Epidemiological study of suicide by physical methods between 1993 and 2013 in Ilam province, Iran

Trend Analysis of Suicide Mortality and Years of Life Lost from 2016 to 2021 in Southern Iran

Background

Suicide as the commonest psychiatric emergency imposes a heavy burden on communities. We aimed to evaluate the years of life lost (YLLs) due to premature death from suicide in Kohgiluyeh and Boyer-Ahmad Province, Iran.

Methods

Data regarding suicidal deaths were extracted from the Forensic Medicine Organization. The YLL of each year were calculated among gender and age groups. The YLL calculation was performed using the 2015 WHO excel calendars template. The Join Point Regression method was used to examine the trend of the crude mortality rate, the standardized mortality rate, and the YLL rate.

Results

Overall, 572 people died by suicide between 2016 and 2021 (63.5% in males and 36. 5% in females). The main method of death in most cases was hanging (52.8%). The total YLL due to premature death in the 6 year- period was 9248 (4.2 per 1000 persons) in males, 5602 (2.6 per 1000 persons) in females. Hanging (7909) compromised the largest YLL category between different methods of suicide. According to the joinpoint regression analysis, the 6-year trend of YLL rate due to premature mortality was increasing in males: the annual percent change (APC) was 4.8% (95% CI 1.0 to 8.7, P=0.024) and stable trend for females.

Conclusion

The YLL was higher in men than in women. Effective training interventions should be designed and implemented to reduce the incidence of suicide.

Spatiotemporal clustering of suicide attempt in Kermanshah, West-Iran

Background

A suicide attempt is a major societal problem because it imposes high costs on societies worldwide. This paper analyses the spatiotemporal clustering of suicide attempt in Kermanshah, Iran from 2006-14.

Methods

This study draws on 18,333 individuals (7,234 males and 11,097 females) who attempted suicide across the Kermanshah province. Data was collected from the records of individuals registered in hospitals across the Kermanshah province between 2006 and 2014. Mean Center, Standard Deviational Ellipse (SDE), Moran's I and Kernel Density Estimation (KDE) in Arc/GIS10.6 software were used for the analysis of the spatial distribution of suicide attempt, while the chi-squared test in SPSS was used to examine the different demographic variables between groups within/outside spatial clusters of suicide.

Results

The results show that a total of 18,331 suicide attempts (39.46% male and 60.53% female) were reported between 2006 and 2014 in the Kermanshah province. The spatial pattern of suicide attempts was clustered in 16 clusters (6 high clusters and 10 low clusters) and statistically significant differences were found within and outside the hotspots of suicide attempts. Most hot spots were formed in and around cities. Younger people were at a greater risk. The rate of suicide attempts reduced in illiterate people and increased in people with university degrees. Unmarried people were associated with a higher risk of suicide attempt than was married status for both males and females.

Conclusion

The results of this study could help public health practitioners and policymakers in Iran prioritize resources and target efforts for suicide attempt prevention.

Co-occurrence of Aggression and Suicide Attempt Among Young People and Related Factors: Findings from Iranian Youth Cohort Study in Ravansar

BACKGROUND

Aggression and suicide attempt are behaviors that affect public health. To better understand the nature of these behaviors, the present study was conducted to investigate the concurrence of suicide attempt and aggression in young people. This study sought to identify those factors which contribute to the co-occurrence of suicide attempt and aggression in young people.

METHODS

The present study was part of the recruitment phase of Ravansar youth cohort study (a branch of the PERSIAN Cohort) with a sample of 2991 people from Ravansar in western Iran. Registration and data collection were done between October 2014 and January 2017. Data were collected using structured interviews and standard questionnaires, and analyzed using multi-nominal logistic regression analysis.

RESULTS

The results showed that the variables of age and education were significant correlates of concurrence of suicide attempt and aggression. Also, among the mental disorders, only major depressive disorder (MDD) (OR=8.34, P=0.001) predicted the concurrence of suicide attempt and aggression in the past 12 month. In contrast, the variables of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), dysthymia, and substance use disorder were not significant in predicting the concurrence of attempted suicide and aggression.

CONCLUSION

The occurrence of aggression and suicide in young people is a complex phenomenon, and more research should be done to better understand this phenomenon.

