Disaster and Emergency Medicine Journal

2023, Vol. 8, No. 1, 27–32

ORIGINAL ARTICLE DOI: DEMJ.a2023.0001
Copyright © 2023 Via Medica
ISSN 2451–4691, e-ISSN 2543–5957

SUICIDE ATTEMPTS, SUICIDE AND THEIR ASSOCIATION

WITH SOCIO-DEMOGRAPHIC VARIABLES IN IRAN:
A RETROSPECTIVE, REGISTRY-BASED,
COHORT STUDY (2016–2021)
Arash Ziapour1 , Francesco Chirico2 , Gabriella Nucera3, Sepideh Soltanipour4,
Asghar Moradgholi4, Javad Yoosefi Lebni5 , Parisa Janjani1 , Vahid Hatami Garosi4
1
Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
2
Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
3
Department of Emergency, Fatebenefratelli Hospital, ASST Fatebenefratelli and Sacco, Milano, Italy
4
Kermanshah University of Medical Sciences, Kermanshah, Iran
5
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran

ABSTRACT
INTRODUCTION: Suicide is recognized as one of the most significant concerns in healthcare and a serious
psychological health issue in many countries throughout the world. Suicide attempts occur in all social
sectors and demographics. It is important to know what are the causes for people to try to commit suicide
for an effective prevention and control. The aim of this review was to find out the levels and predictors
of suicide attempts.
MATERIAL AND METHODS: A cross-sectional descriptive-analytical research looked for suicide attempt re-
ported cases at Dr. Moaven Hospital in Sahneh, Iran, during the 2016–2021 period. Data was collected via
checklists completed by supervisors during referrals and subsequently analyzed using the SPSS Statistics
software tool (version 24). Descriptive statistics and the Chi-square test were used. A significance threshold
of 0.05 was used.
RESULTS: A total of 1,059 cases of suicide attempts were found. The highest prevalence rate was reported
in the group ages 16–25. Males had higher rates of cases (57.4%), which were twice more prevalent in
cities and more common in lower-socioeconomic-status families Furthermore, the most common method
used (79.5%) was medication intake. There was also a significant association between marital status, job,
and suicide-attempt rates (p < 0.05).
CONCLUSIONS: Suicide attempts are among the most important issues in terms of psychosocial healthcare
in all countries and communities, and their prevalence rates may be determined by a variety of factors, such
as mental health status, family and living conditions, financial problems and unemployment rate. Preventive
control of these factors can contribute to reducing the prevalence of these acts.

KEY WORDS: suicide; suicide attempt; prevalence rate; risk factor; prevention
Disaster Emerg Med J 2023; 8(1): 27–32

ADDRESS FOR CORRESPONDENCE:

Vahid Hatami Garosi, Kermanshah University of Medical Sciences, Kermanshah, Iran
e-mail: hatami.vahid92@gmail.com
Received: 22.10.2022 Accepted: 23.01.2023 Early publication date: 22.02.2023
This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download
articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Copyright © 2023 Via Medica, ISSN 2451–4691, e-ISSN 2543–5957 27

