The Profile of Self-Harm and Suicide in Iran Considering Gender Differences: A Multicenter Study Affiliated with the National Trauma Registry of Iran
-
Zahra Ramezani
,
Vafa Rahimi-Movaghar
,
Mohammadreza Zafarghandi
,
Esmaeil Fakharian
,
Seyed Houssein Saeed-Banadaky
,
Homayoun Sadeghi-Bazargani
,
Yousef Mohammadpour
,
Reza Farahmand Rad
,
Farideh Sadeghian
,
Mehdi Nasr Isfahani
,
Vahid Rahmanian
,
Amir Ghadipasha
,
Mohammad Shahidi
,
Seyed Mohammad Piri
,
Sara Mirzamohamadi
,
Khatereh Naghdi
,
Payman Salamati
Abstract
Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI).
Method: This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death.
Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15.
Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.
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3. Castellví P, Lucas-Romero E, Miranda-Mendizábal A, Parés-Badell O, Almenara J, Alonso I, et al. Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. J Affect Disord. 2017;215:37-48.
4. McMahon EM, Hemming L, Robinson J, Griffin E. Editorial: Suicide and self harm in young people. Front Psychiatry. 2022;13:1120396.
5. Casey P, Dunn G, Kelly BD, Lehtinen V, Dalgard OS, Dowrick C, et al. The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study. Soc Psychiatry Psychiatr Epidemiol. 2008;43(4):299-304.
6. Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA, Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012;34(5):557-65.
7. Lim KS, Wong CH, McIntyre RS, Wang J, Zhang Z, Tran BX, et al. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(22).
8. Schaffer KB, Dandan T, Bayat D, Castelo MR, Reames SH, Hutkin-Slade L, et al. Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes. Eur Geriatr Med. 2022;13(1):119-25.
9. Mobinizadeh M, Berenjian F, Mohamadi E, Habibi F, Olyaeemanesh A, Zendedel K, et al. Trauma Registry Data as a Policy-Making Tool: A Systematic Review on the Research Dimensions. Bull Emerg Trauma. 2022;10(2):49-58.
10. Ghodsi Z, Movaghar VR, Zafarghandi M, Saadat S, Mohammadzadeh M, Fazel M, et al. The minimum dataset and inclusion criteria for the national trauma registry of Iran: a qualitative study. Arch Trauma Res. 2017;6(2):7.
11. Sharif-Alhoseini M, Rasouli MR, Saadat S, Haddadi M, Gooya MM, Afsari M, et al. Suicide attempts and suicide in Iran: results of national hospital surveillance data. Public Health. 2012;126(11):990-2.
12. Khaleghi-Nekou M, Moradi A, Zafarghandi M, Fayaz-Bakhsh A, Saeednejad M, Rahimi-Movaghar V, et al. Epidemiology of fatal injuries among patients admitted at Sina hospital, the national trauma registry of Iran, 2016-2019. Frontiers in Emergency Medicine. 2021;5(1):e9-e.
13. Sharif-Alhoseini M, Zafarghandi M, Rahimi-Movaghar V, Heidari Z, Naghdi K, Bahrami S, et al. National Trauma Registry of Iran: A Pilot Phase at a Major Trauma Center in Tehran. Arch Iran Med. 2019;22(6):286-92.
14. Moore L, Clark DE. The value of trauma registries. Injury. 2008;39(6):686-95.
15. Gal M, Rus D, Peek-Asa C, Cherecheş RM, Sirlincan EO, Boeriu C, et al. Epidemiology of assault and self-harm injuries treated in a large Romanian Emergency Department. Eur J Emerg Med. 2012;19(3):146-52.
16. Swarnkar M, Pal G, Lilhare S. Assault and self-harm injuries: pattern, severity and etiology of injuries in victims attending emergency department of teaching hospital in central India. Int Surg. 2016;3(3):1618-22.
17. Hassan Zadeh Tabatabaei MS, Baigi V, Zafarghandi M, Rahimi-Movaghar V, Pourmasjedi S, Khavandegar A, et al. Epidemiologic and Clinical Characteristics of Intentional Injuries among Cases Admitted to Sina Hospital: Affiliated with the National Trauma Registry of Iran. J Res Health Sci. 2023;23(3):e00587.
18. Nguyen TQ, Simpson PM, Braaf SC, Gabbe BJ. Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm. Injury. 2017;48(1):184-94.
