Epidemiology of suicide in 10-19 years old in southern Iran, 2011-2016: A population-based study on 6720 cases

Psychometric properties of the Persian short form of the Stigma of Suicide Scale

Objective

Suicide stigma is a major obstacle to suicide prevention, resulting in a decrease in mental help seeking. This study aimed to survey the psychometric characteristics of the Persian short form of the Stigma of Suicide Scale (SOSS).

Methods

This psychometric study was conducted on 956 people (EFA = 399 samples, CFA = 557) in 2022 to evaluate the validity (face, content, and structure validity) and reliability (Cronbach's alpha coefficient, McDonald Omega coefficient, and intraclass correlation coefficient) of the SOSS. The structural validity of the scale was assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).

Results

The scores of S-CVI/Ave and CVR for SOSS were 0.982 and 0.921, respectively. In the EFA section, three factors with eigenvalues above one were shown, and 60.60% variance of the scale was explained by these factors, and one question was eliminated due the factor loading less than 0.4 and also moving to an irrelevant factor. Finally, based on the goodness-of-fit indices (such as RMSEA = .077, CFI= .902, IFI= .903, GFI= .915), the Persian short form of SOSS was approved with 15 items and three factors of Glorification/Normalization (4 items), Stigma (7 items), Isolation/Depression (4 items). The McDonald Omega coefficient, Cronbach's alpha coefficient, and ICC for SOSS were 0.841, 0.834, and 0.881, respectively.

Conclusion

In this study, the Persian short form of the SOSS was approved with 15 items and 3 factors, and this scale is an appropriate instrument for determining the status of suicide stigma among general population.

Trend Analysis of Suicide and Homicide Mortality and Years of Life Lost (YLL) in Children Aged 10-19 Years in the South of Iran, 2004-2019

BACKGROUND

This study aimed to investigate mortality and years of life lost (YLL) due to suicide and homicide in children aged 10-19 years in southern Iran from 2004 to 2019. Study Design: A cross-sectional study.

METHODS

The data on all deaths due to suicide and homicide in Fars province were obtained from the population-based electronic death registration system (EDRS). Crude mortality rate and YLL were calculated. The joinpoint regression method was used to examine the trend.

RESULTS

During the study period, 563 cases of suicide and 218 cases of homicide in children aged 10-19 have occurred. The total number of YLL due to suicide was 9766 in men and 6261 in women. According to the joinpoint regression analysis, the trend of YLL due to suicide was increasing in males. In other words, the annual percent change (APC) was 4.8% (95% CI 0.4 to 9.5, P=0.036). Additionally, there was a constant trend in females, and APC was 2.7% (95% CI -2.0 to 7.7, P=0.241). The number of YLL due to homicide was 4890 in males and 1294 in females. The trend of YLL due to homicide was stable in males and females. In other words, APC was -1.6% (95% CI -5.6 to -2.6, P=0.422) in males and -2.7% (95% CI -10.0 to 5.2, P=0.467) in females.

CONCLUSION

Based on the findings of this study, the trend of mortality rate and YLL due to suicide in men has been increasing and it has been stable in women. Moreover, the trend of mortality due to homicide was stable for both males and females. Therefore, it is necessary to take preventive actions.

Evaluation the validity and reliability of persian short form of the literacy of suicide scale (LOSS): a methodological study in 2022

INTRODUCTION

This research was conducted with the aim of evaluating the validity and reliability of Persian short version of the Literacy of Suicide Scale (LOSS) among the general population.

METHODS

This methodological study was conducted to evaluate the validity and reliability of Persian short form of LOSS among the general population, using a sample of 1175 participants in Iran, 2022. Participants were entered to study using method of proportional stratified sampling. The validity of Persian short form of LOSS was checked by four measures of validity: qualitative face validity, qualitative content validity, EFA (exploratory of factor analysis), and CFA (confirmatory factor analysis). The measure of reliability of Persian short form of LOSS was checked by three reliability of McDonald omega coefficient, ICC (Intraclass Correlation Coefficient), and Cronbach's alpha coefficient.

