Suicide has become a major international health problem, with an estimated 800,000 deaths annually. To date, there is a dearth of evaluation research on public health approaches to suicide prevention. Given this state of affairs, we are presented with Wasserman and Varnik's (1998) evaluation of a natural experiment that took place in the republics of the former Soviet Union during the era of perestroika.
The authors calculated crude annual suicide and mortality rates based on published and unpublished mortality databases in the USSR for the years 1884-1990. The reliability of these statistics was considered to be quite good, except in the Central Asian and Caucasian republics. As 85% of all suicides occurred in the Slavic region, these exceptions appear to have had no major impact on the overall measurement of suicide mortality. Regression analyses, with alcohol consumption as the independent variable, were then performed.
These authors, with hyperbole, argue that perestroika appears to have been "one of the most effective programs for suicide prevention in modern history." The significantly reduced rates of suicide mortality during these years, in their interpretation, are "obviously...attributable to the strict anti-alcohol policy" instituted under Mikhail Gorbachev.
There are statistical issues to consider. We are not presented with a time series analysis using equivalent control group years. There is no equivalent data reflecting the role of increased alcohol consumption as an explanatory factor in increases in suicide rates observed between the 1970's and 1984. And, most importantly, there is no data reported to reflect that there was less proportionate involvement of alcohol in those suicides that did occur during perestroika. Nevertheless, increased suicide rates observed since 1990 do correlate with a relaxation of perestroika's strict controls on purchasing and consumption of alcohol, as well as an increase in the availability of alcohol on the black market.
While supported by research from the United States during prohibition, (alcohol and alcoholism - are significant risk factors for suicide) such a definitive interpretation, however; is premature. Aggregate level analyses are correlational. As most social scientists learned early in their careers that the price of beer and the salary of clergyman tend to co-vary, we have to be cautious of any cause-effect interpretation between two coexisting phenomena.
Perestroika was a period of significant social - and political reform. With that, reform came other social reforms that induced hope, optimism and trust. Moreover, earlier repressive uses of psychiatry and suspicious attitudes toward mental health services eased during perestroika. It is reasonable to presume, therefore, that other factors of risk, not measured in this study, also changed.
Bottom line for public policy: With control over predisposing risk and/or the strengthening of protective factors, suicide is preventable. However, definitive empirical proof for this assertion remains elusive. Wasserman D., Varnik A. (1998). Suicide-preventive effects of perestroika in the former USSR: the role of alcohol restriction. Acta Psychiatrica Scandinavica 98 (Suppl. 394): 1-4.
