in Estonia, which might have been due to their privileged status. Russian immigrants in Estonia had privileges in salaries and housing, and their needs received greater attention than local populations in Estonia and in Russia. There was no need for integration and acculturation, and Russians maintained their sense of ethnic identity and confidence in belonging to a privileged class.

After Estonian independence in 1991, Estonian Russians had to adapt themselves to new conditions, study Estonian as an official language, and apply for citizenship. The loss of privileged position and ideals, many years after immigration, may have caused stress leading to suicidal behaviours² and suicide rates significantly higher than for Estonians in Estonia and Russians in Russia.

During 1995-8, stabilisation and adaptation processes began in Estonian society. Convergence of the Russian and Estonian suicide rates in Estonia in 1998 could be interpreted as an adaptation to sociopolitical changes and efforts of the Estonian government to integrate the Russian minority.³

What is already known on this topic Migration is an important risk factor for suicide, and immigrants have a higher risk of suicide than exists in their country of origin and in the native population of the new country What this study adds During the Soviet period the suicide rate among the Russian minority in Estonia was lower than the rate in native Estonians When Russians changed from a privileged to a non-privileged minority in independent Estonia, the suicide rate in the Russian minority in Estonia became significantly higher than in native Estonians and in Russians in Russia

The statistics on suicides in the former Soviet Union are valid and reliable.^{4 5} Then the procedure for reporting and registration was uniform and remained the same in the Russian Federation and also in Estonia. The present study is limited, however, because of the relatively small number of suicides in Estonia.

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See also pp 167, 175

This article was posted on bmj.com on 15 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38328.454294.55

We thank Max Goldstein, Swedish National and Stockholm County Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, and Liina-Mai Tooding for advice on statistics.

Contributors: AV and DW designed the study and wrote the paper. KK and AV participated in data collection. KK did the statistical analysis. All authors interpreted the data. AV is guarantor.

Funding: AV received grants from the Swedish Research Council and the Estonian Scientific Foundation Project No 5349. He also holds the Olof Palme professorship at NASP, Karolinska Institute.

Competing interests: None declared.

Ethical approval: Not required.

References

1. Burwill PW. Migrant suicide rates in Australia and in country of birth. Psychol Med 1998;28: 201-8.[CrossRef][Web of Science][Medline]
2. Hovey JD. Acculturative stress, depression, and suicidal ideation among Central American immigrants. Suicide Life Threat Behav 2000;30: 125-39.[Web of Science][Medline]
3. Värnik A, Kõlves K. Estonians' and non-Estonians' suicides. Tallinn-Tartu, Estonia: Tallinna Lennuliikluse Trkikoda, 2001: 14.
4. Värnik A, Wasserman D, Palo E, Tooding LM. Registration of external causes of death in the Baltic States 1970-1997. Eur J Public Health 2001;11: 84-8.[Abstract/Free Full Text]
5. Wasserman D, Värnik A, Dankowicz M, Eklund G. Suicide preventive effects of perestroika in the former USSR: the role of alcohol restriction. Acta Psychiatr Scand 1998;98(suppl 394): 1-41.[Medline]

(Accepted 14 September 2004)

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