 DISASTER AND EMERGENCY MEDICINE JOURNAL 2023, Vol. 8, No. 1

INTRODUCTION ing the most commonly mean used in both genders

Over the years, researchers have identified suicide [23]. In another study, 82.7% of people who tried
as one of the major psychiatric crises [1] and one of suicide had moderate or severe depression classified
the most frequently reported challenges in the field and the major risk factors are were family problems,
of health care [2, 3]. Suicide has been described by mental illnesses, unemployment, and financial prob-
the World Health Organization (WHO) as a con- lems [22, 24].
scious and intentional act in which a person termi- In this regard, Behirooz and Haghayegh showed
nates his or her own life [3, 4]. A suicide attempt is in Kermanshah, a western Iranian province, a high
when someone harms themselves with any intent prevalence rate of suicide attempts, accounting for
to end their life, but they do not die as a result of 11% of all cases documented in Iran in 2006, rank-
their action. Suicide and suicidal ideation have been ing third behind Tehran and Ardabil provinces [4].
identified as public health concerns [5, 6]. Every Moreover, researches in various regions of Iran over
year, more than 800,000 individuals worldwide the past two decades showed high prevalence rates
commit suicide [5, 7]. It is also the third major cause of suicide attempts, particularly among young peo-
of mortality among adolescents aged 10 to 24 [8] ple and adolescents [9]. Another survey found that
and the eighth cause of adult mortality in various young people aged 15 to 25 years had the highest
countries. In the last 50 years, suicidal deaths are prevalence rate of suicide, with 52% of the cases
more prevalent than accidents, with thousands of in- in males, whereas 68.1% of them showed previously
dividuals committing suicide every day. The number one or more suicide attempts [25]. There are many
of suicide attempts is increasing [9, 10], showing determinants of suicide attempts, which policymak-
rates 10–40 times higher than the number of deaths ers need to understand in order to establish effective
from suicide. Suicide occurs in all socioeconomic strategies against this issue. For this reason, the
groups, yet the incidence of suicide attempts is higher aim of this study was to study prevalence rates and
in women than in men, while completed suicides social determinants of suicide and suicide attempts
are higher in males [11]. In Iran, the prevalence of in a sample of individuals presented at the emergency
suicide attempts is 9.4%, with a mean age of 29, department in Sahneh, Iran.
which is lower than in Western nations [12].
The reasons for suicide attempts are various,
but they may be classified into three main catego- MATERIAL AND METHODS
ries: mental diseases, social challenges, and physical Study design and procedure
conditions [13–15]. Depression, alcoholism, drug In this retrospective, registry-based, cohort study,
addiction, schizophrenia [16, 17], and personali- a convenience and purposive sample, random-
ty disorders have been identified as relevant risk ly drawn, of all suicide attempts reported from
factors for suicide attempts [18, 19]. In relation 2016 to 2021 at the emergency department of the
to social factors, the primary causes are isolation, “Dr. Moaven” Hospital in Sahneh, Iran, were collect-
deprivation, separation, and unemployment [20]. ed. This study was authorized by the Ethics Commit-
Physical diseases or health-related issues, malignant tee of Kermanshah University Medical Sciences with
tumors, neurological disorders, and low levels of the number IR.KUMS.REC.1397.1064. An informed
serotonin in the brain have so far been recognized consent form was fulfilled and obtained by all par-
as key contributors in the domain of physical illness- ticipants.
es [21]. Risk factors and approaches to dealing with Before our group commenced the research,
suicide attempts differ from place to place since the main researchers of the teamwork visited the
this intentional act reflects the cultural-psychological study area for explaining research objectives and
background of the community where a person lives procedures to hospital officials and supervisors. The
[22]. According to an Iranian survey, 33.9% of sui- eligibility criterion was people admitted to the
cide attempters were single women, whereas 64.9% emergency department with a recent history (within
were single men. In addition, 43.4% of those sur- 48 hours since the entrance into the hospital) of sui-
veyed had a modest level of education, and 48.2% cide attempts, carried out with any means and result-
and 19.8% were males and females experiencing ing in death or not. All adults, previously healthy or
marital conflict Medications are the most commonly affected by psychiatric comorbidities, aged 18 years
used method of suicide (88.5%), with sedatives be- and over from the general population were asked

28 www.journals.viamedica.pl
 Arash Ziapour et al., Investigating the prevalence rate of suicide attempts and their associated risk factors

Table 1. Frequency distribution of suicide attempts by socio-demographic data

Variable Group Male Female Pearson Chi-Square

Marital status Single 26.2% 18.8% p-value = 0.000
Married 15.6% 35.4% df = 3
89.302 = Chi-Square
Divorced 0.9% 2.5%
Widowed 0.0% 0.8%
Job Farmer 2.6% 0.2% p-value = 0.000
Worker 3.8% 2.2% df = 8
535.666 Chi-Square
Clerk 2.1% 0.8%
Student 7.2% 10.8%
Free 10.9% 1.5%
Jobless 13.5% 4.5%
Soldier 1.5% 0.2%
Housewife 0.7% 37.2%
Other 0.4% 0.1%
df — degree of freedom

