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.

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.

[Forty years (1979-2019) of our working group in the service of Hungarian and international suicidology]. / Munkacsoportunk 40 éves tevékenysége (1979­2019) a hazai és a nemzetközi szuicidológia szolgálatában.

In our study we have summarised the various fields of our suicide research made in the last 40 years. We have devided our whole publications into thematic chapters: cultural-history, regional differences, follow-up studies, prenvention, ecological researches, mostly sociology. Some of them had been firstly published in Hungarian or/and also in international literature. We repeatedly reiterate the importance of writing a Hungarian suicide prevention program. We agree with the opinion: "Suicide prevention is far more than a psychiatric business".

Risk factors for multiple suicide attempts among Roma in Hungary.

In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.

[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.

An ecological study of Hungarian suicide data using complex statistical methods

Background and Objectives: According to a number of psychiatrists, the decrease in the number of suicides can almost exclusively be ascribed to the increasing use of new antidepressants (ADs). Several ecological studies have been carried out to lend support to this claim; unfortunately, many of these started out from either methodologically or statistically flawed assumptions. The purpose of the current study is to demonstrate the examined relationships using complex time-series techniques on Hungarian national sample. Methods: When investigating the relationships between our time series, first we ensured their stationarity using several methods. We used two methods for the analysis involving several independent variables. Results: When using dynamic regression to ensure stationarity, the residuals of the suicide and AD time series showed a significant negative correlation. At the same time, when using the more robust technique of time series differentiation, the stationary time series showed no significant relationship between the use of antidepressants and suicide rates. Conclusions: The models fitting our data showed somewhat mixed results. The vagueness of ecological models is well demonstrated by the fact that even those sociological variables (number of divorces, alcohol consumption) failed to show a significant relationship with suicides here, which are usually significant in analyses using micro data (AU)

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[Ecological study of the Hungarian suicide data using complex statistical methods]. / A Magyar öngyilkossági adatok ökologiai vizsgálata complex statisztikai módszerekkel.

UNLABELLED: Problem posing:According to a number of psychiatrists, the decrease in the number of suicides can almost exclusively be ascribed to the increasing use of new antidepressants (ADs). Several ecological studies have been carried out to lend support to this claim; unfortunately, many of these started out from either methodologically or statistically flawed assumptions. The purpose of the current study is to demonstrate the examined relationships using complex time-series techniques on our national sample. METHOD: When investigating the relationships between our time series, first we ensured their stationarity using several methods. We used two methods for the analysis involving several independent variables. RESULTS: The models fitting our data showed somewhat mixed results. When using dynamic regression to ensure stationarity, the residuals of the suicide and AD time series showed a significant negative correlation. At the same time, when using the more robust technique of time series differentiation, the stationary time series showed no significant relationship between the use of antidepressants and suicide rates. Moreover, those regression models in which several independent variables were entered to control for the AD data showed no significant relationship between the variables either. A further detail is provided by the fact that according to our calculations, suicide rates are not Granger caused by the amount of antidepressants sold. However, the vagueness of ecological models is well demonstrated by the fact that even those sociological variables (number of divorces, alcohol consumption) failed to show a significant relationship with suicides here, which are usually significant in analyses using micro data.

Effects of Parliamentary Elections on Suicide Rates in Hungary.

Background: Phillips and Feldman reported a decline in suicides leading up to the American presidential elections, but Wasserman argued that elections had no impact on suicide. Aims: The present study explored the impact of elections on suicides in Hungary. Method: The study examined changes in the number of suicides in Hungary during the period 1990-2010 on the days of parliamentary elections, and in the weeks and months surrounding the elections. Results: There was no significant impact from the elections on the number of suicides. Conclusion: The data from Hungary replicated the results of Wasserman rather than those of Phillips and Feldman.

Panic disorder and suicidal behavior: a follow-up study of patients treated with cognitive therapy and SSRIs in Hungary.

BACKGROUND: Previous research has suggested that patients with panic disorder but no comorbid disorder are not at greater risk for suicidal behavior. AIMS: The present study followed up patients with panic disorder in order to assess the frequency of their suicidal behavior. METHODS: A sample of 281 outpatients with panic disorder, but without a comorbid psychiatric disorder, was followed up for an average of 5 years. The patients were given 6-8 weeks of cognitive therapy, and 65% were prescribed SSRIs. RESULTS: At the time of first admission, 5 patients (1.7%) reported a previous (lifetime) suicide attempt, and 53 patients (18.2%) reported previous (lifetime) suicidal ideation (both thoughts and plans), not greatly different from the Hungarian population in general. During the follow-up period, no patient committed suicide, 2 patients attempted suicide (0.7%), and 4 patients (1.4%) reported suicidal ideation. CONCLUSIONS: This study indicates that people with panic disorders without comorbid disorders have no higher suicidal risk than the general population in Hungary. After treatment with cognitive therapy and SSRIs, 38.5% were symptom-free, and only 7.8% required continued close therapeutic contact after the follow-up period.

[The effect of birthday in the fluctuation of suicides in Hungary(1970-2002)]. / A születésnap hatása az öngyilkossági számok alakulására Magyarországon (1970-2002).

