Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 54 10 2025 11 01 2251 2262 Rezvan Feizi 1. Safety Promotion and Injury Prevention Research Center, Research Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Hossein Panahi 1. Safety Promotion and Injury Prevention Research Center, Research Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Saeed Hashemi Nazari Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Reza Hajmanouchehri Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran Ali Delpisheh 1. Safety Promotion and Injury Prevention Research Center, Research Institute for Health Sciences and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Azadeh Nouhi Siahroudi Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2025 01 29 2025 08 10 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/38008 https://ijph.tums.ac.ir/index.php/ijph/article/download/38008/8683