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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 16-21

Epidemiological study of attempted suicide among children and teenagers in Qazvin Province, Iran


1 Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
2 Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

Date of Web Publication24-Jul-2018

Correspondence Address:
Dr. Sonia Oveisi
Metabolic Diseases Research Center, Qazvin University of Medical Science, Bahonar Blvd, Qazvin
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_4_18

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  Abstract 


Introduction: Suicide in children and young adolescents up to 14 years of age has been increased in many countries. This study aimed to determine the incidence, gender difference, timing difference, and cause of suicide attempts among children and teenagers in Qazvin Province, Iran, between 2007 and 2012. Methods: A descriptive-analytic study was performed in a register-based manner. In total, 2771 children and teenagers with suicide attempts who were referred to urban or rural health centers, hospitals, and legal medicinal centers in Qazvin Province were recruited. The residential background, the cause of suicide attempts, and the nature of the suicide acts were assessed. Results: Among all the children who had suicide attempts, 32.12% were male and 67.88% were female (sex ratio 0.47). Most of the suicide cases happened in autumn, and 786 (28.37%) were between 20:00 and 24:00 h. Swallowing poisonous drugs was the most prominent suicide methods, while hanging was the most dangerous method. In addition, familial dispute was the leading cause of suicide. Conclusion: It is a largely complex issue why some children attempt or commit suicide. The understanding of the pattern of suicide can help us provide suitable preventive programs.

Keywords: Children, Iran, suicide, teenagers


How to cite this article:
Mahram M, Oveisi S, Hosseinzadeh-Milani M. Epidemiological study of attempted suicide among children and teenagers in Qazvin Province, Iran. Soc Health Behav 2018;1:16-21

How to cite this URL:
Mahram M, Oveisi S, Hosseinzadeh-Milani M. Epidemiological study of attempted suicide among children and teenagers in Qazvin Province, Iran. Soc Health Behav [serial online] 2018 [cited 2019 Nov 13];1:16-21. Available from: http://www.shbonweb.com/text.asp?2018/1/1/16/237423




  Introduction Top


Suicide is referred to conscious or semiconscious destruction of individual's life who chose suicide as the best method due to any mental illness and commit it.[1] A more detailed definition is: an act with a fatal outcome, which is deliberately initiated and performed by the deceased, in the knowledge or expectation of its fatal outcome, where the outcome has been considered by the actor as instrumental in bringing about desired changes in consciousness and/or social conditions.[2] Although suicide is extremely rare before puberty, globally, it has been estimated that about 4 million adolescents attempted suicide annually, resulting in approximately 100,000 deaths.[3] Suicide in children and young adolescents up to 14 years of age has increased in many countries, which urgently need comprehensive research and clinical awareness to prevent such devastating incident. Suicide rates in this young population have been reported between 0 and 3.1/100,000 in different countries, with a mean rate of approximately 0.6/100.000 pa with a male–female ratio of 2:1 worldwide.[4]

The vast majority of children and adolescents who performed suicide have some form of psychiatric illness such as schizophrenia, bipolar, and unipolar disorder.[5] The risk of successful suicide after one unsuccessful attempt has been reported to be around 10% over 5- to 35-year follow-up period.[6],[7] In some epidemiological studies, gender, age, and psychiatric disorders have been identified as risk factors.[8] To aid aftercare for individuals at high risk of suicide, the most attempted suicide methods should be assessed to avoid repeated suicide attempts.

This study aimed to determine the incidence of suicide among children and teenagers, taking into consideration gender, variables, and the cause of suicide attempts. The study focused on the data collected during 6-year period of time (2007–2012) in Qazvin Province, Iran.


  Methods Top


Data sources

This descriptive-analytic study was carried out as Qazvin Province register-based study (Iran). In total, 2771 children and teenagers with suicide attempts between 2007 and 2012 in Qazvin were investigated. Participants were referred to urban or rural health centers, hospitals, and legal medicine centers over the province. All personal information was treated confidentially, and this research has been approved by the Ethics Committee of Qazvin University of Medical Science.

Variables

The factors considered include certain personal data (age, gender, and residential information), the nature of the accident (method, time during the day, and seasonal pattern), the causes of suicide attempts, and the outcome of the attempt. The data were categorized based on age as follows: <10, 11–14, and 15–19 (n = 2771).