RESULTS

Based on the findings of EFA, 4 components with eigenvalues > 1 were extracted and these 4 factors were able to explain 57.96% of variance. In EFA section, only 1 question was deleted due to entry into the non -relevant sub -scale. Based on the results of CFA, all items had the factor loading greater than 0.4 and none of the items were removed at this stage. In CFA, based the results of goodness-of-fit indexes for example: χ2/df = 2.077, NFI: 0.957, IFI = 0.977, RMSEA = 0.030, GFI: 0.988, and PGFI = 0.569, the final mode was approved with 11 items and 4 factors. In this study for all items, Cronbach's alpha coefficient was 0.739, McDonald omega coefficient was 0.753, and ICC was 0.860. Finally, the Persian short form of LOSS was approved with 11 items and four dimensions of signs/ symptoms with 3 questions, the risk factors with 2 questions, treatment/ prevention with 2 questions, and causes/ triggers with 4 questions.

CONCLUSION

The Persian short form of LOSS with 11 items and four subscales is a valid and reliable scale to survey the suicide literacy status in the general population.

Title page: psychometric properties of literacy of suicide scale (LOSS) in iranian population: long form

INTRODUCTION

Suicide and suicide attempts are among the most important indicators of mental health in the world. In this research, the validity and reliability of Literacy of Suicide Scale (LOSS) was examined in general people over the age of 18.

METHODS

This cross-sectional psychometric study was conducted in 2022 among 952 general population in Iran. Participants were selected by two methods of proportional stratified sampling and simple random sampling. The internal consistency of the tools was assessed using Cronbach's alpha coefficient, and McDonald omega coefficient. Also, test-retest reliability was checked by Intraclass Correlation Coefficient (ICC).

RESULTS

In the confirmatory factor analysis section, the factor loading of all questions were above 0.4 and one questions were deleted and final model with four factors and 25 questions was confirmed (Some of goodness-of-fit indexes: AGFI = 0.910, RMSEA = 0.050, IFI = 0.901, and χ2/df = 3.333). For all questions, the Cronbach's alpha coefficient was 0.859, McDonald omega coefficient was 0.866, and ICC was 0.895. Finally, the Persian long version of LOSS was approved with 25 items and four subscales: causes/triggers (9 items), risk factors (7 items), signs and symptoms (5 items) and treatment/prevention (4 items).

CONCLUSION

The Persian long version of LOSS with four subscales and 25 items is an appropriate tool to investigate the state of suicide literacy in the public population.

The relationship between causes of suicidal attempts in Iran and individual and social variables: a retrospective study

OBJECTIVE

Determine the prevalence of suicide attempts and the relationships between the different causes of attempts with sociodemographic and clinical characteristics among individuals in Iran.

METHODS

A retrospective review of data about suicide attempts from poisoning care centers in Babol city between 2017 and 2021. Multinomial regression analysis (with mental illness being the reference variable) was used to determine the factors associated with the different causes of suicide attempts (addiction, romantic relationship problems, and economic problems).

RESULTS

The overall prevalence of completed suicide in the population sampled was 10.8% (95% confidence interval 9.5-12.1) (244/2,263). Relative to mental disorder, given that other variables in the model are held constant the following were associated with suicide attempts. A previous history of suicide attempts was associated with increasing the relative risk ratio of attempting suicide while having no positive history of smoking was associated with reducing the relative risk ratio of a suicidal attempt. However, the use of multiple drugs to attempt suicide was associated with an increased relative risk ratio of attempting suicide with romantic relationship problems and addiction as causes of suicide attempts. The first year of data collection (2017) and the female gender were both associated with an increased relative risk ratio of having a suicide attempt due to romantic relationships and economic problems. A family history of suicide was associated with an increased relative risk ratio of suicide attempts due to romantic relationship problems. However, using Pesticides-aluminum phosphide and detergent and javel water to attempt reduced the relative risk ratio of attempting due to romantic relationship problems. Age, self-employment, middle income, and married were associated with an increased relative risk ratio of suicide attempts among individuals due to addiction. However, staying longer at the emergency department was associated with a reduced relative risk ratio of having had a suicide attempt due to addiction.

CONCLUSIONS

This study highlights the interplay between romantic hardships, addiction, economic hardships as reasons for suicide attempts and various sociable variables in a population in Northern Iran. The most associated reason for suicide attempts was romantic relationship hardships. Therefore, interventions such as sessions on conflict resolution, boundary setting, and management of grieving would greatly benefit this society and reduce the rate of suicide, especially among individuals with a history of suicide attempts.

