Trends of Suicide Attempts and Completed Suicide in Ilam Province of Iran; A Demographic Analysis Study

Suicide is defined as an intentional act of self-killing [1]. In 2015, there were 800,000 new recorded cases of suicide globally. The global incidence of suicide in same year was 10.7 per 100,000 people (13.6 men and 7.8 women). The rate of suicide in Iran has been reported to be 3.6 per100,000 people in both genders annually, that is lower than the global suicide rate [2]. Therefore, suicide is serious public health concern that needs more attention. Previous report in Ilam province has shown that the suicide rate was 19.53 per 100,000 in 2016 [3]. Previous studies revealed that suicide is more common in men [4]. Others have shown that suicide occur more oftenly in older people [5, 6] . The 15-24 aged groups has been reported to have the highest rate of suicide per 100,000 people in Iran [7]. The purpose of the study was to investigate the trend in suicide rate according to the age and gender and also to compare the suicide rate between different age and gender groups in Ilam.
In this cross-sectional study, the total number of attempts and completed suicides during a 6-year period from 21 March 2011 to 21 March 2017 were included in the current study. Data was derived from the systematic registration suicide data (SRSD) which collects official statistics from the Ilam University of Medical Sciences. In the second step, completed suicides were added to SRSD by Forensic Medicine Organization. The incidence rate was calculated per 100,000 populations per year. The incidence was also compared between age and gender groups. All analysis was performed using statistical software package STATA for Windows version 11.2 and statistical package for social sciences (SPSS Inc., Chicago, Illinois, USA) version 21. Data are presented as mean ± SD and proportions as appropriate. A 2-sided p-value of less than 0.05 was considered statistically significant.
The attempts and completed suicidal rates by gender are shown in Table 1. Attempts; the results indicate that the attempts in men ranged from 177.9 to 172.2 per 100,000 populations per year in the study period. The highest rate occurred in 2012 (232.0 per 100,000) and lowest in 2014 (168.0 per 100,000). Attempts in women ranged from 221.1 to 144.9 per 100,000 populations per year in the study period. The highest rate occurred in 2011 (272.2 per 100,000) and lowest in 2016 (144.9 per 100,000). The overall attempts rate was higher in women compared to men (219.4 per 100,000) and (191.1 per 100,000), respectively. The total number of attempt in the 6-year period was 205.2 per 100,000 in both genders. Suicide rate in period of the study in men was reported to be 24.0 in 2011 to 17.9 in 2016 per 100,000 populations; also this rate in women was between 16.2 in 2011 to 7.3 in 2016 per 100,000 populations. The incidence rate of the completed suicide was significantly higher in men compared to women (18.7 vs.14.3 per 100,000 per year; p=0.003).

Table 1. Attempts/completed rates by gender in Ilam province between 2011 and 2016.

 ^aper 100,000 people

Figure 1 shows the trends in suicide by age and in both genders from 2011 to 2016. The attempts and completed suicidal rates by all age groups is shown in Table 2. The highest attempts rate per 100,000 people was observed in 15-24 age groups (663.4 per 100,000) and the lowest was observed in <15 age groups (18.4 per 100,000). The overall suicide rate per 100,000 people in <15, 15-24, 25-44, 45-64, and 65+ year age groups were 0.50, 33.9, 18.8, 12.7 and 28.8, respectively. Trend of suicide and attempt per 100,000 people between 2011 and 2016 are shown in Figure 2. Trend analysis demonstrated that attempts rate significantly decreased during the study period (r = -0.82, p=.043). Also the variations of completed suicide in the time period of the study decreased significantly (r = -0.53, p=.048).
In the current study we have demonstrated that the incidence rate of both attempts and completed suicides decreased significantly during the 6-year period of the study. Our results showed that in all years of study period (expect 2016) the rate of attempts was higher in women compared to men. The results are consistent to current trend of attempts in Iran according to existing literature. In one study that conducted in Hamadan province in 2012, it was demonstrated that majority of attempts occurred in women [8]. In Zahedan city, in 2014, 65%, and in Kermanshah city 62% of attempts were women [9, 10] . Some factors have been shown that related to more frequency of attempts in women including, hormonal changes especially in girls [11], and severe morbidity of mental disorders in women [12].
Our results demonstrated that attempt rate per 100,000 was decreasing in over the time period of the study in both genders (2011-2016). This finding is consistent to global trend of suicide [2]. The important global strategies leading to reduced suicide rate include the restrictions and limiting access to pesticides, and development of medical emergencies toward suicide [13]. According to our finding the highest attempts and completed rates was observed in 15-24 age groups and, the lowest was observed in <15 age groups. Previously, similar results have been reported from different geographic and ethnic regions of Iran [7-9] . Socioeconomic factors such as educational level and income level was the important factors related to suicide in Iran [8, 9] . In place of our study inequality in age between attempters [14] and also inequality in addiction and mental disorders has been reported [4]. In USA, some factors were linked to the high prevalence of suicide in young people aged 15-19 including school concerns. Legal/disciplinary problems, Family conflict, and mental health conditions such as depression  [15].

Fig. 1. The distribution of suicide by age in both genders.

Table 2. Attempts/completed rates by age groups in Ilam province between 2011 and 2016.

 ^aper 100,000 people

Fig. 2. Trend of attempts/completed rates per 100,000 people in Ilam province between 2011 and 2016.

In conclusion, our results demonstrated that the incidence rates of both completed and attempts of suicide have decreased significantly from 2011 to 2016 in Ilam province of Iran. The completed rate of suicide was significantly higher in men when compared to women.

Conflict of Interest: None declared.