A Spatial-Temporal Study of the Incidence of Fatal Suicide during the Years 2009 to 2023
-
Rezvan Feizi
,
Mohammad Hossein Panahi
,
Seyed Saeed Hashemi Nazari
,
Reza Hajmanouchehri
,
Ali Delpisheh
,
Azadeh Nouhi Siahroudi
Abstract
Background: This ecological cross-sectional study examines suicide incidence and identifies high- and low-risk clusters across Iranian districts from 2009 to 2023. This study aimed to determine district-specific suicide rates and map spatial risk patterns.
Methods: Overall, 52,665 suicide cases of recorded in forensic medicine were analyzed, with incidence rates calculated per 100,000 population. Spatial autocorrelation techniques were used to identify clusters of high and low suicide risk, and GIS software facilitated mapping. Hanging was the most prevalent method, accounting for 50.88% of cases. Temporal trends across months were also assessed.
Results: The average age of individuals who died by suicide was 33.98 years. High-incidence districts were located in parts of different provinces of Iran, including Eshtehard (Alborz), Firuzeh (Razavi Khorasan), Varzeghan (East Azerbaijan), Sahneh (Kermanshah), Famenin (Hamadan), and Miami (Semnan). High-risk clusters were primarily concentrated in the western provinces of Kermanshah and Hamadan, particularly in Sahneh and Famenin. Conversely, districts in Sistan and Baluchestan in southeastern Iran showed markedly lower suicide rates, possibly due to underreporting or systemic differences in data collection practices, which warrants cautious further investigation.
Conclusion: This study highlights substantial regional disparities in suicide incidence across Iran, with specific high-risk areas identified for targeted intervention. These findings have important implications for public health policy, emphasizing the need for regionally tailored suicide prevention strategies and improved surveillance systems. Further research is needed to understand better the low suicide rates that observed in some districts and to assess potential reporting inconsistencies.
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3. M M (2021). An analysis of motivational strategies for mental health in Islamic teachings. Scientific-Specialized J Qur'anic Hadith Sci, 2(4): 80–104.
4. Wilcox HC, Arria AM, Caldeira KM, et al (2010). Prevalence and predictors of persistent suicide ideation, plans, and at-tempts during college. Affect Disord, 127(1-3): 287–94.
5. Diekstra RF, Gullone E (1995). On the na-ture, magnitude, and causality of suicidal behaviors: an international perspective. Suicide Life Threat Behav, 25(1): 36–57.
6. Khazaei S, Armanmehr V, Nematollahi S, et al (2017). Suicide rate in relation to the human development index and oth-er health-related factors: a global eco-logical study from 91 countries. J Epi-demiol Glob Health, 7(2): 131–4.
7. Miranda BC, Salas M, Pérez R (2016). Mor-talidad por suicidio, factores de riesgo y protectores. Rev Habanera Cienc, 15(1): 90–100.
8. Yaraghi A, Ebrahimi M, Nikbakht A, et al (2014). Comparison of factors associated with suicide among employed women and housewives. Iran J Forensic Med, 20(2): 47–54.
9. Fakhari A, Farahbakhsh M, Esmaeili ED, et al (2021). A longitudinal study of suicide and suicide attempt in northwest Iran: incidence, predictors, socioeconomic status, and the role of sociocultural sta-tus. BMC Public Health, 21(1): 1486.
10. Mirahmadizadeh A, Rezaei F, Mokhtari AM, et al (2020). Epidemiology of sui-cide attempts and deaths: a population-based study in Fars, Iran (2011–16). J Public Health (Oxf), 42(1): e1–e11.
11. Farahbakhsh M, Azizi H, Fakhari A, et al (2022). Developing a community-based suicide prevention program in primary health care. Community Ment Health J, 58(4): 713–9.
12. Daliri S, Ramezani A, Sayehmiri K, et al (2018). Causes and attempts methods of suicide in the Iranian people during 2001–2014: A systematic review and me-ta-analysis study. Koomesh, 20(3): 417–24.
13. Moradi AM, Rahimi R, Mostafavi E (2012). A survey of the rate and effective fac-tors on suicide in Bahar. J Res Behav Sci, 10(1): 50–8.
14. Amiri B, Pourreza A, Rahimi Foroushani A, et al (2012). Suicide and associated risk factors in Hamadan province, west of Iran, in 2008 and 2009. J Res Health Sci, 12(2): 88–92.
15. Rezaeian M, Shadpour P (2008). Seasonal pattern of suicide and attempted suicide in Ilam province during 1995–2002. J Ilam Univ Med Sci, 16: 51–7.
