In the recent survey, the number of suicide attempters who came to Educational Therapy centers and hospitals of Kermanshah province during 2014 was 2,501, that 1,406 were female and 1,095 were men. Average age in male suicide attempts was 28.77 and in females was 28.92. Imposing t test on average age didn’t provide a meaningful difference between the two sides from the age aspect. Totally, 74.4% of suicide attempters were below 30 years old and the most attempts to suicide in both sexual groups in age classification is found below 20 years old (58.3%). In all age groups, the female number is significantly more than male attempters. In single men (29.7%) and in married women (29.5%) rate of suicide washigher.

By using X2 test between gender and cause of attempt to suicide, age and reason for attempting suicide there was a meaningful connection. The most common reason to suicide in men was conflict with parents (21.8%) and in women was conflict with husband (17.9%). In age group below 30 years old the most common cause for taking action to suicide was conflict with parents (below 20 years old 16.4% and for 20 – 29 years old 18.2%) and in the age group above 30 years old conflict with husband (9.9%) was the most common reason to suicide. Relationship between living area and suicide attempt cause became meaningful. The highest number of attempts to suicide (78.8). was observed in city residents. The highest number of attempts to suicide in both urban and country areas was attributed to family conflict with parents.

Relationship between education and the reason for suicide attempt became meaningful. The most common reason for suicide attempt in illiterates was marital conflict (2.7%) and in other people with educational level below high school diploma and above that was conflict with family (below diploma 23.6%, diploma 11.8%, above diploma 3.2%). Relationship between occupation and the reason to suicide attempt became meaningful. The most common reason for suicide attempt in working people (3.4%), school and college student (8.6%), unemployed (18.4%) and the other (2.3%) was conflict with parents and in housekeeping people (16.6%) was marital conflict. In women the highest number of suicide attempts was in housekeepers in (34%) and in men the highest number of suicide attempts was in unemployed people (21.9%) and the least number were observed in retired people (0.2%).

In total, the highest and the least number of suicide attempts took place in summer and in winter, respectively. Rate of suicide attempts in men was observed more than women in autumn (13.2%). The result of this study has shown totally 4.1% of participants in suicide action, had a successful outcome and 64.1% of them were for women and 35.9% were men. The mortality rate due to suicide in women was 1.7 times more than men. Burning Self-immolation (58.3%) was the most method taken to suicide that led to death. As you see in Table and Diagram 1, in both male and female groups suicide attempt was made by taking pills and using poison and the biggest causes were conflict with parents and spouse and after that mental health problems and then family and economic problems. Connection between suicide attempt causes with personal features of people who attempted suicide became meaningful. Using burning/self-immolation was the most painful and the most excruciating suicide ways that were common in women and in ages 20 – 29.

Table 1 shows connection between demographic features of people who attempted to suicide and the cause.

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Diagram 1 - Connection between demographic features of people who attempted to suicide and the cause

DISCUSSION

Suicide problems originate from different aspects and it is a multi-cause phenomenon. These people feel the only way out of their problems is to suicide. Most studies showed that most cases of suicide attempts happened in people below 20 years old (2, 19 and 20). In this study, the most common reason to suicide was seen below 20 years old which indicates the vulnerability of people in adolescence to the teenager period, to suicide attempts(2). Higher rates of suicide in teenagers and recognition and paying attention to counteracting factors and reasons to suicide must be considered as a serious and important health issue.

The result of previous studies showed that women attempt to suicide more than the other gender (12, 21, 23). In this study, women attempted to suicide significantly in all age groups. Totally the proportion of women to men was almost 1.3. The idea of “Successful suicide in men is more than in women” didn’t prove to be the result of this study and the proportion of successful suicides in women was more than in men. The result of study shows that married women take action more than single ones. This is despite the fact that in bachelor men the suicide rate was more than married ones. This result matches with recent results(12, 20, and 24). The reason that married women attempt to suicide more than singles must be found in post-marriage problems and their spouses’ behavior. About women, the highest number of suicide attempts in was observed in housekeepers while in men, the highest number was seen in unemployed men. This study’s result matches recent results in Iran(2, 12, 20, and 25). There is a meaningful connection between not having a job and suicide attempt that matches Nojumi et al (22). The most common reason of suicide attempt in men, unemployed and age below 30 was conflict with parents and in women, housekeepers and ages above 30 was conflict with spouse. This result matches the studies(12, 20).

