Geographical epidemiology
of common methods of suicide and suicide attempts
during the years 2010-2013 in Fars Province, Iran
Gorgi Z, MSc1, Sheikh Fathollahi M, PhD2,
Vazirinejad R, PhD3, Rezaeian M, PhD4*
1- MSc in Epidemiology, Dept. of Epidemiology and Biostatistics,
Medical School, Rafsanjan University of Medical Science, Rafsanjan, Iran. 2-
Assistant Prof., Dept. of Epidemiology and Biostatistics, Environment Research
Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan,
Iran. 3- Professor, PhD of Epidemiology, Social Determinants of Health Research
Centre, Medical School, Rafsanjan University of Medical Science, Rafsanjan,
Iran. 4- Professor, Dept. of Epidemiology and Biostatistics, Occupational
Environmental Research Center, Medical School, Rafsanjan University of Medical
Sciences, Rafsanjan, Iran.
Abstract Received:
November 2015, Accepted: February 2016
|
Background: One of the important
aspects of the epidemiologic
study of suicide and its
related behaviors is the identification of suicide methods. This study aimed to investigate the geographical epidemiology of common methods of suicide and suicide attempts in Fars Province located in Southwestern
Iran during the years 2010-2013. Materials
and Methods: The present study was conducted on 17,342 suicide
and suicide attempt cases in Fars Province. To collect the data, the monthly suicide prevention program checklist was used. Data were analyzed using the
SPSS software, R software, and ArcGIS software. Using
Bayesian hierarchical models, the
standardized mortality ratios (SMRs) were
prepared and calculated according to
the common suicide and suicide attempt methods. Results: On average,
the suicide rate in Fars Province was 3.85 in one hundred thousand
people per year. The geographic
pattern of suicide in the mentioned province showed that
the highest rates of hanging were reported in the cities of Firuzabad, Farashband,
and Larestan, Iran, and the highest rates of
self-immolation were reported in cities of Mamasani, Shiraz,
and Firuzabad, Iran. Conclusions: Despite
the low rate of suicide in the cities of Fars
Province, the rate of suicide-related behaviors,
including suicide attempt and suicide by violent and deadly methods, was high in
some areas of the province. Therefore, restricting
access to lethal means and methods of suicide and planning to identify areas with high risk for suicide in the province is necessary. |
Keywords: Epidemiology, Suicide,
Suicide attempt, Iran.
Introduction
Suicide is a social and mental health disorder and is considered as a serious public health issue; thus, it has gained
attention in the first and second
levels of healthcare (1).
One of the important
aspects of the epidemiologic
study of suicide and its related behaviors is the identification of suicide methods. The International Association for Suicide
Prevention (IASP) has stressed that if access to the means and
methods of suicide were limited, the
number of suicide cases would decrease
dramatically (2). For this reason,
the World Health Organization (WHO) has emphasized the investigation of the
methods and practices used for this multidimensional phenomenon
and its preventive programs (3). Previous studies have
shown that geographical shifts, especially in the
access to suicide* methods that may affect
the rate of regional suicides do exist.
For example, it has been shown that stricter restrictions and laws on access to
(4) and keeping firearms at home (5) have been associated with decreased rate
of regional suicide
by firearms in the United States of America.
There are many methods
for committing suicide and its related behaviors. The use of some of
these suicide methods such as the use of firearms,
jumping from height, use of cold weapons, and poisoning by narcotics
and drugs were more common due to their
availability and ease of use (6). In Italy, the most
common methods of suicide are
hanging and jumping
from heights (7).
The most common method of suicide among women in
the USA was use of drugs and poisons, while men more often used firearms
to end their own
life (8).
Drug intoxication and overdose were the most common methods of suicide in
Iran due to easy access or lack of decisiveness (9). In a study in
Iran, self-immolation was the most common method of suicide among women and the use of firearms and hanging were the most
common methods among men (10). However,
the results of a study showed
that hanging and the use of
firearms among men and self-immolation and hanging among women were
the most common methods of suicide
in Fars Province in Southwestern Iran (11).
Due to an increase in suicide-related
behaviors in recent years in Iran,
the identification and investigation of its
geographical patterns can help
to prevent and control this health problem. This
study with a broader perspective
aimed to investigate the geographical epidemiology
of common methods of suicide and suicide attempt in Fars Province during the years 2010-2013.
