Recovering from the first shock? Changes in suicidality during the first two years of the COVID-19 pandemic in a country with traditionally high levels of completed suicides.

BACKGROUND: Hungary was among the few countries where suicidality increased in the first year of the COVID pandemic. In this study, we sought to investigate whether that elevated suicide mortality had changed by 2021, when the number of fatalities due to COVID-19 was much higher than in 2020. METHODS: We used an interrupted time-series analysis with (quasi-) Poisson regression, controlling for linear trend and seasonal effects, to estimate the effect of the pandemic on the suicide rates of various subpopulations. For both pandemic years the changes in risk of suicide were compared to the period between 2015 and 2019. RESULTS: Although the pandemic had a significant adverse effect on suicidality in 2020 in the Hungarian total population and in males, by 2021 this effect had vanished. In the total population, those aged 25 years and older had elevated suicidality in 2020 but neither age group in the total population had elevated suicidality in 2021. In the total population, increased risks of suicide death could be observed among residents of the capital city (in 2020 and 2021), villages (in 2020), and - in terms of regions - "Central Hungary" (in 2020 and 2021). Only the risk of violent suicides was significantly higher for both the total and male populations (and only in 2020). LIMITATIONS: We used non-individual level data. CONCLUSIONS: The increased suicidality in 2020 had abated by 2021. In the paper, we discuss the possible explanations for our findings.

Inequalities in Diabetes Mortality Between Microregions in Hungary.

Objectives: Regional differences in diabetes mortality are high in Hungary. In our cross-sectional study, we aim to reveal the drivers of the inequalities in diabetes mortality across the 197 microregions of Hungary. To account for the influence of changes in healthcare and social conditions, we compared two periods (2009-12 and 2013-16). Methods: Traditional and re-conceptualized deprivation- and healthcare provison measures were used in OLS regression models. Results: Microregions with a high proportion of population living in "service deserts," especially in regard to the lack of grocery stores, suffer the highest rates of diabetes mortality. Alcohol-related mortality has been proven to be a similarly and surprisingly strong predictor of diabetes mortality. Conclusion: Food provision should be supported in areas characterized by low service density, and alcohol policy should be strengthened and targeted.

[Age-specific regional characteristics of COVID-19 mortality in 2021]. / A COVID­19-halandóság életkor-specifikus regionális jellemzoi 2021-ben.

INTRODUCTION: In most countries, COVID-19 mortality increases exponentially with age, but the growth rate varies considerably between countries. The different progression of mortality may reflect differences in population health, the quality of health care or coding practices. OBJECTIVE: In this study, we investigated differences in age-specific county characteristics of COVID-19 mortality in the second year of the pandemic. METHOD: Age-specific patterns of COVID-19 adult mortality were estimated according to county level and sex using a Gompertz function with multilevel models. RESULTS: The Gompertz function is suitable for describing age patterns of COVID-19 adult mortality at county level. We did not find significant differences in the age progression of mortality between counties, but there were significant spatial differences in the level of mortality. The mortality level showed a relationship with socioeconomic and health care indicators with the expected sign, but with different strengths. DISCUSSION AND CONCLUSION: The COVID-19 pandemic in 2021 resulted in a decline in life expectancy in Hungary not seen since World War II. The study highlights the importance of healthcare in addition to social vulnerability. It also points out that understanding age patterns will help to mitigate the consequences of the epidemic. Orv Hetil. 2023; 164(17): 643-650.

Suicide in Hungary during the first year of the COVID-19 pandemic: Subgroup investigations.

