Geographical Epidemiology of Suicide and Suicide Attempts During the Years 2010-2013 in Fars Province, Iran

Original Article Geographical epidemiology of suicide and suicide attempts during the years 2010-2013 in Fars Province, Iran Gorgi Z, MSc1, Sheikh Fathollahi M, PhD2, Vazirinejad R, PhD3, Rezaeian M, PhD4* 1- MSc in Epidemiology, Dept. of Epidemiology and Biostatistics, Medical School, Rafsanjan University of Medical Science, Rafsanjan, Iran. 2- Assistant Prof., Dept. of Epidemiology and Biostatistics, Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 3- Professor, PhD of Epidemiology, Social Determinants of Health Research Centre, Medical School, Rafsanjan University of Medical Science, Rafsanjan, Iran. 4- Professor, Dept. of Epidemiology and Biostatistics, Occupational Environmental Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. Abstract Received: November 2015, Accepted: February 2016 Background: One of the important aspects of the epidemiologic study of suicide and its related behaviors is the identification of suicide methods. This study aimed to investigate the geographical epidemiology of suicide and suicide attempts in Fars Province located in Southwestern Iran during the years 2010-2013. Materials and Methods: The present study was conducted on 17,342 suicide and suicide attempt cases in Fars Province. To collect the data, the monthly suicide prevention program checklist was used. Data were analyzed using the SPSS software, R software, and ArcGIS software. Using Bayesian hierarchical models, the standardized mortality ratios (SMRs) were prepared and calculated according to the common suicide and suicide attempt methods. Results: On average, the suicide rate in Fars Province was 3.85 in one hundred thousand people per year. The geographic pattern of suicide in the mentioned province showed that the highest rates of hanging were reported in the cities of Firuzabad, Farashband, and Larestan, Iran, and the highest rates of self-immolation were reported in cities of Mamasani, Shiraz, and Firuzabad, Iran. Conclusions: Despite the low rate of suicide in the cities of Fars Province, the rate of suicide-related behaviors, including suicide attempt and suicide by violent and deadly methods, was high in some areas of the province. Therefore, restricting access to lethal means and methods of suicide and planning to identify areas with high risk for suicide in the province is necessary. Keywords: Epidemiology, Suicide, Suicide attempt, Iran. Introduction multidimensional phenomenon and its preventive programs (3). Previous studies have Suicide is a social and mental health disorder shown that geographical shifts, especially in and is considered as a serious public health the access to suicide* methods that may affect issue; thus, it has gained attention in the first Archivethe ofrate of regionalSID suicides do exist. For and second levels of healthcare (1). example, it has been shown that stricter One of the important aspects of the restrictions and laws on access to (4) and epidemiologic study of suicide and its related keeping firearms at home (5) have been behaviors is the identification of suicide associated with decreased rate of regional methods. The International Association for suicide by firearms in the United States of Suicide Prevention (IASP) has stressed that if America. access to the means and methods of suicide were limited, the number of suicide cases * would decrease dramatically (2). Corresponding author: Mohsen Rezaeian, Dept. of Epidemiology and Biostatistics, Occupational For this reason, the World Health Organization Environmental Research Center, Medical School, (WHO) has emphasized the investigation of Rafsanjan University of Medical Sciences, Rafsanjan, Iran. the methods and practices used for this Email: [email protected] 224 JOHE, Autumn 2014;www.SID.ir 3(4) Gorgi et al There are many methods for committing suicide prevention program checklist was suicide and its related behaviors. The use of used. This checklist consisted of two parts. some of these suicide methods such as the use The first part was related to personal of firearms, jumping from height, use of cold demographic information such as age, gender, weapons, and poisoning by narcotics and occupation, education, marital status, and drugs were more common due to their residence location. The second part was availability and ease of use (6). In Italy, the related to information regarding other most common methods of suicide are hanging variables related to suicide and suicide and jumping from heights (7). The most attempt, which included the history of suicide common method of suicide among women in attempts, physical and mental illness history, the USA was use of drugs and poisons, while suicide method, season, year, data source, and