Material and Methods
This descriptive study was conducted to determine the geographical epidemiology of common methods of
suicide and suicide attempt in
Fars Province using census method. The
study population consisted of all
cases of suicide and suicide attempt referred to healthcare centers (emergency hospitals,
and forensics of the provinces) in
the 27 cities of Fars Province since the
beginning of the year 2010 until the end of 2013. To collect data on suicide and
suicide attempt, the monthly suicide
prevention program checklist was used. This checklist consisted of two parts. The first part was related to
personal demographic information such
as age, gender, occupation, education,
marital status, and residence location.
The second part was related to information regarding other variables related to
suicide and suicide
attempt, which included the history of suicide attempts,
physical and mental illness history,
suicide method, season,
year, data source, and the result of suicide. In order to maintain confidentiality, the individual’s
name, address, and phone number were not used.
After collecting and coding the
data, they were entered into SPSS software (version 21, SPSS Inc., Chicago, IL,
USA) for analysis and calculation of the frequency of the most common methods of suicide and suicide
attempts in Fars province. It should
be noted that due to the reduced
frequency of some methods of suicide and suicide attempts, the most
common methods of suicide and suicide attempts were
examined. To map out the geographical distribution according to common methods
of suicide and suicide attempts, the frequency of the
most common methods were first
calculated according to gender.
Nevertheless, the frequency of common
methods in terms of gender were low in
some cities; therefore,
the most common methods of
suicide (self-immolation, use of drugs,
and hanging) and
suicide attempts (use of drugs, pesticide poisoning, use of cold weapons) were generally determined at the provincial level, and then, in the 27
cities of the province. Then, for each
of the three common methods of
suicide and suicide attempts, raw
standardized mortality ratio (SMR) was calculated using indirect method based on the
following formula:
SMR
= The number of observed cases/The number of expected cases
The number of
expected cases was calculated using
the following formula (12):
The number of expected cases =
(The number of cases in the province/Population of the
province) × The population of the city
In order to calculate the rate of suicide and suicide attempts, the demographics information of the 2012 census was used (13).
Due to the small population and reduced incidence of suicide in some cities
and also to show
a clear spatial pattern of suicide and suicide attempt before mapping (14),
Bayesian hierarchical models and smoothed SMR (12) were calculated
to separate the common methods
of suicide and suicide attempts. The Bayesian hierarchical models for observed cases of
suicide were based
on the Poisson assumption which allows the possibility of
random effects for nonstructural diversity
(heterogeneity
in all regions of the area under consideration) and structural variation (the correlation between neighboring areas)
(14, 15). Bayesian hierarchical models were estimated using
Markov Chain Monte Carlo (MCMC) methods in R software (version
3/1/2, R Core Team, Vienna, Austria) (12).
Subsequently, the divergent
design of colors that
represented the wide range of SMR for suicide and
suicide attempts were selected on the map. In other words, the two ends of this spectrum were identified by different colors that
gradually turned to
bright and lighter colors. Dark blue
represented the "areas with the lowest risk",
while dark red represented
the "areas of greatest risk"
and yellow represented
the middle class (16).