Rate and Causes of Suicide in Ilam: A Report of the Suicide Registry

Objective: Suicide is one of the most important health problems in the world. Financial, academic, social, and environmental difficulties along with genetic, physical, and mental disorders affect suicide attempts. This study aimed to find risk factors for completed suicide in Ilam province according to the suicide registry in Ilam province. Method : This was a prospective study and was performed based on suicide case registration data, pre-determined checklist data, and death registration data in Ilam province from March 2019 to September 2020. Logistic regression models and the Chi-square test were used to determine the relationship between completed suicide and its risk factors. Results: Among 1,410 attempted suicides, 66 (4.7 %) were executed. Rate of completed suicides was higher in men (6.5%) compared to women (4.5%), (p = 0.005), age groups over 65 years (P < 0.001), retirees and farmers (P = 0.009), illiterate people (P < 0.001), villagers (P = 0.02), people motivated due to physical problems (P = 0.016), suicide by physical methods (P < 0.001) and self-immolation (P < 0.001). Logistic regression showed that incidence of completed suicide was significantly higher in the age group over 65 years, illiterate people, people using physical methods, villagers, and men. Multivariate logistic regression also showed that men and individuals using physical methods of suicide were significantly more successful in suicide. Conclusion: Men, the elderly, illiterates, villagers, and people who used physical suicide methods were in high-risk groups. Despite lower prevalence of suicide, a higher rate of completed suicide was demonstrated. To decrease completed suicide rates, we must pay attention to these groups.

Iran's National Suicide Prevention Program

Background and Aims: Iran is one of the few countries in the Eastern Mediterranean Region (EMR) to have developed a national suicide prevention program (NSPP). This report introduces Iran's NSPP to policy planners and researchers working in suicide prevention, and is intended to encourage other low- and middle-income countries to develop, implement, and evaluate their own NSPPs. Method: This was a case study of a NSPP in one country, integrating quantitative and qualitative data. Bibliographic searches were conducted using both international and national databases, supplemented by other documents. The study benefited from the experiential evidence provided by the senior author. Results: While the national incidence of suicide is low, there are higher rates among young adults, particularly women, in western regions. In 2010, Iran's NSPP was integrated into primary health care. A rigorous evaluation of Iran's suicide prevention program concluded that Iran has the potential to take a leadership role in suicide prevention within the EMR, although several challenges were identified. Limitation: The findings of this case study cannot be generalized to other contexts. Conclusion: Given Iran's unstable situation, the NSPP needs to be monitored, evaluated, and adjusted according to evidence and ongoing changing national and local needs.

Predictive Factors Associated With Methods of Suicide: The Korean National Investigations of Suicide Victims (The KNIGHTS Study)

Background: Because the suicide mortality depends on the lethality of suicide methods, the identification and prediction of suicide methods are important for suicide prevention. Methods: Examination data of suicide decedents were collected based on police reports. Suicide decedents were divided into groups according to the suicide methods (hanging, gas poisoning, pesticide poisoning, jumping, drug poisoning, and drowning) they used. Predictive factors for each suicide method in comparison to other suicide methods were identified. Results: Among 23,647 subjects, hanging was the most common method of suicide. Regarding gas poisoning, the history of previous suicide attempt was a risk factor and being age of 65 or older was a protective factor. Being age of 65 or older showed a highly strong association with suicide by pesticide poisoning. Being age of 18 or younger and the presence of schizophrenia were associated with jumping. A history of psychiatric outpatient treatment was a risk factor for drug poisoning. Regarding suicide by drowning, schizophrenia was a risk factor, while being age of 65 or older was a protective factor. Limitations: Only eight out of a total of 17 regions in South Korea were examined and included in the data of this study. Also, the methods of suicide were defined as one method that directly caused the death, which could undermine other less fatal methods used. Conclusions: There were differences in predictive factors according to the method of suicide. Predicting the method of suicide in people at high risk for suicide stands to be an important strategy for suicide prevention in clinical settings.

Psychological factors of vulnerability to suicide ideation: Attachment styles, coping strategies, and dysfunctional attitudes

BACKGROUND

Suicide ideation is one of the common mental health problems among university students. This study aimed to explain suicide ideation susceptibility by examining the relationships between psychological factors.

