ORIGINAL ARTICLES
FEATURES OF SUICIDAL DEATHS IN HARGHITA COUNTY BETWEEN 2000-2009 Albert Veress 1, Attila Dorgó 2, Réka Veress 3 Abstract: Purpose: suicide and alcoholism, among others, cause serious problems and difficulties in supplies, prevention and therapy for the health care in our county. This paper analyses the evolution of the suicide phenomenon of a sample of 350.000 people over a period of ten years, stressing upon several specific aspects on the problem. We put forward the necessity of organizing some structural formulas for the prevention and intervention in the crisis. Methods: I performed a statistical survey who committed suicidal acts. Data have been processed in Excel. Results: from a death rate of 23.41 o/oooo in 1991 it increased to 47.18 o/oooo in 1998. Then it decreased to 29,43 o/oooo in 2000. Increased in 2001 to 35,87, then decreased till 2009 to 24,52 o/oooo,. The occurrence of the phenomenon in different categories - socio-professional, religion, nationality, gender, habitance and associated diseases show values matching actual national and international rates. Conclusions: The decrease of the suicidal phenomenon can be obtained by early notice and correct treatment of affective disorders, by organizing services for prevention and intervening in case of crises. We cannot give a plausible explanation for the oscillating figures recorded in the 1991-2009 period, nor can we understand the almost equal figures in 1991 and 2009. Key words: suicide in Hargita County; suicide in Transylvania; suicide in Romania.
Rezumat: Scopul: suicidul ºi alcoolismul, printre altele, provoacã probleme ºi dificultãþi considerabile în aprovizionare, prevenire ºi terapie pentru sistemul de îngrijire a sãnãtãþii din judeþul nostru. Aceastã lucrare analizeazã evoluþia fenomenului de sinucidere pe un eºantion de 350.000 de persoane pe o perioadã de zece ani, cu accent pe mai multe aspecte specifice cu privire la aceastã problemã. Am invocat necesitatea de organizare a unor formule structurale pentru prevenirea ºi intervenþia în crizã. Metode: Am efectuat un studiu statistic a persoanelor care au comis acte de sinucidere. Datele au fost prelucrate în Excel. Rezultate: rata de deces de 23.41 o/oooo în 1991 a crescut la 47.18 o/oooo în 1998. Apoi a scãzut la 29,43 o/oooo în 2000. A crescut din nou în 2001 la 35,87, apoi a scãzut în 2009 la 24,52 o/oooo. Apariþia fenomenului în diferite categorii – social-profesional, religios, naþionalitate, sex, habitat cât ºi boli asociate – aratã valori conforme cu ratele naþionale ºi internaþionale actuale. Concluzii: Scãderea fenomenului suicidal poate fi obþinutã prin descoperirea prematurã ºi tratarea corectã a tulburãrilor afective, prin organizarea de servicii de prevenire ºi intervenþie în caz de crizã. Nu putem da o explicaþie plauzibilã pentru cifrele oscilante înregistrate în perioada 1991-2009, nici nu putem înþelege cifrele aproape egale din 1991 ºi 2009. Cuvinte cheie: suicid în judeþul Harghita, suicid în Transilvania, suicid în România.
Motto: “He who saves a life has not lived in vain!” (A. Veress).
Between 1991-1999 we analysed the suicidal phenomenon in its entirety, (attempts and deaths). In the following period, 2000-2009, we restricted our research to recording only fatal attempts, data being obtained retroactively from records in Legal Medicine Laboratories, and also from death certificates.
Our first research began just a few months after the events in December 1989, as information about suicide was not any longer rated top national secret. Cases of fatal suicide events are being recorded with great accuracy in medico-legal laboratories with no margin of error. Certainly, in this epidemiological research we did not only evaluate the size of the phenomenon. We also attempted to create a network for prevention and crisis intervention in the district center, and further on, across the whole district, all based on the information now available. The research has been carried out in Hargita district using questionnaires, which were filled in by GP,s, doctors of legal medicine or other medical personnel trained to do that. Demographical data of reference were taken from the population census carried out in January 1992, which does not include migration throughout the years.
