Sir--Vladimir Shkolnikov and colleagues (March 24, p 917)
interpret the striking decline in mortality among men and women aged 25-60
years, after the break up of the Soviet Union, as being due to the decrease
of 19% in mean alcohol consumption between 1994 and 1998.
We have shown a positive correlation between decreasing
alcohol consumption and falling mortality from suicide, violent causes
of death, and accidental alcohol poisoning, which supports Shkolnikov and
colleagues' interpretation. In all 15 republics of the former Soviet Union,
suicide rates decline significantly for people aged 15 years and older.
For the whole Union of Soviet Socialist Republics (USSR), the decrease
was 34·0% (38·8% for men, 17·6% for women) in 1984-88, when a restrictive
alcohol policy was introduced. The corresponding proportions for Russia
alone were 35·7% (40·2% and 19·1%). Mortality among men from suicide, violent
death, and alcohol intoxication were much higher than those among women,
but mortality decreased for both sexes.
Alcohol consumption, expressed as L absolute alcohol per person per
year, measured by sales statistics (a measure with shortcomings in its
method), fell by 40-52% in the Slavic republics and 46-53% in the Baltic
republics in 1984-88.2
Regression analysis with alcohol consumption as the
independent variable and suicide rates and violent death rates as dependent
variables have revealed that suicide and alcohol consumption were positively
correlated, as were violent death and alcohol consumption, in all 15 republics.
Mortality due to alcohol intoxication also sharp decreased sharply between
1984 and 1988.
The reliability of statistics on suicide and other violent deaths in
the Slavic and Baltic republics of the former USSR has been shown by quantitative
and qualitative analyses to be good. Analyses show also that statistical
fluctuations during the period studied cannot be explained by systematic
changes in the issue of death certificates and encoding of causes of death.4
We noted a striking fall in suicide rates for men and women aged 25-54
years. This finding tallies well with those of Shkolnikov and colleagues.
This age-group seems to be sensitive to sudden social,
economic and labour-market changes, since they are bringing up children
and caring for elderly relatives.
However, the influence of social, economic, and political factors, and
especially feelings of hope, on this exceptional decrease in suicide and
other violent causes of death cannot be excluded. Changes in life expectancy
are attributable not only to changes in the frequency of excessive drinking.
People consume or abuse alcohol because of their ambient psychosocial conditions.
Alcohol can exert a protective effect when consumed in small amounts per
week, but is a hazard to health and life when used as a coping mechanism
in situations when hope, trust and belief in the future are lacking.
Institute for Psychosocial Medicine, Karolinska Institute;
National Swedish Centre for Suicide Research and Prevention of Mental Ill
Health, Granits Vag 4, Box 230; 171177 Stockholm, Sweden; and Tartu University,
Tallin, Estonia
Shkolnikov V, McKee M, Leon DA. Changes
in life expectancy in Russia in the mid-1990s. Lancet 2001; 357: 917-21.
[Text]
Wasserman D, Varnik A, Eklund G. Male
suicides and alcohol consumption in the former USSR. Acta Psychiatr Scand
1994; 89: 306-13. [PubMed]
Varnik A, Wasserman D, Dankowicz M, Eklund G. Marked decrease
in suicide among men and women in the former USSR during perestroika. Acta
Psychiatr Scand 1998; 98: (suppl 394) 13-19. [PubMed]
Wasserman D, Varnik A. Reliability of statistics on violent
death and
suicide in the former USSR. Acta Psychiatr Scand 1998;
98: (suppl 394) 34-41. [PubMed]
Wasserman D, Vdmik A. Perestroika in the
former USSR: histroy's most effective suicide prevention programme for
men. In: Wasserman D, ed. Suicide: an unnecessary death. London: Martin
Dunitz, 2001: 253-57.