Research paperThe Iraqi national study of suicide: Report on suicide data in Iraq in 2015 and 2016
Introduction
The recent history of Iraq has been very traumatic with four decades of wars, sanctions and civil conflict. At least one traumatic incident had been experienced by half of the population surveyed in the WHO Iraq Mental Health Survey (Alhasnawi et al., 2009). The same survey found a lifetime prevalence rate of any disorder (excluding psychotic disorders) of 18.8%. Iraq has 206 psychiatrists, 3 psychiatric hospitals and 23 psychiatric units (Al-Uzri et al., 2012).
Suicide is a major challenge facing mental health services across the globe. The World Health Organization (WHO) estimated that there were 800,000 cases of suicide in 2012 with a rate of 11.4 per 100 000 population and a Male: Female (M:F) ratio of 1.9 (WHO, 2014). Rates of suicide vary across different countries, gender and age groups. In general, estimated rates of suicide are higher in high income countries (12.7 per 100 000 population with a M:F ratio of 3.5) than in low income countries (11.2 per 100 0000 population with a M:F ratio of 1.6) (WHO, 2014). The 2012 rate of suicide is much lower in Low and Middle Income Countries (LMIC) of the Eastern Mediterranean including Iraq (6.4 per 100 000 population with a M:F ration of 1.4) (WHO, 2014). One of the possible reasons for this variation is that quality of suicide data varies across different countries. Under-reporting or misclassification has been suggested, especially in countries where suicide is illegal or stigmatized (WHO, 2014). However, there is some evidence that real differences still exist in countries with good quality data (WHO, 2014).
The WHO classify mortality data into four categories from 1 (comprehensive vital registration) to 4 (no vital registration). Iraq is given a score of 2 (vital registration with low coverage, a high proportion of indeterminate causes or no recent). The Iraqi National Study of Suicide (INSS) is a government initiative managed by the Mental Health Office (MHO) at the Iraqi Ministry of Health (MOH). It has been developed as part of the Iraqi National Strategy of Suicide Prevention and as the first step in creating a national register of suicide cases to improve the quality of data. This paper presents the first report of the INSS covering the years 2015 and 2016.
Section snippets
Iraqi national population
Iraq has 18 provinces (governorates). Three of them (Erbil, Dohuk and Al-Sulaimaniya) are part of the semi-autonomous Kurdistan Regional Government (KRG) and were not included in this study. Data was not available from another two provinces (Anbar and Nineveh). These two provinces were under the control of the terrorist organization Islamic State of Iraq and Syria (ISIS). According to the data obtained from the Central Statistics Office at the Iraqi Ministry of Planning, the estimated total
Demographics
In total there were 647 cases of suicide, 290 cases in 2015 and 357 cases in 2016. In 2015, there were slightly more males (162, 55.9%) than females (128, 44.1%). Crude rates of suicide per 100 000 population were 1.21 for males, 0.97 for females and 1.09 for the total sample with a M:F ratio of 1.25. In 2016, there were 212 (59%) males and 145 (40%) females. Crude rates per 100 000 population were slightly higher for both males (1.54), females (1.07) and for the total sample (1.31). The M: F
Main findings
This is the first report of the INSS. This government initiative aims to create a national register of suicide in Iraq which will inform the Iraqi National Strategy of Suicide Prevention. There are four main findings of our study: low rate of suicide compared to international and regional figures, higher rates in young people, low M:F ratio specially in young suicides and low rates of recognised psychiatric and substance abuse disorders. These findings are discussed below.
Acknowledgments
we would like to thank the families of cases, police stations which provided the data, the Iraqi Ministry of Interior, the Iraqi Ministry of Health and the Iraq Subcommittee of the Royal College of Psychiatrists for supporting this project.
Author statement
We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. The contribution of authors is as follows:
Dr. Mohammed J Abbas: Literature search, design of the project, data analysis, interpretation of results, writing of the paper.
Dr. Nesif Alhemiary: design of the project,
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