Methods of studying suicides in the Leningrad region.

Owing to a number of objective and subjective reasons, the problem of suicides has not been paid the due attention in Russia. Until very recently, the information on different aspects of suicides has not been widely published. It especially concerned forensic medical studies. The only doctor's dissertation (L.?M. Bedrin, 1968) had a limited access. It was only in 1996 that the public presentation of V. A. Spiridonov's thesis took place. It concerned the complex forensic medical and social hygienic diagnostics of the suicides.

Meanwhile, the world history of studying suicides is long enough and presented by a few conceptual trends: psychiatric, anthropological, psychoanalytical, and sociological. It is obvious that these trends merge intertwining into a single integrated notion about suicides.

Suicides in the north-western and north eastern areas of Russia reach 40-50?cases per 100,000 people.

We have attempted to analyze some general indications of the suicides committed in the Leningrad Region in 2000.

Most of the suicides were men. Their number is two or three times as big as that of the cases among women almost all the year round (Diagram 1).

The marital status of the suicides is also different: there are more bachelors and singles among them, which is especially true for women (Diagram 1).

As a rule, suicides are committed by people of the most socially active age groups: from 30 to 50-year olds (Diagram 2).

The presence of alcohol in suicides of different marital status is of great interest: there were fewer intoxicated people both among the married ones and singles prior to death, and this correlation is more distinct among the singles (Diagram 2).

The so-called motiveless suicides were registered only in 16 per cent of the cases. We have managed to establish motives in the rest of the cases: they are social changes, worsening of the well-being, conflicts at work and home, fear of criminal prosecution, incurable severe disease, a feeling of quilt, alcohol or drug addiction, unshared love and alike. It is obvious that some motives are of the markedly social character, whereas others are of the medical one. The latter could be connected with certain inefficiency of medical officers who are obliged to contact systematically with the category of patients like this, supplying to them not only somatic but psychological and psychiatric aid as well.

The obtained data concerning general social characteristics of the suicides seem paradoxical at first glance: socially stable ones have turned out to be twice more numerous than those who were socially unstable (Diagram 3). However, the indicator of the ?stability' is the combined one, and much depends in its estimation upon its constituent characteristics.

For example, the number of the unemployed among the suicides is three times more than those having a job who are considered in the category of the social stability (Diagram 4).

Individuals with the secondary level of education have prevailed among the suicides - the fact to be pointed out in the common program of preventive events (Diagram 5).

Any notable differences concerning a profession, season, month of the year or area of inhabitance have not been found.

The course of the analysis has revealed some methodological deficiency forming the ground for further suggestions.

Suicide prevention includes the revealing and eliminating of the causes for acts like these. During the pre-suicide period medical services must get ready for urgent psychological and psychiatric aid. This problem is solved in megapolises by means of establishing corresponding centres. There are actually no suggestions as to the organization of suicide prophylaxis in small communities. The analysis of reasons causing suicides in Leningrad region has some ground to offer the following two solutions: a) psychological training of medical officers and b) the organization of confiding offices within the system of social security. The analysis of the information data from different medical and non-medical establishments has shown that it is the forensic medical service that has the most valuable data available. Therefore the Bureau of Forensic Medical Examination of the Leningrad Region in collaboration with experts from St. Petersburg State medical University have composed an analytical chart containing versatile information. Besides personal identification data, the following information in included into it: psychiatric analysis, hereditary data, addiction to alcohol, drugs, nicotine, etc. On a par with this, medical and social officers are brought to the notice of the structure concerning suicide reasons.

Table 1. Distribution of the suicides in the Leningrad Region according to the sex and months of the year

?	I	II	III	IV	V	VI	VII	VIII	IX	X	XI	XII
Men	10	9	6	13	9	9	8	6	6	6	11	10
married	2	4	4	2	7	4	3	2	3	5	4	5
single	8	5	2	11	2	5	5	4	3	1	7	5
Women	3	3	2	1	-	2	3	5	1	2	1	-
married	1	1	-	-	-	1	1	-	-	-	-	-
bachelor	2	2	2	1	-	1	2	5	1	2	1	-

Diagram 1. Distribution of the suicides in the Leningrad Region according to the sex and months of the year.

Table 2. Distribution of the suicides in the Leningrad Region according to age group and marital status.

?	under 20	21-30	31-40	41-50	51-60	61-70	upward 70
Married + alcohol	2	2	3	9	4	4	-
Married	-	1	6	10	5	3	4
Single (bachelor) + alcohol	-	4	3	5	4	1	2
Single (bachelor)	3	7	8	10	8	11	7
Sum total	5	14	20	34	21	19	13

Diagram 2. Distribution of the suicides in the Leningrad Region according to the sex and months of the year.

Table 3. Distribution of the suicides in the Leningrad Region according to social indications men and women

Social characteristics		Sex		Sum total
		women	men
Stable	Alcohol	-	22	22
	Sum total	12	67	79
Unstable	Alcohol	4	15	19
	Sum total	9	26	35
It is not known	Alcohol	1	1	2
	Sum total	2	10	11
Total of alcohol		5	38	43
Total amount		23	103	126

Diagram 3. Distribution of the suicides in the Leningrad Region according to social indications among men and women.

Table 4. Distribution of the employed and unemployed among the suicides in the Leningrad Region.

?	alcohol (+)	alcohol (-)	Sum total
Unemployed	28	65	93
Having a job	15	18	33
Sum total	43	83	126

Diagram 4. Distribution of the employed and unemployed among the suicides in the Leningrad Region.

Table 5. Distribution of the suicides in the Leningrad Region according to their level of education.

Education	Social characteristics
	it is not known	stable	unstable	Sum total
Higher	?	6	?	6
Secondary	8	55	22	85
Lower secondary	2	12	7	21
Primary	1	7	6	14
Sum total	11	80	35	126

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