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Incidence of Suicide in East Azerbaijan Province, Iran

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Incidence of Suicide in East Azerbaijan Province, Iran Zeinalzadeh A-H et al. Original Article Incidence of suicide in East Azerbaijan Province, Iran Ali Hossein Zeinalzadeh1*, Somaieh Saiyarsarai2, Ali Jafari-Khounigh3, Joaquim J.F. Soares4 1Social Determinants of Health Research Center, Associate Professor of Preventive and Community Medicine Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2Medical student, Tabriz University of Medical Sciences, Tabriz, Iran. 3MSc in Epidemiology, Azarshahr Network of Health and Treatment, Tabriz University of Medical Sciences, Tabriz, Iran. 4Professor, Department of Health sciences, Section of Public Health Science, Mid Sweden University, Sundsvall, Sweden. Corresponding author and reprints: Dr. Ali Hossein Zeinalzadeh MD MPH. Social Determinants of Health Research Center, Associate Professor of Preventive and Community Medicine Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Email: [email protected] Accepted for publication: 16 April 2016 Abstract Background: Suicide is a major problem world-wide. The aim of the present study was to etermine the incidence of suicide in East Azerbaijan province, Iran. Methods: The study used collected data from the Systematic registration within East Azerbaijan province from 2010 to 2011. We analysed some characteristics of the cases of suicide based on the health system database. Variables such as demographics, outcomes (fatal/nonfatal), and methods used were recorded. Data was analysed using Chi-square and T-test. Results: A total of 3,768 reported cases of suicide were analysed. More cases were reported from married people. The incidence rate of suicide was 101.3 per 100,000. Most of the attempted suicides were observed in younger people. The number of attempted suicides was higher in women (63.7%) than in men (36.3%). The most frequent method of commiting suicide in both sexes was drug overdose. A statistically significant relationship was observed between suicide’s outcome and gender, job, marital status, and education (P<0.001). The case fatality rate among males was significantly higher than that in females (OR=3.7, 95% CI: 2.5–5.8). Hanging (72.3%) and drug overdose (0.9%) had respectively the highest and the lowest case fatality rates. Drug overdose was slightly more frequent among women than in men (91.3% versus 84.2%). The rate of poisoning increased gradually until the age-group 45-54 years. Also, drug overdose was more prevalent among single individuals than in married people. Conclusion: Due to the high incidence of completed suicides, it is recommended that counselling centres be established for mental ill-health, especially a suicide hotline with appropriate availability to all population. Keywords: Attempted suicide; Completed suicide; Epidemiology; Incidence Cite this article as: Zeinalzadeh A-H, Saiyarsarai S, Jafari-Khounigh A, J.F. Soares S. Incidence of Suicide in East Azerbaijan Province, Iran. SDH. 2016;2(2):61-69. Social Determinants of Health, Vol.2, No.2, 2016 61 Suicide in East Azerbaijan Province, Iran Introduction Multiple factors such as age, gender, race, Suicide is a major public health, mental, religion, marital status, job, drug abuse, and and social problem, which increases in mental and physical diseases are regarded as many societies due to complicated relations risk factors of suicide (2, 15). In fact, the risk and interactions (1, 2). Based on a World factors of suicide, and consequently how to Health Organization (WHO) report, suicide manage it are different in different societies is the 5th leading cause of death for people because it indicates a reflection of the mental aged 15-29 and 30-44 years. It was also the and cultural history of the society (5, 16, 17). 16th cause of death world-wide in 2004. It Although most efforts in reducing suicidal is estimated that committing suicide will thoughts and attempts to suicide have so far rise to the 12th place among top causes of been unsuccessful (2, 18), obtaining reliable mortality in 2030 (3). In the United States, information about epidemiology of suicide suicide is the second leading cause of death is very important for decision making and in people aged 25-34 years, and the 10th preventive strategies (2, 5, 16, 17). leading cause of death overall in 2010 (4). Having in mind these notes, the incidence rate Moreover, it is the 2nd leading cause of death of total suicide (attempted and completed) for people aged 15-34 years in Europe (5). and related factors in East Azerbaijan Published statistics of WHO indicates that Province was not reported to date. The aim suicide prevalence is 16 per 100,000 people of the present study was to determine the globally (6). Thus, about one million people epidemiology of attempted and completed annually attempt suicide world-wide. Several suicides in East Azerbaijan province, Iran. studies have reported that an attempted suicide occurs every