A Population-Level Study Concerning the Assumed Association Between Suicide Rates and Antidepressant Consumption in Hungary

BACKGROUND

It has been claimed that the advent of modern antidepressants has reduced the suicide rate.

AIMS

To examine the correlation between the suicide rate and the prescription of antidepressants.

METHOD

A dynamic regression was employed to analyze a 73-month-long, monthly time series between 2010 and 2016 in Hungary. The independent variable was the Defined Daily Dose value for the number of antidepressant (AD) prescriptions filled each month.

RESULTS

The models failed to show a significant association between the prescription of antidepressants and age- and sex-specific monthly suicide rates.

CONCLUSIONS

The prescription of antidepressants in Hungary has had no impact on suicide rates.

Inequalities in Diabetes Mortality Between Microregions in Hungary

Objectives: Regional differences in diabetes mortality are high in Hungary. In our cross-sectional study, we aim to reveal the drivers of the inequalities in diabetes mortality across the 197 microregions of Hungary. To account for the influence of changes in healthcare and social conditions, we compared two periods (2009-12 and 2013-16). Methods: Traditional and re-conceptualized deprivation- and healthcare provison measures were used in OLS regression models. Results: Microregions with a high proportion of population living in "service deserts," especially in regard to the lack of grocery stores, suffer the highest rates of diabetes mortality. Alcohol-related mortality has been proven to be a similarly and surprisingly strong predictor of diabetes mortality. Conclusion: Food provision should be supported in areas characterized by low service density, and alcohol policy should be strengthened and targeted.

[Age-specific regional characteristics of COVID-19 mortality in 2021]

INTRODUCTION

In most countries, COVID-19 mortality increases exponentially with age, but the growth rate varies considerably between countries. The different progression of mortality may reflect differences in population health, the quality of health care or coding practices.

OBJECTIVE

In this study, we investigated differences in age-specific county characteristics of COVID-19 mortality in the second year of the pandemic.

METHOD

Age-specific patterns of COVID-19 adult mortality were estimated according to county level and sex using a Gompertz function with multilevel models.

RESULTS

The Gompertz function is suitable for describing age patterns of COVID-19 adult mortality at county level. We did not find significant differences in the age progression of mortality between counties, but there were significant spatial differences in the level of mortality. The mortality level showed a relationship with socioeconomic and health care indicators with the expected sign, but with different strengths.

DISCUSSION AND CONCLUSION

The COVID-19 pandemic in 2021 resulted in a decline in life expectancy in Hungary not seen since World War II. The study highlights the importance of healthcare in addition to social vulnerability. It also points out that understanding age patterns will help to mitigate the consequences of the epidemic. Orv Hetil. 2023; 164(17): 643-650.

Öngyilkossági halálozás Magyarországon a COVID–19-pandémia idején

Bevezetés: Míg a legtöbb országban jobbára nem változtak (esetleg csökkentek) a szuicid ráták az első járványévben (azaz 2020-ban), addig hazánkban a befejezett öngyilkosságok száma szignifikánsan emelkedett. Célkitűzés: Tanulmányunkban azt vizsgáltuk, hogy a hazai szuicid rátának a pandémia kitörése utáni kedvezőtlen fordulata folytatódott-e a második járványévben is. Módszer: Prais–Winsten-regresszió segítségével megszakított idősorelemzést alkalmaztunk, kontrollálva az autoregresszív hatás mellett az idő- és a szezonális hatásokat is, hogy megbecsüljük a pandémia hatását a 2020-as és 2021-es hazai férfi-, női és a teljes népesség szuicid rátájára. Eredmények: A járvány első évében az öngyilkossági ráta szignifikáns növekedését tapasztaltuk a férfiaknál és a népesség egészénél. 2021-ben a férfi- és a teljes népességben megfigyelt esetszámok meghaladták ugyan a járvány előtti év esetszámait, ám a regressziós becslés szerint a ráta növekedése a férfiaknál nem tért el szignifikánsan a járvány előtti évek szintjétől, és csak 10%-on bizonyult szignifikánsnak a teljes populáció esetében. Megbeszélés és következtetés: Az első két járványév adatainak vizsgálata alapján megállapítható, hogy a pandémiának az öngyilkosságra gyakorolt kedvezőtlen hatása 2021-re a teljes populáción belül mérséklődött, míg a férfiaknál eltűnt. Nyitott kérdés, hogy ez a kedvező fordulat tartósnak bizonyul-e a jövőben. Orv Hetil. 2022; 163(48): 1895–1901.

