Risk-taking behaviors and subgrouping of suicide in Iran: A latent class analysis of national registries data

Characteristics of suicide attempts in Northwestern Iran: a five-year population-based survey

BACKGROUND

Suicide is a serious public health problem in the world. This study aims to describe the characteristics of suicide attempters in North-Western Iran and identify latent classes of suicide attempts.

METHODS

This cross-sectional study was conducted in Ardabil Province (Northwest Iran) during 2017-2021 based on a registration system for suicide attempts. We performed latent class analysis (LCA) using a procedure for LCA (PROC LCA) in SAS to investigate the subgroups of suicide attempters based on their characteristics and method, history, and outcome of suicide.

RESULTS

Three latent classes were identified for males and females; the first class (non-lethal attempters with lower educational levels) comprised 41.3% of males and 55.4% of females. The second class (non-lethal attempters with higher educational levels) described 52.4% of males and 42.7% of females. Finally, the third class (lethal attempters) included 6.4% of males and 1.9% of females. The main method of suicide attempts was poisoning with medications (87.3%). The results show that only 2.8% of people have a history of suicide attempts. Also, the suicide rate reached 8.26 per 100,000 population in 2021.

CONCLUSION

The present study showed an increasing trend of suicide attempt incidence rate in Ardabil Province from 2017 (99.49 per 100,000 population) to 2021 (247.41 per 100,000 population). This means that the rate of change was 147.92 per 100,000 population during the study period. The findings of LCA, stress the necessity of identification and prioritization of unmet needs of people who had an incomplete suicide in Ardabil.

The Impact of Relational Adverse Childhood Experiences on Suicide Outcomes During Early and Young Adulthood

This study aimed at investigating the degree to which relational adverse childhood experiences (ACEs) would affect suicide outcomes during early and young adulthood of Iranian female and male students. In all, 487 undergraduate students (59.2% females) with a mean age of 20.66 ± 1.42 were recruited using a multistage clustering sampling method from eight schools from the fields of humanities, engineering, and basic sciences. Suicide Behavior Questionnaire-Revised form (SBQ-R) was employed for assessing past year suicidal ideation (PYSI, once or more), the meaningful likelihood of future suicide (mLoFS, a score of 2 or more), and suicide risk (SR ≥7). Relational ACEs were assessed in the form of a yes/no question, including caregivers' maltreatment, household relational dysfunction, family loss events, school events, and sexual abuse. Analyses were conducted using Fisher's exact test, chi-square test, and univariate binary logistic regression. The rates of PYSI, LoFS, and SR were, respectively, 37.2%, 44.6%, and 30.8%. The most experienced event was witnessing verbal violence (68.8%) and the least was divorce/separation (6.2%). All the events and domains (except family loss events), the interaction of domains, and cumulative events significantly increased the odds of suicide outcomes, in which females were more affected by all types of relational ACEs. Students whose ethnicity was Azari & Turk and who were studying in humanities or basic sciences showed a higher suicide risk than their counterparts. The study showed that the rates of relational ACEs and suicide outcomes were remarkable, in Iran. Because of the detrimental effects of relational ACEs on suicidality, mostly for females, it is necessary to improve the initiatives promoting child protection and legal support for health professionals to address child abuse. There is also an urgent need for providing young students with supports and effective interventions.

Suicide-related interpersonal needs of young Iranian people: A preliminary validation of thwarted belongingness and perceived burdensomeness constructs

The aim of the current study was to validate the Interpersonal Needs Questionnaire (INQ-15) and to test its reliability in Persian-speaking Iranian undergraduate students. In this cross-sectional study, 485 undergraduate students (age: 20.66 ± 1.42, 60% female) were assessed on the two subscales of perceived burdensomeness (PB) and thwarted belongingness (TB) and the Suicide Behavior Questionnaire-Revised (SBQ-R). Exploratory structural equation modelling (ESEM) confirmed the construct validity of INQ-14, excluding INQ#9. In addition, INQ#8, articulated in an equivalent Persian phrasing, loaded well on TB. The measurement model tested by confirmatory factor analysis (CFA) suggested INQ#11 to be eliminated, resulting in INQ-13-P to consist of PB and TB-7. The internal consistency and convergent/discriminant validity were established. The concurrent validity of PB was solidly established in terms of past year suicidal ideation (PY-SI) above and beyond anxiety, depression, prior suicidality, and TB-7. The effect of PB on PY-SI was stronger, where prior suicidality had already occurred or the perceived likelihood of future suicide (PLFS) was high. Moreover, TB-7 could only indicate PY-SI, where prior suicidality had already occurred or PLFS was high, albeit when PB was omitted. The interaction term was significant; however, beyond anxiety and depression, the effect of TB-7 on PY-SI was significant where PB was very high (n = 40, 8.25%). Therefore, future studies can utilize INQ-13-P as a valid and reliable instrument in Persian-speaking populations. However, further studies should examine the construct validity of TB and its relationship with suicide ideation in different populations.