Estonia's suicide mortality rate is 1.5 greater than the European Union average. University researchers emphasized that schools, the healthcare system as well as the entire population have a significant part to play in suicide prevention. Special attention must also be paid to the loved ones who have to cope with the death by suicide.

Of the 2,543 people who died by suicide from 2006-2016, 80 percent were men and 4 percent young people below the age of 20. Both in men and women, the likelihood of death by suicide increased with age. The average age of men to die by suicide was 49; the average age of women was 60.

Liis Rooväli, assistant in healthcare management at the University of Tartu's Institute of Family Medicine and Public Health, said that knowing the profile of people who have died by suicide is helpful in identifying risk groups and planning preventive activities.

"Most of the men who died by suicide were Estonians, those living alone, unemployed, and those who had been in prison or exposed to a crime during the past year," Rooväli said. "Non-Estonians, single people and people who were unemployed accounted for most of the women who died by suicide."

She added that among the men and women who died by suicide were people with mental health problems, hearing and vision problems as well as chronic pain, and had also visited a doctor or gone to the emergency room during the last year.

Altogether 37 people with loved ones who had died by suicide were interviewed in the framework of the study.

"It's difficult for loved ones to cope with suicide," Rooväli acknowledged. "It takes time to adjust. Many don't have a support network to rely on. Some have been offered professional help, but most don't know where to get help or have no money to do so."

Those grieving mostly miss meeting people with similar backgrounds, she added.

Improve access, increase awareness

Based on the results of the study, researchers drew up suggestions for how to reduce the risk of suicide at the school, healthcare system and population level.
"Psychsocial stress and few social contacts serve as a direct risk factor for suicide," Rooväli highlighted. "People around [those at risk] could help improve the situation if it were noticed."

Risk factors for suicide include negative childhood experiences such as bullying at school, domestic violence, and bereavement. The study found that young people who died by suicide had problems with other students or teachers at school or came from split-up families.

The study found that more attention should be paid to ensuring that educators, other professionals who come into contact with children as well as parents are able to spot and help children and adolescents with problems as well as intervene, if necessary.

According to the researchers, it is important to educate the entire population and inform them about how to spot and help those in need. Information should also be provided about facilities providing assistance available in Estonia, especially crisis response services available by phone and online.

Losing a loved one as a result of suicide is emotionally difficult and, in combination with constant emotional stress, is another risk factor for suicide. It is necessary to train staff exposed to suicide in their line of work as well as to establish a support system for the loved ones of people who died by suicide that would help prevent future deaths.

Access to care and treatment systems for patients with mental health problems, including the integration of services and the treatment of the individual as a whole, also need to be enhanced and developed. It is also important to ensure access to treatment for people with substance abuse problems.

It is likewise necessary to raise awareness in authorities facing these types of problems as well as to create opportunities for them to refer people with such problems to treatment.

Necessary help for people with chronic illnesses should be made more accessible and consistent, and more attention should be paid to suicide risk assessment, the researchers found. Greater emphasis needs to be placed on the training of healthcare professionals in recognizing suicide risk factors and in providing support techniques, and a system for the detection and professional assistance of a patient with suicidal thoughts or ideation needs to be developed and implemented as well.

The study was commissioned by the Ministry of Social Affairs and funded by the Estonian Research Council and the Ministry of Social Affairs, and carried out by the Institute of Family Medicine and Public Health of hte Faculty of Medicine and the Centre for Applied Social Sciences (CASS) at the University of Tartu.

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