Research report Associations between marital and educational status and risk of completed suicide in Hungary Lajos Bálint a,n , Péter Osváth b , Zoltán Rihmer c,d , Péter Döme c,d a Demographic Research Institute of the Hungarian Central Statistical Office, Buday László u. 1-3, 1204 Budapest, Hungary b Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Pécs, Rét u. 2, 7623 Pécs, Hungary c Department of Clinical and Theoretical Mental Health, Semmelweis University, Faculty of Medicine, Kútvölgyi út 4, 1125 Budapest, Hungary d National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Lehel u. 59,1135 Budapest, Hungary article info Article history: Received 24 June 2015 Received in revised form 13 October 2015 Accepted 9 November 2015 Available online 12 November 2015 Keywords: Suicide Marital status Marriage Educational level Gender differences abstract Background: Suicide rates in Hungary are notoriously high. According to the literature, marital and educational status are associated with suicidal behaviour and these associations are somewhat influ- enced by gender. Since in Hungary these associations have not yet been investigated by means of large- scale multivariate epidemiological studies we aimed to investigate these in the current paper. Method: Census data on marital and educational status, age and gender from 1980,1990, 2001 and 2011 were used for the general population. Corresponding data from the same years for suicide victims de- rived from the Hungarian Demographic Register. Suicide victims younger than 20 years were excluded. Negative binomial regression analyses were used to reveal the effects of the above variables on suicide. All statistical procedures were conducted using Stata 12 software (StataCorp. 2011). Results: Female gender, young age, higher educational attainment and marriage were significantly as- sociated with decreased risks of suicide. Intriguingly, effects of educational and marital status on suicide were stronger in males. Limitations: Data on the length of the periods between changes in marital status and suicides were unavailable. Our four categories are not suitable to cover the whole gamut of marital statuses in a modern society (e.g. we did not have a specific category for people living in cohabitation). Ecological study design. Conclusion: We found that in Hungary between 1980 and 2011 the effects of some frequently in- vestigated societal factors (e.g. educational and marital status) on suicide risk were very similar to those found in the majority of other countries. The effects of studied determinants of suicide have not changed dramatically over the past three decades in Hungary. & 2015 Published by Elsevier B.V. 1. Introduction Currently – despite its almost monotonic and approximately 50% decrease from the mid-1980s – Hungary has the second highest suicide rate (after Lithuania) in the EU27 group of coun- tries and the Hungarian suicide rate ranked in the global top 10 (WHO; Värnik, 2012; Rihmer et al., 2013). Furthermore, Hungary has had the world’s highest suicide rate averaged over the last 100 years (Szanto et al., 2007). It is well known that suicide is a multicausal event, so the probability of its occurrence is determined by several factors (Balint et al., 2014). According to the literature, marital status is one such factor. Enrico Morselli (1882), one of the most influential authors before Émile Durkheim, was the first who convincingly argued that proportionally fewer married than unmarried men commit suicide in Italy and France, but he found the opposite for women. He also demonstrated that widowhood (compared to married or unmarried status) was associated with the highest risk of suicide in both genders. In addition, he found that divorce is a potent suicide risk factor in both genders. Durkheim found that unmarried and widowed status are associated with a higher sui- cide risk than married status among those aged over 20. Further- more, he demonstrated that widowed subjects generally are less likely to commit suicide than unmarried persons (Durkheim, 2005). However, based on his datasets, Durkheim was not able to determine clearly whether the above associations were stronger in males or in females (Durkheim, 2005). The majority of more recent investigations on this question have found – irrespective of data type (i.e. individual or aggregated) used – that widowed, divorced and, less obviously, unmarried statuses are associated with higher Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.11.011 0165-0327/& 2015 Published by Elsevier B.V. n Corresponding author. E-mail address: balint@demografia.hu (L. Bálint). Journal of Affective Disorders 190 (2016) 777–783