METHODOLOGY

The population of the study included all female undergraduate students at the University of Isfahan in autumn 2018. A sample of 180 individuals were selected through multistage sampling from different faculties and majors. The scales used in this study included adults attachments inventory, Coping Inventory for Stressful Situation, Dysfunctional Attitudes Scale, and Suicide Ideation Scale. The statistical analyses included t-test, Pearson correlation, and path analysis.

RESULTS

Suicide ideation was reported in 25% of the participants. The t-test analysis indicated that the mean scores for dysfunctional attitudes (P < 0.01) and problem-focused coping (P < 0.01) were significantly different in with and without suicide ideation groups. Suicide ideation significantly correlated with problem-focused coping (r = -0.42, P < 0.01), emotion-focused coping (r = 0.25, P < 0.05), and dysfunctional attitudes (r = 0.23, P < 0.05). Path analysis showed that dysfunctional attitudes and emotion-focused coping significantly influenced suicide ideation. Moreover, the indirect effect of insecure (ambivalent and avoidant) attachment styles by mediating role of dysfunctional attitudes and emotion-focused coping was statistically significant (P < 0.01) and the indirect effect of dysfunctional attitudes by mediating role of emotion-focused coping as well (P < 0.05).

CONCLUSION

Insecure attachment styles and dysfunctional attitudes work as stress-diathesis model in predicting suicide ideation and increase suicide ideation susceptibility by affecting emotion-focused coping strategy. The hypothesized model in this study can help formulate, evaluate, and prevent suicide risk.

The Suicide Rate in the Elderly Population of Iran between 2008 and 2014

Background: We aimed to investigate the suicide rate led to death in the elderly population of Iran between 2008 and 2014.

Study design: A cross-sectional study.

Methods: The present study was conducted on all suicide-related deaths in elderly people (≥65 yr) during the years 2008 to 2014 reported to the Iranian Legal Medicine Organization. For data collection, legal medicine standard form was used and the cases were classified by age, gender, suicide way and time (year). The incidence of death from suicide was calculated by age and sex. Statistical soft-ware stata12 was used to analyze data. The significance level has been considered to be 0.05.

Results: Overall, 1,601 suicide-related deaths were investigated throughout the country. The mean age was 70.36 ± 0.17 years. The incidence trend (per 100,000 people) of the elderly suicides in Iran indicates that successful suicides have been on the rise, rising from 3.7 in 2008 to 4.37 per 100,000 people in 2014.

Conclusions: It is necessary to identify and treat suicidal important predisposing factors of suicide such as psycho-social illnesses including depression and also implement prevention programs and policies for this fast-rising population age-group.

The trend of burn mortality in Iran - A study of fire, heat and hot substance-related fatal injuries from 1990 to 2015

INTRODUCTION

Burn injuries are a major cause of preventable mortality worldwide. To implement preventive strategies, a detailed understanding of the rate and trend of fatal burn injuries is needed. The aim of this study was to determine the rate and trend of burn mortality at national and province level in Iran from 1990 to 2015.

MATERIALS AND METHODS

The data were retrieved from various sources: the Death Registration System, cemetery databases, the Demographic and Health Survey and three national population and housing censuses. ICD-10 codes were converted to Global Burden of Disease (GBD) codes for comparability. After addressing the incompleteness of death data, statistical methods such as spatio-temporal modelling and Gaussian Process Regression (GPR) were applied to estimate the levels and trend of death and cause specific mortality.

RESULTS

The number of deaths due to burning across Iran was 80,625, with a male to female ratio of 0.88, 0.94 and 1.14 in 1990, 1995 and 2015, respectively. The annual percentage change of age-standardized death rate from 1990 to 2015 was -5.42% and -4.22% in women and men, respectively. The burn-related age-standardized mortality rate decreased considerably from 5.97 in 1990 to 1.74 per 100,000 in 2015. The mortality rate due to burns was highest among those aged more than 85 years, especially in Ilam province.

CONCLUSION

This study showed a decline in burn mortality in Iran from 1990 to 2015. Continued efforts to reduce the burden of burns are needed to accelerate this progress and prevent injuries.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.