Suicide in Iran

Image of Khurshid Spahbed. He, who was the last Spahbed of Dabuyid dynasty in Tabaristan, after losing the war against Arabs in the year 761, committed suicide at the age of 27.

Suicide in Iran is believed to be a growing concern in recent years. Although suicide rate in Iran is less than most European countries, this country rates the third most committed suicides between the Islamic countries. According to statistics, each day more than 13 people take their lives with suicide in Iran; most of whom are aged 15–35. Some studies also show that in the year 2013, for instance, the average death rate of suicide in Iran was 6 in every 100,000 people.

Economical problems, mental illnesses, cultural compulsories, political issues and social pressures are the major factors of committing suicide in Iran.

Definitions

The word "suicide" in Persian dictionaries like Moeen, Dehkhoda, and Amid, has been defined as "killing self with by any means". The Oxford English Dictionary records the first use of the word "suicide" by Walter Charleton in 1651. Apparently the word suicide in French was used by Pierre Desfontaines for the first time. Later, this word was accepted by the French Academy of Sciences. Ali EslamiNasab, considers the combination of two Latin words sui (self=Persian: خود) and cide (killing=Persian: کُشی) a correct term for suicide (self-killing=Persian: خودکشی). The concept of suicide in the Moaser Persian Dictionary is defined as "the intentional termination of life by own willing and own hands".

The first sociological analysis of suicide has been put forward by the French sociologist, Émile Durkheim. He states in his 1897 book suicide that "suicide is any type of death which is a direct or indirect cause of the victim's own positive or negative acts that he/she was aware of in advance". Durkheim categorized suicides into the following 4 types all of which are related to the relationship of the individual and the society: 1- Egoistic suicide that is the cause of individualism and the separation from the society. 2- Altruistic suicide that occurs when the individual has a deep attachment to the society. 3- Anomic suicide which is the cause of anomie and lawlessness in the society. 4- Fatalistic suicide that occurs when the wills, emotions and incentives of the members of the society is under the restrict control of the society.

In the late 19th century, Sigmund Freud was the first to review suicide from a psychological point of view. He considered suicide as "the ultimate anger towards self cause by the unconscious". Freud, divided human instincts into two categories: death instinct (Thanatos) and life instinct (Eros). He believed that the death instinct starts immediately after birth and intends to come back in the future. This instinct is the cause of extinction, grudge, and termination of generation (reproduction). On the other hand, the life instinct, is the cause of friendship, love, reproduction. Gradually, Freud developed his theory of death instinct, which is in opposition of Libido.

Erwin Stengel is the first one to differentiate between suicide and suicide intention from a psychological point of view. After some researches, he dedicated an independent branch of psychology to the suicide intention. The researches of psychologists have suggested that unlike suicide, the intention of suicide, has some other goals rather than just simple "self destriction". Kayral has mentioned the following 4 goals of suicide intention: 1- an invitation or asking for help and support; 2- a reaction to a disaster or an unexpected catastrophe; 3- abusing or threatening of others and 4- an escape from a harsh situation. According to Eslaminasab, the following five behaviors of suicide ideation, threatening to commit suicide, suicide gesture (harming oneself), suicide attempt and successful suicide, are categorized under suicidal behavior.

The term "suicidology" became prevalent in the 1960s. It was first used in 1929 by the Dutch scientist, W. A. Bonger. Suicidology is the scientific study of suicide and its different aspects.

Reasons

Table 1: Reasons of suicide among 7,553 subjects referred to Loghman Hospital in Tehran from 1970 to 1972.

Reasons Age period	Love-related issues	Family-related issues	Society-related issues	Finance-related issues
10–14	67	86	4	1
15–19	632	1٬268	134	108
20–24	669	1٬121	272	155
25–34	377	944	139	75
35–44	269	423	116	67
45–54	36	161	44	10
55–64	24	78	11	5
65 and older	9	87	26	6
N/A	35	61	17	15
Total	2,118	4,229	763	443

According to the field research questionnaires given to the suicidal patients referred to Loghman Hospital from 1970 to 1972, family-related issues, with a prevalence of 56%, were the most important reasons of committing suicide. (Table 1). In this study, family-related issues consisted of conflicts between married couples and their parents, and also improper interpersonal relations between parents and their children or other siblings with each other. Such issues started from the ages of 15 to 19 and were most frequent among 20 to 24 year old. These 2 age periods combined, were the cause of 56% of total suicides related to family issues. In general, 81% of suicides related to family issues were committed by youths from 10 to 34 years old. In addition, family-related issues, were the most prevalent reason among children from 10 to 14 years old (33%).