[The Number of Deliberate Self-Poisoning Suicide Attempts in the First Year of the Covid-19 Epidemic in Budapest and Pest County]

INTRODUCTION

In contrast to most other countries, in Hungary, suicide rates increased significantly in the first year (March to December 2020) of the COVID-19 epidemic. Worldwide, the burden of emergency health care tended to decrease in the first period of the pandemic. The main goal of the present research was to assess how the number of suicidal deliberate self-poisoning has changed in the first two years of the pandemic compared to the trend of the previous years (before March 2020) in the capital of Hungary, Budapest, and in Pest County (population approx. 3 million).

METHODS

In our retrospective cross-sectional study, we analyzed the results of emergency psychiatric evaluations of patients admitted to the Péterfy Hospital Emergency Department and Clinical Toxicology due to self-intoxication. From the data stored in the hospital's electronic health care system, we recorded two variables: suicidal self-poisoning, that is, suicide attempt, and the gender of the patient. Interrupted time series analysis was used, which relied on negative binomial regression estimates. In addition, the leveling in the trends was examined by changepoint detection.

RESULTS

In males, suicide attempts decreased by 16.6% compared to the pre-pandemic period (p<0.001). A similar and significant decrease was observed in females and the overall population. The trend change took place in August 2020 for women and the total population, and in October for men.

CONCLUSIONS

It is suggested that people who have undergone a non-violent drug self-poisoning suicide attempt are less likely to call for help, such as an ambulance. Alternatively, fewer had attempted suicide because they did not want to be hospitalized. This hypothesis is supported by the fact that the change in the examined trend (August and October) coincides with the beginning of the second wave of the epidemic in Hungary.

Changes in suicide mortality of Hungary during the first year of the COVID-19 pandemic

Összefoglaló. Bevezetés: Az öngyilkosság fő rizikófaktorának a pszichiátriai zavarokat tekintjük. A COVID-19 többek között neuropszichiátriai kórképek kialakulásához is vezethet. Ezen túl a pandémia egyéb velejárói, mint például az izoláció vagy a munkahelyvesztés, a társadalom egészséges tagjaiban is stresszhez, végül pszichiátriai zavarokhoz vezethetnek. Célkitűzés: Vizsgálatunk célja annak a teóriának a tesztelése volt, hogy a fenti tényezők miatt együtt járt-e a járvány a hazai suicid halálozás csökkenő trendjének irányváltásával. Módszer: Vizsgálatunkban a megszakított idősorok elemzésének módszerét használtuk, a becslésekhez kvázi-Poisson-regressziót alkalmazva, hogy összehasonlítsuk a 2010 és 2020 közötti időszak havi bontású adataiból kirajzolódó trendek alapján a járvány időszakában (2020. március-december) "elvárt" öngyilkossági esetszámokat a ténylegesen bekövetkezett esetek számával. Eredmények: A COVID-19-hónapok alatt a férfiak által elkövetett öngyilkosságok száma szignifikánsan, 18%-kal nőtt, ahhoz a trendhez képest, amely a COVID-19 hiányában állt volna elő. A teljes populációban szintén szignifikáns, 16%-os emelkedést lehetett megfigyelni, míg a nők által elkövetett öngyilkosságok száma nem tért el szignifikánsan a pre-COVID-19-időszak trendje alapján elvárt értéktől. Megbeszélés és következtetés: A járvány kitörése utáni időszakban a magyar férfiak szignifikánsan gyakrabban követtek el öngyilkosságot, míg a nőknél az adatok nem tükröztek lényegi változást. A más országokban kivitelezett vizsgálatok eredményei érdekes módon inkább csökkenést vagy nem szignifikáns változást jeleztek, amikor a COVID-19-éra suicid számait az azt megelőző időszakok számaival hasonlították össze. A hazai és a nemzetközi eredmények közti eltérések magyarázata egyelőre még nem ismert, így a téma mindenképpen további vizsgálatokat igényel. Orv Hetil. 2021; 162(41): 1631-1636.

SUMMARY

INTRODUCTION

Psychiatric disorders are the main risk factors for suicide. COVID-19 may result in the appearance of neuropsychiatric syndromes. Moreover, other corollaries of the pandemic (e.g., isolation, job loss) may lead to increasing stress and, ultimately, psychiatric disorders even among the non-infected population.

OBJECTIVE

We aimed to test the theory of whether the pandemic, due to the aforementioned factors, was associated with the reversal of the declining suicide rate trend in Hungary.

METHOD

To compare the observed number of suicides during the COVID-19 months (March-December 2020) with the expected numbers, we used an interrupted time series model and, for the estimations, quasi-Poisson regression. Expected numbers were calculated based on trends derived from monthly data between 2010 and 2020.