men more often used firearms to end their own the result of suicide. In order to maintain life (8). confidentiality, the individual’s name, address, Drug intoxication and overdose were the most and phone number were not used. common methods of suicide in Iran due to After collecting and coding the data, they were easy access or lack of decisiveness (9). In a entered into SPSS software (version 21, SPSS study in Iran, self-immolation was the most Inc., Chicago, IL, USA) for analysis and common method of suicide among women and calculation of the frequency of the most the use of firearms and hanging were the most common methods of suicide and suicide common methods among men (10). However, attempts in Fars province. It should be noted the results of a study showed that hanging and that due to the reduced frequency of some the use of firearms among men and self- methods of suicide and suicide attempts, the immolation and hanging among women were most common methods of suicide and suicide the most common methods of suicide in Fars attempts were examined. To map out the Province in Southwestern Iran (11). geographical distribution according to Due to an increase in suicide-related behaviors common methods of suicide and suicide in recent years in Iran, the identification and attempts, the frequency of the most common investigation of its geographical patterns can methods were first calculated according to help to prevent and control this health gender. Nevertheless, the frequency of problem. This study with a broader perspective common methods in terms of gender were low aimed to investigate the geographical in some cities; therefore, the most common epidemiology of common methods of suicide methods of suicide (self-immolation, use of and suicide attempt in Fars Province during drugs, and hanging) and suicide attempts (use the years 2010-2013. of drugs, pesticide poisoning, use of cold weapons) were generally determined at the Material and MethodsArchive provincial of level, SID and then, in the 27 cities of the province. Then, for each of the three This descriptive study was conducted to common methods of suicide and suicide determine the geographical epidemiology of attempts, raw standardized mortality ratio common methods of suicide and suicide (SMR) was calculated using indirect method attempt in Fars Province using census method. based on the following formula: The study population consisted of all cases of SMR = The number of observed cases/The suicide and suicide attempt referred to number of expected cases healthcare centers (emergency hospitals, and The number of expected cases was calculated forensics of the provinces) in the 27 cities of using the following formula (12): Fars Province since the beginning of the year The number of expected cases = (The number 2010 until the end of 2013. To collect data on of cases in the province/Population of the suicide and suicide attempt, the monthly province) × The population of the city 225 JOHE, Autumn 2014;www.SID.ir 3(4) Geographical epidemiology of suicide and suicide attempts In order to calculate the rate of suicide and hierarchical models and smoothed SMR (12) suicide attempts, the demographics were calculated to separate the common information of the 2012 census was used (13). methods of suicide and suicide attempts. The Due to the small population and reduced Bayesian hierarchical models for observed incidence of suicide in some cities and also to cases of suicide were based on the Poisson show a clear spatial pattern of suicide and assumption which allows the possibility of suicide attempt before mapping (14), Bayesian random effects for nonstructural diversity (heterogeneity in all regions of the area under suicide and suicide attempts were selected on consideration) and structural variation (the the map. In other words, the two ends of this correlation between neighboring areas) (14, spectrum were identified by different colors 15). Bayesian hierarchical models were that gradually turned to bright and lighter estimated using Markov Chain Monte Carlo colors. Dark blue represented the "areas with (MCMC) methods in R software (version the lowest risk", while dark red represented the 3/1/2, R Core Team, Vienna, Austria) (12). "areas of greatest risk" and yellow represented Subsequently, the divergent design of colors the middle class (16). that represented the wide range of SMR for Table 1: Frequency distribution of the most common methods of suicide based on gender in Fars Province during the years 2010-2013 Female N (%) Male N (%) Self- Drug Self- Drug Cities Hanging Hanging immolation consumption immolation consumption Abadeh 1(6.7) 1(0.6) 1(1.1) 0 1(1.4) 1(1.0) Arsanjan 0 0 1(1.1) 2(2.7) 0 0 Estahban 0 0 1(1.1) 0 2(2.7) 1(1.0) Eqlid 1(6.7) 0 2(2.2) 1(1.4)

Load more