16. Saberi-Zafaghandi MB, Hajebi A, Eskanda-rieh S, et al (2012). Epidemiology of sui-cide and attempted suicide derived from the health system database in the Islamic Republic of Iran: 2001–2007. East Mediterr Health J, 18(8): 836–41.
17. Shojaei A, Moradi S, Alaeddini F, et al (2013). The association between com-pleted suicide and season of the year in an Iranian population. Iran J Public Health, 42(3): 293–7.
18. Shojaei A, Moradi S, Alaeddini F, et al (2014). Association between suicide method, and gender, age, and education level in Iran over 2006–2010. Asia Pac Psychiatry, 6(1): 18–22.
19. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, et al. (2012). Spatial analysis and mapping of malaria risk in an endemic area, south of Iran: a GIS-based deci-sion making for planning of control. Ac-ta Trop, 122(1): 132–7.
20. . Mollalo A, Alimohammadi A, Shirzadi MR, et al (2015). Geographic infor-mation system-based analysis of the spa-tial and spatio-temporal distribution of zoonotic cutaneous leishmaniasis in Go-lestan Province, north-east of Iran. Zoon-oses Public Health, 62(1): 18–28.
21. Mollalo A, Sadeghian A, Israel GD, et al (2018). Machine learning approaches in GIS-based ecological modeling of the sand fly Phlebotomus papatasi, a vector of zoonotic cutaneous leishmaniasis in Go-lestan province, Iran. Acta Trop, 188: 187–94.
22. Torok M, Konings P, Batterham PJ, et al (2017). Spatial clustering of fatal and non-fatal suicide in New South Wales, Australia: implications for evidence-based prevention. BMC Psychiatry, 17(1): 339.
23. Zangeneh A, Najafi F, Karimi S, et al (2018). Spatial-temporal cluster analysis of mortality from road traffic injuries using geographic information systems in west of Iran during 2009–2014. J Forensic Leg Med, 55: 15–22.
24. Cao K, Wu B (2019). A big data–based geo-graphically weighted regression model for public housing prices: a case study in Singapore. Ann Am Assoc Geogr, 109: 173–86.
25. Ihantamalala FA, Rakotoarimanana FMJ, Ramiadantsoa T, et al. (2018). Spatial and temporal dynamics of malaria in Madagascar. Malar J, 17(1): 58.
26. Du Z, Wu S, Zhang F, et al. (2018). Extend-ing geographically and temporally weighted regression to account for both spatiotemporal heterogeneity and sea-sonal variations in coastal seas. Ecological Informatics, 43: 185–99.
27. Razai D, et al. (2020). The suicide rate in the elderly population of Iran between 2008 and 2014. J Res Health Sci, 20(1): e00471.
28. Veisani Y, Delpisheh A, Mohamadian F, et al (2018). Trends of suicide attempts and completed suicide in Ilam Province of Iran; a demographic analysis study. Bull Emerg Trauma, 6(3): 245–8.
29. Veisani Y, Delpisheh A, Sayehmiri K, et al (2017). Seasonality and time patterns in attempted suicide in Ilam province of Iran: an appraisal of current data of 2010–2014. Med J Islam Repub Iran, 31: 11.
30. Veisani Y, Delpisheh A, Valizadeh R, Kikhavani S (2019). Income inequality by Gini-coefficient on suicide death in Iran: a review of national data. Iran J Public Health, 48(8): 1512–7.
31. Kikhavani S, Veisani Y, Mohamadian F, et al (2019). Socioeconomic inequality in self-immolation, between genders; Oa-xaca-Blinder decomposition, results of registration-based suicide data. Bull Emerg Trauma, 7(4): 399–403.
32. Rahmani S, Etemad K, Kavousi A, et al. (2023). Suicide attempts in the provinces of Iran between 2009–2016 – an obser-vational study. PREPRINT (Version 1) available at Research Square. 09 May 2023. doi:10.21203/rs.3.rs-2823730/v1.
33. Höfer P, Rockett IR, Värnik P, et al (2012). Forty years of increasing suicide mortal-ity in Poland: undercounting amidst a hanging epidemic? BMC Public Health, 12: 644.
34. Moftakhar L, Mirahmadizadeh A, Amiri S, et al. (2023). Epidemiology of suicide by hanging in Fars Province, Iran (2011–2019): a population-based cross-sectional study. J Prev Med Public Health, 56(3): 264–71.
35. Hernández-Alvarado MM, González-Castro TB, Tovilla-Zárate CA, et al. (2016). In-crease in suicide rates by hanging in the population of Tabasco, Mexico between 2003 and 2012. Int J Environ Res Public Health, 13(6): 552.
