Years of Life Lost Due to Complete Suicide in Iran: A National Registry-Based Study.

BACKGROUND: Suicide was the fourth leading cause of death among individuals aged 15 to 29 years worldwide in 2019, highlighting its significant impact on young people. Iran's suicide-related mortality rate was 5.1 per 100000 population in the same year, which is lower than the global average. This study aimed to estimate the years of life lost (YLLs) due to complete suicide in Iran. Study Design: A registry-based cross-sectional study. METHODS: The data on complete suicide cases used in this study were obtained from the national suicide registry of the Iranian Forensic Medicine Organization (FMO) that was registered between March 21, 2016 and March 20, 2020. RESULTS: The total number of YLL due to premature death by suicide over the four-year period was 611068 years (15.97 per 1000 persons) in males, 286847 years (7.65 per 1000 persons) in females, and 897915 years (11.86 per 1000 persons) for both genders. Moreover, the age group of 15-29 years experienced the highest YLL attributed to suicide. Furthermore, the study revealed an increasing trend of YLL due to suicide among individuals aged 30-44. CONCLUSION: These findings highlight the significant impact of suicide on the loss of potential years of life in Iran. The study indicates that the young and productive age groups of 15-29 and 30-44 years are particularly affected, with the highest YLL due to complete suicide. The study provides valuable insights for designing targeted and evidence-based suicide prevention programs that can reduce the burden of suicide in Iran, particularly among young and middle-aged adults.

Bayesian spatial analysis of age differences and geographical variations in illicit-drug-related mortality in the Islamic Republic of Iran.

Background: Drug use disorders are significant social and public health concerns in the Islamic Republic of Iran; however, little is known about drug-related mortality. Aims: We quantified the spatial and age distribution of direct illicit-drug-related mortality in the Islamic Republic of Iran, to inform harm reduction policies and interventions. Methods: We modelled and mapped registered illicit-drug-related deaths from March 2016 to March 2017. Data were obtained from the Iranian Forensic Medicine Organization. Besag-York-Mollie models were fitted using Bayesian spatial analysis to estimate the relative risk of illicit-drug-related mortality across different provinces and age groups. Results: There were 2203 registered illicit-drug-related deaths during the study period, 1289 (58.5%) occurred in people aged 20-39 years and among men (n = 2013; 91.4%). The overall relative risk (95% credible interval) of illicit-drug-related mortality in the provinces of Hamadan (3.37; 2.88-3.91), Kermanshah (1.90; 1.55-2.28), Tehran (1.80; 1.67-1.94), Lorestan (1.71; 1.37-2.09), Isfahan (1.40; 1.21-1.60), and Razavi Khorasan (1.18; 1.04-1.33) was significantly higher than in the rest of the country. Conclusion: We found evidence of age differences and spatial variations in illicit-drug-related mortality across different provinces in the Islamic Republic of Iran. Our findings highlight the urgent need to revisit existing drug-use treatment and harm reduction policies and ensure that overdose prevention programmes are adequately available for different age groups and settings.

Improving the Mechanical/Anticorrosive Properties of a Nitrile Rubber-Based Adhesive Filled with Cerium Oxide Nanoparticles Using a Two-Step Surface Modification Method.

To prepare a nanocomposite adhesive based on nitrile rubber (NBR) with excellent mechanical/anticorrosion properties, cerium oxide (CeO2) nanoparticles were grafted with bis-[3-(triethoxysilyl)propyl]tetrasulfide silane (TESPT) at different concentrations (i.e., 1, 5, 10, and 20 times the stoichiometric content). The surface-modified nanoparticles were characterized by Fourier transform infrared spectroscopy (FTIR), ζ-potential, X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), and field emission scanning electron microscopy (FE-SEM) techniques. The results showed that the steaming process resulted in an increase in the grafting ratio (R g) by 2.35 times. Pure and modified cerium oxide nanoparticles were added at 1.5, 4.5, and 7.5 wt % to a mixture of a phenolic resin and NBR compound to prepare adhesive samples. The prepared adhesives were evaluated for curing behavior and thermomechanical properties. The morphology of the adhesives was also characterized using SEM analysis. The bonding of adhesives to steel plates was measured by a cathodic disbonding test. The adhesive-coated steel plates were evaluated for anticorrosion performances using a salt spray test. It was found that surface-modified hydrothermally steamed CeO2 nanoparticles that had the highest silane grafting ratio enhanced the anticorrosion properties and cathodic disbonding of NBR-based adhesives. The curing rate index (CRI) and crosslinking of the NBR compound were enhanced using the modified and steamed nanoparticles. This also improved the interfacial interactions between rubber chains and nanoparticle surface, resulting in a 6 °C increase in the glass-transition temperature (T g) of NBR compared to the pristine rubber.