In the aforementioned study (Table 1), love-related issues with a prevalence of 28%, were the second reason of suicide and the most frequent age period was from 15 to 24 (61٪). In this study, housing, Unemployment, and educational failure, have been categorized under society-related issues which was the third reason of suicide with the highest frequency in patients from the age of 20 to 24 years old. In this study, financial issues were found to be the last reason of suicide with the prevalence of 6% of all committed suicides.

In a study done on 260 suicides refereed to the Medical jurisprudence Organization of Iran in the first half of 2004, according to the answers that the families of these suicide victims provided, it was found out that the most prevalent reasons of suicide among men were mental disorders (41%) and financial problems (31%), and among women, were family conflicts (54%) and mental disorders (31%). The most prevalent mental disorder among both men and women was depression and in 27% of the cases, the victim had a long history of hospitalization.

Demographics

Table 2: Age and gender of subjects who committed suicide by poisoning and referred to Loghman Hospital in Tehran from 1970 to 1972.

& Date Gender Age	1970			1971			1972			Total
	Men	Women	Total	Men	Women	Total	Men	Women	Total
10–14	29	76	105	30	50	80	11	61	72	257
15–19	363	824	1٬187	243	283	526	237	462	699	2,412
20–24	423	512	935	223	350	573	372	416	788	2,296
25–34	338	462	800	260	305	565	251	423	674	2,039
35–44	136	232	368	120	150	270	125	371	496	1,134
45–54	36	55	91	56	83	139	47	35	82	312
55–64	22	31	53	34	44	78	18	7	25	156
65 and older	40	22	62	20	38	58	5	3	8	128
N/A	48	22	70	30	45	75	23	26	49	194
Total	1,435	2,236	3,671	1,016	1,348	2,364	1,089	1,804	2,893	8,928

The first suggestion that the google search suggestion shows by typing the phrase "methods of..." (...روش‌های) in Persian, is "methods of suicide" (روش‌های خودکشی). March 4, 2016.

Gender

Main article: Gender differences in suicide

Women

Iranian women are more vulnerable to suicide than other groups in the society. Actually, in 2007, Iran ranked the third country in which women were outnumbering men in committing suicide.

According to a study published in 2008, women's suicide rate in Iran was double the amount of men by that year. This study also found that Drug overdose is the most popular method of suicide among Iranians; hanging and self-immolation, respectively, are most popular method after drug overdose.

Age

Children and teenagers

Based on Iran statistics, from 1984 to 1993, nearly 1,500 to 27,000 deaths suspected to suicide among children and teenagers were recorded annually. Teens from 13 to 17 years of age omitted most of these suicides and suicide rate among boys were 4 times the girls'. The whole number of suicides from 1994 to 2001, were 4,250 which showed an increase from the last mentioned period of time. Jalili, by excluding the exceptional cases, found the whole number of suicides among teens from 1993 to 2001 to be approximately 3,225 cases. In this period of time, the suicide rate based on gender was 3.7 boys to 1 girl. The most chosen methods of suicide were, respectively, drug poisoning, hanging, jumping from height and very rarely, firearms. Boys chose firearms, explosives, hanging and suffocation, whereas girls mostly chose poisoning and drug overdoes as a method to kill themselves. The most chosen methods of suicides among children were jumping from height, poisoning, hanging, hitting by knife and jumping under vehicles.

In September 2015, Fateme Daneshvar, the director of the social committee of the Islamic City Council of Tehran, declared that from 2002 to 2004, 111 children committed suicide in Tehran. This data is from the Loghman Hospital in Tehran and is for the suicides by poisoning from the ages of 8 to 13. Majid Mohammadi, sociologist, considers the following 5 reasons for the Iranian children and teens' suicides: 1- conflicts in Sexual identity which increases suicide rates among LGBT youths. 2- neglected depression. 3- group pressure and being bullied at school. 4- copycatting the suicide of another person and public hanging of criminals . 5- Forced marriage in some provinces.

