The study found that approximately 2,039 suicides and suicide attempts were recorded in Rafsanjan between 2018 and 2022. The trend of suicide attempts and deaths by suicide increased with a gentle slope over the last five years. This result is in line with the study by Afrozi et al. in northern Iran, who predicted an increase in suicide rates in the coming years based on modeling analysis.9Similarly, a study by Razai et al. showed that suicide rates among older people in Iran are on the rise.17A systematic review and meta-analysis of papers published in Iran between 2010 and 2021 found that Iran ranked with a low incidence of suicide attempts and deaths by suicide compared to the global average, but the trend of suicide attempts is increasing, mainly affecting young people.2Unlike our study, the results of this systematic review study showed a downward trend in suicide deaths.2Possible reasons for this discrepancy include differences in how suicide data is recorded in different regions and over different periods.
According to a study by Alinejad et al.13 There were 339 suicide attempts in Rafsanjan, of which six (1.8%) ended in death.13In the 2018 study, there were 279 suicide attempts, of which 16 (5.39%) ended in death, which is a significant difference. This difference may be due to the fact that Alinejad’s study did not include cases of suicide deaths registered by the forensic medicine department.13in this study, these registered suicide death cases were also included. Moreover, in these two studies, different suicide attempt cases were observed in the same year, which suggests that accurate recording of suicide information is lacking. Therefore, a comprehensive investigation of the causes of this problem is very important. Because suicide is a public health problem, recording suicide attempts and suicide deaths can help understand basic epidemiological characteristics, monitor trends over time, evaluate risk factors, comorbidities, and economic burden associated with treatment, develop new treatment protocols, health policies, and ultimately improve people’s quality of life. Registering suicide attempts and suicide deaths also helps researchers have a data bank to conduct research studies in this field. However, although Iran has a suicide registration system, this system has many deficiencies. Due to the lack of continuous monitoring of this system, some suicide cases may not be registered, and many important factors related to suicide, such as history of mental disorders, socioeconomic status, etc., are not registered in this system. Also, some of the recorded information has missing data, such as history of suicide attempts. Therefore, it is recommended to create a systematic program to record all cases of suicide attempts and deaths by suicide and their related important factors.
This study also showed that gender (male), employment (unemployed, housewife), and education (less than educated) were associated with suicide death after controlling for the effects of confounding factors in the adjusted model. The frequency of suicide attempts was higher in women than in men, but the frequency of suicide death was significantly higher in men. In addition, in the adjusted model, the odds of suicide death were 6.48 (95% CI 3.39-12.42) times higher in men than in women. This result is consistent with a previous study conducted by Mobasheri et al. in Chaharamahal and Bakhtiari, Iran.18Gorgi et al. Shiraz19Dadpour et al. Mashhad20and Afroozi et al.9 Moravej et al., Kashantwenty oneMen appear to be more likely to attempt suicide seriously and to use more violent methods than women. The higher suicide attempt rate among women may be due to factors such as economic dependence, lack of social support, emotional problems, low self-esteem, and the oppressive nature of patriarchal structures within the family. Although contradictory to the results of this study, a study conducted by Shao et al. in China from 2003 to 2013 reported a higher suicide mortality rate among women than men.twenty twoIn addition, some previous studies5,23More men than women attempted suicide, a difference that may be due to cultural and economic differences around the world.9.
The results of the univariate analysis of this study showed that suicide attempts were more prevalent among people aged 24 years or younger, while suicide deaths were significantly more prevalent among older people (aged 32 years or older), which is consistent with the findings of a study conducted by Miramadizadeh et al. in Fars.twenty four and Khademi et al., Kermanshah Provincetwenty five Suicide attempts were reported more frequently among people under the age of 24. This is consistent with Babol’s Afroj et al study, which showed that suicide attempts were more common among people under the age of 40, but deaths by suicide were more common among people over the age of 40.9.
In this study, a statistically significant relationship between age and suicide mortality was observed in the univariate analysis, but this relationship was not observed in the multivariate analysis after controlling for the effects of confounding factors, which is consistent with some previous studies.9,26In contradiction to the results of the present study, a study by Deram et al. conducted in Shiraz found that increasing age was a predictor of suicide deaths, even after controlling for the effects of confounding factors.27A study by Glover et al. also found that older age was associated with an increased likelihood of suicide.28.
In our study, the adjusted models showed that the odds of suicide death for unemployed people and housewives were 2.64 (95% CI 1.50–4.67) and 7.45 (95% CI 3.08–18.07) times higher, respectively, than for employed people.Similarly, previous studies also found a significant association between unemployment and suicide death.29,30The findings indicate that unemployment plays a key role in increasing people’s vulnerability, especially among young people who have the highest frequency of suicide. Unemployed people and housewives are more likely to attempt suicide due to despair over future employment, and effective planning is needed in this area.
Additionally, in the adjusted model, individuals with less education were found to have a 10.85 (95% CI 1.48–79.54) higher odds of suicide compared with those with a university degree, a finding consistent with previous studies conducted in Iran.31Additionally, a systematic review of 33 meta-analyses published between 2008 and 2021 found that people with lower levels of education had a two-fold increased risk of death by suicide.29The higher frequency of suicide attempts and deaths by suicide among people with lower levels of education may be due to limited knowledge about the complications and consequences of suicide.