Table 1: Frequency distribution of the most common
methods of suicide based on gender in Fars
Province during the years 2010-2013
|
Cities |
Female N (%) |
Male N (%) |
||||
|
Hanging |
Self-immolation |
Drug consumption |
Hanging |
Self-immolation |
Drug consumption |
|
|
Abadeh |
1(6.7) |
1(0.6) |
1(1.1) |
0 |
1(1.4) |
1(1.0) |
|
Arsanjan |
0 |
0 |
1(1.1) |
2(2.7) |
0 |
0 |
|
Estahban |
0 |
0 |
1(1.1) |
0 |
2(2.7) |
1(1.0) |
|
Eqlid |
1(6.7) |
0 |
2(2.2) |
1(1.4) |
0 |
2(1.9) |
|
Bavanat |
0 |
3(1.7) |
0 |
3(4.1) |
0 |
0 |
|
Pasargad |
0 |
0 |
1(1.1) |
2(2.7) |
0 |
0 |
|
Kharameh |
0 |
1(0.6) |
6(6.7) |
0 |
0 |
3(2.9) |
|
Khoram Bid |
0 |
0 |
2(2.2) |
2(2.7) |
1(1.4) |
1(1.0) |
|
Khonj |
0 |
0 |
0 |
2(2.7) |
0 |
1(1.0) |
|
Darab |
0 |
9(5.1) |
3(3.4) |
0 |
0 |
2(1.9) |
|
Rostam |
1(6.7) |
3(1.7) |
4(4.5) |
0 |
0 |
0 |
|
Zarin Dasht |
0 |
2(1.1) |
0 |
0 |
3(4.1) |
0 |
|
Sepidan |
0 |
0 |
2(2.2) |
0 |
2(2.7) |
1(1.0) |
|
Sarvestan |
0 |
0 |
2(2.2) |
1(1.4) |
0 |
0 |
|
Shiraz |
2(13.3) |
99(56.3) |
28(31.5) |
17(23.3) |
47(63.5) |
51(49.5) |
|
Farashband |
2(13.3) |
4(2.3) |
3(3.4) |
1(1.4) |
0 |
1(1.0) |
|
Firuzabad |
2(13.3) |
7(4.0) |
1(1.1) |
14(19.2) |
3(4.1) |
5(4.9) |
|
Qir-o Karzin |
0 |
1(0.6) |
1(1.1) |
0 |
2(2.7) |
1(1.0) |
|
Kazerun |
3(20.0) |
12(6.8) |
2(2.2) |
4(5.5) |
1(1.4) |
5(4.9) |
|
Kavar |
0 |
0 |
0 |
0 |
0 |
0 |
|
Gerash |
0 |
0 |
0 |
0 |
0 |
0 |
|
Larestan |
0 |
5(2.8) |
3(3.4) |
11(15.1) |
0 |
1(1.0) |
|
Lamerd |
0 |
4(2.3) |
0 |
0 |
1(1.4) |
0 |
|
Marvdasht |
2(13.3) |
9(5.1) |
18(20.2) |
8(11.0) |
5(6.8) |
20(19.4) |
|
Mamasani |
1(6.7) |
8(4.5) |
6(6.7) |
3(4.1) |
5(6.8) |
3(2.9) |
|
Mohr |
0 |
4(2.3) |
0 |
1(1.4) |
1(1.4) |
1(1.0) |
|
Neyriz |
0 |
4(2.3) |
2(2.2) |
1(1.4) |
0 |
3(2.9) |
|
Total |
15(100) |
176(100) |
89(100) |
73(100) |
74(100) |
103(100) |
The ArcGIS software
(version 9.3, Esri, Redlands, CL,
USA) was used to display the geographical distribution of standard deaths by suicide
and suicide attempts according to common methods
of suicide and suicide
attempts in each city. For the spatial correlation in the
smoothed values of common methods of suicide and
suicide attempts, Moran's I statistical index
was used in R software (17). The index value of zero
showed lack of spatial correlation
and the positive values indicated
correlation between regions (the maximum value of
Moran's I was 1) (18).
The significant level was considered as 0.05.
Results
During the studied years, 17342 cases
including 646 cases of suicide
with forensic records and 16696 cases of attempted suicide had
occurred in Fars Province. On average,
the incidence of suicide in Fars Province was 3.85
in one hundred thousand
people a year.