COMPARING RESULTS For decades, Hargita district has been ranked as one of the top four on the national list of suicidal deaths: ranked 4th in 1990, with 18.82 o/oooo deceased. Ranked 2nd in 1991 with 23.41 o/oooo. Ranked 1st between the year 1992 and 1998 with a rate between 26.65 and 47.18 o/oooo. Then it decreased to 29.43o/oooo in 2000. Increased in 2001 to 35,87 then decreased till 2009 to 24,52 o/oooo, Considering the constant decrease of the natural birth rate in Romania, which came to a negative value in 1992, the high suicidal rate prompts us to take measures for prevention and crisis intervention in order to stop and reverse the tendency of
1 Sc. D.,M.D.,senior psychiatrist at Department Psychiatry of County Hospital, Miercurea-Ciuc, 530.111-Miercurea Ciuc, str. Gabor Aron 10, Romania,
[email protected] 2 M.D., psychiatrist, Miercurea-Ciuc, Romania. Received August 14, 2010, Revised November 09, 2010, Accepted November 30, 2010 3 M.D., psychiatrist at Department Psychiatry of County Hospital, Miercurea-Ciuc, Romania.
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Albert Veress, Attila Dorgó, Réka Veress: Features Of Suicidal Deaths In Harghita County Between 2000-2009
the suicidal evolution, thus promoting the natural increase of the population (see it in table 1). 19 34 1 4 ,8
19 64 7 ,1
196 7 1 8 ,1
196 9 1 3 ,2
198 9 5 ,3
1 991 1 ,0
1 992 - 0 ,2
19 93
199 4
1 995
199 6
1 99 7
1 998
….
-1 ,3 2
-0 ,7 0
- 1 ,4 0
-1 ,1 5
- 0 ,8 4
-0 ,4 5
….
O
Table. 1. Natural Birth Rate In Romania ( /OO) The steep increase in natality will show a tendency of constant decrease after the abortions were interdicted by the ex-dictator Ceao in 1967, and would decrease from 1992 on. This value has not ever since come above zero (see it in chart 1 and figue 1).
Figure 1. Number Of Suicides Per 100.000 Romania 2003-2009
HR population 360779 349050 348488 347145 345860 344898 343639 342939
Year 1991 1992 1993 1994 1995 1996 1997 1998
HR population 342609 326222 326222 326222 326222 326222 326222 326222 326222 326222 326222
Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Total deaths 82 93 136 131 132 158 165 118 Total deaths 136 96 116 117 108 99 112 107 105 87 80
Table. 2. Number Of Suicides Per 100.000 Harghita County 1991-2009 68
Chart 1. Total suiciders 0 / 000 Romania 2003 – 2004
Year of Suicide 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Male 77 100 101 91 86 97 88 86 74 73
Female 19 16 16 17 13 15 19 19 13 7
Total 96 116 117 108 99 112 107 105 87 80
Male 0 /0000 23,60 30,65 30,96 27,90 26,36 29,73 26,98 26,36 22,68 22,38
Female 0 /0000 5,82 4,90 4,90 5,21 3,99 4,60 5,82 5,82 3,99 2,15
Total 0 /0000 29,43 35,56 35,87 33,11 30,35 34,33 32,80 32,19 26,67 24,52
Table 3. Distribution Of Deaths By Years And Gender (2000-2009)
Romanian Journal of Psychiatry, vol. XIII, No.2, 2011
T o ta l n u m b e rs o f s u ic id e 1 9 9 1 -2 0 0 9 H R C o u n t y
80
2 00 9
87 1 05
2 00 7
10 7 1 12
2 00 5
99 10 8 11 7 116
2 00 3 2 00 1
96 13 6
1 99 9
118 1 65
1 99 7
1 58 132 1 31 1 36
1 99 5 1 99 3
93 82
1 99 1 0
20
40
60
80
1 00
1 20