In the current study, most suicide attempt cases were seen in urban residents and the biggest reason for suicide attempts in both urban and rural groups was family conflict which matches the study result(3); but Xia et al who showed that suicide rate in rural middle aged people in China is three to five time more than urban middle aged people didn’t match(18). Most women who attempted suicide had the wife role and in men had the child role in the family. In people with Head of the family and spouse role, the most common cause for taking action to suicide was marital conflict and in children the most common reason to suicide was conflict with parents. The most common reason to suicide attempt in single people was conflict with parent, in married and divorced people was conflict with spouse and in widows was mental health problems. Most suicide attempt cases were in men and women with education less than diploma and the least that were seen were within academic educated men and women which is matched with previous results(2, 12, 20). Illiteracy and low educational level are from the factors that are known risk factors for suicide attempt.

In this study most suicide attempt causes were conflict with parents, family and then mental health problems. Shakeri concluded in his study that female suicide attempters had experienced distresses like marital struggles, family conflicts, emotional problems and failure in education as factors more than other mental, social and psychosocial stress factors, while in men occupational and economic problems had effects more than mental, or social factors(20). Recognition of some risk predictive factors after doing epidemiological studies on people attempting to suicide can present a proper way for prevention for social, and health care planners.

Teenagers, especially young women and probably people who have more marital, domestic and educational problems are the more vulnerable groups(21). Young ages between 15-24 years old, female gender, lack of education, unemployment, single life and history of social and economic deprivation are potential suicide risk factors(14). In our study, most common way to suicide in married women was burning by self-immolation and the reason was marital conflict which matches the study of Amir Moradi and et al (26). In this survey it has been cleared that the suicide proportion that led to death in

men and burning self-immolation is the most common way. 49.5% were housekeepers and 28.2% were unemployed.

In the study of Judd et al study that checked the dead people due to suicide, one third of them were married and more than one third of them were working (39.2%) and one fifth of them were unemployed (20.8%)27. In this study, motive and reason to suicide of 1.9% was due to addiction to drugs and 1.5% of surveyed people attempted to suicide because of that reason. In the study of Skala et al the suicidal thoughts in teenagers with Alcohol dependence problems, illicit consumers of drugs and teenagers with low education have been reported (28). As the Haw et al study reported, potential risk factors for male gender suicide attempts are being a teenager or young, drugs or alcohol abuse and history of self-harm(16). It seems that addiction and drug overuse problems lead to suicide attempts more than is reported and it may be not mentioned in suicide attempters self-reporting or their aware companions due to social considerations.

CONCLUSION

This study’s result showed that being young, female gender, low educational level, unemployment in men and domestic conflicts and mental problems especially married status, and domestic conflicts with husband in women are important factors of suicide attempts in surveyed people. Married and housekeeper women, unemployed bachelor men and teenager, and less than 30 years old are the most vulnerable social strata in this case. It seems that work is a protective factor against suicide. Unemployed people have a higher rate of suicide, probably due to stressful life, creation of a mental illness background and economic – social matters are unemployment consequences. Social and government support for married women against husband’s misbehavior can reduce suicide rate in these women.

Since most reasons for suicide attempts is domestic conflict and psychological-mental health problems, developing governmental and publicly available counseling centers and encouraging families to visit there for solving domestic and psychological-mental problems can be an effective way to manage family problems and stresses that lead to suicide. Also education through media is an important factor that will lead to awareness and suicide rate reduction. Stemming social problems and difficulties and trying to resolve them are the factors that can lead to decreasing suicide.

Acknowledgement
Cost of study execution has been provided from Kermanshah Medical Science University Research Deputy. Thanks to officials and staff of this deputy.