19. Rezaeian M. Suicide/homicide ratios in countries of the Eastern Mediterranean Region. East Mediterr Health J. 2008;14(6):1459-65.
20. Barrigon ML, Cegla-Schvartzman F. Sex, Gender, and Suicidal Behavior. Curr Top Behav Neurosci. 2020;46:89-115.
21. Rezaeian M. Age and sex suicide rates in the Eastern Mediterranean Region based on global burden of disease estimates for 2000. East Mediterr Health J. 2007;13(4):953-60.
22. Bukur M, Inaba K, Barmparas G, DuBose JJ, Lam L, Branco BC, et al. Self-inflicted penetrating injuries at a Level I Trauma Center. Injury. 2011;42(5):474-7.
23. 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.
24. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28(1):1-23.
25. Michaud L, Brovelli S, Bourquin C. [The gender paradox in suicide : some explanations and much uncertainty]. Rev Med Suisse. 2021;17(744-2):1265-7.
26. Schrijvers DL, Bollen J, Sabbe BG. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138(1-2):19-26.
27. Karanth S, Nayyar V. What influences outcome of patients with suicidal hanging. J Assoc Physicians India. 2005;53:853-6.
28. Penney DJ, Stewart AH, Parr MJ. Prognostic outcome indicators following hanging injuries. Resuscitation. 2002;54(1):27-9.
29. Renuka MK, Kalaiselvan MS, Arunkumar AS. An analysis of the predictors of mortality and morbidity in patients admitted after suicidal hanging to an Indian multidisciplinary Intensive Care Unit. Indian J Anaesth. 2017;61(7):538-42.
30. Salim A, Martin M, Sangthong B, Brown C, Rhee P, Demetriades D. Near-hanging injuries: a 10-year experience. Injury. 2006;37(5):435-9.
31. Khan MM, Reza H. Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors. Suicide Life Threat Behav. 1998;28(1):62-8.
32. Shaikh MA, Lloyd J, Acquah E, Celedonia KL, M LW. Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi. BMC Public Health. 2016;16(1):843.
33. Luna G, Adye B, Haun-Hood M, Berry M, Taylor L, Thorn R. Intentional injury treated in community hospitals. Am J Surg. 2001;181(5):463-5.
34. Ting SA, Sullivan AF, Miller I, Espinola JA, Allen MH, Camargo CA, Jr., et al. Multicenter study of predictors of suicide screening in emergency departments. Acad Emerg Med. 2012;19(2):239-43.
35. Hoeflein B, Chiu L, Corpus G, Lien M, Jorden MA, Chu J. Ethnic variations in suicide method and location: An analysis of decedent data. Death Stud. 2022;46(5):1282-6.
36. Hawton K, James A. Suicide and deliberate self harm in young people. Bmj. 2005;330(7496):891-4.
37. Alves VM, Francisco LC, de Melo AR, Novaes CR, Belo FM, Nardi AE. Trends in suicide attempts at an emergency department. Braz J Psychiatry. 2017;39(1):55-61.
38. Balvardi M, Imani-Goghary Z, Babaee K, Izadabadi Z. Suicide and attempted suicide epidemiology in sirjan in 2018. Int J High Risk Behav Addict. 2021;10(2).
39. Rasouli MR, Saadat S, Haddadi M, Gooya MM, Afsari M, Rahimi-Movaghar V. Epidemiology of injuries and poisonings in emergency departments in Iran. Public Health. 2011;125(10):727-33.
40. Fisher LB, Overholser JC, Dieter L. Methods of committing suicide among 2,347 people in Ohio. Death Stud. 2015;39(1-5):39-43.
41. MORADI SE. Evaluation of suicides resulting in death in Iran, comparing with the world rates. 2002.
42. Mergl R, Koburger N, Heinrichs K, Székely A, Tóth MD, Coyne J, et al. What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS One. 2015;10(7):e0129062.
43. Lee KS, Sung HK, Yoo SY, Min HS. Temporal Trends and Characteristics of Adult Patients in Emergency Department Related to Suicide Attempt or Self-Harm in Korea, 2016-2020. J Korean Med Sci. 2023;38(6):e40.
2. Sutton J. Healing the Hurt Within: Understand Self-injury and Self-harm, and Heal the Emotional Wounds: How To Books; 2007.