140
160
180
Chart 2. Number Of Suicides Per 100.000 Harghita County 1991-2009
D is t r ib u t io n o f d e a t h s b y y e a r s a n d g e n d e r ( 2 0 0 0 - 2 0 0 9 )
4 0 ,0 0 3 5 ,0 0 3 0 ,0 0 2 5 ,0 0 0
/
0 0 0 0
2 0 ,0 0
M a le F e m a le
1 5 ,0 0
T o ta l
1 0 ,0 0 5 ,0 0 0 ,0 0 2 0 0 0
2 0 0 1
2 0 0 2
2 0 0 3
2 0 0 4
2 0 0 5
2 0 0 6
2 0 0 7
2 0 0 8
2 0 0 9
Y e a r
Chart 3. Distribution Of Deaths By Years And Gender (2000-2009) N r. o f s u i c i d e s b y m o u n t h o f d e a t h 2 0 0 0 - 2 0 0 9 H R C o u n t y 109
88 58
65
72
78
80
82
93
96
104 85
53
60
46
55
66
80
T o ta l
67
78
10 0
89
91
103
12 0
F e m la e 106
M a le
14
r be
er
em ec D
ct O
em pt Se
A
ob
be
t us ug
ly Ju
ne Ju
ay M
il pr A
ch ar M
ua br Fe
Ja
nu
ar
y
0
ry
r
10
17
13
13
19
17
12
7
20
11
11
40
Chart 4. Number of suicides by months of death in harghita county, 2000-2009 69
Albert Veress, Attila Dorgó, Réka Veress: Features Of Suicidal Deaths In Harghita County Between 2000-2009
T h e n u m b e r o f s u ic ide s by d a y o f d e a th 2 0 0 0 -2 0 0 9 H R C o u n ty
22
18
da n
rid
u
a S
T
y
y a
ay
y a d hu
rs
es n d
M a le F e m ale T o ta l
W
e
30
26
18
y da
ay sd ue T
13 6
1 21
117
11 6
18
22
y a d
on M
1 39
rd
128 1 10
15 8
147
14 2
S
1 50 13 2
tu
16 3 141
F
18 0 16 0 14 0 12 0 10 0 80 60 40 20 0
Chart 5. Number of suicides by day of death in harghita county, 2000-2009 The number of males who die, is in average 5,66 times greater than that of the females, because men generally choose more effective methods. As compared with our data, this value was 4,1 in 1997, in the USA (1). Gender
Number of persons
Male Female
873 154
Total
1.027
Female 15%
Male Female
Male 85%
Table 4. Distribution of deaths by gender (2000-2009) Chart 6. Distribution of deaths by gender (2000-2009) 8 73 9 00 8 00 7 00
57 1
6 00 5 00
M a le F e m a le
3 02
4 00 3 00
1 54
117
2 00 37
1 00 0 U rb a n
R u ra l
T o ta l
Chart 7. Distribution of deaths by residential area and gender D e a th r a t e b y m a r ita l s ta tu s a n d g e n d e r M a le
0
/0 0 0 0
F e m a le
0 ,7 1 1 ,8 4
w id o w
2 ,6 4 1 5 ,4 8
m a rrie d
0 ,4 0 d ivo rc e d
0 ,0 9 1 ,2 9
u n m a rrie d 0 ,0 0
9 ,0 4 5 ,0 0
Chart 8. Distribution of deaths by marital status and gender 70
1 0 ,0 0
1 5 ,0 0
2 0 ,0 0
Romanian Journal of Psychiatry, vol. XIII, No.2, 2011
Male / female
divorced
widows/widowers
married
unmarried
1.55
8.08
57.54
32.81
Table 5. Male-female ratio of deaths by marital status M a l e -f e m a le r a tio o f d e a t h s b y m a r i ta l s ta tu s ( % )
5 7 .5 4 60 50
3 2 .8 1
40 30 20
8.08 1.55
10 0
d i vo r c e d
w i d o w s /w i d o w e rs
m a rr i e d
u n m a rri e d
Chart 9. Male-female ratio of deaths by marital status We come to three separate conclusions: -The rate is higher for men than for women. (after data evaluation over a period of 9 years we concluded that 85% of deaths occur among men, and only 15 % among women);
-The most exposed are the married and unmarried (Highest values for the married) -The most protected are the divorced and the widowed. (Highest values for the widowed.)