Table 2: Frequency distribution of the most common
methods of suicide attempt based on gender in Fars
Province during the years 2010-2013
|
Cities |
Female N (%) |
Male N (%) |
||||
|
Drug consumption |
Cold
weapons |
Pesticide
poisoning |
Drug consumption |
Cold
weapons |
Pesticide
poisoning |
|
|
Abadeh |
286(3.1) |
3(2.3) |
8(1.4) |
169(3.0) |
11(4.1) |
10(2.4) |
|
Arsanjan |
93(1.0) |
2(1.6) |
8(1.4) |
74(1.3) |
4(1.5) |
4(0.9) |
|
Estahban |
183(2.0) |
3(2.3) |
13(2.2) |
157(2.8) |
8(3.0) |
22(5.2) |
|
Eqlid |
151(1.7) |
1(0.8) |
12(2.1) |
89(1.6) |
0 |
10(2.4) |
|
Bavanat |
45(0.5) |
0 |
8(1.4) |
19(0.3) |
0 |
8(1.9) |
|
Pasargad |
91(1.0) |
0 |
5(0.9) |
36(0.6) |
2(0.7) |
10(2.4) |
|
Kharameh |
86(0.9) |
2(1.6) |
7(1.2) |
40(0.7) |
3(1.1) |
7(1.6) |
|
Khoram Bid |
95(1.0) |
2(1.6) |
8(1.4) |
46(0.8) |
7(2.6) |
4(0.9) |
|
Khonj |
148(1.6) |
1(0.8) |
11(1.9) |
58(1.0) |
2(0.7) |
3(0.7) |
|
Darab |
513(5.6) |
1(0.8) |
26(4.5) |
291(5.2) |
2(0.7) |
20(4.7) |
|
Rostam |
103(1.1) |
0 |
0 |
46(0.8) |
0 |
1(0.2) |
|
Zarin Dasht |
35(0.4) |
0 |
0 |
24(0.4) |
2(0.7) |
1(0.2) |
|
Sepidan |
139(1.5) |
1(0.8) |
11(1.9) |
49(0.9) |
1(0.4) |
9(2.1) |
|
Sarvestan |
59(0.6) |
1(0.8) |
1(0.2) |
36(0.6) |
2(0.7) |
6(1.4) |
|
Shiraz |
3926(43.0) |
97(75.2) |
241(41.4) |
2483(44.2) |
174(64.9) |
128(30.1) |
|
Farashband |
97(1.1) |
2(1.6) |
6(1.0) |
50(0.9) |
7(2.6) |
7(1.6) |
|
Firuzabad |
24(0.3) |
0 |
7(1.2) |
16(0.3) |
0 |
0 |
|
Qir-o Karzin |
213(2.3) |
0 |
13(2.2) |
109(1.9) |
0 |
8(1.9) |
|
Kazerun |
543(6.0) |
2(2.3) |
76(13.1) |
415(7.4) |
9(3.4) |
83(19.5) |
|
Kavar |
130(1.4) |
0 |
0 |
51(0.9) |
0 |
0 |
|
Gerash |
32(0.4) |
0 |
0 |
17(0.3) |
0 |
0 |
|
Larestan |
284(3.1) |
5(3.9) |
5(0.9) |
178(3.2) |
8(3.0) |
4(0.9) |
|
Lamerd |
145(1.6) |
1(0.8) |
4(0.7) |
43(0.8) |
4(1.5) |
2(0.5) |
|
Marvdasht |
910(10.0) |
1(0.8) |
85(14.6) |
656(11.7) |
8(3.0) |
63(14.8) |
|
Mamasani |
550(6.0) |
1(0.8) |
14(2.4) |
304(5.4) |
3(1.1) |
6(1.4) |
|
Mohr |
33(0.4) |
1(0.8) |
2(0.3) |
8(0.1) |
3(1.1) |
0 |
|
Neyriz |
208(2.3) |
1(0.8) |
11(1.9) |
160(2.8) |
8(3.0) |
9(2.1) |
|
Total |
9122(100) |
129(100) |
582(100) |
5624(100) |
268(100) |
425(100) |
In table 1, the most common
methods of suicide in terms of gender based on the devision
by cities are shown in Fars Province. In the
comparison between the means of suicide in men and women, the frequency
distribution of hanging, self-immolation, and drug consumption among women was related
to the cities of Kazerun and Shiraz, while
in men, the highest rates of the mentioned three methods were
observed in Shiraz. In contrast, table
2 illustrates the most common methods
of suicide attempts in terms of gender
in each city in the Fars Province. As shown in table 2, Shiraz
had the most cases of suicide attempts according to the three most common
methods in both genders.
The
results of maps related to the geographical patterns of suicide and suicide attempts
according to common methods in 27
cities of Fars Province
There were significant changes in geographical patterns of suicide by the three common methods (drugs consumption, hanging, and self-immolation)
(Figure 1).
