“Healthy people don’t commit suicide” – in addition to risk factors, there is also a predisposition

30 November 2018, from the city of Glazov, which is 200 km from Izhevsk (Udmurtia), received terrible news – her grandmother, mother and granddaughter, 55, 35 and 8 years old, fell from the roof of flats. The alleged reason for the fall – a mass family suicide. Now under investigation, which may open new facts. What could cause such a terrible act – is not yet clear.

Photo: Silvia Grav / Facebook

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Boris Polozhy

The high rate of suicides among representatives of Finno-Ugric peoples, including the Udmurts, were noted in the Soviet era. With 80-ies of the Udmurt Republic is among the Russian regions with the highest suicide rate.

In the late 90-ies of the Institute. Serbian (now “national medical research centre of psychiatry and addiction to them. V. P. Serbsky” of the Ministry of health of Russia) carried out extensive studies on the problem of suicide among Finno-Ugric peoples of Russia. The situation is being monitored to this day. The head of the division of clinical and prevention of suicide-studying Center Boris polozhy said “Pravmiru” about why the Udmurts and other Finno-Ugric peoples are in the group of high suicidal risk and what other factors can lead a person to suicide.

– Boris Sergeevich, the high rate of suicides among representatives of Finno-Ugric peoples, including the Udmurts, were noted in the Soviet era. Whether these indicators in recent years in our time?

– The latest statistics on the number of suicides that we have is 2016. By this time, suicidal situation in the country improved significantly in comparison with 90-mi years. However, in the Udmurt Republic, it continues to be dysfunctional. So, in 2016, the frequency of suicides in the Udmurt Republic amounted to 38.2 cases per 100 thousand population, which is 2.4 times more than in the country as a whole (15.8 per 100 thousand).

The most unfavorable situation is observed among men. In the Udmurt Republic, the frequency of completed suicides, that is, cases with a fatal outcome to 68.3 per 100 thousand men. Among women, the rate is 5.4 times less: than 12.6 per 100 thousand women. It follows that suicide is a problem primarily “male”. In the town and village of the suicidal situation is substantially different. If we take the urban population of Udmurt Republic, among them – 24.5 per 100 thousand. But among men who live in the Udmurt villages, the frequency of completed suicides 64.4 cases per 100 thousand. This is 2.6 times more than in urban areas.

– It turns out that the measured rural life in harmony with nature, sometimes dreams of the inhabitants of the metropolis, does not contribute to stabilization of the psyche?

– First, we must understand that we are not talking about those villages and towns that are within 30 km from the cities. Our country is a vast area, many settlements are located far from each other. In large regions from some village (or even small town) to the regional center need to get a half day or day, and in the “capital” of the region or in other major city – even more.

Therefore, many patients with depression do not fall in a timely manner to a specialist. They are actually inaccessible to skilled care – and that’s a very big problem. Meanwhile, the disease becomes heavier, which often leads such patients to commit suicide.

Secondly, we should always remember that suicide is a complex phenomenon that depends on many factors – social, medical, and psychological. The level of economic development, unemployment, etc. – is also an important component.

Where a higher frequency of suicides?

In depressed areas, which, for example, on subsidies, sitting there, where unemployment, where wages are small, where employment is difficult and so on. It becomes clear why among men as high. He is the breadwinner, needs to provide for his family, and in poor regions is not all and not always.

Photo: Edward Honaker

– You said that patients skilled care is not available. Is there some sort of work at the level of countries, regions, republics, that this situation changed?

– The level of organization of psychiatric care is the most important factor in the prevention of suicides. In Udmurtia it is organized well, but that’s such a solid, good running results link, which is in some regions of Russia, there is not.

We have been trying to convince the authorities that the country needs a national program for the prevention of suicide. To date, we have areas where there are no results service, there are regions where it is, though exists, but at a low, not meet the current achievement level, some regions (a few of them, though), where results service looks very decent. These include Krasnodar, Stavropol, Khabarovsk region; the Tomsk and Tyumen region.

A lot depends on how the problem of suicide-responsive by the chief physician and chief psychiatrist of the region, as he understands it, as far as it is concerned, as far as he can and wants to prove to the Governor, mayor, etc., the need for a system of assistance to a suicide.

The problem, of course, complex, but in terms of medical assistance and prevention, suicide is the leading place occupied by physicians and especially psychiatrists. In Bashkortostan, for example, in recent years, on the basis of the Republican psychotherapeutic center has an excellent results service. Where there is interaction between the authorities and management, psychiatrists, public organizations – good results. Very important is the cooperation with various religious faiths.

– Why did the representatives of Finno-Ugric peoples are in the group highest rates of suicides?

– There is another important factor that plays a significant role, along with the other is ethnoculturally factor. The fact that there are people, including in Russia, which – historically – have to this day an increased risk of suicidal behavior.

Udmurts belong to the group of Finno-Ugric peoples, which, unfortunately, all over the world have an increased suicidal risk. It in no way is about some suicidal doom, but in these ethnic groups there is a bonLSI suicidal risk compared to some other Nations (e.g., Slavic). But the peoples of the North Caucasus suicide is generally rare.

For ethnic groups increased suicidal risk is necessary to create a special prevention program is primarily educational, explaining what is necessary to pay attention to where and when to apply, etc. In such regions results service must necessarily be, and their work must incorporate ethnoculturally characteristics of the population. In particular, in rural areas it is advisable to use the language of the indigenous nationality. In some Finno-Ugric republics the situation is more favorable (for example, in Mordovia – 28.1 per 100 thousand), in others more complex (the Republic of Komi 54,7 per 100 thousand).

In General, the critical level of suicides, as defined by the world health organization, is 20 cases per 100 thousand per year. Anything above requires the adoption of urgent measures at the state level. And I’d add that we should start building at the regional level (republics, oblasts, krais).

Photo: iStock

– There are people, say, with an innate predisposition to suicide?

Above I have described the risk factors of suicide. But there are factors in the predisposition to suicidal response. Their three groups:

1. Hereditary a family history of suicide and depression. If someone in the family suffered from chronic or periodic depression or commit suicide – that the representatives of this family may be a biological predisposition to suicide. It should know from childhood, district doctors, pediatricians. Expectant mother during pregnancy should be aware of this predisposition, and know how to raise their future child, on what to look for, where to turn if you suspect a change of behavior, etc.

2. Personal-psychological predisposition. At risk from suicide of the personality – is a complex of characteristics, which attests to their discrepancies. This is a weak, unstable, impulsive, inadequately responsive to stress personality. In most cases, these personalities are formed as a result of wrong (pathological) upbringing in the parental home as early as preschool age.

3. The third type of disposition is a mental disorder. A healthy mental attitude of people, as if it argued no ordinary people and even some professionals, do not commit suicide. This requires at least a temporary (transient) or long chronic mental disorder. People with a healthy psyche will never be able to overcome the powerful, God-given human instinct of self-preservation.

We know many examples when people were living in inhumane situations, but they even thought of suicide arose. And there are people who after an unsuccessful conversation with the head running over the rope. Such different behavior is due to the presence or absence of the above preconditions of suicidal behavior.

Most often leads to suicide neglected, severe, untreated depression, when the despair and hopelessness. Life loses all meaning. And man does this life escape.

As for the scary stories in the city of Glazov, here we see a family suicide. While one should not make any hasty conclusions, now the main task facing the consequence. This is a very complicated case.

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