In a field study done on 323 students (159 boys and 164 girls) between the ages of 14 to 17 in the city of Isfahan, which was published in 2001، it was found out that the prevalence of Major depressive disorder among teenagers was nearly 43.4% and Suicidal ideation 32.7%. It was also unveiled that 55.5% of girls and 30,8% of boys had been suffering from mild or sever depression. This study also showed that the most frequency of suicide ideation (58,3%) was among teenagers who described their parents' behavior to be restrictive (less emotional and more controlling) and the least frequency of suicide ideation (11.6%) was among teenagers who described the behavior of their parents to be democratic (more emotional and less controlling). The prevalence of suicide ideation among girls was more than boys (37.7% vs 27.5% respectively).

Youths

According to suicide statistics of 2013, which were the most recent until July 2015, 54% of all suicides in Iran were committed by younger people aged under 30.

A longitudinal study done on students from 2003 to 2008, showed that hanging was the most chosen method and wrist cutting was the least chosen method of suicide. According to this study, single male students aged 22 who were studying Humanities in the Islamic Azad University, had committed more suicide than any other group. It has also found out that most of these suicides were committed near the time of the exams and in holidays between semesters.

Another study done on students in the city of Isfahan, published in 2001, showed that the prevalence of Major depression among teenagers was 43.4% and 32.7% of them were literally suicidal. This also showed that those teenagers who described their parents to being over restrictive (nearly 58.3%), had the most amount of suicidal thoughts; in comparison with those who said that their parents behaved in a more democratic manner and less restrictive (nearly 11.6%).

Methods

Main article: Methods of suicide

Table 3: Statistics of successful suicide methods in Tehran from 1964 to 1974. (Data from the Medical Jurisprudence Organization of Iran)

Year	Hanging	Shooting	Cutting vessel	Self-immolation	Jumping from height	Poisoning	Electric shock	Drinking gasoline	Total
1974	12	8	1	–	1	–	–	1	23
1973	18	3	2	5	–	–	–	–	28
1972	20	8	6	1	–	1	–	–	36
1971	22	8	2	3	–	3	–	–	38
1970	16	14	–	2	–	–	–	–	32
1969	17	13	5	2	–	3	–	–	40
1968	12	10	5	–	3	–	1	–	31
1967	20	9	6	4	1	–	2	–	42
1966	21	12	2	2	3	1	–	–	41
1965	19	8	9	–	1	1	–	–	38
1964	13	15	1	–	1	–	–	–	30
Total	190	108	39	19	10	9	3	1	379

Poisoning

Drug overdose is the most common method of suicide in Iran. (Image is for illustration purpose only).

A 2006 study with the population of 3,477 conducted by Ghoreyshi and Mousavi Nasab, showed that 55.8% of the population chose drug overdose as the most favorite method with the median of %55.8 of the total population.

In a meta-analysis study on other studies done until April 2012, Bidel and others found out that from all methods of poisoning, drug overdose with 75% and other poisons (including agricultural and domestic pesticides) with 13%, had the most prevalence among suicidals. According to this study, provinces of Golestan (90%), Markazi (89%), Razavi Khorasan (88%) and Hormozgan (88%) respectively, ranked the highest in suicide with drug overdose and provinces of Ilam (25%), Bushehr (21%) and East Azerbaijan (20%) respectively, ranked the highest in suicide with other types of poisions. According to Bidel and others, the reason behind Ilam's high incidences of suicide with agricultural pesticides is because such substances are easily accessible in this province.

Self-immolation

According to a 2001 report by the Medical jurisprudence organization of Iran, self-immolation has been the most chosen method of suicide among women with 69.29% prevalence. This report also states that the highest rate of self-immolation as a method of suicide among men was from Yazd Province with 47% prevalence and the highest suicide rate with this method for women was recorded in Bushehr province with 94.4% prevalence.