Figure 1: Map of the smoothed standardized
mortality ratio (SMR) of suicide according to the common methods of drug
consumption (A), hanging (B) and self-immolation in the 27 cities of Fars Province during the years 2010-2013
The ratio of deaths of smoothed
standard of suicide by self-immolation compared to other methods of
suicide had the least spatial diversity. The highest
rates were observed in Mamasani, Shiraz, and Firuzabad, and the lowest rates
were observed in Eqlid, Kavar, and Larestan. SMR values
ranged from 0.65472
to 2.15225 (3.29
times). Significant changes were observed in smoothed rates of
suicide by hanging [SMR values ranged
from 0.48298 to
6.35480 (13.16 times)],
with highest rates in the cities of Firuzabad, Farashband,
and Larestan and lowest
values in the cities of Darab, Shiraz,
and Sepidan. Suicide
by drug overdose had the highest rates in the cities of Marv Dasht, Kharameh,
and Farashband, and the lowest in the cities of Lamerd, Kavar,
and Zarin Dasht [with
values range from 0.64927 to 3.23999 (4.99
times)] (Maps A
to C).
There was no evidence regarding spatial
correlation (i.e. areas adjacent to each other tend to have similar
suicide rates) between the three common
methods of suicide. The highest value of Moran's
I index was related to excessive drug use
(Moran's I = 0.0276, P = 0.0754), and the lowest value to self-immolation (Moran's I = -0.0340,
P = 0.9090), and hanging (Moran's I = -0.0385, P = 0.9970), respectively.
Figure 2 (Maps A to C) illustrates the geographical distribution of common methods
of suicide in Fars
Province. The standard mortality ratio for suicide by cold
weapons showed that it had the lowest spatial diversity. The
highest rates were related to the
cities of Farashband, Shiraz,
and Khoram Bid and
the lowest values to the cities of
Firuzabad, Kavar, and Qir-o karzin [with
values ranging from 0.34308 to 4.23425 (12.34
times)]. Significant variations
were observed in suicide attempt rates by pesticide
poisoning. The highest rates were observed in the cities of Kazerun,
Estahban, and Marv Dasht and the lowest rates in the cities of Kavar,
Gerash, and Zarin Dasht, respectively [SMR rates ranged
from 0.19509 to 4.03716 (20.69 times)]. Suicide attempts
by drug overdose
had the highest rates in Mamasani, Marv Dasht, and Khonj cities and the lowest
rates in Firuzabad, Mohr, and Zarin Dasht, respectively [SMR rates
ranged from 0.14326 to 2.78728 (19.46 times)] (Maps A
to C).
No evidence of spatial correlation was observed in suicide by the three common
methods of suicide attempts. The
highest rate of Moran's I was observed in pesticide poisoning
method (Moran's I = 0.0162, P = 0.1549) and the lowest rates in excessive
drug use (Moran's I = -0.0462, P =
0.8398) and cold weapons use (Moran's I = -0.0616, P = 0.5470), respectively.
Figure 2: Map of the smoothed standardized mortality ratio (SMR)
of suicide attempts according to the common methods of drug consumption
(A), hanging (B), and cold weapons in the 27 cities of Fars Province
during the years 2010-2013
Discussion
Significant and individual geographical
variations were observed in the patterns
of spatial components
of the common methods of suicide and suicide
attempts in Fars Province. In this study, the technique and method of suicide and suicide attempts differed based on gender in different
cities. Therefore, most suicide cases in women based on the three
common methods were observed in
Kazerun and Shiraz and in men were
observed in Shiraz. However, the city
of Shiraz had the highest rate of suicide
attempts based on the three common methods in both genders. Geographical differences in specific suicide methods have been reported among
different countries (19), and smaller areas in a country
(20). It was shown that distinct geographical patterns in
specific suicide and suicide attempt
methods can be explained to a large extent by the availability of or access to lethal methods
of suicide. Two examples of this
case are the high rates of the use of
pesticides in most Asian countries with agricultural economy and the high rate of the use of firearms for suicide in the United States of America, where the use of firearms is legal (19,
20).
In addition, in this study, the greatest variety of the ratio of smoothed standard death was
hanging, which had the highest rates in the city of
Firuzabad, Farashband, and Larestan and
the lowest values in the cities of Darab,
Shiraz, and Sepidan.
Therefore, the identification
of areas at risk for suicide using
spatial statistical techniques may be of
great importance for the more efficient use of resources
and interventions for suicide prevention efforts
in the future (21). It should be noted that due to the lack of similar
studies in the country, the direct comparison of the findings with other studies
cannot be allowed.
