Relationship between recognized depression and suicide in Hungary

In the 1980s, the suicide rate in Hungary was the highest in Europe. A retrospective analysis of 200 consecutive suicides revealed depressive illness in 63%, with primary major depression in 50%, and schizophrenia in 8%. The primary major depression group was divided equally between unipolar disorders and bipolar II disorder, compared to an incidence of bipolar disorder of less than 1% in the general population. Concomitant depression with panic disorders was associated with a higher risk of suicide than panic disorder alone. Only 16% of suicides had seen their general practitioner; the suicide rate was lower in regions with more practising general practitioners and a higher rate of reported depression. Drug treatment prior to suicide with anxiolytics or hypnotics (33%) was more common than treatment with lithium (2%) or antidepressants (18%). In a further study, lithium treatment markedly reduced the number of suicide attempts by patients with bipolar disorder. In conclusion, suicide in Hungary was associated strongly with psychiatric illness, particularly primary major depression. Poor access to healthcare due to a lack of practising general practitioners, appears to have exacerbated the suicide risk. The development of suicide prevention strategies, which enhance the effectiveness of healthcare services, has reduced the suicide rate substantially over the last decade.