RESULTS

During the months of the pandemic, the number of suicides among males rose significantly by 18% compared to the hypothetical trend that would have occurred in the absence of COVID-19. A significant increase (16%) was also observed in the total population. By contrast, the number of female suicides did not differ significantly from the number expected based on the pre-COVID-19 trend.

DISCUSSION AND CONCLUSION

After the outbreak of the epidemic, Hungarian males committed significantly more suicides, while no relevant changes were observed among females. Interestingly, studies from other countries found either no change or decrease when comparing suicide numbers from the COVID-19 period with the corresponding numbers from the pre-COVID-19 period. The explanation for this discrepancy is still lacking, so further investigations are needed. Orv Hetil. 2021; 162(41): 1631-1636.

[Relationship between the number of hours of sunshine and the number of (violent) suicides in Hungary]

Background and purpose

Aim - Studying the impact of the sunshine on the numbers of suicides. The number of suicides is highest in the late spring and early summer months, while it is lowest in the cold, gloomy winter. Although the exact causes are still unknown, there are some theories about this phenomenon. A number of studies conducted in recent years have concluded that the rise in suicide rate during the warm months might be due to an increased exposure to sunlight, especially in the cases of the violent method. We studied the validity of this hypothesis on a large Hungarian database.

Methods

We analyzed the number of monthly hours of sunshine and the number of suicides by sex and by violent vs. non-violent method over a 360-month period. Our sample consisted of 127 877 committed suicides between 1971 and 2000. The parabolic trend of seasonality had to be removed from the suicide time series, then regression analysis was conducted on the seasonally adjusted data.

Results

Our analysis revealed that in Hungary there was no statistically significant direct relationship between the number of hours of sunshine and the number of suicides. Moreover, there was no correlation between the hours of sunshine and the number of violent suicides either.

Conclusion

If the above claim were confirmed in subsequent research, it would mean that our current therapeutic regime should be reconsidered during the spring-summer seasons.

[Lottery and suicide - the effect of number of lottery tickets on Hungarian suicide rates]

AIM

The relationship of suicide and gambling is a neglected field in the study of suicidology. In Hungary, no statistical studies have been published to date with regard to the whole of the population. Our study investigates the relationship between a very popular high prize game, lottery, and suicide rates.

METHOD

The relationship between daily rates of suicide by gender and age and the number of winning tickets has been analysed over the periods between 1991 and 1997 and from 1997 to 2013. During the first period of time examined, the lottery draws took place on Fridays, while they were held on Saturdays in the second. Time series covariance analysis based on ARIMA modelling on detrended data was used to test the relationship of gambling and self-destruction.

RESULTS

Out of the 27 models tested, the only significant models, which are also in line with what can be expected based on the literature, could be found during the period when the draws took place on Fridays. Corresponding to the increase in the number of lottery tickets, there was also an increase in the number of suicides somewhat delayed in time. The relationship only held true for males with one exception.

CONCLUSIONS

In our study, we found a weak positive relationship between rates of suicide and the spread of the lottery game. The significance of our study is well reflected by the fact that - to the best of our knowledge - this effect has never been investigated on such a large sample before. Our results point to the significance of cultural and social factors, to differences in gender roles, and to the accentuated role of the factor of hopelessness in shaping the suicide scene in Hungary. In order to clarify the role of different factors in more detail, there seems to be a need for further studies on suicide conducted on large samples.

[Effect of residential region, and educational and marital status on suicide: census-based negative binomial regression analysis]

AIMS

Suicidal behaviour is a multicausal phenomenon, accordingly its occurence is determined, in a mutually non-exclusive manner, by several medical, sociodemographic, cultural and lifestyle factors. In the current study we investigated the effects of age, gender, marital and educational statuses and region of residence on the risk of completed suicide.

METHOD

Our raw data came from the census in 2011 and from the Demographic Register of the Hungarian Central Statistical Office. Negative binomial regression analyses were used to reveal the effects of our variables on suicide.

RESULTS

We found that the risk of completed suicide varies significantly by gender, age, educational attainment, marital status, and region of residence. Effects of sociodemographic and region of residence variables on suicidal risk were strongly influenced by gender. Suicide risk was elevated for both men and women who are living in the Great Plain and also for women who are living in the region Central Hungary and men who are living in the region Northern Hungary.

CONCLUSIONS

The thorough clarification of sociodemographic determinants of suicide is essential in the identification of endangered groups and it is the prerequisite of successful prevention as well.

The Effects of Significant International Sports Events on Hungarian Suicide Rates

BACKGROUND

Several studies found a significant relationship between important sport events and suicidal behavior.