In a meta analysis study consisted of 19 studies with a population of 22,498 suicide cases done until 2012, Nazarzade and others, have concluded that generally speaking, from all physical methods of suicide, self-immolation, with a prevalence of 13%, is the most chosen method of suicide in Iran. They also found out that the provinces of Kohgiluyeh and Boyer-Ahmad (48%), Ilam (28%) and South Khorasan (10%), respectively, ranked the highest rate in self-immolation as a method of killing oneself. According to Nazarzade and others, although suicide with this method in Iran occurs less than other countries like India (40%), Sri Lanka (24%) and Egypt (17%); the prevalence of this method in Iran is more than some African countries like Zimbabwe (11%) and South Africa and also some European countries like Germany. Their report states that in general and except poisoning, Iranian men and women tend to use violent methods like self-immolation, hanging and shooting with firearms for their suicide. It has to be mentioned that the prevalence of these type of methods is higher in western and south-eastern provinces of the country.

Hanging

Table 4: The frequency of successful suicide methods referred to the Medical Jurisprudence Organization of Iran in the first half of 2004.

Method	Numbers	Per cent
Hanging	118	45.4
Drug overdose	42	16.2
Self-immolation	41	15.8
Jumping	18	6.9
Agricultural pesticides	7	2.7
Melee weapon	6	2.3
Firearm	5	1.9
Aluminium phosphide	5	1.9
Heroin injection	5	1.9
Carbon monoxide	2	0.8
Burning substances	2	0.8
Detergents	2	0.8
Plastic bag	2	0.8
Cyanide poisoning	2	0.8
Collision with train	1	0.4
Drowning	1	0.4
Total	260	100

Based on a 2001 report from the medical jurisprudence organization of Iran, Hanging, with the prevalence of 56.5%, was the most important method of suicide among men.

According to Nazarzade and others, based on a meta-analytical study on other studies conducted during the 1990s and 2000s, (excluding the studies that covered solely the suicides ended in the death of the victim), with a population of 22,468 cases of attempted suicides, the prevalence of hanging was only 2%. Based on this study, Kermanshah Province, in 2005 had the highest rate of hanging (17%) and Golestan Province, in 2002, had the lowest rate of hanging (1%). According to Nazarzade and others, suicide by hanging in Iran occurs less than western and Asian countries.

The table on the right, shows the frequency of methods used in successful suicides that were referred to the medical jurisprudence organization of Iran in the first half of 2004. According to this data, the most chosen method of suicide among both women and men in Iran was hanging. (Population= 180 men and 80 women). Among Iranian men who committed suicide, hanging (57%) and poisoning (17%) respectively, were the most important method and for women, poisoning and self-immolation were the most chosen method, with a prevalence nearly alike each other.

Shooting

The diagram of prevalence of suicide by firearms in Iran in comparison with other countries whose statistics were available. (per 100,000 people)

According to Khademi and others, due to limitations of accessing and using firearms in Iran, suicide by this method, in comparison with other methods such as poisoning, self-immolation and hanging is less favorable.

Based on the data available from the medical jurisprudence organization of Iran, in 2001, 8% of suicides ending in death were involved with a type of firearms (269 persons) and in total, the prevalence of this method was 0.42% in every 100,000 people. In the same year, male suicide rate with this method was 91.4% whereas women's rate with this method was only 8.6%. Also it has to be mentioned that 62% of suicides by shooting occurred in military places. According to Khademi and others, the subject of suicide by firearms among duty soldiers in Iran is problematic and needs to be paid special attention.

Based on statistics from 2001, the provinces of Kermanshah, Ilam and Lorestan, respectively with 1.71, 1.67 and 1.63 suicides by firearm in every 100,000 people, ranked the highest and the provinces of Qom, Zanjan and Mazandaran, respectively with 0, 0 and 0.07 suicides by firearm in every 100,000 people, ranked the lowest. Khademi and others, attribute the high level of suicide by shooting in western and eastern provinces to trafficking of firearms and the fact that in those provinces, people have easier access to these type of lethal equipments than other provinces.

Sites

Main article: List of suicide sites

Tehran Metro

In Iran, like other countries, suicide by train occurs. According to authorities, on average, each month one person kills himself by jumping on Tehran's subway railway. For example, in May 15, 2015, a 35-year-old man after throwing himself under subway train in Moniryeh Station, was injured and brought to hospital. In January 16, 2016, a young lady committed suicide in Darvazeh Dolat Station.