Statistical analysis

All data were analyzed using SPSS-19 (Armonk, NY: IBM Corp) Statistical Package for the Social Sciences [version 19] and STATA 12 (StataCorp, USA) software. P< 0.05 was considered statistically significant.


  Results Top


Over the 6 years, there was a high incidence of suicide attempts in children and teenagers in Qazvin Province from 2007 to 2012 [Table 1] and [Figure 1]. Furthermore, among the children who had attempted suicide, 32.12% were male and 67.88% were female with a male–female ratio 0.47 [Figure 2]. However, the difference of gender over the 6 years was not statistically significant (χ2 = 5.63, P = 0.344). In 2012, the teenagers between 15 and 19 years old had significantly more attempted suicide acts in comparison of the other age groups (χ2 = 20.29, P = 0.027). In addition, 15.92% of pupils lived in rural area and 84.08% were in urban area, suggesting higher suicide attempts in urban area [Figure 3]. The other findings show that 738 (26.63%) individuals who committed suicides were in autumn and 786 (28.37%) were between 20:00 and 24:00 h. The most prevalent suicide methods were drug poisoning and poisoning with toxins, although hanging was the most dangerous method. Among all causes of suicide, familial dispute was the most prominent complaint. Although suicide attempts are more prevalent in girls, the death rate is significantly higher in the boys (χ2 = 13.91, P = 0.001, [Appendix 1].
Table 1: Suicide attempts in children and teenagers, Qazvin province, Iran 2007-2012

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Figure 1: Trend of suicide attempts in children and teenagers based on age (per 100,000 population of age group), Qazvin Province (I.R. Iran), 2007–2012

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Figure 2: Trend of suicide attempts in children and teenagers based on gender (per 100,000 population of age group), Qazvin Province (I.R. Iran), 2007–2012

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Figure 3: Trend of suicide attempts in children and teenagers based on residential area, Qazvin Province (I.R. Iran), 2007–2012

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  Discussion Top


In this cross-sectional registry-based study, we assessed 2771 suicide attempts which have happened from 2007 to 2012 in Qazvin Province. It is quite clear that the girls had committed more suicide attempts than the boys.

Campi et al.[9] reported that the prevalence of suicide in Italian children and teenagers between 1973 and 2002 was 0.44 and 2.58/100,000 in 10–14 and 15–19 years old, respectively. The male–female ratios in the above-mentioned age groups were 2.54:1 and 2.64:1, respectively. The incidence was much higher in Iran with quite different gender preference from the western country, where girls are more likely to have such incident. The difference in social status of female gender between the two countries may play a role.

Furthermore, results of our study show that drug poisoning was the most frequently used among all reported methods, although hanging is more likely to succeed. This is consistent with another study which showed that individuals who had attempted suicide by hanging, strangulation, or suffocation had the worst outcome.[10] It seems that cutting was not associated with high suicide mortality rate than poisoning. This method usually represents a low intention of suicide of the individual and rather poor emotional regulation.[11] This is because cutting does not necessary lead to hospital admission.[12] The other methods on the contrary have a high risk of hospitalization for life-saving treatments, which also lead to higher success rate of suicide.[10] For the other methods such as gassing, jumping from a height, or drowning, the risks of success were significantly lower than that of hanging. Most of those who successfully committed suicide chose the same method as they had used at the initial attempt. In our study, 30 (3.8%) men and 26 (1.5%) women successfully committed suicide after the first attempt (hazard ratio 2.59, 95% confidence interval 1.5–4.4). Runeson et al. also confirmed that 258 (54%) men and 125 (57%) women successfully committed suicide after their first attempts (hazard ratio 6.2, 95% confidence interval 5.5–6.9).[10]

Suicide attempt is a very complex issue with so many variables taken into consideration. In the current study, familial disputes were the most common reason. The other studies showed that psychological diseases such as depression, anxiety, schizophrenia, bipolar, and unipolar disorder are the most prominent cause of suicide attempt in women and men (4.1 and 4.0, respectively). Alcohol misuse (women), drug misuse, and personality disorder are also contributing factors. However, those studies were carried out most in adult population, which may not be applicable in children and teenagers in Iranian population. The incident is high in the night when the activity is less likely to be discovered by the others. Seasonal preference is also prominent in this study where there was a high incident rate in the autumn. This may be related to the reduction of daylight time, which is also a cause of depression. The risks of suicide and all-cause mortality were extremely high among suicide survivors immediately after hospitalization for attempted suicide.[13] Unfortunately, a suicide attempt is a psychiatric disorder and a risk factor for a successful suicide.[5]