three seconds, and on Methods average one attempted suicide takes place The present study used completed and every 40 seconds and every day 1,000 attempted suicide data collected by people die by suicide in the world (7, 9). the Systematic registration within East Similarly, investigations regarding the two Azerbaijan province. The study area is one last decades in Iran indicate that attempted of the largest health regions in the northwest and completed suicides are growing in of Iran, with a population of about 3,691,270 most regions of the country, particularly million. This province has 19 counties with among adolescents (10). However, in most independent health and treatment networks. countries, due to a variety of legal, religious, Each district health centre has a mental ethnical, and cultural factors, the actual health section, which routinely collects data cases of suicide is not publically reported on suicide events from various resources (11-13). In addition, most of the people and such as the rural and urban health centres, families repudiate the occurrence of suicide general and mental hospitals, forensics, and because of social stigma and attribute it to the death registration system. Finally, data coincidences (11). Since suicide is not is sent to the health centre of the province compatible with Iranian cultural values, where they organize the data again and under-reporting in Iran appears to be a valid double-check the data entry. In the present claim (14). study, data from all completed suicide Social Determinants of Health, Vol.2, No.2, 2016 62 Zeinalzadeh A-H et al. cases accessible at the health centre of the completed suicide, 62.8% were males, Province from March 20, 2010 to March 52.9% aged 15-24 years, and 51.9% were 19, 2011 were analysed. We had access to married. About 85.2% of the cases occurred the primary data of suicide in the health among those aged <35 years and only 3% centre of the province and included all cases were among those aged ≥55 years. There of attempted and completed suicides. The were more reported cases among married Ethics Committee of Tabriz University of than among single individuals (51.9% versus Medical Sciences approved the study (Code 47.8%), although data about marital status no. 90/1-6/7). was missing for 11 cases. Variables such as demographic data (sex, There was a statistically significant difference age, job, education, residency, seasons of between marital status and suicide outcome year, mental disease background, history of (P<0.001). In addition, drug overdose previous suicide, and marital status), outcome (88.7%) was the most commonly used (fatal/nonfatal), and the method used were method in attempted/completed suicides recorded. In case of incomplete information, followed by poisoning (4.9%) and hanging patients’ families were contacted on phone or (1.7%). The other variables studied were using their addresses in order to complete the level of education, job, residency, suicide information. All data related to the cases were method, and history of mental and physical assured to remain confidential. diseases. There was a significant difference After removing repeated cases, data was between each of these variables and suicide inserted into Statistical Package for the outcome (fatal/nonfatal) (P<0.001). There Social Sciences (SPSS), version 16 columns was also an association between history and were analysed. Descriptive indices were of previous suicide and suicide outcome calculated and reported. Qualitative variables (P<0.05). The highest rate of suicide occurred were compared using the Chi-square test and in the summer (31.7%) and the lowest in the quantitative data was analyzed using T-test. winter (19.2%), but the difference was not All P-values were two-sided with P<0.05 statistically significant (P=0.6).There were considered as the level of significance. 101 completed suicides with a case fatality rate of 2.7%. The fatality rate among males Results (4.9%) was significantly higher than that A total of 3,768 reported cases of suicide among females (1.3%) (OR=3.7, 95%CI: (attempted and completed) were studied. 2.5–5.8). The three most commonly used From among these cases, 3,665 (97.3%) were methods among the reported fatal cases were collected from hospitals, 85 (2.3%) from hanging (46.5%), drug overdose (29.7%), forensics, and 18 (0.5%) from health care and self-burning and poisoning together centres. The total incidence rate was 102.07 (5.9%). The calculated case fatality rates for per 100,000 people in East Azerbaijan. This the different methods of suicide showed that rate was 99.34 and 2.73 per 100,000 people hanging (72.3%), self-burning (60%), and for attempted and completed suicides, jumping off (50%) were significantly more respectively. likely to lead to death than the other methods As shown by Table 1, of those who attempted/ (P<0.001). Poisoning had the lowest case Social Determinants of Health, Vol.2, No.2, 2016 63 Suicide in East Azerbaijan Province, Iran Table 1.
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