Recent life events and suicide: a case-control study in Tallinn and Frankfurt

The purpose of this study was to analyze the differences in the disposition and frequency of recent life events preceding suicide in two cities with different socio-political backgrounds: Tallinn in Estonia and Frankfurt/Main in Germany. The information about 156 suicidents in Tallinn and 163 suicidents in Frankfurt was compiled using the psychological autopsy technique [Shneidman, E. S. (1981). The psychological autopsy. Suicide and Life-Threatening Behavior, 11, 325-340; Jacobs, D., & Klein-Benheim, M. (1995). The psychological autopsy: A useful tool for determining proximate causation in suicide cases. Bulletin of American Academy of Psychiatry Law, 23(2), 165-182]. General population controls were matched by age and sex. The occurrence of recent life events was similar among suicidents in Tallinn (81%) and Frankfurt (77%). However, in both sites only male suicides had higher risk of occurrence of any life event than controls (Tallinn: OR'=1.9; 95% CI=1.1-3.7; Frankfurt: OR'=2.0; 95% CI=1.0-4.1) and the mean number of life events was significantly higher among male suicidents in Tallinn in comparison with controls. This may indicate that males are more sensitive to the rapid changes in a society undergoing transition. It seems that it is not the number of life events, but rather their meaning and disposition that creates the risk of suicide. Family discord (weighted OR=4.5; 95% CI=2.5-8.1), loss of job (weighted OR=2.6; 95% CI=1.0-6.4) and financial deterioration (weighted OR=2.2; 95% CI=1.3-3.8) were more prevalent among suicides in Tallinn in comparison with those in Frankfurt. The most significant differences between suicides and controls were family discord, separation and loss of job in Tallinn and somatic illness in Frankfurt. These differences between the two societies, post-Soviet Estonia and Germany, could be explained by the different positions of Estonia and Germany on the survival/self-expression dimensions recorded by the World Value Survey. People in Estonia tend to emphasize economic and physical security above all other goals, and feel threatened by the changes taking place in society. In Germany, good health is considered a necessity for a consumer and self-expressive style of life, and poor health is perceived as a serious threat to the quality of life in a post-materialistic value system.