Silent Change of Suicide in the West of Iran (Kermanshah): Joinpoint Regression Analysis

Background Suicide in Iran is more or less the problem of the western region of the country. Although previous studies have described the features of suicide, they didn’t study the trends through reliable methodology. Objectives We study changes in temporal trends of suicide mortality in the west of Iran using joinpoint regression analysis. Methods This is a cross-sectional study. Data for all registered suicide cases in western province of Kermanshah in Iran during 2003 - 2014 was retrieved from the death registry of Iranian legal medicine organization. After direct standardization of the rates, we analyzed data by joinpoint regression analysis to discover the main changes of the trends. Results Overall suicide mortality has increased from 10.6 per 100,000 in 2003 to 12.4 in 2014, which equals to 1.5 % (+0.1 - + 2.8) annual percentage change (APC). Increase in suicide rate for women was remarkably higher than men (APC = 4.5 for women and 0.5 for men (P value < 0.001)). Majority of increase belonged to age group 20 - 29 in women and 30-39 in men. Old men have an increasing trend during the last decade. Hanging constantly increased in both genders with APC of 4.2 (+1.9 - + 6.5) while self-burning decreased after 2006 in women with APC of -5.9 (-12.6 - + 1.2) and poisoning increased in 2011 in men with APC of 17.0 (-4.0 - + 42.5). The number of suicide death in married couples has increased for both genders while for single women decreased in 2007. For women, suicide in low educated or illiterate decreased and in high educated increased, while in men it increased in both educational levels. Conclusions Suicide in the west of Iran has increased slightly during 2003 - 2014 with remarkable differences for men and women. Suicide in old men and women has increased profoundly and may be due to losing their familial and social support in modern life. Pattern of suicide in women has changed dramatically from most rural, uneducated, and self-burned to most urban, high educated, and hanging use form.