Self-immolation was considered as one of the
most violent, fatal, and painful suicide methods (22).
Every year about 310,000 individuals
lose their lives due
to self-immolation (23). It was
estimated that the rate of death
due to self-immolation in low-income
and average income countries was about 11 times higher than high-income countries and 95%
of self-immolations cases have occurred in those
countries (24). In this regard,
the results of this study showed that the smoothed SMR of suicide by self-immolation compared to other methods of suicide had the lowest spatial
diversity. The highest rates were observed in Mamasani,
Shiraz, and Firuzabad and the lowest rates were observed in Eqlid, Kavar, and
Larestan, respectively. It is expected that through
implementation of lifestyle changes, such as replacing alternative fuels with gas, among the inhabitants of those areas, their access to fuels such as petroleum will
be reduced, and thus, the number of cases of suicide by
self-immolation will also be reduced (22).
The results of this study also showed
significant variation in smoothed rates of suicide attempts by pesticide poisoning. The highest rates were observed in the cities
of Kazerun, Estahban,
and Marv Dasht (most
of the inhabitants were engaged
in agriculture). However,
cities located in the South and Southeast of
Fars Province, such as Kavar, Gerash,
and Zarin Dasht (non-agricultural due
to reduced rainfall) had the
lowest rates of suicide attempts by pesticide
poisoning. In accordance with the results of this study, the findings of a study in Taiwan showed
that almost half
(47%) of all
suicide by pesticide cases had occurred in areas where
only 13% of
Taiwan's population lived (12). The areas where the majority of its inhabitants were engaged
in agriculture had the highest
rates of suicide by pesticides (12). Therefore, it appears
that strategies such as restricting access to
pesticides, particularly highly toxic pesticides, and improving medical care services for poisoned individuals can help to reduce the
rate of suicide by pesticides.
The limitations of
this study included failure to register the causes of and motivation for suicide
and suicide attempts, the type of pesticide and fuel
used, and socio-economic conditions of the
individual in the checklist, and unknown
and missing data (about
1.75%) during the
study years. Moreover,
lack of access to the study population regarding age-gender groups to calculate the required
indices was another limitation of the present study.
Similar studies are recommended to allow
comparisons and more accurate understanding
of geographical patterns of suicide methods. Furthermore, further
studies are recommended on geographical
distribution of all suicide
and suicide attempt methods regarding gender and age group distribution in Fars
Province and other provinces in the country over a longer period.
Conclusion
In general, the geographical
pattern of common methods of suicide and
suicide attempts in Fars Province
showed that most cases of hanging were observed in the cities of Firuzabad, Farashband, and Larestan and the highest rates of
self-immolation cases were observed in Mamasani, Shiraz,
and Firuzabad. Therefore,
restricting access to lethal means and methods of suicide, planning for high-risk areas for suicide, and
conducting further studies on the
causes of and motivation
for turning to violent
and lethal means
of suicide is essential.
Acknowledgement
Our sincere appreciation goes to
the Health Deputy
of Shiraz University of Medical Sciences
who supported the implementation of this study, and Dr. Mehdi Yaseri and Amin
Ghanbarnezhad who assisted in the statistical analysis of this study.
Conflict of interest: None declared
References
1.
Bursztein
Lipsicas C, Mäkinen IH, Apter A, De Leo D, Kerkhof A, Lönnqvist J, et
al. Attempted suicide among immigrants in European countries: An international
perspective. Soc Psychiatry Psychiatr Epidemiol 2012; 47(2):241-51.
2.
Perry IJ,
Corcoran P, Fitzgerald AP, Keeley HS, Reulbach U, Arensman E. The incidence and
repetition of hospital-treated deliberate self harm: findings from the world's first
national registry. PLoS One 2012; 7(2):e31663.
3.
Anbari M, Bahrami
A. Study of the poverty and violence effects on suicide rates in Iran: A case
study in Puldokhtar. Iranian Journal of Social Problems 2010; 1(2):1-30.
4.
Sloan JH, Rivara
FP, Reay DT, Ferris JA, Kellermann AL. Firearm regulations and rates of
suicide. A comparison of two metropolitan areas. N Engl J Med 1990; 322(6):369-73.
5.
