To examine the occurrence of suicide in urban and rural regions of Belarus in the post-Soviet period. Design: Unlinked cross-sectional study using data drawn from four time points.

Age and sex-specific suicide data for urban and rural regions of Belarus were obtained from the Ministry of Statistics for the years 1990, 1995, 2000 and 2005. The data were recalculated into seven age categories and then directly standardized. Poisson regression models were used to assess changes in urban-rural suicide rate ratios.

Between 1990 and 2000 the suicide rate rose sharply in Belarus and by 2005 it remained much higher than its initial level. After 1995 there was a divergence between sex-specific rates in urban and rural areas. By 2005 although suicide rates had fallen from their 2000 level for both sexes in urban and rural locations, the fall was much smaller in rural areas. These changes resulted in a deteriorating rural/urban suicide ratio across the period 1990 to 2005 with suicide rates among nearly every rural male age group remaining extreme after 1995. Although it is probable that a deteriorating social and economic situation has underpinned increasing suicide rates in all regions, there may be factors that are specific to rural locations such as social isolation, alcohol abuse and the poor provision of medical services.

By 2005 Belarus had one of the highest suicide rates in the world. This now requires urgent intervention by the necessary authorities to ameliorate this situation in urban and especially rural locations.