BACKGROUND: COVID-19 may unfavourably affect the mental health of individuals in various ways. Accordingly, the concern has been raised that national suicide rates will increase in the wake of the outbreak of the pandemic. METHODS: In the current study, we tested this conjecture in three age groups (<25; 25-64; ≥65) of the Hungarian total population and the male and female populations. In addition, we assessed whether the pandemic had different effects on counts of suicides committed by violent or non-violent methods. Finally, by comparing the monthly suicide rates in 2020 and the corresponding monthly rates in 2019, we also investigated the "pulling together" hypothesis that postulates that a temporary decrease in suicides may occur after large-scale catastrophic events. RESULTS: With regard to the total population only the suicide counts of individuals aged 25-64 rose significantly (p < 0.05) during the COVID months of 2020. Similar patterns, but at lower levels of significance (0.05 < p < 0.1), were found in those members of the total population aged 65 or older and among males aged between 25 and 64. Furthermore, we found that the number of violent suicides increased significantly (p < 0.05) during the COVID months. Finally, our results have not confirmed the existence of a "pulling together" phenomenon in association with the COVID-19 pandemic in Hungary. LIMITATIONS: We used non-individual level data and were therefore unable to control suicide risk factors at the level of individuals. DISCUSSION: The number of suicides rose significantly in some subgroups of the Hungarian population during the COVID months of 2020.

[Suicide mortality in Hungary during the COVID-19 pandemic.] / Öngyilkossági halálozás Magyarországon a COVID­19-pandémia idején.

INTRODUCTION: While suicide rates did not change (or decreased) in the first pandemic year (i.e., 2020) in the majority of countries, in Hungary the number of completed suicides rose significantly. OBJECTIVE: In our study, we investigated whether the unfavourable trend reversal of the Hungarian suicide rate following the outbreak of COVID-19 pandemic persisted in the second pandemic year. METHOD: We used an interrupted time-series analysis with Prais-Winsten regression, controlling for time and seasonal effects as well as autoregressive effects, to estimate the effect of the pandemic on the suicide rates of the Hungarian male, female and total populations in 2020 and 2021. RESULTS: In the first pandemic year, we observed a significant increase in suicide rates in males and the total population. Although the case numbers for males and the total population in 2021 exceeded the case numbers of the pre-pandemic year, regression estimates suggest that the increase in rates did not differ significantly from the pre-pandemic years in males and it was only found to be significant at the 10% level in the total population. DISCUSSION AND CONCLUSION: Based on the examination of data from the first two pandemic years, we may conclude that by 2021 the adverse effect of the pandemic on suicidality reduced in the total population and disappeared in males. The question remains open whether this favourable development will continue. Orv Hetil. 2022; 163(48): 1895-1901.

[The Number of Deliberate Self-Poisoning Suicide Attempts in the First Year of the Covid-19 Epidemic in Budapest and Pest County].

INTRODUCTION: In contrast to most other countries, in Hungary, suicide rates increased significantly in the first year (March to December 2020) of the COVID-19 epidemic. Worldwide, the burden of emergency health care tended to decrease in the first period of the pandemic. The main goal of the present research was to assess how the number of suicidal deliberate self-poisoning has changed in the first two years of the pandemic compared to the trend of the previous years (before March 2020) in the capital of Hungary, Budapest, and in Pest County (population approx. 3 million). METHODS: In our retrospective cross-sectional study, we analyzed the results of emergency psychiatric evaluations of patients admitted to the Péterfy Hospital Emergency Department and Clinical Toxicology due to self-intoxication. From the data stored in the hospital's electronic health care system, we recorded two variables: suicidal self-poisoning, that is, suicide attempt, and the gender of the patient. Interrupted time series analysis was used, which relied on negative binomial regression estimates. In addition, the leveling in the trends was examined by changepoint detection. RESULTS: In males, suicide attempts decreased by 16.6% compared to the pre-pandemic period (p<0.001). A similar and significant decrease was observed in females and the overall population. The trend change took place in August 2020 for women and the total population, and in October for men. CONCLUSIONS: It is suggested that people who have undergone a non-violent drug self-poisoning suicide attempt are less likely to call for help, such as an ambulance. Alternatively, fewer had attempted suicide because they did not want to be hospitalized. This hypothesis is supported by the fact that the change in the examined trend (August and October) coincides with the beginning of the second wave of the epidemic in Hungary.

A Population-Level Study Concerning the Assumed Association Between Suicide Rates and Antidepressant Consumption in Hungary.

