Uncorrected Proof Hormozgan Med J. In Press(In Press):e103041. doi: 10.5812/hmj.103041. Published online 2020 November 11. Research Article Trend of Incidence Rate of Suicide and Associated Factors in 2011 - 2015 in Zarand, Iran Behnaz Aflatoonian 1, Mohammad Reza Aflatoonian 1, Habibalah Khanjari 2, Reza Mirzahosini Zarandi 3 and Parisa Divsalar 4, * 1Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran 2Zarand Governorship of Kerman, Kerman, Iran 3HSR Research Committee, Kerman University of Medical Sciences, Kerman, Iran 4Neuroscience Research Center, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran *Corresponding author: Assistant Professor, Neuroscience Research Center, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Email: [email protected] Received 2020 March 28; Revised 2020 June 27; Accepted 2020 July 21. Abstract Background: The study of suicide and identification of mental health problems, social, cultural, and environmental communities are effective for preventive measures and reducing risk factors. Objectives: This study aimed to study the epidemiology of suicide and its associated factors over 2011 - 2015 in Zarand. Methods: In this observational-epidemiological study (cohort study), all people who committed suicide in 2011 - 2015 were recorded on a standardized questionnaire, and demographic data of Zarand were collected by the health center and government. Data were analyzed by SPSS software using descriptive statistics, Chi-square tests, and logistic regression analysis. Results: During 2011 - 2015, 2,401 persons (372 at one hundred thousand) committed suicide, of whom 33 cases (5.1 at one hundred thousand) died. Chi-square and logistic regression information showed suicide attempt rate in people with middle school educa- tion was 15.7 times greater than less or more educated ones; similar results showed the rate of suicide of the people in the age group 15-29 was 6.3 times higher than other age groups, retired, and unemployed 3.1 times more than employed and finally, urban living had suicide attempt rate of 1.6 times higher than rural living. Conclusions: In Zarand, the incidence of suicide is much higher than the global, country, and province average (more than three to four times), and leading to death was much less than expected. However, there are significant differences in the cause and manner and demographic characteristics with other studies, which require the creation of Suicide Registry Center (SRC) and qualitative studies with form layer analysis of causes in Zarand. Keywords: Epidemiology, Suicide, Risk Factors, City of Zarand 1. Background altruistic suicide due to an extreme knit correlation of a person with other society members. Third, anomic suicide The World Health Organization (WHO) describes sui- occurs when there is a lack of control over society norms cide as a known endeavor with a fatal end attempted by a and disillusionment. Fourth, fatalistic suicide, which is person aware of this consequence (1). Suicide is a mental due to destiny with heavy and permanent limitations that health problem, and the third reason for death in the age make life fruitless (3). range of 15 to 44 years old, estimated to be at 1 million peo- ple annually (2). From the viewpoint of sociologists and by In contrast to sociologists, psychologists further con- definition of Emile Durkheim’s–top sociologist- suicide is centrate on personal characteristics, and they consider sui- applied to every case of death, which results directly or in- cide’s origin in the psychological state of people (4). Sui- directly from a positive or negative act carried out by the cide motives are categorized into three areas of mental victim himself, knowing that it will produce this result. In disorders, social issues, and somatic illnesses, or in illness this view, four sorts of suicide based on levels of balance in classification, suicide is in the group of violence and in sub- social force, social solidarity, and moral conscience are as- group of self-directed violence. Based on the outcomes of sumed. First, egoistic suicide occurred when an individual a person’s action, suicide is classified into two groups of was detached from others in his/her community. Second, attempted suicide and fatal suicide (5,6). WHO reports, Copyright © 2020, Hormozgan Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Uncorrected Proof Aflatoonian B et al. 804,000 occurrences of suicidal deaths in 2012 when the 3. Methods suicide was regarded as the second cause of death at the age group of 15 to 29 years old worldwide (7). On the other This study is an observational-epidemiological study hand, reports of the year 2000 revealed that 1,000 cases (cohort study). Full particulars of suicide attempters who of