36. Monsef Kasmaee V, Zohrevandi B, Asadi P, et al (2015). Non-judicial hanging in Guilan Province, Iran between 2011 and 2013. Emerg (Tehran), 3(4): 155–8.
37. Al Madni OM, Kharoshah MA, Zaki MK, et al (2010). Hanging deaths in Dammam, Kingdom of Saudi Arabia. J Forensic Leg Med, 17(5): 265–8.
38. Babanejad M, Pourkaramkhan T, Delpisheh A, et al (2014). Epidemiologi-cal investigation of suicide due to men-tal disorders in Ilam Province during 1993–2009. J Ilam Univ Med Sci, 22(5): 104–13.
39. Veisani Y, Delpisheh A, Sayehmiri K, et al (2017). Seasonality in violent and nonvi-olent methods of suicide attempts: a cross-sectional study on systematic regis-try data. Acta Med Iran, 55(8): 507–13.
40. Arya V, Page A, Gunnell D, Dandona R, et al. (2019). Suicide by hanging is a priori-ty for suicide prevention: method spe-cific suicide in India (2001–2014). J Affect Disord, 257:1-9.
41. Der EM, Dakwah IA, Derkyi-Kwarteng L, et al (2016). Hanging as a method of sui-cide in Ghana: a 10 year autopsy study. Pathol Discov, 4(1): 2.
42. Starkuviene S, Kalediene R, Petrauskiene J (2006). Epidemic of suicide by hanging in Lithuania: does socio-demographic status matter? Public Health, 120(8): 769–75.
43. Baker SP, Hu G, Wilcox HC, Baker TD (2013). Increase in suicide by hang-ing/suffocation in the U.S., 2000–2010. Am J Prev Med, 44(2): 146–49.
44. Moradi S, Khademi A (2002). Evaluation of suicides resulting in death in Iran, com-paring with world rates. Iran J Forensic Med, 8(1): 16–21.
45. Choi YS, Shin HK, Hong DY, et al. (2019). Self-esteem as a moderator of the ef-fects of happiness, depression, and hos-tility on suicidality among early adoles-cents in Korea. J Prev Med Public Health, 52(1): 30–40.
46. Janghorbani M, Sharifirad GR (2005). Completed and attempted suicide in Ilam, Iran (1995–2002): incidence and associated factors. Arch Iran Med, 8(2): 119–26.
47. Nazarzadeh M, Bidel Z, Ayubi E, et al (2013). Factors related to suicide attempt in Iran: a systematic review and meta-analysis. Hakim Res J, 15(4): 352–63 [Per-sian].
48. Meel BL (2003). A study on the incidence of suicide by hanging in the sub-region of Transkei, South Africa. J Clin Forensic Med, 10(3): 153–7.
49. Meel B (2006). Epidemiology of suicide by hanging in Transkei, South Africa. Am J Forensic Med Pathol, 27(1): 75–8.
2. World Health Organization (1946). Consti-tution of the World Health Organisation 1946. Available from: [http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1](http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1)
3. M M (2021). An analysis of motivational strategies for mental health in Islamic teachings. Scientific-Specialized J Qur'anic Hadith Sci, 2(4): 80–104.
4. Wilcox HC, Arria AM, Caldeira KM, et al (2010). Prevalence and predictors of persistent suicide ideation, plans, and at-tempts during college. Affect Disord, 127(1-3): 287–94.
5. Diekstra RF, Gullone E (1995). On the na-ture, magnitude, and causality of suicidal behaviors: an international perspective. Suicide Life Threat Behav, 25(1): 36–57.
6. Khazaei S, Armanmehr V, Nematollahi S, et al (2017). Suicide rate in relation to the human development index and oth-er health-related factors: a global eco-logical study from 91 countries. J Epi-demiol Glob Health, 7(2): 131–4.
7. Miranda BC, Salas M, Pérez R (2016). Mor-talidad por suicidio, factores de riesgo y protectores. Rev Habanera Cienc, 15(1): 90–100.
8. Yaraghi A, Ebrahimi M, Nikbakht A, et al (2014). Comparison of factors associated with suicide among employed women and housewives. Iran J Forensic Med, 20(2): 47–54.
9. Fakhari A, Farahbakhsh M, Esmaeili ED, et al (2021). A longitudinal study of suicide and suicide attempt in northwest Iran: incidence, predictors, socioeconomic status, and the role of sociocultural sta-tus. BMC Public Health, 21(1): 1486.
