The aim of the current study was to provide comprehensive overview of data on suicide rates and trends and their associated variables in Montenegro between 2000 and 2018. Results indicate that Montenegro belongs to the category of countries with high suicide rates (i.e. 20-24.9, e.g. according to Peković, 2010), as this rate is around 21.06. In the last three years (2016–2018), suicide rates reached the point lower than the average rate calculated for that whole period of time, placing Montenegro in the category of countries with moderate suicide rates (i.e. 10-19.9, Peković, 2010). The overall trend in the last three years could be a result of the better quality of mental health services and the increased number of non-governmental organizations (NGOs) primarily focused on different aspects of mental health protection and implementation of projects in this domain. Crude suicide rates in females were much lower compared to those reported before 2016. Injac Stevovic and Vodopic (2017) reported that most suicides attempts by females in Montenegro were associated with poisoning with psychotropic drugs, especially benzodiazepines. Up until 2015, these drugs have been available without a prescription which could explain reduced availability of benzodiazepine in subsequent years.
In comparison to its neighbour countries, Bosnia and Herzegovina and Serbia, Montenegro had higher crude suicide rates for the period 2007–2011 and 2006–2010, respectively. To be more specific, crude suicide rates in Bosnia and Herzegovina ranged from 12.3 in 2008 to 14.6 in 2007 (Bojanić & Srdanović, 2012) whereas in Serbia these rates ranged from 16.58 in 2010 to 19.43 in 2006 (Dedić, 2014). In this period, the lowest crude suicide rate in Montenegro was 17.34 in 2009 and the highest crude suicide rate was 25.69 in 2010.
Overall and gender-specific suicide rates were not in statistically significant relationships neither with year nor with average net salary. Hence, suicide rates did not increase steadily as time passes and this type of rates is not influenced by average net salary growth. It should be taken into account that only data for average salaries were available and not those for median salaries which could be considered as better indicator of individual income.
Nonsignificant correlation between overall suicide rates and unemployment was obtained. This finding was in accordance with findings obtained by Gutierrez-Barroso et al. (2018). In fact, as research evidence showed (e.g. Kim & Cho, 2017), unstable employment is better predictor of suicide rates. However, some studies (e.g. Nordt et al., 2015) revealed that unemployment and lack of job security are important factors that can increase risk of suicide. Other studies (e.g. Agerbo et al., 2002) underlined the possibility that mental health could mediate the relationship between unemployment and suicide rates. In spite of that, numbers of suicides by firearms and hanging were significantly associated with unemployment rate. Additionally, higher net salary seems to have negative relationship with suicide by firearms. In other words, unemployment and low salaries are linked to suicides committed by firearms.
These results should be interpreted with caution as unemployment data may not reflect accurately the labour situation in the country. Official employment and unemployment data do not include information on those who are not looking for a job anymore, those who have been deprived of working abilities, or those who are working in undocumented positions (Yuryev et al., 2010).
Overall suicide rates were relatively stable between 2000 and 2008 with minor oscillations. Notable change can be observed in data from 2009 where the suicide rate drops down below 17.5 and already in 2010 it increases above 25, reaching its highest point of more than 26 in 2014 (placing Montenegro among countries with very high suicide rates). This trend in suicide rates was highlighted by Fountoulakis et al. (2014).
Males are 2.41 times more likely to commit suicide compared to females, which is in accordance to previously conducted studies on gender differences in commiting suicide (Tsirigotis et al., 2010; WHO, 2014). In 2018, this ratio was even 4.29. This finding can be explained with regards to Montenegrin cultural context which imposes high expectations on males in securing financial and material stability of households. Due to these expectations, it is plausible to assume that males in Montenegro are more prone to experience intense stress and pressure during times of economic, political and social disturbances, in comparison to females. Males’ reactions on economical changes related to employment and the average salary, seem to be more severe and lead to more extreme behavioral acts than those of females (Medojević, 2011). The risk of suicide in different population groups change during times of economic crisis or uncertainty. Men are more vulnerable than women to the adverse effects of economic recession, what also include suicide risk (McDaid, 2017:39).
Montenegro, as a small state, goes through the processes of transition (economic, political, social) in last three decades, what causes uncertain political and economic environment, and inevitably effects and concerns for well-being of citizens. By the sources reported from World Bank, poverty in Montenegro dropped about 11% in the mid-2000’s to its minimum of 4.9% in 2008, and rising again to 8.6% in 2013, with a huge proportion of vulnerable categories, which are close to the poverty line (World Bank, 2016). Possibly, it indicates correlation between the suicide ratio and poverty, but also correlation with unstable socioeconomic situation in Montenegro.
The main advantages of the study are summarized as follows. Analysed data were obtained from the reliable and valid source and collected in a systematic way according to official Department of Interior’s procedures. In addition to this, they encompass an extensive time period from 2000 to 2018. Database used in the present study has potential to inform statistical registries on suicide rates and trends of worldwide organizations such as WHO.
Further research should focus on age-adjusted suicide rates in Montenegro and should analyse data for other methods of suicide (e.g. suffocation, drowning, poisoning, wrist cutting). At the same time, these recommendations can be considered as limitations of the present study. Another recommendation could be investigating the relationship of mental health, online and offline social networking, some other socioeconomic characteristics (e.g. marital status and educational level), and urban population growth with crude and age-adjusted suicide rates in Montenegro.