Depression, mood disorders and suicide cause equal heartbreak in every affected household or community across the globe. But in Russia and several other nations in the former Union of Soviet Socialist Republics (USSR) and Eastern Europe, suicide disproportionately affects one half of the population more than the other.

According to the World Health Organization …

In Russia, Ukraine, Belarus, Latvia, Poland and Kazakhstan, the suicide rate is more than six times higher for men than it is for women.

Other nations in the former USSR (or in its historic sphere of influence) aren’t far behind: Male suicide rates exceed those for women by a ratio of more than 5.5 to 1 in Estonia, Lithuania, Hungary, Slovakia and Kyrgyzstan. The incidence of male suicide in these countries is unique in the world. (The extreme gender imbalance in five other countries, including Oman, Saudi Arabia and Belize, is due to relatively low suicide fatalities for both men and women.) In these six former Soviet countries, though, the male suicide rate is heartbreakingly high — 36 deaths per 100,000 men per year in Russia, which is about three times the world average. The rates for females in these six countries don’t even break the top 40 worldwide.

Alcohol appears to play an important role. William Alex Pridemore, School of Criminal Justice, State University of New York at Albany

In fact, almost all countries have higher rates of suicide among men than women, though to a lesser extent. “Suicide is a complex phenomenon,” says Dr. Alexandra Fleischmann of the World Health Organization’s Focal Point for Suicide Prevention. “There is no one answer to it.” But it is likely that the gender disparity in many countries is related to the fact that men tend to have more immediate access to more lethal means of suicide, she says, such as firearms or pesticides in agricultural areas.

The turbulent recent history of the former Soviet Union might play a part, says William Alex Pridemore, dean of the School of Criminal Justice at the State University of New York at Albany. This could contribute to “a bleak outlook on the future” as well as limit the growth of strong familial, educational, religious and civic institutions to promote community and social well-being. Indeed, suicide rates have been falling across the region in recent decades as various other socioeconomic indicators have improved.

But it’s not just about the legacy of the fall of communism; Pridemore’s research suggests that suicide rates were just as high before the Russian Revolution. Plus, there are several other former Soviet states that do not show this pattern, and plenty of other parts of the world suffer from fractured social and economic communities without an associated increase in suicide rates, suggesting that cultural factors might be significant. “Alcohol appears to play an important role” in Russia and other Slavic nations, says Pridemore. Men in these countries are prone to high rates of binge drinking, especially of vodka — “distilled spirits can result in a quicker and deeper intoxication,” he notes — which can make people more likely to act on suicidal thoughts as well as indirectly contribute to mental health issues associated with economic hardship, domestic violence and family breakdown. An estimated 22 percent of global deaths from suicide can be attributed to alcohol, notes the WHO’s Fleischmann.

Given all the factors that contribute to suicide rates, it’s difficult to really know what has long caused Russian and other Slavic men in the region to take their own lives in such numbers. “More research is required,” says Pridemore. A review of research from Our World in Data shows how everything from gun ownership rates to divorce laws to daylight patterns correlate with the prevalence of suicide. There are many examples of “effective strategies for suicide prevention” says Fleischmann, such as access to mental health care, alcohol policies and responsible media reporting, all of which can help to bring down rates in Russia and the other countries of the former USSR.

If you are dealing with suicidal thoughts or know of someone who is, you can receive immediate help by visiting global resources such as iasp.info, or by calling 1-800-273-8255 in the U.S.