Spatial heterogeneity in gender and age of fatal suicide in Iran

Abstract

Background: The suicide incident has had an increasing trend in Iran over the past years. This study mainly aimed to investigate and visualize the spatial variations of registered suicide cases at the province level. A two-step modeling approach was employed in order to estimate the relative risks (RRs) and model the age of fatal suicide across provinces in Iran. Study design: An applied ecological study. Methods: This study used the suicide death data recorded by the Iranian forensic medicine organization from March 21, 2016, to March 20, 2018. Furthermore, a Bayesian spatial approach - Besag, York, and Mollie (BYM) model- was applied to estimate the RR of suicide across provinces in Iran. Results: This risk was found to be significantly higher than the average in both men and women in the west of Iran. For women, higher population density (mean: 0.003; 95% CrI: 0.001-0.005) and lower urbanization rate of provinces (mean: -0.025; 95% CrI: -0.038, -0.012) were associated with increased RR of suicide. Based on the log-normal model fitted to the data, the overall mean age of the fatal suicide at the national level was 34 years. Conclusions: The magnitude of gender and age differences was quantified, and many spatial variations were identified in suicide mortality across provinces in Iran. Given the heterogeneity in suicide mortality risk among different subgroups of age and gender, our findings point to the urgent need in developing gender- and age-specific suicide prevention strategies. Moreover, efficient allocation of healthcare resources for suicide prevention can be attained by targeting provinces with higher risk.

Years of Life Lost Due to Complete Suicide in Iran: A National Registry-Based Study

“…All cases referred to the FMO undergo forensic autopsy as part of the process. 9 If the forensic examination confirms that the cause of death was intentional self-harm, the case is included in the national suicide registry maintained by the FMO. 9 Consequently, the suicide registration data from the FMO’s database are considered the most comprehensive source for complete suicide data in Iran.…”

“… 9 If the forensic examination confirms that the cause of death was intentional self-harm, the case is included in the national suicide registry maintained by the FMO. 9 Consequently, the suicide registration data from the FMO’s database are considered the most comprehensive source for complete suicide data in Iran. 8 This is due to Iranian legal directives assigning that causes of death be exclusively written in Persian on death certificates issued by forensic physicians, with ICD codes or English terms prohibited.…”

“… 8 This is due to Iranian legal directives assigning that causes of death be exclusively written in Persian on death certificates issued by forensic physicians, with ICD codes or English terms prohibited. 9 For this cross-sectional study, data on age, gender, method, and year of death of people who committed suicide were extracted from the FMO’s suicide registry database. The study analyzed suicide data and covered a specific period from March 21, 2016 to March 20, 2020.…”

The association between nation-level social and economic indices and suicide rates: A pilot study

“…In addition, an attempt was made to control for certain other confounding factors that have been associated with regional or national suicide rates. These include the Human Development Index (HDI) (Khazaei et al, 2017;Yasir Arafat et al, 2022), land area and population density (Vichi et al, 2020;Jakobsen and Lund, 2022;Rostami et al, 2022), urbanization (Ivey-Stephenson et al, 2017Li and Katikireddi, 2019), and distance from the equator (An et al, 2023). Information on the HDI for the year 2019 was obtained from the United Nations Human Development Report (United Nations Development Programme, 2019); data on land area and population density was obtained from the World Bank's Open Data database (The World Bank, 2020); and data on latitude was obtained for the capital city of each included country from Google Earth (Google, 2023).…”