Authors review the literature related to the suicide and the victims' birthday, but they have not found study, which have shown a strong connection. They investigated a large Hungarian sample using the well-known methods, but they have applied also a new one supposing they will found some connection. All the three methods have shown a strong relationship between the date of birthday and the date of suicide among man in all age-groups: namely, much more man committed suicide on his birthday than on other days of the year. Only a slight significant connection they found among the female aged 60 and more. Authors did search the conceivable causes (sociologic, cultural etc.) but they have not found any explanation. The cause is presumably is the special sensibility of the Hungarian man.

The impact of holidays on suicide in Hungary.

The suicide rate on religious and public holidays was examined for 133,699 suicides for Hungary for the period 1970-2002. For both men and women, more suicides were committed on Monday, while fewer were committed on the weekends. More suicides occurred on New Year's Day than expected. On Christmas Day and on Easter Sunday and Monday, suicides were less frequent only for men, a result consistent with Durkheim's theory. There was less evidence for Gabennesch's broken promise effect on the days after the holidays. National holidays had no impact on the frequency of suicide.

One-hundred cases of suicide in Budapest: a case-controlled psychological autopsy study.

UNLABELLED: The authors performed a case-controlled psychological autopsy study of 100 successive suicides in Budapest, examining the presence of major depression, alcohol, and drug and/or medicament dependency/ abuse according to DSM-IV. The presence of somatic diseases, psychosocial stress, oppressive experiences, and interpersonal relationship disorders within the period of 1 month previous to death was also examined. The control group of 100 people who died of natural causes was identical with the suicide group in respect of number, sex, and age. RESULTS: Among those committing suicide, psychosocial stress, oppressive experiences, and interpersonal relationship disorders were much more frequent and behavioral changes occurred more often in the weeks preceding death compared to the control group. A single suicide attempt during one's life span did not prove to be predictive for a later fatal action, but multiple attempts did. Major depression was diagnosed in 36% of the cases in the suicide group and 17% in the control group. Half of major-depressed suicides (18 persons) and almost all in the control group (16 persons) suffered from reactive (secondary) major depression as a result of somatic disease. Severe alcoholism was found in 33% of the suicide cases and in 44% of the control group. Drug and/or medicament consumption (misuse and/or abuse) occurred in 14% and 8% of the cases, respectively. The data emphasize again that alcoholism seems to be one of the most serious problems in Hungary both in psychological and somatic illnesses.

Preventing suicide by educating general practitioners.

An education program for GPs about treating patients with depressive disorders and panic disorders was implemented in one district in the year 1998. A neighboring district was used as a control. Although the educational program was followed by an increase in referrals for panic disorder in the target district, there was no impact on referrals for depressive disorders, the prescribing of antidepressants by the GPs, or the suicide rate.

Seasonal fluctuation of suicide in Hungary between 1970-2000.

The authors studied the seasonal fluctuation of suicide events in Hungary in a 31-year period. A summer maximum and a winter minimum were found in both genders. A second autumn peak did not occur among women. The suicide rate of Hungary fell markedly in 1998, parallel with the fundamental political-economical-social changes in the country. After 1988 the ANOVA statistic did show a moderate decrease in the seasonal fluctuation but only among those under 29 years of age. This young generation was the real "winner" of the deep social changes which suggests an indirect connection between the decrease of the seasonal fluctuation of suicide and the socio-political changes.

[The effect of public holidays on the suicide drive (frequency) in Hungary (1970-2002)]. / Az ünnepek hatása az öngyilkossági hajlandóságra Magyarországon (1970-2002).

INTRODUCTION: The aim of the study was to examine the relationship between suicide frequency and the days of the week and major public holidays in Hungary (1970-2002). The analysis was based on data of approximately 140,000 suicides. The authors intended to examine whether the "broken promise effect" (Gabennesch), which is cited with increasing frequency in the literature, is valid also in Hungary or not. RESULTS: Suicides occur most frequently on Monday and least on weekends for both males and females. On the days of Christmas and Easter the suicide drive has decreased among males only. The first day of the year is associated with a large increase of suicide risk in both genders, while there appears to be no change in suicide-frequency on the public holidays of 1st May and 20th August. CONCLUSIONS: The findings of our study confirm the validity of the "broken-promise effect" theory also under Hungarian circumstances. It is a very important to know that suicides do not show an increase on and before weekend and public holidays, but after the following day(s). This finding can be an important aspect when preventive measures are adopted.

Seasonality of suicide in Eastern Europe: a rejoinder to Lester and Moksony .

Seasonality of suicide in Hungary decreased from the 1980s to the 1990s, supporting the 2003 conclusion of Lester and Moksony. However, it was the strongest ever to be documented with contemporary suicide data, supporting the conjecture of Voracek, et al. (2002) that seasonality of suicide remains high in Eastern Europe. A new hypothesis regarding the co-occurrence of high incidence and strong seasonality of suicide is presented.

Blood type and bipolar disorder.

Type I bipolar patients in Budapest were reported to have type O blood more often and types A and B blood less often than Type II bipolar patients.