Postpartum depression and suicide in Iran.

In Iran, postpartum depression is one of the common emotional symptoms which affects approximately 25% of the women who experienced childbirth. Iranian Forensic Medicine Organization (IFMO) and its branches across the country are the comprehensive sources of collecting data related to suicide deaths. In the data collecting form of suicide, there is not any item about the pregnancy of women at the time of suicide, having childbirth during the previous six weeks, and the time interval between delivery and suicide. It is suggested that, in addition to modifying the suicide registration forms by the IFMO, attention should be given to developing a mechanism that gives forensic physicians access to medical records information in the integrated health system as well as hospital information system.

Spatial heterogeneity in gender and age of fatal suicide in Iran.

BACKGROUND: The suicide incident has had an increasing trend in Iran over the past years. This study mainly aimed to investigate and visualize the spatial variations of registered suicide cases at the province level. A two-step modeling approach was employed in order to estimate the relative risks (RRs) and model the age of fatal suicide across provinces in Iran. STUDY DESIGN: An applied ecological study. METHODS: This study used the suicide death data recorded by the Iranian forensic medicine organization from March 21, 2016, to March 20, 2018. Furthermore, a Bayesian spatial approach - Besag, York, and Mollie (BYM) model- was applied to estimate the RR of suicide across provinces in Iran. RESULTS: This risk was found to be significantly higher than the average in both men and women in the west of Iran. For women, higher population density (mean: 0.003; 95% CrI: 0.001-0.005) and lower urbanization rate of provinces (mean: -0.025; 95% CrI: -0.038, -0.012) were associated with increased RR of suicide. Based on the log-normal model fitted to the data, the overall mean age of the fatal suicide at the national level was 34 years. CONCLUSIONS: The magnitude of gender and age differences was quantified, and many spatial variations were identified in suicide mortality across provinces in Iran. Given the heterogeneity in suicide mortality risk among different subgroups of age and gender, our findings point to the urgent need in developing gender- and age-specific suicide prevention strategies. Moreover, efficient allocation of healthcare resources for suicide prevention can be attained by targeting provinces with higher risk.

Time Series Analysis of Monthly Suicide Rates in West of Iran, 2006-2013.

INTRODUCTION: Iran's western provinces have higher suicide rate compared to the other provinces of the country. Although suicide rates fluctuate over time, suitable statistical models can describe their underlying stochastic dynamics. METHODS: This study was conducted to explore the fluctuations of the monthly suicide rates in the most populated western province of Iran using exponential smoothing state space model to compute the forecasts. For this reason, the monthly frequencies of completed suicides were converted to rates per 100,000 and a state-space approach was identified and fitted to the monthly suicide rates. Diagnostic checks were performed to determine the adequacy of the fitted model. RESULTS: A significant seasonal variation was detected in completed suicide with a peak in August. Diagnostic checks and the time series graph of the observed monthly suicide rates against predicted values from the fitted model showed that in the study period (from March 2006 to September 2013), the observed and predicted values were in agreement. Thus, the model was used to obtain the short-term forecasts of the monthly suicide rates. CONCLUSIONS: In this study, we had no significant trend but seasonal variations in the suicide rates that were identified. However, additional data from other parts of the country with longer duration are needed to visualize the reliable trend of suicide and identify seasonality of suicide across the country.

Gender and geographical inequalities in fatal drug overdose in Iran: A province-level study in 2006 and 2011.

AIM: We aimed to compare the fatal drug overdose rates in Iran in 2006 and 2011. METHODS: This analysis was performed based on data on fatal drug overdose cases from the Iranian death registration system. The crude and adjusted rates per 100,000 populations for geographical regions stratified by gender and age groups were calculated using the 2006 and 2011 census of Iranian population. Annual percentage change was calculated to examine annual changes of fatal drug overdose rates across different regions. RESULTS: The overall age-adjusted rate of fatal drug overdose decreased from 3.62 in 2006 to 2.77 in 2011. A substantial difference in the distribution of fatal drug overdoses was found across geographical regions by gender and age groups. CONCLUSION: Rates of fatal drug overdose were higher among Iranian men and in both younger and older age groups which call for scaling up harm reduction and increasing access to gender- and age-specific substance use treatment services.

Modeling spatio-temporal variations of substance abuse mortality in Iran using a log-Gaussian Cox point process.

Substance use disorder is one of the main mental health problems in Iran. In this paper, the six-monthly counts of deaths due to substance abuse in Iran at provincial level between March 21, 2005, and March 20, 2014, were modeled using a log-Gaussian Cox point process model. By assuming population density as the exposure variable, the considered model incorporated known and unknown influential factors in order to describe spatio-temporal variations in the relative risk of substance abuse mortality. We found evidence of spatial heterogeneity and inequality by gender in deaths related to substance abuse across Iran. This study provides the first evidence in Iran on the spatio-temporal heterogeneity in mortality caused by substance use disorders.

