Abstract
OBJECTIVESRates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran.METHODSWe estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level.RESULTSThe recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population.CONCLUSIONSNearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.
Highlights
Treatment for attempted suicide is an important social and health problem in many countries, accounting for a great part of primary and secondary health care [1]
Studies conducted on suicide attempts (SA), by poisoning, have regrettably shown that the number of attempted suicides is subject to undercounting, underreporting, and denial due to political, cultural, and social reasons, as well as the taboo among individuals and societies at large
The study population consisted of all individuals in the city of Kermanshah who attempted suicide by Deliberate self-poisoning (DSP) (International Classification of Diseases, 10th revision [ICD-10] codes: X60-X69) in 2015 and were taken to the Imam Khomeini Hospital, the principal poisoning treatment center in the west of the country
Summary
Treatment for attempted suicide is an important social and health problem in many countries, accounting for a great part of primary and secondary health care [1]. Deliberate self-poisoning (DSP) is the most common method of suicide around the world [2] and accounts for 80% of suicide attempts (SA) globally. While DSPbased SA result in fewer deaths than other methods [3,4], the rate and risk of repetition of DSP is very high [4,5]. The most important solution for reducing the rate of SA and the mortality caused by SA is to identify and help those who have The more influential these issues, the more prevalent the underreporting and undercounting of SA [4]
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