A ge
0- 10
11 -20
21 -30
3 1-4 0
4 1-50
5 1-6 0
61- 70
71-8 0
8 1-9 0
9 1-10 0
M ale Fe m ale
0.3 1
11 .6 5 2.45
30 .96 1.5 3
3 7.70 3 .99
5 2.72 6 .7 4
6 1.31 1 1.34
35.5 6 8.89
27.90 7.66
9 .20 4 .29
0 .3 1 0 .3 1
Table 6. The evolution of the death rate by age groups and sexes 2000-2009
THE EVOLUTION OF THE DEATH RATE BY AGE GROUPS AND SEXES 2000-2009 70,00 60,00
0
/0000
50,00 40,00 30,00 20,00 10,00 0,00 0-10
11-20
21-30
31-40
41-50 Male
51-60
61-70
71-80
81-90
91-100
Female
Chart 10. The evolution of the death rate by age groups and sexes 2000-2009
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Albert Veress, Attila Dorgó, Réka Veress: Features Of Suicidal Deaths In Harghita County Between 2000-2009
T HE E V O LUT IO N O F T HE D E AT H RAT E B Y AG E GR OUP S AN D S E X E S 20 00 -2 00 9 F em ale
T otal
37
200
25 0
116
145
20 0
116 29
136
15 0
91 25
13
101 5 106
123
172 22
194
237
M ale
1 1 2
30 14 44
1
1
38 8 46
10 0 50 0 0-1 0
1 1-2 0
21 -30
31 -40
4 1-5 0
51 -60
61 -70
7 1-8 0
8 1-9 0
9 1-1 00
Chart 11. The evolution of the death rate by age groups and sexes 2000-2009 problems accumulated over the years a lot harder (2). The death rate among Roman Catholics is high as related to the Reformed, Unitarian and Orthodox. I have no explanation for that.
Both among women and men we noticed a lot higher rate of deaths between the age of 40 and 60, and a great increase over the eighties. (80's). It seems that in this range people can solve their vital
T h e n u m b e r o f s u ic id e s b y r e lig io n
0
/0 0 0 0 H R C o u n ty
2 .57 4 0.0 6 1
4 .4 44
R o m a n C ath olic O rt h o d o x R e fo r m e d U n it a r i a n 1 .83 9
O t h e rs 22 .5 61
Chart 12. Distribution of deaths by confessional groups M e th o d s o f s u ic i d e s 2 0 0 0 -2 00 9 H R C o u n ty
s t a b b in g
ju m p in g fr om h ig h t
i n to x ic a t i o n 2%
1%
2%
j u m p i n g in t o w a t e r/ dr o w n in g 2%
tr a in sh ot gun
1%
0% e le c t ro c u t io n 0%
h a n g in g 9 2% h a n g in g
e l e c tr o c u ti on
sh ot gun
s t a b b in g
ju m p in g fro m h e ig h t
in to x i c a tio n
ju m p in g in to w a t e r/d r o w n in g
Chart 13. Distribution of deaths by suicidal methods in Harghita county and Romania 72
Romanian Journal of Psychiatry, vol. XIII, No.2, 2011
0
/ 0 M e t h o d o f s u i c i d e 2 0 0 9 R O M A N IA
i n to x i c a ti o n 6 .2 % ju m p i n g f ro m h i g h t 6 .2 %
ju m p i n g i n to w a te r /d r o w n i n g 4 .1 % o th e r m e th o d s 2 .4 %
b u r n e d h i m s e lf 0 .9 % s h u t g u n 0 .6 % e l e c tro c u t i o n 0 .3 %
h a n g i n g 7 6 .5 %
ha ng in g
e l e c t ro c u t i o n
s h ut g u n
b u rn e d h i m s e lf ju m p i n g i n to w a te r/d ro w n i n g
ju m p i n g fr o m h i g h t o t h e r m e th o d s
i n t o x i c a ti o n
Chart 14. Distribution of deaths by suicidal methods in Harghita county and Romania
The num ber of suicides by na tionality
0.398
0
/0000 H R C ounty
2.023
R om anian Hungarian O thers
29.059
Chart 15. Distribution of deaths by ethnic groups From the point of view of prevention and crisis intervention, it is mostly concerning that the majority has chosen the harsh but effective methods of hanging. If it goes on like that, we will not be able to intervene more efficiently in salvaging those who commit suicide. By accepting the official statistical data of 93% (29,059 o/oooo) Hungarians, 6% (2,023o/oooo) Romanians and 1% (0,398 o/oooo) others, the chart reveals the correlation: evidently and undoubtedly, the Hungarian ethnic group have a lot higher death rate than that of the Romanian population. The Hungarians resort to suicide 14,36 times more frequently as a means to overcome difficulties. The most endangered ones are Hungarian males; the least exposed are Romanian females. The high rate of the suicidal occurrence is mostly caused by the contribution of the Hungarian population. Amongst the Romanian population the death rate is essentially lower. Certainly, several speculations could be iterated by
revealing the correlation between the main causes of the phenomenon and the status of the Hungarian ethnic minority within the country. I would not make such an attempt myself, as I know the situation in Hungary, a country which is – similarly to our district - on top of the international suicidal list. And all this stands not only for the period after the Trianon Treaty. The statistics in 1898, when Hungary was part of the Austro-Hungarian Empire, it was still rated top on the suicidal list in Europe (3,4).