Developing inpatient suicide prevention strategies in medical settings: Integrating literature review with expert testimony

OBJECTIVE

According to some recent evidence, suicide rate is higher in inpatients than in the general population around the world. However, suicide prevention strategies (SPS) are poorly focused and understood in medical settings. This study aimed to develop effective SPS and interventions in medical settings of Iran and provide evaluation checklists/procedures for them.

METHODS

The study was performed in two steps, including literature review and expert opinions panel. In the first stage, we conducted a comprehensive literature review to find relevant suicide prevention programs, strategies, interventions, or any efforts to prevent suicide in the medical settings. In the second stage, an expert panel was arranged for developing effective and feasible SPS in medical settings. Data were analyzed through content analysis approach.

RESULTS

Overall, 11 records were included in the literature review. SPS varied from staff training, safety plan and quality improvements, and prevention programs to therapy methods. Finally, in the second stage, the following seven major SPS were recommended by the expert panel: 1) Integration and application of obtained suicidal behavior data through evaluating medical records, 2) Screening and suicide risk assessment, 3) Staff training, 4) Quality improvement, 5) Follow-up of inpatients with high-risk behaviors, 6) Reducing stigma and improving public awareness, and 7) Follow-up of discharged high-risk inpatients. Also, 23 interventions within the strategies were presented.

CONCLUSION

Given that SPS are poorly focused in medical settings, the practical framework that emerged in this study could be used to develop or advance SPS in various medical settings.

Short-term changes in meteorological conditions and suicide: A systematic review and meta-analysis

BACKGROUND

Suicide is a leading cause of death, particularly for young adults. Suicidal behaviours are influenced by a wide-range of personal, social, and cultural factors. Emerging evidence suggests that daily changes in meteorological conditions, including temperature, increases the risk of suicide.

METHODS

We conducted a systematic review and meta-analysis of studies that examined associations between either daily, or weekly, variations for eight meteorological variables and suicide outcomes (attempts, or deaths). Meta-analytic methods were applied to derive summary measures of association using random effect models. We assessed the heterogeneity in these associations by region and biological sex.

RESULTS

We identified 29 studies of suicide. Of these, 26 reported associations between temperature, while fewer studies reported on rain (n = 4), solar radiation (n = 4), humidity (n = 3), sunshine (n = 3), atmospheric pressure (n = 2), wind (n = 2) and cloud cover (n = 2). The overall relative risk for suicide deaths/attempts per 1 °C increase in ambient temperature was 1.016 (95% CI: 1.013-1.019). Subgroup analysis of temperature found stronger associations with suicide when using the maximum rather than the mean daily temperature, among men, and for completed suicides relative to attempts. Regionally, the strongest associations were found in the East Asia and Pacific region. While associations were found for solar radiation and cloud coverage and suicide, we did not undertake a meta-analysis for these exposures as it was not possible to standardize measures of association across studies. Statistically significant associations were not observed for other identified meteorological variables.

CONCLUSIONS

Our findings suggest that daily increases in temperature increase the risk of suicide, particularly, among men and in the East Asia and Pacific region.

The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

Background and Aims

Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran.

Methods

This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16.

Results

Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%).

Conclusion

These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

Patterns of six behaviors and psychosomatic symptoms in adolescents: A six-province study in China

BACKGROUND

Psychosomatic symptoms are often related with behaviors. However, the association between different behaviors and their latent patterns and psychosomatic health status is unclear. Current study aimed to identify the patterns of six behaviors and explore the association between different patterns and psychosomatic symptoms in a school-based sample of Chinese adolescents.

METHODS

From November 2015 to January 2016, the study enrolled 22,628 students from six cities in China (15.36 ± 1.79 years). Six behaviors [unintentional injury (UI), non-suicidal self-injury (NSSI), suicidal behaviors (SB), drinking, smoking, screen time (ST)] and psychosomatic symptoms (psychological and physical symptoms) were measured by self-report validated questionnaires.

RESULTS

Six behaviors were all related to psychosomatic symptoms, among which SB was the strongest. Four patterns of behaviors were be identified as follows: low-risk pattern (64.0%), substance use pattern (4.5%), injury pattern (28.8%) and high-risk pattern (2.7%). Logistic regression analysis of psychological symptoms indicated that compared with low-risk pattern, high-risk pattern had the highest risk, followed by injury pattern, substance use pattern showed the lowest risk. Compared with low-risk pattern, the results of physical symptoms suggested the degree of risk was high-risk pattern, injury pattern and substance use pattern, respectively.