Many studies state that suicide prevention programs have significantly reduced self-reported suicide attempts.[14] Thus, it is essential to define the priorities and assess the potential to reduce the markedly rising rate of suicide in the last decade in Iranian children and teenagers.[15]

The limitations of this study included (1) inability to access the cases that had not been referred to the health centers or hospitals and (2) the bias of not giving information or true information around the cause of suicide attempt by the patients.


  Conclusion Top


The incident of suicides is increasing in Iran, and the girls are more likely to commit suicide than the boys. The mostly used method is drug poisoning, which is more likely to be adopted by the urban children. However, the reasons for such act are complicated. Understanding the pattern of suicide can help us design and provide suitable preventive programs to high-risk individuals.

Acknowledgments

This study was supported by the Vice Chancellor for Health and Curative affairs. The authors would like to thank the staff at the hospitals and primary health centers for reporting the data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sadock B, Kaplan SV, Sadock VK. Sadocks Synopsis of Psychiatry. Philadelphia: Williams and Wilkins; 2003. p. 1279-81.  Back to cited text no. 1
    
2.
Retterstøl N. Suicide: A European Perspective. Great Britain: Cambridge University Press; 1993.  Back to cited text no. 2
    
3.
Boris NW, Dalton R. Suicide and attempted suicide. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: W.B. Saunders; 2007. p. 124.  Back to cited text no. 3
    
4.
Dervic K, Brent DA, Oquendo MA. Completed suicide in childhood. Psychiatr Clin North Am 2008;31:271-91.  Back to cited text no. 4
    
5.
Tidemalm D, Långström N, Lichtenstein P, Runeson B. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ 2008;337:a2205.  Back to cited text no. 5
    
6.
Jenkins GR, Hale R, Papanastassiou M, Crawford MJ, Tyrer P. Suicide rate 22 years after parasuicide: Cohort study. BMJ 2002;325:1155.  Back to cited text no. 6
    
7.
Suokas J, Suominen K, Isometsä E, Ostamo A, Lönnqvist J. Long-term risk factors for suicide mortality after attempted suicide – Findings of a 14-year follow-up study. Acta Psychiatr Scand 2001;104:117-21.  Back to cited text no. 7
    
8.
Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 1997;170:205-28.  Back to cited text no. 8
    
9.
Campi R, Barbato A, D'Avanzo B, Guaiana G, Bonati M. Suicide in Italian children and adolescents. J Affect Disord 2009;113:291-5.  Back to cited text no. 9
    
10.
Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N. Method of attempted suicide as predictor of subsequent successful suicide: National long term cohort study. BMJ 2010;341:c3222.  Back to cited text no. 10
    
11.
Tuisku V, Pelkonen M, Kiviruusu O, Karlsson L, Ruuttu T, Marttunen M, et al. Factors associated with deliberate self-harm behaviour among depressed adolescent outpatients. J Adolesc 2009;32:1125-36.  Back to cited text no. 11
    
12.
Madge N, Hewitt A, Hawton K, de Wilde EJ, Corcoran P, Fekete S, et al. Deliberate self-harm within an international community sample of young people: Comparative findings from the child & adolescent self-harm in Europe (CASE) study. J Child Psychol Psychiatry 2008;49:667-77.  Back to cited text no. 12
    
13.
Haukka J, Suominen K, Partonen T, Lönnqvist J. Determinants and outcomes of serious attempted suicide: A nationwide study in Finland, 1996-2003. Am J Epidemiol 2008;167:1155-63.  Back to cited text no. 13
    
14.
Aseltine RH Jr., DeMartino R. An outcome evaluation of the SOS suicide prevention program. Am J Public Health 2004;94:446-51.  Back to cited text no. 14
    
15.
Caine ED. Forging an agenda for suicide prevention in the United States. Am J Public Health 2013;103:822-9.  Back to cited text no. 15
    


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