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.