LIMITATIONS

Cross-sectional data were used in the study that could not evaluate causal relationships between six behaviors and psychosomatic symptoms.

CONCLUSIONS

Six behaviors and their latent patterns are related to psychosomatic symptoms among Chinese adolescents differently, so different intervention and prevention protocol need to be taken for different patterns of adolescents.

Self-inflicted injuries among adolescents: Prevalence and associated factors, Espírito Santo, Brazil

Objective: To identify the prevalence of notified self-inflicted injuries among adolescents in Espírito Santo and to analyze the associated factors. Materials and methods: A cross-sectional and analytical study, with the notified data of self-inflicted violence among adolescents in Espírito Santo registered in the Notifiable Diseases Information System from 2011 to 2018. The bivariate analyses considered the Chi-square (χ²) and Fisher’s Exact tests. The multivariate analysis considered the log-binomial model, and the adjustment results were presented as prevalence ratio. Results: The prevalence of notified self-inflicted injuries was 33 % and, of this total, 79.8 % occurred among female adolescents. Prevalence was higher among adolescents aged from 13 to 17 years old (female gender) and from 18 to 19 years old (male gender), as well as among those with some disability or disorder. Higher prevalence values were found in the residence and in collective housing, as well as among those who did not consume alcohol at the event in question. In the female gender, there was also an association with the urban area (p < 0.05). Conclusions: High prevalence of notified self-inflicted injuries is perceived among adolescents in Espírito Santo, as well as of the factors associated to this phenomenon. The importance of adopting promotion, prevention and recovery measures for the problem is verified.

Predictors of completed suicide: Results from the suicide registry program in the west of Iran

Suicide is a crucial public health problem with a serious harmful impact on individuals, families, and societies. Therefore, the current study aimed to evaluate the predictors of death or serious injury related outcome regarding this lethal phenomenon in Hamadan Province. In this registry-based study we used all of suicide attempt entered in Hamadan Suicide Registry Program from January 2016 to the end of 2017. Serious injury and death were considered as suicide worse outcome and its prognostic factors were examined using logistic regression model. From 2493 patients with suicide attempts in 5.61 % and 4.09 % of them, suicide behaviour led to serious injury and death, respectively. Males had 2.83 times higher odds of the worse suicide outcomes ([OR = 2.83, 95 % CI: 1.71, 4.68)], P < 0.001). Moreover, the odds of worse outcomes of suicide in individuals with low level of education, advanced age and with the history of suicidal ideation was significantly higher (P < 0.05). Among different suicide methods, the highest odds of suicide worse outcomes were related to self-immolation, falls, hanging, self-harm, poisoning, and drugs (P < 0.001). We found that the increase odds of suicide worse outcomes were associated with individuals advance age, low level of education, time of suicide attempt, previous history of suicidal ideation and choosing self-immolation, falls, hanging, self-harm, poisoning, and drugs as a suicide method.

The epidemiology of suicide in the elderly population in Southern Iran, 2011-2016

BACKGROUND

The epidemiology of suicide within the elderly is unique to each cultural setting. In most countries, despite the higher rate of suicide attempts among adolescents and young people, the rate of suicide deaths in the elderly is higher than other age groups. The purpose of this study was to investigate the suicide rates among persons 65 years and above in Fars, Iran.

METHODS

In this cross-sectional study, we investigated suicide cases (65 years and older) during 2011-2016 in Fars, Iran. The data were collected from the Mental Health and Suicide Surveillance Systems of Fars province, using filled forms that included suicide and demographic information. After eliminating duplications, suicidal rates were calculated.

RESULTS

Of 299 suicide attempts, 64.9% were men, and 69.6% were urban residents. The rate of suicide attempts and deaths were 21.47 and 4.52 per 100,000 population, respectively; and the case fatality rate (CFR) of suicide was 21.07% during the study period. The rate of suicide attempts and deaths in this population showed an increase during the study years.

CONCLUSIONS

Considering the increasing trend of suicide rates in the elderly in Fars, Iran, measures should be taken to facilitate the access of this group to the mental health care system and psychological counseling.