BACKGROUND: It has been claimed that the advent of modern antidepressants has reduced the suicide rate. AIMS: To examine the correlation between the suicide rate and the prescription of antidepressants. METHOD: A dynamic regression was employed to analyze a 73-month-long, monthly time series between 2010 and 2016 in Hungary. The independent variable was the Defined Daily Dose value for the number of antidepressant (AD) prescriptions filled each month. RESULTS: The models failed to show a significant association between the prescription of antidepressants and age- and sex-specific monthly suicide rates. CONCLUSIONS: The prescription of antidepressants in Hungary has had no impact on suicide rates.

Investigation of the association between lithium levels in drinking water and suicide mortality in Hungary.

BACKGROUND: In recent decades, a series of ecological studies from various countries have attempted to reveal whether there is an association between trace amounts of lithium in drinking water and suicide mortality. With some notable exceptions, results have indicated that there is an inverse association between these two variables. Since Hungary had extremely high rates of suicide with a persistent spatial pattern, we consider that our country is ideal to investigate this research question. METHODS: We carried out our research on Hungarian data at the level of districts (n = 197). The dependent variable was the age- and gender-standardized mortality ratio for suicide (sSMR). Our main explanatory variable was the tap water lithium level (Li) from public drinking water supply systems using their own water source (n = 1 325). Those data, which give full national coverage, were aggregated to the level of districts. Confounding factors were religiosity, alcohol consumption and income. Various regression models were used for statistical calculations. RESULTS: Findings from our most appropriate regression model - adjusted for relevant confounding variables and able to handle spatial autocorrelation and heteroscedasticity - suggest a significant (p < 0.05) and a trend-like (p < 0.1) negative association between Li and sSMR in the total population and among males, respectively. However, such an association was not found between these two variables among females. CONCLUSION: In line with the majority of findings from other countries, our results indicate that the intake of lithium with drinking water may have a gender-dependent suicide-protective effect.

Changes in suicide mortality of Hungary during the first year of the COVID-19 pandemic / A magyarországi öngyilkossági halálozás változásai a COVID-19-járvány elso évében.

Összefoglaló. Bevezetés: Az öngyilkosság fo rizikófaktorának a pszichiátriai zavarokat tekintjük. A COVID-19 többek között neuropszichiátriai kórképek kialakulásához is vezethet. Ezen túl a pandémia egyéb velejárói, mint például az izoláció vagy a munkahelyvesztés, a társadalom egészséges tagjaiban is stresszhez, végül pszichiátriai zavarokhoz vezethetnek. Célkituzés: Vizsgálatunk célja annak a teóriának a tesztelése volt, hogy a fenti tényezok miatt együtt járt-e a járvány a hazai suicid halálozás csökkeno trendjének irányváltásával. Módszer: Vizsgálatunkban a megszakított idosorok elemzésének módszerét használtuk, a becslésekhez kvázi-Poisson-regressziót alkalmazva, hogy összehasonlítsuk a 2010 és 2020 közötti idoszak havi bontású adataiból kirajzolódó trendek alapján a járvány idoszakában (2020. március-december) "elvárt" öngyilkossági esetszámokat a ténylegesen bekövetkezett esetek számával. Eredmények: A COVID-19-hónapok alatt a férfiak által elkövetett öngyilkosságok száma szignifikánsan, 18%-kal nott, ahhoz a trendhez képest, amely a COVID-19 hiányában állt volna elo. A teljes populációban szintén szignifikáns, 16%-os emelkedést lehetett megfigyelni, míg a nok által elkövetett öngyilkosságok száma nem tért el szignifikánsan a pre-COVID-19-idoszak trendje alapján elvárt értéktol. Megbeszélés és következtetés: A járvány kitörése utáni idoszakban a magyar férfiak szignifikánsan gyakrabban követtek el öngyilkosságot, míg a noknél az adatok nem tükröztek lényegi változást. A más országokban kivitelezett vizsgálatok eredményei érdekes módon inkább csökkenést vagy nem szignifikáns változást jeleztek, amikor a COVID-19-éra suicid számait az azt megelozo idoszakok számaival hasonlították össze. A hazai és a nemzetközi eredmények közti eltérések magyarázata egyelore még nem ismert, így a téma mindenképpen további vizsgálatokat igényel. Orv Hetil. 2021; 162(41): 1631-1636. INTRODUCTION: Psychiatric disorders are the main risk factors for suicide. COVID-19 may result in the appearance of neuropsychiatric syndromes. Moreover, other corollaries of the pandemic (e.g., isolation, job loss) may lead to increasing stress and, ultimately, psychiatric disorders even among the non-infected population. OBJECTIVE: We aimed to test the theory of whether the pandemic, due to the aforementioned factors, was associated with the reversal of the declining suicide rate trend in Hungary. METHOD: To compare the observed number of suicides during the COVID-19 months (March-December 2020) with the expected numbers, we used an interrupted time series model and, for the estimations, quasi-Poisson regression. Expected numbers were calculated based on trends derived from monthly data between 2010 and 2020. RESULTS: During the months of the pandemic, the number of suicides among males rose significantly by 18% compared to the hypothetical trend that would have occurred in the absence of COVID-19. A significant increase (16%) was also observed in the total population. By contrast, the number of female suicides did not differ significantly from the number expected based on the pre-COVID-19 trend. DISCUSSION AND CONCLUSION: After the outbreak of the epidemic, Hungarian males committed significantly more suicides, while no relevant changes were observed among females. Interestingly, studies from other countries found either no change or decrease when comparing suicide numbers from the COVID-19 period with the corresponding numbers from the pre-COVID-19 period. The explanation for this discrepancy is still lacking, so further investigations are needed. Orv Hetil. 2021; 162(41): 1631-1636.

Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011.

From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of "Standardization and Decomposition (SDA)" was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.

The effects of sunshine duration and ambient temperature on suicides in Hungary.

BACKGROUND: A couple of studies suggest that sunshine duration and ambient temperature contribute to suicide. Few studies have happened in East-Central European area. OBJECTIVE: We scrutinized the daily suicide rates and other measured meteorological parameters spanning from 1971 to 2013 in the region of Hungary exhibiting the highest suicide rate. METHODS: The meteorological parameters measured in the area signified the independent variables of the statistical model, while the observed suicide rate connoted the dependent variable. Dynamic Regression, a time series analytical method was employed for creating the model. RESULTS: Three meteorological parameters displayed a weak, yet statistically significant relationship with suicide rates. 1/ Daily sunshine duration has shown an immediate, significant positive correlation, 2/ daily changes in temperature at ground level also exhibited a significant relationship, albeit it followed a complex transient profile overarching three days. Tropopause height was also significant in the model: an immediate positive effect was followed by a negative effect six days later. CONCLUSIONS: We estimated consistent and immediate positive associations between daily suicide and daily change of elevated ambient temperature and duration of sunshine in a high rated area of Hungary.

[Lottery and suicide - the effect of number of lottery tickets on Hungarian suicide rates].

AIM: The relationship of suicide and gambling is a neglected field in the study of suicidology. In Hungary, no statistical studies have been published to date with regard to the whole of the population. Our study investigates the relationship between a very popular high prize game, lottery, and suicide rates. METHOD: The relationship between daily rates of suicide by gender and age and the number of winning tickets has been analysed over the periods between 1991 and 1997 and from 1997 to 2013. During the first period of time examined, the lottery draws took place on Fridays, while they were held on Saturdays in the second. Time series covariance analysis based on ARIMA modelling on detrended data was used to test the relationship of gambling and self-destruction. RESULTS: Out of the 27 models tested, the only significant models, which are also in line with what can be expected based on the literature, could be found during the period when the draws took place on Fridays. Corresponding to the increase in the number of lottery tickets, there was also an increase in the number of suicides somewhat delayed in time. The relationship only held true for males with one exception. CONCLUSIONS: In our study, we found a weak positive relationship between rates of suicide and the spread of the lottery game. The significance of our study is well reflected by the fact that - to the best of our knowledge - this effect has never been investigated on such a large sample before. Our results point to the significance of cultural and social factors, to differences in gender roles, and to the accentuated role of the factor of hopelessness in shaping the suicide scene in Hungary. In order to clarify the role of different factors in more detail, there seems to be a need for further studies on suicide conducted on large samples.