Studies
Number of persons
primary school
572
high education
13
illiterate
16
high school
426
Table 8. Distribution of deaths by educational level and sexes 73
Albert Veress, Attila Dorgó, Réka Veress: Features Of Suicidal Deaths In Harghita County Between 2000-2009
0
/0 of suicidesby studies2000-2009 HRCounty
highschool 41% primaryschool higheducation illiterate primary school 56% illiterate 2%
highschool
high education 1%
Chart 16. Distribution of deaths by educational level and sexes I find it interesting that people with only primary school education commit suicide more often than those with more years at school, or high education. Occupation Employed Retired Pupils, students Unemployed grant Dependent Others
Number of persons 472 279 30 235 9 2
Table 9. Average of deaths by groups of jobs 0/
0 by Occupation 2000-2009 HR County
1% Employed
0% 23%
Retired Pupils, students Unemployed grant
3%
Dependent Others 27%
46%
Chart 17. Average of deaths by groups of jobs CONCLUSIONS 1. Although the suicidal death-rate varried significantly between 1991 – 2009, with almost the same turn-out in 2009 and 1991, Hargita County has always been placed 1st to 3rd on the suicidal death-rate scale, and the average values in the years 2003-2009 were 225 % greater than the national average. 2. After the peak values recorded in 2001, 2002 and 2005, the death rate has been continuously diminishing ever since. 3. Most affected were May, June and July, Mondays and Sundays. 4. The number of males, who die, is in average 5.66 times greater than that of the females, because men generally choose more effective methods. As compared with our data, this value was 4.1 in 1997, in the USA (1). 5. The death rate among males is higher than among females, both in urban and rural areas. 74
6. Death-rate in rural areas is 2.02 times higher 7. The rate is higher for men than for women. (after data evaluation over a period of 9 years we concluded that 85% of deaths occur among men, and only 15 % among women); 8. The most exposed are the married and unmarried (Highest values for the married) 9. The most protected are the divorced and the widowed. (Highest values for the widowed.) 10. The age-frame mostly affected is between 51-60 11. The death rate among Roman Catholics is high as related to the Reformed, Unitarian and Orthodox. 12. The majority has chosen the harsh but effective methods of hanging. 92% in HR compared with 76.5% in Romania 13. Evidently and undoubtedly, the Hungarian ethnic group have a lot higher death rate than that of the Romanian population. The Hungarians resort to suicide 14.36 times more frequently as a means to overcome difficulties. 14. The most vulnerable ones are Hungarian males; the least exposed are Romanian females. 15. People with only primary school education commit suicide more often than those with more years at school, or high education. 16. The most vulnerable were the employers, the retired and the unemployed. The most protected were the pupils and students. In spite of the fact that we expected a very high rate among the unemployed, this did not prove to be true in our research. Why's!!! Why do some people resort to suicide? We cannot give a certain answer to this question. There are a lot of ways to address the problem. Is suicide a disease in a conservative meaning, or is it a disorder in adaptation, communication or learning? In a way, suicide is an active and free action, on the other hand it is a manifestation of certain psychic trauma. Both views are to be considered. Every suicidal attempt is an alarm signal, the sign of a faulty development of the character. The prevention problem should be seriously dealt with. The person should be cautiously taken care of. The victim does not want to die at all, but seeks solution to his unbearable situation. In examining the phenomenon, in revealing the causes of a life abandoning attitude, DURKHEIM (5) brought in view also the biological, psychological and social approach, and besides, he considered the mechanisms of learning depending on culture, and the way the victim followed different suicidal models. Mainstream psychiatry, however, considered suicide to be an illness related to a psychic or psychopathic character development, or a “momentary disturbance of the mind”. Mainstream psychiatrists interpreted suicide not as the end product of a definite inner development, but as an expression of an anxious, desolated mind, with no perspectives. An essential feature - they thought - was the fact that the victim had a drive towards brutality and towards extending this brutality (for example murder in the family prior to suicidal act), and to consequently re-try suicide. This inclination - they supposed - was strong. The stronger it was, the more severe was his abnormal state of mind.
