3-Ghaleiha

JRHS 2009; 9(1): 48-51

Copyright © Journal of Research in Health Sciences

An Annual Survey of Successful Suicide Incidence in Hamadan, western Iran

Ghaleiha A( MD)a, Khazaee M( MD)b, Afzali S( MD)c, Matinnia N( MSc)d, Karimi B( MD)b

aAssistant Professor of Psychiatry, Research Center For Behavioral Disorders and Substance Abuse (RCBDASA), Farshchian  Hospital, University of Medical Sciences Hamadan, Iran

b Hamadan University of Medical Sciences, Iran

cAssociate Professor of Forensic Medicine, Farshchian Hospital, Hamedan University of Medical Mciences and Health Services,Iran

dHamadan Islamic Azad University, Iran

*Corresponding Author: Ghaleiha A, E-mail: ghaleihaali@yahoo.co.uk

Received: 7 December 2008; Accepted: 19 May 2009

Abstract

Background: Suicide has constituted a critical public health problem for many decades. The number of completed suicide is traditionally high in Iran. The objective of the present study was to describe the patterns of methods of suicide among registered deaths due to suicide in Hamada, western Iran

Methods: In this cross-sectional study, all completed suicide cases (n=146) were included from March 2004 through March 2005 based on Hamadan's Forensic center registered deaths because of suicide. Supplementary data were gauged through a questionnaire from the attempters relatives. All statistical analyses were performed using version 13 of the statistical software package SPSS and an alpha level of .05 for all statistical tests.

Results: Prevalence of completed suicide was 8.3 per 100,000 in Hamadan, Iran. From 146 cases, the male-to-female ratio was 7.1:1. Average age of cases was 33.9 yr (Min=10, Max=94) across all age groups, males show consistently higher completed suicide rates than females. Of the 69.2% were from urban population versus 30.8% form rural population. The most common method of suicide was hanging (78.1 %). Other common methods were poisoning (11.6%), and self-burning (6.2%).

Conclusion: Suicide rate in Hamadan is high among males through hanging which can be due to substance dependency and unemployment.

Keywords: Suicide, Substance dependency, Suicide method, Mental disorders, Iran

Introduction

Suicide is referred to conscious or semicon­scious destruction of individual who chose sui­cide as the best method due to various ail­ments and commit it (1). Retterstol offers a more detailed definition: An act with a fatal out­come, which is deliberately initiated and per­formed by the deceased him- or herself, in the knowledge or expectation of its fatal out­come, the outcome being considered by the actor as instrumental in bringing about de­sired changes in consciousness and/or so­cial conditions (2). There are many different methods and means of deliberate self-injury ac­cording to geo­graphi­cal region, social fac­tors and gender (3). It is well known that avail­ability of means to com­mit suicide has a major impact on actual sui­cides in any re­gion (4). The incidence, pat­tern and trends of suicide differ considerably be­tween Asian and Western countries. They also differ consid­erably between Asian coun­tries and re­gions (5).

In the last 45 yr, suicide rates have in­creased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 yr (both sexes).In the year 2000, approximately one million peo­ple died from suicide and global mortal­ity rate of suicide is estimated 16 per 100,000 (6). The rate of successful suicide was 5.7 cases in every 100,000 for males ver­sus 3.1 for females in Iran. Moreover, west­ern provinces of Iran have a high propor­tion of suicide, while the sui­cide ratio was the highest in Hamadan (7).

There are various factors influencing suicide amongst different counties and cultures and the objective of the present study was to de­scribe the patterns of methods of suicide among reg­istered deaths due to suicide in Hamada, Iran.

Methods

This cross-sectional study was done in Ha­ma­dan Province, West of Iran. All success­ful suicides in the 1 yr period from March 2004 through March 2005 obtained from Forensic Center of Hamadan, Iran (ICD codes E950.0-E959.9). There were 146 cases of completed suicide in Hamadan Province in 2005; all of them were referred to Forensic Center and consequently death rea­son was confirmed based on forensic medi­cine's specialists as suicide. A special checklist was applied to study the mental health and socio-demographic status of the cases. Factors recorded included age, gender, educational and marital status, methods of sui­cide, history of addictions, and psychologi­cal and organic disorders.

All statistical analyses were performed using ver­sion 13 of the statistical software package SPSS and an alpha level of .05 for all statisti­cal tests.

Results

Mortality rate of suicide was estimated 8.3 per 100,000. Among all of the suicide cases, 87.7% of cases were male which male to fe­male ratio for suicide was estimated 7.1: 1.

The most cases of suicide were observed in the age of 21-30 yr (Table 1, P< 0.05). 79.5% of cases were employed and 20.5% of them were unemployed tended to commit sui­cide. Regarding marital status, 49.3% were mar­ried, 43.2% were unmarried, and 7.5% were di­vorced and widowed (P< 0.05). 69.2% of all suicides happened in urban area and 30.8% in the rural area and Hamadan City had the high­est rate of suicide (P< 0.05). For season­ality, the suicide rate in spring was in the highest level (28.1%) but winter was in the lowest level (21.9). The most com­mon method for doing sui­cide was hang­ing followed by self-poisoning.