[Relationship between the number of hours of sunshine and the number of (violent) suicides in Hungary]. / A napfényes órák és a (violens) öngyilkosságok számának összefüggése Magyarországon.

BACKGROUND AND PURPOSE: Aim - Studying the impact of the sunshine on the numbers of suicides. The number of suicides is highest in the late spring and early summer months, while it is lowest in the cold, gloomy winter. Although the exact causes are still unknown, there are some theories about this phenomenon. A number of studies conducted in recent years have concluded that the rise in suicide rate during the warm months might be due to an increased exposure to sunlight, especially in the cases of the violent method. We studied the validity of this hypothesis on a large Hungarian database. METHODS: We analyzed the number of monthly hours of sunshine and the number of suicides by sex and by violent vs. non-violent method over a 360-month period. Our sample consisted of 127 877 committed suicides between 1971 and 2000. The parabolic trend of seasonality had to be removed from the suicide time series, then regression analysis was conducted on the seasonally adjusted data. RESULTS: Our analysis revealed that in Hungary there was no statistically significant direct relationship between the number of hours of sunshine and the number of suicides. Moreover, there was no correlation between the hours of sunshine and the number of violent suicides either. CONCLUSION: If the above claim were confirmed in subsequent research, it would mean that our current therapeutic regime should be reconsidered during the spring-summer seasons.

[Effect of residential region, and educational and marital status on suicide: census-based negative binomial regression analysis]. / Az iskolai végzettség, a családi állapot és a lakóhelyi régió hatasa az öngyilkosságra-cenzus alapú negative binomiális elemzés.

AIMS: Suicidal behaviour is a multicausal phenomenon, accordingly its occurence is determined, in a mutually non-exclusive manner, by several medical, sociodemographic, cultural and lifestyle factors. In the current study we investigated the effects of age, gender, marital and educational statuses and region of residence on the risk of completed suicide. METHOD: Our raw data came from the census in 2011 and from the Demographic Register of the Hungarian Central Statistical Office. Negative binomial regression analyses were used to reveal the effects of our variables on suicide. RESULTS: We found that the risk of completed suicide varies significantly by gender, age, educational attainment, marital status, and region of residence. Effects of sociodemographic and region of residence variables on suicidal risk were strongly influenced by gender. Suicide risk was elevated for both men and women who are living in the Great Plain and also for women who are living in the region Central Hungary and men who are living in the region Northern Hungary. CONCLUSIONS: The thorough clarification of sociodemographic determinants of suicide is essential in the identification of endangered groups and it is the prerequisite of successful prevention as well.

The Effects of Significant International Sports Events on Hungarian Suicide Rates.

BACKGROUND: Several studies found a significant relationship between important sport events and suicidal behavior. AIMS: We set out to investigate whether there is a significant relationship between the raw suicide rate and the most important international sports events (Olympic Games, FIFA World Cup, UEFA European Championship) in such an achievement-oriented society as the Hungarian one, where these sport events receive great attention. METHOD: We examined suicide cases occurring over 15,706 days between January 1, 1970, and December 31, 2012 (43 years), separately for each gender. Because of the age-specific characteristics of suicide, the effects of these sport events were analyzed for the middle-aged (30-59 years old) and the elderly (over 60 years old) generations as well as for gender-specific population groups. The role of international sport events was examined with the help of time-series intervention analysis after cyclical and seasonal components were removed. Intervention analysis was based on the ARIMA model. RESULTS: Our results showed that only the Olympic Games had a significant effect in the middle-aged population. Neither in the older male nor in any of the female age groups was a relationship between suicide and Olympic Games detected. CONCLUSION: The Olympic Games seem to decrease the rate of suicide among middle-aged men, slightly but significantly.

Associations between marital and educational status and risk of completed suicide in Hungary.