Miller M, Azrael
D, Hemenway D. Household firearm ownership and suicide rates in the United
States. Epidemiology 2002; 13(5):517-24.
6.
Ghaleiha A,
Khazaee M, Afzali S, Matinnia N, Karimi B. An annual survey of successful suicide
incidence in Hamadan, western Iran. J Res Health Sci 2009; 9(1):13-6.
7.
Pavia M, Nicotera
G, Scaramuzza G, Angelillo IF. Suicide mortality in Southern Italy: 1998-2002. Psychiatry Res 2005; 134(3):275-9.
8.
de Macedo JL,
Rosa SC, Gomes e Silva M. Self-inflicted burns: attempted suicide. Rev Col Bras
Cir 2011; 38(6):387-91.
9.
Lester D. Suicide
and islam. Arch Suicide Res 2006; 10(1):77-97.
10.
Saberi-Zafaghandi
MB, Hajebi A, Eskandarieh S, Ahmadzad-Asl M. Epidemiology of suicide and
attempted suicide derived from the health system database in the Islamic
Republic of Iran: 2001-2007. East Mediterr Health J 2012; 18(8):836-41.
11.
Zarenezhad M,
Gorgi Z, Sheikh Fathollahi M, Gholamzadeh S, Ghadipasha M, Rezaeian M. A survey on epidemiology of suicide in Fars
province in south of Iran during 2003 to 2011. Journal of Rafsanjan University
of Medical Sciences 2014;13(12):1129-40.
13. Yazdanbakhsh
M, Jamshidi Z, Ranjbar H, Ranjbaran Z, Nikzad NK. Statistical Yearbook 2011
Fars province. Shiraz: Deputy of planning and employment of the Fars province
Statistics Office; 2012 March.
14.
Lawson AB,
Biggeri AB, Boehning D, Lesaffre E, Viel JF, Clark A, et al. Disease mapping
models: an empirical evaluation. Disease Mapping Collaborative Group. Stat Med
2000; 19(17-18):2217-41.
15.
Besag J, York J, Mollie A. Bayesian
image restoration, with two applications in spatial statistics. Ann I Stat Math
1991; 43(1):1-20.
16.
Brewer CA.
Guidelines for selecting colors for diverging schemes on maps. Cartogr J 1996;
33(2):79-86.
17.
Anselin L, Syabri
I, Kho Y. GeoDa: an introduction to spatial data analysis. Geogr Anal 2006;
38(1):5-22.
18.
Chang SS, Sterne
JA, Wheeler BW, Lu TH, Lin JJ, Gunnell D. Geography of suicide in Taiwan:
spatial patterning and socioeconomic correlates. Health Place 2011;
17(2):641-50.
19.
Ajdacic-Gross V,
Weiss MG, Ring M, Hepp U, Bopp M, Gutzwiller F, et al. Methods of suicide:
international suicide patterns derived from the WHO mortality database. Bull
World Health Organ 2008; 86(9):726-32.
20.
Marzuk PM, Leon
AC, Tardiff K, Morgan EB, Stajic M, Mann JJ. The effect of access to lethal
methods of injury on suicide rates. Arch Gen Psychiatry 1992; 49(6):451-8.
21.
Saman DM, Walsh
S, Borówko A, Odoi A. Does place of residence affect risk of suicide? a
spatial epidemiologic investigation in
Kentucky from 1999 to 2008. BMC Public Health 2012; 12:108.
22.
Rezaeian M.
Epidemiology of Suicide. Arak, Iran: Nevisandeh Publications; 2009. P.17-30.
23.
Forjuoh S, Gielen
A. Burns, Chapter 4.. In: Peden M, Oyegbite K, Ozanne-Smith J, Hyde rA A,
Branche C, Fazlur Rahman A, et al, editors. World report on child injury and
prevention. 1st ed. Switzerland, Geneva: World Health Organization;
2008. PP.79-98.
24.
Mock C, Peck M, Peden
M, Krug E. A WHO plan for burn prevention and care. Geneva: World Health
Organization; 2008.
* Corresponding
author: Mohsen Rezaeian, Dept. of Epidemiology and Biostatistics,
Occupational Environmental Research Center, Medical School, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran.
Email:
moeygmr2@yahoo.co.uk