10. Mirahmadizadeh A, Rezaei F, Mokhtari AM, et al (2020). Epidemiology of sui-cide attempts and deaths: a population-based study in Fars, Iran (2011–16). J Public Health (Oxf), 42(1): e1–e11.
11. Farahbakhsh M, Azizi H, Fakhari A, et al (2022). Developing a community-based suicide prevention program in primary health care. Community Ment Health J, 58(4): 713–9.
12. Daliri S, Ramezani A, Sayehmiri K, et al (2018). Causes and attempts methods of suicide in the Iranian people during 2001–2014: A systematic review and me-ta-analysis study. Koomesh, 20(3): 417–24.
13. Moradi AM, Rahimi R, Mostafavi E (2012). A survey of the rate and effective fac-tors on suicide in Bahar. J Res Behav Sci, 10(1): 50–8.
14. Amiri B, Pourreza A, Rahimi Foroushani A, et al (2012). Suicide and associated risk factors in Hamadan province, west of Iran, in 2008 and 2009. J Res Health Sci, 12(2): 88–92.
15. Rezaeian M, Shadpour P (2008). Seasonal pattern of suicide and attempted suicide in Ilam province during 1995–2002. J Ilam Univ Med Sci, 16: 51–7.
16. Saberi-Zafaghandi MB, Hajebi A, Eskanda-rieh S, et al (2012). Epidemiology of sui-cide and attempted suicide derived from the health system database in the Islamic Republic of Iran: 2001–2007. East Mediterr Health J, 18(8): 836–41.
17. Shojaei A, Moradi S, Alaeddini F, et al (2013). The association between com-pleted suicide and season of the year in an Iranian population. Iran J Public Health, 42(3): 293–7.
18. Shojaei A, Moradi S, Alaeddini F, et al (2014). Association between suicide method, and gender, age, and education level in Iran over 2006–2010. Asia Pac Psychiatry, 6(1): 18–22.
19. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, et al. (2012). Spatial analysis and mapping of malaria risk in an endemic area, south of Iran: a GIS-based deci-sion making for planning of control. Ac-ta Trop, 122(1): 132–7.
20. . Mollalo A, Alimohammadi A, Shirzadi MR, et al (2015). Geographic infor-mation system-based analysis of the spa-tial and spatio-temporal distribution of zoonotic cutaneous leishmaniasis in Go-lestan Province, north-east of Iran. Zoon-oses Public Health, 62(1): 18–28.
21. Mollalo A, Sadeghian A, Israel GD, et al (2018). Machine learning approaches in GIS-based ecological modeling of the sand fly Phlebotomus papatasi, a vector of zoonotic cutaneous leishmaniasis in Go-lestan province, Iran. Acta Trop, 188: 187–94.
22. Torok M, Konings P, Batterham PJ, et al (2017). Spatial clustering of fatal and non-fatal suicide in New South Wales, Australia: implications for evidence-based prevention. BMC Psychiatry, 17(1): 339.
23. Zangeneh A, Najafi F, Karimi S, et al (2018). Spatial-temporal cluster analysis of mortality from road traffic injuries using geographic information systems in west of Iran during 2009–2014. J Forensic Leg Med, 55: 15–22.
24. Cao K, Wu B (2019). A big data–based geo-graphically weighted regression model for public housing prices: a case study in Singapore. Ann Am Assoc Geogr, 109: 173–86.
25. Ihantamalala FA, Rakotoarimanana FMJ, Ramiadantsoa T, et al. (2018). Spatial and temporal dynamics of malaria in Madagascar. Malar J, 17(1): 58.
26. Du Z, Wu S, Zhang F, et al. (2018). Extend-ing geographically and temporally weighted regression to account for both spatiotemporal heterogeneity and sea-sonal variations in coastal seas. Ecological Informatics, 43: 185–99.
27. Razai D, et al. (2020). The suicide rate in the elderly population of Iran between 2008 and 2014. J Res Health Sci, 20(1): e00471.
28. Veisani Y, Delpisheh A, Mohamadian F, et al (2018). Trends of suicide attempts and completed suicide in Ilam Province of Iran; a demographic analysis study. Bull Emerg Trauma, 6(3): 245–8.
29. Veisani Y, Delpisheh A, Sayehmiri K, et al (2017). Seasonality and time patterns in attempted suicide in Ilam province of Iran: an appraisal of current data of 2010–2014. Med J Islam Repub Iran, 31: 11.
30. Veisani Y, Delpisheh A, Valizadeh R, Kikhavani S (2019). Income inequality by Gini-coefficient on suicide death in Iran: a review of national data. Iran J Public Health, 48(8): 1512–7.