BACKGROUND: Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influenced by gender. Since in Hungary these associations have not yet been investigated by means of large-scale multivariate epidemiological studies we aimed to investigate these in the current paper. METHOD: Census data on marital and educational status, age and gender from 1980, 1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims derived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). RESULTS: Female gender, young age, higher educational attainment and marriage were significantly associated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. LIMITATIONS: Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. CONCLUSION: We found that in Hungary between 1980 and 2011 the effects of some frequently investigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary.

[Effect of the summer Olympic Games on Hungarian suicide rates]. / A nyári olimpiai játékok hatása a magyarországi öngyilkossági adatokra.

In our study, we set out to investigate whether there is a significant relationship between the count (raw rate) of suicides committed and the summer Olympic Games in such an achievement-oriented society like the Hungarian one, where summer Olympic Games receive extremely considerable attention. For our study, we examined the suicide cases occurring over 15706 days between 1 January 1970 and 31 December 2012 (43 years), separately for each gender. Because of the age-specific characteristics of suicide, the effect of the Olympic Games was analysed for the middle-aged (30-60 year-old) and the elderly (over 60 year-old) generations, as well as for the whole gender specific population. The role of the summer Olympic Games was examined with the help of time series intervention analysis after the cyclical and seasonal components have been removed. Based on our results, the effect of the Olympic Games is significant for the middle-aged (30-60 year-old) population. Neither in the older male, nor in any of the female age groups could a relationship between suicide and this sports event be detected. In summary, the Olympic Games seem to decrease the rate of suicide among middle-aged men slightly but significantly. In the interpretation of our results we emphasise the importance of the complex approach of suicidal behavior.

Investigation of the marked and long-standing spatial inhomogeneity of the Hungarian suicide rate: a spatial regression approach.

BACKGROUND: In the last century Hungary had astonishingly high suicide rates characterized by marked regional within-country inequalities, a spatial pattern which has been quite stable over time. AIMS: To explain the above phenomenon at the level of micro-regions (n=175) in the period between 2005 and 2011. METHODS: Our dependent variable was the age and gender standardized mortality ratio (SMR) for suicide while explanatory variables were factors which are supposed to influence suicide risk, such as measures of religious and political integration, travel time accessibility of psychiatric services, alcohol consumption, unemployment and disability pensionery. When applying the ordinary least squared regression model, the residuals were found to be spatially autocorrelated, which indicates the violation of the assumption on the independence of error terms and - accordingly - the necessity of application of a spatial autoregressive (SAR) model to handle this problem. According to our calculations the SARlag model was a better way (versus the SARerr model) of addressing the problem of spatial autocorrelation, furthermore its substantive meaning is more convenient. RESULTS: SMR was significantly associated with the "political integration" variable in a negative and with "lack of religious integration" and "disability pensionery" variables in a positive manner. Associations were not significant for the remaining explanatory variables. LIMITATIONS: Several important psychiatric variables were not available at the level of micro-regions. We conducted our analysis on aggregate data. CONCLUSION: Our results may draw attention to the relevance and abiding validity of the classic Durkheimian suicide risk factors - such as lack of social integration - apropos of the spatial pattern of Hungarian suicides.

Gender differences in antidepressant use-related seasonality change in suicide mortality in Hungary, 1998-2006.

OBJECTIVES: Studies show that the seasonality of suicide (spring/early summer peak, winter low) is mainly the consequence of the seasonal incidence of depression-related suicides. The aim of the present study was to analyse the relationship between increasing antidepressant utilization and national suicide rate of Hungary between 1998 and 2006, with particular regard to seasonal patterns and gender differences. METHODS: Time trend analysis (ARIMA) had been applied to investigate the correlation between the trend of antidepressant prescription and both of suicide rates and seasonality index. RESULTS: During the 9 years of the study period there was a significant (P<0.001) correlation between the steadily increasing antidepressant prescription (113%) and continuous decline in total national suicide rate (23%) as well as both in females and males (21 and 23%, respectively), but this relationship was 8-fold stronger in males. Increasing antidepressant utilization was associated with significantly decreased seasonality of suicides only among males. CONCLUSIONS: The results suggest that decreasing seasonality of suicides could be a good marker of lowering rate of depression-related suicides in the population particularly among males.