Romanian Journal of Psychiatry, vol. XIII, No.2, 2011 According to the psychoanalytical trends of the early 20th century, suicide was the last in a row of several stages, like difficulties in self-evaluation, self-torture, self-offence and self-mutilation, in other words, the final stage in aggressing and destructing oneself. They also believed that the cause of self-destruction was nothing else but suppressed guilty conscience – thought to be the expression of the death instinct by Freud. So, the unconscious meaning of suicide was believed to be a penance of guilt through death. Modern psychology (Kohut, Henseller, Ammon) explains the phenomenon as a narcistic self-evaluation crisis of a person unsure of its identity (6). These dynamic theories considered that suicide was a solution to a troubled self-evaluation. To understand that, we should take into account that the victim fatally bonds himself to a certain suicidal model and this overrides his mind. The theory of communication and of behaviour, the social learning, and the suicidal theories of modelling and the utilitarian-cognitive theories, all approach this phenomenon from different points of view. According to RINGEL, (7) only a quarter of the suicides can be traced back as being caused by neuroses and psychopathy, the rest are caused by psychoses. In our view (8) the problems caused by a sudden or a constantly sustained inner tension, negative feelings and impulses, are solved by a suicidal act influenced by a communicative society and by the mental-hygienic state of the closer environment. It also depends on the transcultural embedding of the dynamic balance and quality of the basic state of man, which includes four items, as follows: -security (body, sensorial perception); -trust (relations, old customs); -the inner drive to prove (efficiency, reason); -certainty (fantasy, imagination, intuition). THE GAINS OF THE RESEARCH The foundation of the Romanian Balint Society, having the center in our town, Miercurea Ciuc, had a great contribution to promoting and strengthening the changes in the way suicide is perceived as a phenomenon, and in spreading a mental-hygienic view, besides the on-going research activity. Physicians, health workers, teachers,
priests and medical students carry on their activity in the field. The Society has been fruitfully cooperating with Balint Societies in other countries. We have participated at numerous psychiatric and suicidal conferences and congresses abroad, where we could make our results known. In order to promote training of doctors and other medical workers, we have built close relations with institutions in Hungary, Croatia, Germany and the UK. At present, the local county hospital has professional links with our counterparts in Kaposvár, Szeged, Pomáz and Sopron, in Hungary. This was also the aim of creating the foundation called “Cry for Help”. We have organized the suicideprevention telephone hotline and the mental-hygienic counseling service. Finally, we can conclude, that the research work has reached its goal. We have gained such essential medical and statistical knowledge about the suicidal phenomenon in Hargita district, that prevention can now be designed and carried out more precisely, while the results will certainly form the basis for further research. REFERENCES 1. U.S. Sucide Prevention, Awarness and Support. Suicide.org is a 501c3 Non-Profit Organization and Websit. http://www.suicide.org/suicidestatistics.html#death-rates 2. Ureche A, Grecu Gh, Molnár V. Aspecte psihiatrico-legale ale suicidului. In: Ureche A, Grecu Gh, Molnár V (eds.) Actualitãþi ºi perspective în cunoaºterea ºi asistenþa stãrilor depresive. UMF Tg. Mureº, 1987, 325-328. 3. Ozsváth K, Koczán Gy. Az öngyilkossággal szembeni beállitodás vizsgálata és befolyásolhatósága. Tanulmányok a társadalmi beilleszkedési zavarokról. Budapest: Kossuth Kiadó, 1988, 170-196. 4. Jegesy A, Harsányi L. Az öngyilkosság komplex vizsgálata Baranya megyében, 1983-1987. A „Társadalmi beilleszkedési zavarok” kutatási fõirány kutatóinak III. Munkaértekezlete, Pilisszentkereszt, 1990. 5. Durkheim É. Le suicide. Etude de Sociologie. Libr. Felix Alcan, 1897. 6. VERESS A. Unele aspecte epidemiologice, clinice ºi terapeuticoprofilactice ale suicidului în judeþul Harghita. Tezã de doctorat, 1998. 7. Ringel E. Die Selbstmordverhütung. Bem-Stuttgart-Wien: Huber, 1969. 8. Veress A, Vadas G. A Hargita megyei öngyilkosságok epidemiológiai felmérése az 1991-1996 közötti idõszakban. A Magyar Orvosok Világszõvetsége Erdélyi Társasága IV. Orvos-kongresszusa, Tusnádfürdõ 1997; (10): 9-12. ¯ ¯ ¯
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