Suicide has been a pressing problem for decades in Slovenia, but stigma and shame have precluded virtually any serious public discussion. Is Slovenia ready to bring this skeleton out of its closet?
From 10 to 12 May, the National Assembly in Ljubljana hosted an international conference called "Suicide: Interplay of Genes and Environment," co-organized by the Legal Information Center for Non-Governmental Agencies (PIC). This is the first conference in the world that has addressed the role of genetics in suicidal behavior, and is only the first major event this year highlighting the problem of suicide in Slovenia - a second international conference will be held in September in Bled.
Participants from the fields of medicine, genetics, law and psychiatry participated in the conference, coming to Ljubljana from all over the world. Research and findings were presented on the role of genetics in suicide, but most conference participants stopped short of assigning genetics the leading role in suicidal behavior. Most agree that the social environment contributes as much as genetics, if not more.The genetics of suicide
Researchers only started investigating the possibility that genetics plays a role in suicidal behavior in the past decade. So far, they have been unable to isolate a particular gene that contributes to suicidal behavior with any certainty, but speculation is rampant. One participant at the conference, British geneticist Peter McGuffin, maintains that genetics may account for as much as 40 percent of all suicides.
An article in the Budapest Sun in February announced that a team of researchers at the Royal Ottawa Hospital in Canada which conducted a study concentrating on Hungarians believes that it has discovered a mutation in a gene that gives its bearers a predisposition to suicide. As yet, the findings have not been completely verified, but the discovery adds fuel to the fire. Hungary, like Slovenia, has a peculiarly high suicide rate.
The mutated gene in question is the one encoded for a serotonin 2A receptor, a gene that affects mood. The study showed that those with the mutated gene are at least twice as prone to suicidal behavior as those who do not possess it. Studying the brains of Hungarian suicide victims, the researchers discovered an abnormal recurrence of the gene among their subjects.Literacy, poverty, suicide - is there a connection?
Dr Andrej Maruai, a Slovene psychiatrist involved in organizing the conference, presented a paper called "Suicide in Europe: Genetics, Literacy and Poverty" which convincingly shows the links between the social factors of literacy and poverty, and suicidal behavior. Even a cursory glance at recent suicide statistics for Europe shows a striking difference in suicide rates between Northern and Eastern Europe on the one hand, and Southern and Western Europe on the other.
Maruai based his research on the theory that literacy rates and gross national product (GNP) are the reason. According to Maruai's theory, the higher any given country's literacy rate and the lower that country's GNP, the more likely the country is to have a high suicide rate. The theory can be convincingly applied to the countries with the highest suicide rates in Europe, namely the three Baltic states, Hungary and Slovenia, where literacy is at almost 100 percent and where the GNP and standard of living have been adversely affected by the transition process.
Western European and Mediterranean countries have lower literacy rates, more stable GNPs and, accordingly, lower suicide rates. Maruai maintains that better-educated people, especially in countries in transition, are more conscious of their current lower social and economic positions and are therefore more likely to resort to suicide. Furthermore, such people are more familiar with more effective means of taking their own lives, thereby increasing the suicide rate.Suicide and refugee populations
Another paper presented at the conference was "Depression and Parasuicide in Refugee Children." It was delivered by Slovene researchers Dr Anna Mikuš and Vera Slodnjak. The two worked with Bosnian refugee children living in Slovenia and showed that, despite their situation and experiences, the refugees generally are psychologically well adjusted.
The two researchers found that 18 percent of the Bosnian children showed signs of depression, as compared with 27 percent of similar Slovene children. The Bosnians perform similarly in school and are no more likely to resort to violence than Slovenes. It was also found that the Bosnian children thought about suicide less than their Slovene counterparts.
Among the explanations offered is the possibility that the experiences of the Bosnian children during the war strengthened them psychologically, especially strengthening their survival instincts. Another possibility is that they have benefited from psychological counseling that Slovene children as a rule have not had. A genetic explanation was also offered, postulating that the Bosnian children benefit from different genes.Suicide in Slovenia - a long tradition
According to World Health Organization statistics, almost 100,000 people committed suicide in 1998, making it the twelfth leading cause of death worldwide. Slovenia's annual suicide rate is about 30 per 100,000 inhabitants, giving an annual total of about 600. It is believed that as many as one third of Slovenia's suicides are connected to alcoholism. With its small population of around 2 million, this represents a huge problem.
Around the world, Latvia has the highest rate at 43 per every 100,000 inhabitants. Next in line come the other two Baltic states and Hungary. Slovenia is placed sixth in the world, just behind Japan.
Suicide rates everywhere, including Slovenia, are on the rise, especially among children. In Slovenia, the rate of attempted suicide is highest among females, while the actual suicide rate is highest among males. There is great variation around the country despite its small size. The highest suicide rate has been recorded in Šentur pri Celju, with 60 per 100,000; the lowest in Nova Gorica, with 16.5 per 100,000. Most of Slovenia's medium-sized cities share the national average, 30 per 100,000. Slovenia's two largest cities, Ljubljana and Maribor, both have rates just below the national average, 26 per 100,000.
Since these two cities are home to Slovenia's two universities and the highest number of well-educated people, according to Dr. Maruai's theory they should have the highest suicide rates in the country. But there is also the fact that these two cities are home to virtually all of the foreigners in the country, which may be a factor in lowering the two cities' suicide rates.Suicide is nothing new to Slovenia
Dr Janek Musek, one of the participants in the conference, believes that the Slovenes' own culture factors in its high suicide rates. According to Musek, whose theory is supported by various studies, neuroses and psychoses are marks of the Slovene national character and are wide-spread among the population.
In the 1960s, Slovenia led the world in suicide among young people. In the years between 1963 and 1967, hospitals just in Ljubljana treated 795 people for difficulties relating to unsuccessful suicide attempts. Among them were 29 children younger than 15. The youngest was a girl of 12. More than half were under 25.
In 1968, the suicides of six young people from Ljubljana gave rise to rumors of a suicide club in the city. The six ended their own lives in quick succession, and each was connected to the others in some fashion. All six were exemplary students and came from some of Ljubljana's most prominent families. The existence of the suicide club was never proven.An increase in attention to suicide?
Suicide in Slovenia remains shrouded in stigma and shame despite its high rate of occurrence throughout the country. At present, there is no national initiative for suicide prevention due to lack of political will. In an article in the daily newspaper Dnevnik, Dr Martina Tomori discussed a successful national suicide prevention initiative undertaken in Finland. At the initiative's start, Finland had a suicide rate comparable to that of Slovenia. The initiative worked closely with the media at building a positive self-image among school children. Over the course of the past 12 years, Finland's suicide rate has been lessened by one tenth.
Dr. Tomori believes that Slovenia has much to learn from this example. "Suicide: Interplay of Genes and Environment" was covered by all of Slovenia's major newspapers. The media attention it received is an important step forward in bringing the issue of suicide into public debate. Later this year, from 6 to 9 September, Bled will host the Eighth European Symposium on Suicide and Suicidal Behavior. With any luck, Slovenia will be able to capitalize on the momentum generated by these conferences and begin to take proactive steps towards reducing the number of lives lost each year to suicide.
Brian J Požun, 22 May 2000