In most cases (70.5%) a history of substance abu­se such as marijuana or opium was ob­served. More than 62.3% had a history of men­tal disorder and 8.9% had been suffering or­ganic disease (Table 1). 

Table 1: Frequency of some associate factors in patients who attempted suicide

Variable

Frequency (%)

P

Variable

Frequency (%)

P

Gender

128(87.7)

Male

P< 0.01

Educational level

Low

20(13.6)

P< 0.01

18(12.3)

Female

Intermediate

119(81.7)

Age

23(15.8)

10-20

P< 0.01

High

7(4.7)

55(37.7)

21-30

Substance abuse

No abuse

43(29.5)

P< 0.01

25(17.1)

31-40

Smoking

25(17.1)

25(17.1)

41-50

Opium

14(9.6)

8(5.5)

51-60

Alcohol &Marijuana

8(5.5)

10(6.9)

More than 61

Heroin

6(1.4)

Location

101(69.2)

City

P< 0.01

Combine

50(34.2)

45(30.8)

Village

Method of

sui­cide

Hanging

114(78.1)

P< 0.01

Job

30(20.5)

unemployed

P< 0.01

Poisoning

17(11.6)

14(9.6)

Governmental

Self-burning

9(6.2)

10(6.8)

Student

Other

6(4.1)

92(63)

Self-em­ployed

Psycho logic disorder

Depression

64(43.8)

P< 0.01

Season

41(28.1)

Spring

P< 0.01

Schizophrenia

12(8.2)

37(25.3)

Summer

Bipolar

15(10.3)

36(24.7)

Autumn

No disorder

55(37.7)

32(21.9)

Winter

Organic disor­der

Yes

13(8.9)

P< 0.01

Marital status

72(49.3)

Married

P< 0.01

No

133(91.1)

63(43.2)

Single

Stress

Yes

22(15.1)

P< 0.01

11(7.5)

Widow&Divorced

No

124(84.9)

 

Discussion

Rapid increasing of completed suicide has brought with it the necessity of epidemi­ologic surveys in each region, on the find­ings of which to determine the strategies to re­duce suicides. Compared with the statistics presented by Mo­radi and Khademi in 2000, we did not find any remarkable change in 2005 in Hamadan (7) while suicide rate in northern Thailand and the state of Osijek in Crotia is much higher than our observations (8-11). Statistic of 2000 show that men com­mitted suicide twice as many as the women while this rate in Hamadan has hit three times. It can be compared with Serbia-Monte­negro and northern Thailand where men committed twice and three times, respec­tively.

Our results show that men committed suicide seven times more than women did. It seems that men face more with socio-economical prob­lems that lead to more suicide and in ad­di­tion, higher incidence of substance re­lated dis­orders and uncured medical diseases make the men commit suicide more than the women do.

In most countries, the age range occurs in ado­lescence that is compatible with our obser­vations (8-10). In contrast with many studies reporting sui­cide more among single person, we found the sui­cide rate is higher among the mar­ried (9), the reason of which is unknown but it appears to be the unemployment, sub­stance related dis­orders and economical prob­lems.

Based on the statistics presented in Japan, sui­cide rate increase in April and reduces in autumn while it is higher in spring in Fey­salabad of Pakistan. Our findings show a re­la­tive increase in spring (3, 11, 12).

There are many different methods for sui­cide, the most famous of which is device avail­abil­ity with the cases of hanging, self-fir­ing, poi­son­ing with drugs, falling from height and warm and cold weapons. Our find­ing show that the incidence of self-firing and hanging are more common in women and men, respectively which is compatible with those of some other studies (8,11,14).

The study performed in eight northern-easts of the U.S.A shows that the most common method of completed suicide is by warm wea­pon, the major reason of which can be the lack of forbidding warm weapons in these regions (8). On the other hand, Iran's Fo­ren­sic Center reports show that men tend to use warm weapon more (15-19).

Our survey shows that drug abuse is ob­served in most of the people committing sui­cide, which is the most important factor of sui­cide the history of medical disease has been observed among more than half of at­tempters with depression more common than other disorders.

The high rate of unemployment and financial problems are the most important predica­ments of young people, which dead to disap­pointment and repression one hand, and mar­riage inability, crime increase, addiction and corruption, on the other hand, in the society that provides a ground for people to commit suicide.

Assessment of suicide risk exactly and care­fully is up to a practitioner. Of ten persons com­mitting suicide, eight persons express their intention to someone else and in 50% of com­pleted suicides; the attempters had re­ferred to emergency parishioners a month be­fore. In many cases, suicide in psychic pa­tients can be prevented with a complete re­sume and psy­chic assessment of the patients. It is not possible to prevent all suicides or to­tally and absolutely protect a given patient from suicide. What is possible is to reduce the likelihood of suicide for populations or sub­populations and to reduce the risk of it for a given person

Acknowledgements

It is necessary to thank Dr Kazemifar, the Man­ager of Forensic Center of Hamadan.

This proposal was performed as GP thesis without any financial help. The authors de­clare that there is no conflict of interests.

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