31. Kikhavani S, Veisani Y, Mohamadian F, et al (2019). Socioeconomic inequality in self-immolation, between genders; Oa-xaca-Blinder decomposition, results of registration-based suicide data. Bull Emerg Trauma, 7(4): 399–403.
32. Rahmani S, Etemad K, Kavousi A, et al. (2023). Suicide attempts in the provinces of Iran between 2009–2016 – an obser-vational study. PREPRINT (Version 1) available at Research Square. 09 May 2023. doi:10.21203/rs.3.rs-2823730/v1.
33. Höfer P, Rockett IR, Värnik P, et al (2012). Forty years of increasing suicide mortal-ity in Poland: undercounting amidst a hanging epidemic? BMC Public Health, 12: 644.
34. Moftakhar L, Mirahmadizadeh A, Amiri S, et al. (2023). Epidemiology of suicide by hanging in Fars Province, Iran (2011–2019): a population-based cross-sectional study. J Prev Med Public Health, 56(3): 264–71.
35. Hernández-Alvarado MM, González-Castro TB, Tovilla-Zárate CA, et al. (2016). In-crease in suicide rates by hanging in the population of Tabasco, Mexico between 2003 and 2012. Int J Environ Res Public Health, 13(6): 552.
36. Monsef Kasmaee V, Zohrevandi B, Asadi P, et al (2015). Non-judicial hanging in Guilan Province, Iran between 2011 and 2013. Emerg (Tehran), 3(4): 155–8.
37. Al Madni OM, Kharoshah MA, Zaki MK, et al (2010). Hanging deaths in Dammam, Kingdom of Saudi Arabia. J Forensic Leg Med, 17(5): 265–8.
38. Babanejad M, Pourkaramkhan T, Delpisheh A, et al (2014). Epidemiologi-cal investigation of suicide due to men-tal disorders in Ilam Province during 1993–2009. J Ilam Univ Med Sci, 22(5): 104–13.
39. Veisani Y, Delpisheh A, Sayehmiri K, et al (2017). Seasonality in violent and nonvi-olent methods of suicide attempts: a cross-sectional study on systematic regis-try data. Acta Med Iran, 55(8): 507–13.
40. Arya V, Page A, Gunnell D, Dandona R, et al. (2019). Suicide by hanging is a priori-ty for suicide prevention: method spe-cific suicide in India (2001–2014). J Affect Disord, 257:1-9.
41. Der EM, Dakwah IA, Derkyi-Kwarteng L, et al (2016). Hanging as a method of sui-cide in Ghana: a 10 year autopsy study. Pathol Discov, 4(1): 2.
42. Starkuviene S, Kalediene R, Petrauskiene J (2006). Epidemic of suicide by hanging in Lithuania: does socio-demographic status matter? Public Health, 120(8): 769–75.
43. Baker SP, Hu G, Wilcox HC, Baker TD (2013). Increase in suicide by hang-ing/suffocation in the U.S., 2000–2010. Am J Prev Med, 44(2): 146–49.
44. Moradi S, Khademi A (2002). Evaluation of suicides resulting in death in Iran, com-paring with world rates. Iran J Forensic Med, 8(1): 16–21.
45. Choi YS, Shin HK, Hong DY, et al. (2019). Self-esteem as a moderator of the ef-fects of happiness, depression, and hos-tility on suicidality among early adoles-cents in Korea. J Prev Med Public Health, 52(1): 30–40.
46. Janghorbani M, Sharifirad GR (2005). Completed and attempted suicide in Ilam, Iran (1995–2002): incidence and associated factors. Arch Iran Med, 8(2): 119–26.
47. Nazarzadeh M, Bidel Z, Ayubi E, et al (2013). Factors related to suicide attempt in Iran: a systematic review and meta-analysis. Hakim Res J, 15(4): 352–63 [Per-sian].
48. Meel BL (2003). A study on the incidence of suicide by hanging in the sub-region of Transkei, South Africa. J Clin Forensic Med, 10(3): 153–7.
49. Meel B (2006). Epidemiology of suicide by hanging in Transkei, South Africa. Am J Forensic Med Pathol, 27(1): 75–8.
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| Issue | Vol 54 No 10 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20143 | |
| Keywords | ||
| Suicide complete Fatal suicide Spatiotemporal analysis Iran | ||
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How to Cite
1.
Feizi R, Panahi MH, Hashemi Nazari SS, Hajmanouchehri R, Delpisheh A, Nouhi Siahroudi A. A Spatial-Temporal Study of the Incidence of Fatal Suicide during the Years 2009 to 2023. Iran J Public Health. 2025;54(10):2251-2262.
