The East–West Gradient of Suicide in Europe: Epidemiology, Determinants and Public Health Implications
Article Sidebar
Main Article Content
Abstract
Background: Marked regional differences in suicide mortality have long been observed across Europe. One of the most consistent epidemiological patterns is the East–West gradient, characterized by substantially higher suicide rates in Eastern Europe compared with Western and Southern Europe.
Aim: The aim of this review is to examine the epidemiology of the East–West suicide gradient in Europe and to critically evaluate the major explanatory frameworks proposed in the literature, with particular emphasis on alcohol-related factors, socioeconomic transition, cultural determinants, and public health policy.
Results: Eastern European countries consistently demonstrate higher suicide mortality, particularly among working-age men. Hazardous alcohol consumption, especially binge drinking and spirits use, emerges as one of the strongest correlates of suicide mortality. Additional determinants include economic instability, unemployment, social fragmentation, political transition, and limited access to mental healthcare.
Conclusions: The East–West suicide gradient reflects a complex interaction between alcohol use, socioeconomic conditions, cultural norms, and healthcare access. Effective suicide prevention in Eastern Europe requires integrated strategies addressing both mental health and alcohol-related harm.
Downloads
Article Details
Copyright (c) 2026 Razvodovsky YE.
This work is licensed under a Creative Commons Attribution 4.0 International License.
GBD 2021 Suicide Collaborators. Global, regional, and national burden of suicide, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health. 2025;10:e189-e202. Available from: https://doi.org/10.1016/s2468-2667(25)00006-4
Ping Qin, Nordentoft M. Suicide risk in relation to socioeconomic, demographic, psychiatric and familial factors. Br J Psychiatry. 2005;186:494-498.
World Health Organization. LIVE LIFE: an implementation guide for suicide prevention in countries. Geneva: WHO; 2021. ISBN: 9789240026629. Available from: https://www.who.int/publications/b/56794
Massimo Zuin, Diego De Leo. Suicide-related mortality trends in Europe, 2012-2021. Int J Environ Res Public Health. 2025;22:890. Available from: https://doi.org/10.3390/ijerph22060890
World Health Organization. Suicide worldwide in 2019: global health estimates. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240110069
Elizabeth Brainerd. Economic reform and mortality in the former Soviet Union: a study of the suicide epidemic in the 1990s. Eur Econ Rev. 2001;45(4-6):1007-1019. Available from: https://ideas.repec.org/a/eee/eecrev/v45y2001i4-6p1007-1019.html
William C. Cockerham. Health and social change in Russia and Eastern Europe. New York: Routledge; 1999. Available from: https://www.routledge.com/Health-and-Social-Change-in-Russia-and-Eastern-Europe/Cockerham/p/book/9780415920810
Kairi Kõlves, Allison Milner, Peeter Värnik. Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union. Sociol Health Illn. 2013;35(6):956-970. Available from: https://doi.org/10.1111/1467-9566.12011
Danuta Wasserman, editor. Suicide: An Unnecessary Death. London: Martin Dunitz; 2001. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1120728/
Ilkka Henrik Mäkinen. Eastern European transition and suicide mortality. Soc Sci Med. 2000;51(9):1405-1420. Available from: https://doi.org/10.1016/s0277-9536(00)00105-2
Motunrayo Oyesanya, Lopez-Morinigo J, Dutta R. Systematic review of suicide in economic recession. World J Psychiatry. 2015;5(2):243-254. Available from: https://doi.org/10.5498/wjp.v5.i2.243
David Lester. Suicide and unemployment in Eastern Europe. Psychol Rep. 1998;82(3):1000-1002. Available from: https://doi.org/10.2466/pr0.1994.75.1.602
Jonas Landberg. Alcohol and suicide in Eastern Europe. Drug Alcohol Rev. 2008;27(4):361-373. Available from: https://doi.org/10.1080/09595230802093778
Alexander V. Nemtsov. Suicides and alcohol consumption in Russia, 1965-1999. Drug Alcohol Depend. 2003;71(2):161-168. Available from: https://doi.org/10.1016/s0376-8716(03)00094-2
Yury E. Razvodovsky, Siarhei V. Kandrychyn. Alcohol as a potential predictor of East-West gradient in the suicide rates in Europe. Clin Med Microbiol. 2025;1(1):1-3. Available from: https://asrjs.com/pdfs/alcohol-as-a-potential-predictor-of-eastwest-gradient-in-the-suicide-rates-in-europe-267.pdf
Yury E. Razvodovsky, Siarhei V. Kandrychyn. Regional specificity of the relationship between alcohol and suicide in Europe. J Anxiety Depress. 2025;8(1):173. Available from: https://yumedtext.com/article/regional-specificity-of-the-relationship-between-alcohol-and-suicide-in-europe
Ingeborg Rossow. Alcohol and suicide: beyond the link at the individual level. Addiction. 1996;91(10):1413-1416. Available from: https://doi.org/10.1111/j.1360-0443.1996.tb02240.x
Leo Sher. Alcohol consumption and suicide. QJM. 2006;99(1):57-61. Available from: https://doi.org/10.1093/qjmed/hci146
Yury E. Razvodovsky. Alcohol consumption and suicide rates in Russia. Suicidology Online. 2013;4:124-132.
William A. Pridemore, Chamlin MB. A time-series analysis of the impact of heavy drinking on homicide and suicide mortality in Russia. Addiction. 2006;101(12):1719-1729. Available from: https://doi.org/10.1111/j.1360-0443.2006.01631.x
William A. Pridemore. Heavy drinking and suicide in Russia. Soc Forces. 2006;85:413-430. Available from: https://doi.org/10.1353/sof.2006.0138
Mats Ramstedt. Alcohol and suicide in 14 European countries. Addiction. 2001;96:59-75. Available from: https://doi.org/10.1080/09652140020021189
Yury E. Razvodovsky. Alcohol consumption and suicide rate in Belarus. Psychiatr Danub. 2006;18(Suppl 1):64.
Yury E. Razvodovsky. Beverage-specific alcohol sales and suicide rates in Russia. J Environ Public Health. 2011;2011:253409.
Yury E. Razvodovsky. The effect of beverage type on suicide rate in Russia. J Addict Res Ther. 2014;5:181. Available from: https://pubmed.ncbi.nlm.nih.gov/22075739/
Airi Värnik, Wasserman D, Dankowicz M, Eklund G. Age-specific suicide rates in the Slavic and Baltic regions of the former USSR during perestroika, in comparison with 22 European countries. Acta Psychiatr Scand. 1998;34:20-25. Available from: https://doi.org/10.1111/j.1600-0447.1998.tb10761.x
Alexander V. Nemtsov, Yury E. Razvodovsky. Alcohol situation in Russia and Belarus. J Addict Res Ther. 2016;7:281.
Alexander Stickley, Leinsalu M, Andreev E, Razvodovsky YE, Vågerö D, McKee M. Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970-2002. Eur J Public Health. 2007;17(5):444-449. Available from: https://doi.org/10.1093/eurpub/ckl275
Émile Durkheim. Suicide: A Study in Sociology. New York: Free Press; 1951.
J. John Mann, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064-2074. Available from: https://doi.org/10.1001/jama.294.16.2064
Siarhei V. Kandrychyn, Yury E. Razvodovsky. The spatial regularities of violent mortality in European Russia and Belarus: ethnic and historical perspective. J Psychiatry. 2015;18:305.
Naghavi M. Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016. BMJ. 2019;364:l94. Available from: https://doi.org/10.1016/s2468-2667(25)00006-4