to be included in this study and were administered cioeconomic conditions, people with poor financial
a medical interview and a questionnaire containing status (31.8%) attempted suicide more than others.
socio-demographic information (age, gender, fam- In one-third of the cases (30.7%) a mental
ily size, income, and educational levels) as well as disorder was diagnosed, and in more than half
medical information about general and psychiatric of the cases (54%), marital disputes were reported
disorders. Furthermore, means and outcomes of su- as the only life stressful event before the attempt.
icide attempts were drawn by medical interviews to In most cases (80.2%), we reported the first suicide
patients and witnesses. attempt and almost all patients (94.5%) did not have
In this research, the influence of socio- relatives attempting suicides in their medical history.
-demographic variables and the presence of psychi- In nearly two third of the cases (67.8%), without sig-
atric disorders and suicide attempts was explored, nificant differences between males and females, the
and the prevalence of this phenomenon was report- suicide attempts failed. The chi-square test revealed
ed the SPSS Statistics software program (version 24) a positive association between suicide attempts and
was used for elaborating frequency, percentages, gender (p = 0.037), employment status (p = 0.0001),
and descriptive statistics. Chi-square tests between and marital status (p = 0.001) (Tab. 1).
independent and dependent variables were carried
out. A significance level of 0.05 was fixed.
DISCUSSION
Our findings showed a higher prevalence of sui-
RESULTS cide attempts among adolescents and young peo-
Sociodemographic characteristics ple in Iran, in agreement with previous literature
From 2016 to 2021, a total of 1,059 cases of su- [1, 8, 11, 12, 26–28]. In this study, two-thirds
icide attempts were recorded at the Dr. Moaven of suicide attempts failed. Furthermore, we found
Hospital in Sahneh, Iran. 50.6% of the attempts an association between low socio-economic status
were made by people between the ages of 16 and suicide attempts, consistently with Moradi and
and 25, and 57.4% of them were males. Only 8.9% Mostafayi [29]. Prevalence rates of suicide attempts
of the participants had a university degree, while were higher in males than in females, in disagree-
the majority of them (31.1%) had a high school di- ment with some authors [29], and in agreement
ploma or lower educational level. Inhabitants of Sah- with other scholars [29]. As shown in the literature,
neh’s metropolitan regions tried suicide twice com- young males are more likely to commit self-injury
pared to those who lived in rural areas. In terms of so- and violent acts against third parties, due to their

www.journals.viamedica.pl 29
 DISASTER AND EMERGENCY MEDICINE JOURNAL 2023, Vol. 8, No. 1

90
79,3
80

70

60

50

40

30

20
11,3
10 2,6 2,5
2,4 0,4 0,5 1
0,1
0

FIGURE 1. suicide attempts by considering the means of the suicide attempt

impulsivity, especially during the puberty stage of more likely to commit suicide than single, divorced,
their life [29]. and widowed people because marriage is associat-
Our findings agreed with global reports as well ed with a variety of problems, such as unemploy-
as the findings by Salari Lak in West Azerbaijan ment, housing, and financial issues which could put
Province [30], Iran, and Hosseini et al. [11], Behirooz an additional psychological burden on them. Salari
and Haghayegh [4], Gholami Zarini et al. [21], Gho- Lak [30], Khazaei et al. [34], Emad and Hadianfard
drati and Taklavi [1], Bertolote and Fleischmann [9], [35], Ghalambor et al. [21], and Stefan-Dabson et al.
Kim et al. [25], and Gordon et al. [31] in other high- [23]. Our study has some limitations, as we analyzed
risk regions. In terms of literacy and education level, only some socio-demographic characteristics in our
patients with less education levels had greater inci- sample. In literature, suicide ideation has been also
dence rates of suicide attempts, which corroborated associated with a wide number of factors, including
with earlier findings in Iranian research, such as a family history of violence and child abuse, a history
the Miveban survey [32]. of mental health problems, traumatic events such as
Furthermore, medication intake (swallow- experiences of sexual assaults and rapes, workplace
ing medications indicated as “pills” in Fig. 1) was bullying, or traumatic life events and other stress-
the most common means of suicide attempt (79.3%), -related events [36]. All these factors should be con-
in agreement with previous research this fact is con- sidered in future studies as potential risk factors for
sistent with previous research that reported 88.5% suicide attempts, even if the relationship between
[32]. In our study, men were more likely than wom- suicide ideation and suicide attempts is complex.
en to use irreversible methods of suicide, such as Furthermore, the role of the COVID-19 pandem-
hanging, by confirming findings by Yasemi et al. [33] ic due to restrictions and lockdown measures,
in Kerman Province, Iran. fear of contagion, and the high burden of stress-
In agreement with Yasemi et al. [33], the relation- -related disorders among healthcare workers and
ship between the location of the suicides and gen- other essential workers should be considered in fu-
der was not significant, whereas their work positions ture studies. While increased levels of pandemic-
were strongly correlated with suicide attempts. Cu- -related anxiety and depression have been described
riously, unemployed males and housekeepers were among young and old people around the world, among
more likely to commit suicide, consistent with those living alone and the so-called “fragile”, who
the findings from Yasemi et al. [33]. are people affected by pre-existing mental health
A substantial association was also found be- problems, increasingly rates of adjustment disor-
tween marital status and the likelihood of suicide at- ders and post-traumatic stress disorders have been
tempt, showing how married women and men are also described among healthcare workers, who were

30 www.journals.viamedica.pl
 Arash Ziapour et al., Investigating the prevalence rate of suicide attempts and their associated risk factors

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