Many things have changed within Ukraine since the end of the Cold War. Social conditions, economic conditions, religious influences, political allegiances, and national directions all have shifted, most drastically. Now, research is giving us a glimpse, for the first time, of mental illness and its changes after the fall of Communism.

According to two Ukrainian psychiatrists visiting the U.S. for a conference, suicide rates are extremely high (three times the U.S. average), and the mental health community in Ukraine is struggling to find ways to prevent suicide and treat those who attempt it.

Ludmilla Yuryeva, Dr. Med., chief of psychiatry and chair of the postgraduate education faculty at the State Medical Academy in Dnipropetrovsk, Ukraine, spoke to attendees at a conference titled "Suicide: A Matter of Death and Life—The First National Interfaith Conference on Religion and Suicide." It was held at the Carter Presidential Center in Atlanta last month. Joining her was her husband, Eugeni Yuriev, Dr. Med., director, Crisis Department, Dnipropetrovsk Regional Psychoneurological Hospital. Both are Russian-trained psychiatrists; Yuryeva specializes in the emerging effects of religion on Ukrainian mental health, and Yuriev directs a crisis management team and was involved in the treatment of survivors of the Chernobyl nuclear accident.

The husband-and-wife team stopped in Washington, D.C, following the conference to speak at a luncheon gathering of local psychiatrists and religious leaders at the Wesley Theological Seminary of American University, where their daughter, also a Russian-trained psychiatrist, is pursuing postgraduate work.

According to Yuryeva, suicide was difficult to track in the Russian Federation (and the former Soviet Union before it) because, prior to 1999, it was not reported appropriately. Often a suicide attempt was listed as "trauma resulting from accidental sources." Suicide deaths were listed as traumatic, accidental, or "cause undetermined."

Speaking through an interpreter, Yuryeva told Psychiatric News, "In the Russian culture, suicide has been looked upon as a right, especially for political, activist reasons that make the death a martyr; rarely has it been considered a sign of mental illness."

Yuryeva explained that in Ukraine, if an individual is not deemed to be mentally ill, he or she has the legal right to kill himself or herself. A death by suicide for a political reason would be recorded as "political."

According to Yuryeva, the link between suicide attempt and comorbid psychiatric disorders is just beginning to be accepted in the Russian Federation.

Yuryeva presented data gathered in the last year and a half since the term "suicide" has been used as an actual cause of death in Ukraine. The suicide rate in Ukraine for 1999 was 31.9 completed suicides per 100,000 population. Over 300 attempts were made per 100,000 population. This compares with the U.S. average of 11.4 suicides completed per 100,000 population.

The main causes of suicide in Ukraine were listed as "Chernobyl-related illness," economic hardship, political pressures, and, for the first time, religious influences.

"Since the ban on organized religion in the Ukraine was lifted with the fall of Communism," Yuryeva said, "over 1,000 pseudoreligious sects have sprouted up. Many of them have ways of thinking like the American death cults." Under the Communist regime, all Soviet citizens were, by law, atheists, so no religious influences were recognized.

Overall, suicide was listed as the third-leading cause of death in Ukraine in 1999, behind ischemic heart disease and cerebrovascular disease. In comparison, suicide was the eighth leading cause of death in the U.S.

Yuryeva’s husband Yuriev followed her presentation with a discussion of treatment protocols for patients who attempt but do not complete suicide. Developed only in the last two to three years, the protocols are basic, and many of the American psychiatrists listening to Yuriev’s presentation were surprised at the rudimentary tools available to the Ukrainian psychiatrists.

Yuriev, whose crisis department at the Ukrainian hospital sees an average of 450 suicide attempters each year, told the Wesley luncheon crowd that until recently, only psychiatrists treated suicide attempters.

"There were no other mental health workers," Yuriev told Psychiatric News. "Psychiatrists admitted the patient to the hospital and followed the patient for several years afterward."

Today, the mental health profession in Ukraine includes psychologists, psychotherapists, and mental health and social workers. A team approach is intensive and centered around psychotherapy.

"We use techniques such as empathic listening, supportive and suggestive problem solving," Yuriev said. He told Psychiatric News that psychotropic medications are not generally available in Ukraine. "We do not have tools other than psychotherapy."

The Ukrainian psychiatrists’ presentations in Atlanta and Washington, D.C., were supported by the Organization for Attempters and Survivors of Suicide in Interfaith Services (OASSIS), the sponsor of the Atlanta conference.