Factors associated with the choice of suicide method in Kermanshah Province, Iran.

BACKGROUND: Identification of factors in the choice of suicide methods is important in understanding the phenomenon. OBJECTIVES: We aimed to quantify the effect of gender, age, living area, education level and marital status on the choice of suicide method among residents of Kermanshah province in the west of Iran. DESIGN: A cross-sectional study of all completed suicides from March 2006 to September 2013. SETTING: Kermanshah Province, Iran. METHODS: Data were extracted from suicide forms in the electronic files of the Forensic Medicine Organization. A total of 1901 (1138 men), suicide cases were identified. After preliminary analysis, a multinomial logistic model was fitted to the data to test and quantify the impact of each influential factor on the choice of suicide method. The relative risk of each suicide method over hanging as the reference method was estimated by calculating relative-risk ratios from the multinomial logistic model. MAIN OUTCOME MEASURES: Relative risk of suicide by self-immolation, drug and toxic poisoning and firearms. RESULTS: We found that women are at a higher relative risk than men for suicide by self-immolation, intentional drug poisoning and toxic poisoning. The relative risk of suicide by self-immolation and intentional drug poisoning was higher for urban residents and young individuals. On the other hand, men and rural residents were at higher relative risk of suicide by firearm. CONCLUSIONS: In Kermanshah province, the impact of rapid social changes on women and the availability of firearms in rural areas and drugs in urban households require more attention in any suicide prevention planning. LIMITATIONS: The lack of data prevented analysis of factors that may be more influential in choosing suicide.

Modeling and forecasting of the under-five mortality rate in Kermanshah province in Iran: a time series analysis.

OBJECTIVES: The target of the Fourth Millennium Development Goal (MDG-4) is to reduce the rate of under-five mortality by two-thirds between 1990 and 2015. Despite substantial progress towards achieving the target of the MDG-4 in Iran at the national level, differences at the sub-national levels should be taken into consideration. METHODS: The under-five mortality data available from the Deputy of Public Health, Kermanshah University of Medical Sciences, was used in order to perform a time series analysis of the monthly under-five mortality rate (U5MR) from 2005 to 2012 in Kermanshah province in the west of Iran. After primary analysis, a seasonal auto-regressive integrated moving average model was chosen as the best fitting model based on model selection criteria. RESULTS: The model was assessed and proved to be adequate in describing variations in the data. However, the unexpected presence of a stochastic increasing trend and a seasonal component with a periodicity of six months in the fitted model are very likely to be consequences of poor quality of data collection and reporting systems. CONCLUSIONS: The present work is the first attempt at time series modeling of the U5MR in Iran, and reveals that improvement of under-five mortality data collection in health facilities and their corresponding systems is a major challenge to fully achieving the MGD-4 in Iran. Studies similar to the present work can enhance the understanding of the invisible patterns in U5MR, monitor progress towards the MGD-4, and predict the impact of future variations on the U5MR.

Completed suicide and associated risk factors: a six-year population based survey.

INTRODUCTION: The investigations on suicide conducted within low- and middle-income countries are limited. This study evaluated the trend of suicide and its associated risk factors in the west of Iran. METHODS: This six-year population-based survey was conducted in Kermanshah Province, in 2012. The data on suicide was extracted from the suicide database of the Provincial Health Center, which was collected for six successive years. Multivariate logistic regression analysis was performed and odds ratio (OR) as well as its 95% confidence intervals (CI) was reported.  RESULTS: During the study period, 13,810 attempted suicides occurred of which 1,564 (11.33%) were completed. The incidence rate of suicide has increased in recent years. Based on logistic regression analysis, OR estimate of completed suicide increased 1.46 (95% CI: 1.36, 1.56) fold for every 10-year increase in age. Moreover, OR estimate of completed suicide was 2.53 (95% CI: 1.94, 3.31) in men compared to women. Compared to married people, the OR estimate of completed suicide was 1.41 (95% CI: 1.15, 1.72) in single people, 1.92 (95% CI: 1.15, 3.23) in widowed people, and 1.97 (1.32, 2.95) in divorced people. The lower the educational level, the higher the risk of completed suicide. Compared to school/college students, the risk of completed suicide was higher among housewives, employed people or employees, and retirees. A majority of the suicides (90.05%) occurred at home. Taking medications was the most common way (69.13%) of a suicide attempt. CONCLUSION: We indicated that associated factors with completed suicide vary in Iran compared to other developed and developing countries and that factors associated with attempted suicide are different from that of completed suicide.