Milad Tower

Jumping from height is also one of the common methods and it has been proven psychologically that incongruous city appearance can cause suicide thoughts in some people. Before the 1979 Revolution of Iran, places like "Pelasko Building" and "The Aluminum Building" in Tehran were among the favorite sites of suicide by jumping and it has been said that some famous Iranian people like Sadeq Hedayat and Nosrat Rahmani intended to jump from these buildings. After the revolution, Milad Tower, which became higher than any other building, attracted those who wanted to kill themselves by jumping, to itself. At least 3 successful suicide by jumping from the roof of Milad Tower have been reported. .

Laws

Main article: Suicide in law

The act of suicide has not been criminalized in the penal law of the Islamic Republic of Iran. However, no one is allowed to ask other to kill him/her. In addition, threatening to kill oneself is not an offense by the law, however, if this act of threatening is done by a prisoner in a prison, then that would be considered as violation of the prisons' regulations and the offender may be punished according to penal law.

According to the Act. 836 of the civil law of the Islamic Republic of Iran if a suicidal person prepares for suicide and writes a testament, if he/she dies, then by law the will is considered void and if he/she doesn't die, then the will is officially accepted and can be carried out.

According to the theory of "borrowed crime", because suicide itself is not a crime in penal law, thus any type of assisting in an individual's suicide is not considered a crime and the assistant is not punished. Assisting in suicide is considered a crime only when it becomes the "cause" of the suicidal person's death; for example when someone takes advantage of someone else's unawareness or simplicity and convince him/her to kill him/herself. In such cases assisting in suicide is treated as murder and the offender is punished accordingly. In addition, assisting in suicide is considered a crime under section 2 of the Act. 15 of the cyber crimes law of the Islamic Republic of Iran which was legislated on June 15, 2009. According to the mentioned act, any type of encouragement, stimulation, invitation, simplification of access to lethal substances and/or methods and teaching of suicide with the help of computer or any other media network is considered assisting in suicide and thus, is punished by imprisonment from 91 days up to 1 year or fines from 5 to 20 million Iranian Rials or both.

See also

• suicide crisis

Cited texts

Books

• Azar, Mahyar; Noohi, Sima; Shafiei, Alireza (2010). Suicide. Arjmand. ISBN 964-496-034-3. {{cite book}}: |access-date= requires |url= (help); Invalid |ref=harv (help)
• Eslaminasab, Ali; Taghvaei, Zahra (1992). Suicide Crisis. Ferdows & Majid. {{cite book}}: |access-date= requires |url= (help); Invalid |ref=harv (help)
• Fooladi, Ezzatollah (2002). Strategies and Plans of Suicide Prevention with a Focus on Youth and Teenagers. Fajr-e Andisheh. ISBN 964-93963-3-0. {{cite book}}: Invalid |ref=harv (help)
• Headley, L.A. (1983). Suicide in Asia and the Near East. University of California Press. ISBN 978-0-520-04811-9. Retrieved July 6, 2016. {{cite book}}: Invalid |ref=harv (help)
• Shneidman, E.S.; Leenaars, A.A. (1999). Lives and Deaths: Selections from the Works of Edwin S. Shneidman. Series in death, dying, and bereavement. Brunner/Mazel. ISBN 978-1-58391-011-5. Retrieved July 6, 2016. {{cite book}}: Invalid |ref=harv (help)

Journals

• Anbari, Musa; Bahrami, Ardashir (Summer 2010). "A review on effects of poverty and violence on suicide rates of Iran". Social issues of Iran (in Persian) (2): 1–29. ISSN 2008-8973. Retrieved July 5, 2016 – via Magiran. {{cite journal}}: Invalid |ref=harv (help)CS1 maint: date and year (link) (subscription required)
• Shirzad, Jalal; Gharrahdaghi, Jaber. "Review of methods and reasons of lethal suicides referred to the medical jurisprudence organization of Iran in the first half of 2004". SID.ir (in Persian). Retrieved July 16, 2016. {{cite web}}: Invalid |ref=harv (help)