Elsevier

Journal of Affective Disorders

Volume 229, 15 March 2018, Pages 56-62
Journal of Affective Disorders

Research paper
The Iraqi national study of suicide: Report on suicide data in Iraq in 2015 and 2016

https://doi.org/10.1016/j.jad.2017.12.037Get rights and content

Highlights

  • The INSS is the first national study of suicide in Iraq.

  • The rates of suicide per 100 000 population in Iraq were low (1.09 in 2015 and 1.31 in 2016).

  • The rates were higher in young people (67.9% were aged 29 years or below).

  • The M:F ratio was low.

  • Rates of recognised psychiatric and substance abuse disorders were low.

Abstract

Background

Very little is known regarding the epidemiology of suicides in Iraq, given the lack of a national surveillance system. Therefore, the government initiated this project “The Iraqi National Study of Suicide

Methods

The study covered 13 (out of 18) provinces in Iraq. A data collection form was designed by the researchers. The forms were completed by police stations in the 13 provinces. Data were extracted from the legal investigation (which include police investigation, family reports and postmortem reports) of cases of when there was no clear cause of death and where there was final verdict of suicide made by judge after examining these reports.

Results

There were 647 cases of suicide. The crude rate of suicide per 100 000 population was 1.09 (1.21 for males, 0.97 for females) in 2015 and 1.31 (1.54 for males and 1.07 for females) in 2016. The majority of cases (67.9%) were aged 29 years or below. The most common method was hanging (41%) followed by firearms (31.4%) and self-burning (19.2%). 24.1% of cases were reported to have psychiatric disorders, of which the most common diagnosis was depression (53.9%). In the majority of cases (82.1%) there were no previous attempts. Only a small minority were reported to have had psychological trauma (15.5%), financial problems (12.4%) or childhood abuse (2.2%).

Limitations

The study covered only 13 provinces in Iraq. We were able to calculate age-standardized rates for year 2016 only. Data are based on official police records and under-reporting and under-recognition of psychiatric disorders are possible.

Conclusion

On the basis of data available to this study, the suicide rate in Iraq is lower than the global rate. Suicide is more common in young people, where the gender distribution is almost equal. Social and cultural factors might have played a role in these patterns. The findings underscore the need of a national registry with a comprehensive and multipronged surveillance approach to correctly identify suicide events. This study aims to be the first step in this process.

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,

References (37)

  • T.A. Blakely et al.

    Unemployment and suicide. Evidence for a causal association?

    J. Epidemiol. Community Health

    (2003)
  • A. Bosnar et al.

    Suicide and the war in Croatia

    Forensic Sci. Int

    (2005)
  • J.T. Cavanagh et al.

    Psychological autopsy studies of suicide: a systematic review

    Psychol. Med.

    (2003)
  • Y. Conwell et al.

    Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study

    Am. J. Psychiatry

    (1996)
  • P.R. Duberstein et al.

    Poor social integration and suicide: fact or artifact? A case-control study

    Psychol. Med.

    (2004)
  • K. Hawton

    United Kingdom legislation on pack sizes of analgesics: background, rationale, and effects on suicide and deliberate self-harm

    Suicide Life Threat Behav.

    (2002)
  • K. Hawton et al.

    Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis

    BMJ

    (2009)
  • R. Henderson et al.

    Changes in Scottish suicide rates during the Second World War

    BMC Public Health

    (2006)
  • Cited by (0)

    View full text