3. Castellví P, Lucas-Romero E, Miranda-Mendizábal A, Parés-Badell O, Almenara J, Alonso I, et al. Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. J Affect Disord. 2017;215:37-48.
4. McMahon EM, Hemming L, Robinson J, Griffin E. Editorial: Suicide and self harm in young people. Front Psychiatry. 2022;13:1120396.
5. Casey P, Dunn G, Kelly BD, Lehtinen V, Dalgard OS, Dowrick C, et al. The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study. Soc Psychiatry Psychiatr Epidemiol. 2008;43(4):299-304.
6. Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA, Jr. Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012;34(5):557-65.
7. Lim KS, Wong CH, McIntyre RS, Wang J, Zhang Z, Tran BX, et al. Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(22).
8. Schaffer KB, Dandan T, Bayat D, Castelo MR, Reames SH, Hutkin-Slade L, et al. Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes. Eur Geriatr Med. 2022;13(1):119-25.
9. Mobinizadeh M, Berenjian F, Mohamadi E, Habibi F, Olyaeemanesh A, Zendedel K, et al. Trauma Registry Data as a Policy-Making Tool: A Systematic Review on the Research Dimensions. Bull Emerg Trauma. 2022;10(2):49-58.
10. Ghodsi Z, Movaghar VR, Zafarghandi M, Saadat S, Mohammadzadeh M, Fazel M, et al. The minimum dataset and inclusion criteria for the national trauma registry of Iran: a qualitative study. Arch Trauma Res. 2017;6(2):7.
11. Sharif-Alhoseini M, Rasouli MR, Saadat S, Haddadi M, Gooya MM, Afsari M, et al. Suicide attempts and suicide in Iran: results of national hospital surveillance data. Public Health. 2012;126(11):990-2.
12. Khaleghi-Nekou M, Moradi A, Zafarghandi M, Fayaz-Bakhsh A, Saeednejad M, Rahimi-Movaghar V, et al. Epidemiology of fatal injuries among patients admitted at Sina hospital, the national trauma registry of Iran, 2016-2019. Frontiers in Emergency Medicine. 2021;5(1):e9-e.
13. Sharif-Alhoseini M, Zafarghandi M, Rahimi-Movaghar V, Heidari Z, Naghdi K, Bahrami S, et al. National Trauma Registry of Iran: A Pilot Phase at a Major Trauma Center in Tehran. Arch Iran Med. 2019;22(6):286-92.
14. Moore L, Clark DE. The value of trauma registries. Injury. 2008;39(6):686-95.
15. Gal M, Rus D, Peek-Asa C, Cherecheş RM, Sirlincan EO, Boeriu C, et al. Epidemiology of assault and self-harm injuries treated in a large Romanian Emergency Department. Eur J Emerg Med. 2012;19(3):146-52.
16. Swarnkar M, Pal G, Lilhare S. Assault and self-harm injuries: pattern, severity and etiology of injuries in victims attending emergency department of teaching hospital in central India. Int Surg. 2016;3(3):1618-22.
17. Hassan Zadeh Tabatabaei MS, Baigi V, Zafarghandi M, Rahimi-Movaghar V, Pourmasjedi S, Khavandegar A, et al. Epidemiologic and Clinical Characteristics of Intentional Injuries among Cases Admitted to Sina Hospital: Affiliated with the National Trauma Registry of Iran. J Res Health Sci. 2023;23(3):e00587.
18. Nguyen TQ, Simpson PM, Braaf SC, Gabbe BJ. Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm. Injury. 2017;48(1):184-94.
19. Rezaeian M. Suicide/homicide ratios in countries of the Eastern Mediterranean Region. East Mediterr Health J. 2008;14(6):1459-65.
20. Barrigon ML, Cegla-Schvartzman F. Sex, Gender, and Suicidal Behavior. Curr Top Behav Neurosci. 2020;46:89-115.
21. Rezaeian M. Age and sex suicide rates in the Eastern Mediterranean Region based on global burden of disease estimates for 2000. East Mediterr Health J. 2007;13(4):953-60.
22. Bukur M, Inaba K, Barmparas G, DuBose JJ, Lam L, Branco BC, et al. Self-inflicted penetrating injuries at a Level I Trauma Center. Injury. 2011;42(5):474-7.
23. 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.
24. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28(1):1-23.