AIMS

We set out to investigate whether there is a significant relationship between the raw suicide rate and the most important international sports events (Olympic Games, FIFA World Cup, UEFA European Championship) in such an achievement-oriented society as the Hungarian one, where these sport events receive great attention.

METHOD

We examined suicide cases occurring over 15,706 days between January 1, 1970, and December 31, 2012 (43 years), separately for each gender. Because of the age-specific characteristics of suicide, the effects of these sport events were analyzed for the middle-aged (30-59 years old) and the elderly (over 60 years old) generations as well as for gender-specific population groups. The role of international sport events was examined with the help of time-series intervention analysis after cyclical and seasonal components were removed. Intervention analysis was based on the ARIMA model.

RESULTS

Our results showed that only the Olympic Games had a significant effect in the middle-aged population. Neither in the older male nor in any of the female age groups was a relationship between suicide and Olympic Games detected.

CONCLUSION

The Olympic Games seem to decrease the rate of suicide among middle-aged men, slightly but significantly.

[Effect of the summer Olympic Games on Hungarian suicide rates]

In our study, we set out to investigate whether there is a significant relationship between the count (raw rate) of suicides committed and the summer Olympic Games in such an achievement-oriented society like the Hungarian one, where summer Olympic Games receive extremely considerable attention. For our study, we examined the suicide cases occurring over 15706 days between 1 January 1970 and 31 December 2012 (43 years), separately for each gender. Because of the age-specific characteristics of suicide, the effect of the Olympic Games was analysed for the middle-aged (30-60 year-old) and the elderly (over 60 year-old) generations, as well as for the whole gender specific population. The role of the summer Olympic Games was examined with the help of time series intervention analysis after the cyclical and seasonal components have been removed. Based on our results, the effect of the Olympic Games is significant for the middle-aged (30-60 year-old) population. Neither in the older male, nor in any of the female age groups could a relationship between suicide and this sports event be detected. In summary, the Olympic Games seem to decrease the rate of suicide among middle-aged men slightly but significantly. In the interpretation of our results we emphasise the importance of the complex approach of suicidal behavior.

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction

Between December 1996 and December 2002, we treated 79 patients with arthroscopy-assisted anterior cruciate ligament (ACL) reconstructions. In 53 patients we used autografts and in 26 patients allografts. Patients were followed up for 38 (12-72) months. The two groups did not differ in preoperative sport activity level. The postoperative Lysholm score was 89.9+/-8.1 in the autograft group and 84.1+/-18.6 in the allograft group. Comparing the patients' Lysholm score according to whether they had a low (1-5) or a high (6-10) postoperative Tegner score, we found no statistically significant difference between the groups. On one occasion, the allograft ruptured during the implantation procedure just prior to the fixation. Postoperatively, we performed three revisions-two in the allograft group and one in the autograft group-and three second-look arthroscopies. There were no bacterial infections and no cases of viral transmission. No immune rejection, resorption, or immunsynovitis occurred during the follow-up.

Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts

Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response.

[Pancreatogenic panniculitis based on 2 cases]

The rarest and hardly known complication of pancreas diseases is the subcutaneous nodular fat necrosis, a special type of panniculitides. It is mostly associated with pancreatitis and adenocarcinoma of pancreas. Its diagnostic criteria are (1) red painless or occasionally painful nodules showing a tendency of coalescence, emolition and fistulation on the lower extremities and later anywhere on the body, (2) alcoholic case-history, (3) tense, painful joints, (4) elevated pancreatic enzyme levels in the blood and urine. Since the underlying pancreas diseases may be asymptomatic, the pancreatogen panniculitis should be considered as a noteworthy marker of them. The histologic findings are pathognomic. In pancreatogen panniculitis in all likelihood the remote foci of adiponecrosis are due to the local action of pancreatic lipolytic enzymes carried by the blood. The question has not been settled yet. In this article there are presented two cases of pancreatogen panniculitis, recognized by the consultant dermatologist. Referral diagnoses of both cases were misleading: "erythema nodosum" in the first case and "drug eruption" in the second one. The determinant underlying pancreas disease in both cases was pancreatitis with pseudocyst resulted from alcoholic toxicomany.

[The scapula: rare localization of osteochondroma]

The authors demonstrate their 6 cases of scapular exostoses which were operated on between 1973 and 1993 at the Orthopaedic Department of the Medical University of Pécs. Results of the surgery with a mean five year follow up are discussed, and the literature data of incidence, diagnosis and treatment are reviewed. With resection of the osteochondroma good results were achieved in all of the cases.