suicidal deaths occurred daily where attempted suicide referred to hospitals, health centers, public and private was 8 to 10 times more. World Health Organization es- clinics in Zarand during 2011 - 2015 were recorded using a timates approximately 1,500,000 cases of suicidal death, standard questionnaire. The inclusion criteria were all lo- and 10 to 20 times more than this figure, attempted suicide cal people who admitted to having suicide (either them- in the year 2020. This estimation shows that by 2020, sui- selves or the parents) and non-locals, non-admission of sui- cide occurrence will increase approximately 4 times than cide, and the people who pretended to commit suicide by the year 2000 (8). Studies associated with suicide in Iran doctor’s diagnosis and people who did not provide infor- show the prevalence rate of 6.7 cases per 100,000 people; mation (i.e., why, how, etc.) were excluded from the study. therefore, Iran in WHO reports is considered a country Meanwhile, complete information on all suicide cases re- with a low level of suicide (9). Nevertheless, the rate of at- ferred to hospitals, public and private clinics, and those tempted suicide is estimated to be 60 to 130 per 100,000 who did not go to the above-mentioned places, includ- persons. The most dominant method of suicide in men ing frequency distribution of suicide cases throughout the was hanging and in women was self-emollition (7), and the years 2011 - 2015 with the support of the governorate of most prevalent grounds were low education level, unem- Zarand, were collected. Data included age, sex, education, ployment, and mental disorders (9). The predominant ar- employment status, marital status, place of residence, date eas were Iran western Kurdish provinces, especially rural of attempt, reason, and method of suicide. On the other areas, as post-war possible complications (10). Most stud- hand, basic population data of the Zarand, including dis- ies in Iran are conducted using a problem-expressing ap- tribution of age, gender, educational level, marital status proach and with descriptive studies on personal character- and residential place in the city was obtained from the na- istics (7, 11, 12). tional statistics office and census data and city’s health cen- ter and estimated according to the growth rate of popula- tion in stated years. Data were entered into SPSS software version 22 and firstly analyzed using 4W’s (Who, When, 2. Objectives Where, and Why) descriptive statistics. Chi-Square and lo- gistic regression were used to determine the relative risk The suicide rate in Kerman province and Zarand are re- of affecting factors. Furthermore, the mean and ratio dif- ported to be 3.1 and 7.3 cases per 100,000 persons, and with ference were used to compare the incidence rate among an estimated rate of 10 to 20 times, it is expected that at- groups, including age, gender, occupational, educational, tempted suicide in Zarand is something between 70,000 residential place, suicide location, and suicide time. The to 140,000 cases. The age group of 20 to 24 years had the current study was verified by the Ethics Committee of Ker- most cases, and suicide cases in men were twice more than man University of Medical Sciences (IR.KMU.REC.1394, 275), women (13). In a study on suicide attempts conducted in and all necessary prerequisites, regarding the confiden- the city of Jiroft, 95 percent of suicide cases used drugs and tiality and safekeeping of people’s information were taken poisons; moreover, 48 percent of suicide cases were due to into consideration. domestic fights and spouse’s conflicts, and 30 percent of cases were related to mental disorders (14). The increasing 4. Results trend of this portentous phenomenon in the country and in province urges further precise and expansive inquiries. Collectively, from 2011 to 2015, 2041 (372 cases per On the other hand, it is necessary to advance the studies 100,000) cases of attempted suicide and 33 (5.1 per from a problem-expressing approach to causal layered net- 100,000) cases of deaths were reported. The annual aver- work and social epidemiology models. age rate of suicide attempts was 372 ± 31, and those who led The city of Zarand is located 108 kilometers far from the to death were 5.1 ± 1.6 per 100,000 population. The high- capital of Kerman province, with a population of 130,000 est rate of suicide attempts and completed suicide were people, two hospitals, six urban health centers, and nine in 2011 and 2013, respectively. From 2011 to 2015, the sui- rural health centers (15). Since Zarand is one of the riskiest cide attempts rate continued to decline, and on average, areas in suicide; therefore, the current study aimed to de- one in 71 cases of suicide attempt was fatal (Table 1).