25. Michaud L, Brovelli S, Bourquin C. [The gender paradox in suicide : some explanations and much uncertainty]. Rev Med Suisse. 2021;17(744-2):1265-7.
26. Schrijvers DL, Bollen J, Sabbe BG. The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord. 2012;138(1-2):19-26.
27. Karanth S, Nayyar V. What influences outcome of patients with suicidal hanging. J Assoc Physicians India. 2005;53:853-6.
28. Penney DJ, Stewart AH, Parr MJ. Prognostic outcome indicators following hanging injuries. Resuscitation. 2002;54(1):27-9.
29. Renuka MK, Kalaiselvan MS, Arunkumar AS. An analysis of the predictors of mortality and morbidity in patients admitted after suicidal hanging to an Indian multidisciplinary Intensive Care Unit. Indian J Anaesth. 2017;61(7):538-42.
30. Salim A, Martin M, Sangthong B, Brown C, Rhee P, Demetriades D. Near-hanging injuries: a 10-year experience. Injury. 2006;37(5):435-9.
31. Khan MM, Reza H. Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors. Suicide Life Threat Behav. 1998;28(1):62-8.
32. Shaikh MA, Lloyd J, Acquah E, Celedonia KL, M LW. Suicide attempts and behavioral correlates among a nationally representative sample of school-attending adolescents in the Republic of Malawi. BMC Public Health. 2016;16(1):843.
33. Luna G, Adye B, Haun-Hood M, Berry M, Taylor L, Thorn R. Intentional injury treated in community hospitals. Am J Surg. 2001;181(5):463-5.
34. Ting SA, Sullivan AF, Miller I, Espinola JA, Allen MH, Camargo CA, Jr., et al. Multicenter study of predictors of suicide screening in emergency departments. Acad Emerg Med. 2012;19(2):239-43.
35. Hoeflein B, Chiu L, Corpus G, Lien M, Jorden MA, Chu J. Ethnic variations in suicide method and location: An analysis of decedent data. Death Stud. 2022;46(5):1282-6.
36. Hawton K, James A. Suicide and deliberate self harm in young people. Bmj. 2005;330(7496):891-4.
37. Alves VM, Francisco LC, de Melo AR, Novaes CR, Belo FM, Nardi AE. Trends in suicide attempts at an emergency department. Braz J Psychiatry. 2017;39(1):55-61.
38. Balvardi M, Imani-Goghary Z, Babaee K, Izadabadi Z. Suicide and attempted suicide epidemiology in sirjan in 2018. Int J High Risk Behav Addict. 2021;10(2).
39. Rasouli MR, Saadat S, Haddadi M, Gooya MM, Afsari M, Rahimi-Movaghar V. Epidemiology of injuries and poisonings in emergency departments in Iran. Public Health. 2011;125(10):727-33.
40. Fisher LB, Overholser JC, Dieter L. Methods of committing suicide among 2,347 people in Ohio. Death Stud. 2015;39(1-5):39-43.
41. MORADI SE. Evaluation of suicides resulting in death in Iran, comparing with the world rates. 2002.
42. Mergl R, Koburger N, Heinrichs K, Székely A, Tóth MD, Coyne J, et al. What Are Reasons for the Large Gender Differences in the Lethality of Suicidal Acts? An Epidemiological Analysis in Four European Countries. PLoS One. 2015;10(7):e0129062.
43. Lee KS, Sung HK, Yoo SY, Min HS. Temporal Trends and Characteristics of Adult Patients in Emergency Department Related to Suicide Attempt or Self-Harm in Korea, 2016-2020. J Korean Med Sci. 2023;38(6):e40.
| Files | ||
| Issue | Vol 19 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v19i3.15805 | |
| Keywords | ||
| Self-Harm Suicide Trauma Registry Gender | ||
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How to Cite
1.
Ramezani Z, Rahimi-Movaghar V, Zafarghandi M, Fakharian E, Saeed-Banadaky SH, Sadeghi-Bazargani H, Mohammadpour Y, Farahmand Rad R, Sadeghian F, Nasr Isfahani M, Rahmanian V, Ghadipasha A, Shahidi M, Piri SM, Mirzamohamadi S, Naghdi K, Salamati P. The Profile of Self-Harm and Suicide in Iran Considering Gender Differences: A Multicenter Study Affiliated with the National Trauma Registry of Iran. Iran J Psychiatry. 2024;19(3):285-294.
