"The Designing and Implication of the Registration System for Suicide, Suicide Attempt and Self-Harm in Tehran and Ilam Provinces"
Principal Investigator: Seyed Kazem Malakouti
Postdoctoral in Research: Marjan Fathi
Research Center: Mental Health Research Center
University: Iran University of Medical Sciences
Code of Ethics in Research: IR.IUMS.REC.1399.174
The Registration Regions: Baharloo and Rasool-e-Akram Hospitals in Tehran province, and Mostafa Khomeini Hospital in Ilam, Imam Reza Hosptial in Eyvan and vali-E-Asr Hospital in Darreh Shahr Cities in Ilam province
The Duration of Research : since 2019
Main Collaborators:
Ahmad Hajebi, Farnaz Etessam, Gholamreza Kalvandi, Koorosh Sayeh Miri , Mohsen Rezaeeyan, Abbas Sheikhtaheri,Behrooz Ghanbari, Aida Ghaem Magham
Abstract:
“Suicide is a global public health concern”(WHO2018). About 800.00 people die by suicide every year. A large number of the suicide and self-harm cases belongs to the countries with low or average income all over the world. It seems that the lack of knowledge about suicide and self-harm is related to the lack or inefficient registry system in these countries. As a result, comprehensive suicide is not reachable information in the most of the aforesaid countries.
The effectiveness of the suicide prevention and self-harm programs requires a smart monitoring of procedures in population. The registration system by determining the age, gender, suicide methods leading to death (fatal suicide methods) and other related factors due to suicide attempt and selfharm, can help to quantify different aspects of the problem in the region. It can also play a key role to develope related purposeful strategies. Moreover, improving the quality of the relevant data help to identify the risky and exposed to danger groups, situations and the procedure of changes in suicide behavior, suicide attempt and self-harm in course of time. It also helps to reflect the results of the intervention and prevention plans/programs more accurately.
Obtaining reliable national statistics about suicide, suicide attempt and self-harm is difficult in Iran. Different organizations collect data in this area, but the final numbers differ. Hence designing a reliable database for reporting the suicide, suicide attempt and self-harm data is a necessity for the national policymakers.
In Iran, the system of suicide registration was designed in 2008 by Ministry of Health, and is being used ever since for registering data concerning suicide and suicide attempt at national level. The results of a case study in forty-two medical sciences universities indicate that this system has covered 84% of country’s population, but according to the assessment of the World Health Organization in 2017, the report show that this “system” need a qualitative evaluation (11). The World Health Organization has published a comprehensive guide for establishment and improvement of registration systems for suicide and self-harm In 2014, and it has been revised in 2016. WHO has recommended the application of these systems for the accurate registration of related statistics in all countries. Therefore, relying on this guide, the present project/study intends to improve the existing registration system in the city of Tehran (Baharloo, and Rasoul Akram Hospitals) and Ilam Province (Ilam, Eyvan and Darreh Shahr Cities) as pilot regions.
It is worth mentioning that based on the studies, the Province of Ilam has the highest rate of suicide in Iran. Therefore, this provinceand the highest suicide rated cities has been selected for intervention processes and has undergone intervention. Tehran is another city chosen for this project. This city, the capital of Iran, with a population of 9 million and located in Tehran Province, is equipped with medical facilities and has the greatest number of suicide-related receptions in its hospitals. Regarding these factors, durability and development of suicide and self-harm prevention policies in aforesaid cities depend on obtaining more comprehensive statistics and data.
The purpose of the present project/study is the improvement of the registration system for suicide, suicide attempt and self-harm in Tehran, Eyvan and Darreh Shahr. In other words, this study tries to estimate the frequency of suicide, suicide attempt and self harm, and the registration of data concerning their background and surrounding components. It also helps to advance prevention policies and interventions in this area, preparing the ground for future studies.
Background
The research foundation was founded in July 2019 as a post doctoral study by Dr. Seysd Kazem Malakouti, Professor of Psychiatry in Iran University of Medical Science, Suicide Behaviors Study and prevention Division. The main colaborators are Dr. Farnaz Etesam, assistant professor of psychiatry in Tehran University of Medical Sciense; Dr. Kourosh Sayehmiri, Professor of Biostatistics in Ilam University of Medical Sciences; Dr. Abbas Sheikhtaheri, assistant professor of health Information Management and Health Informatics in Iran University of Medical Sciences; Dr. Mohsen Reazaeean, professor of epidemiology in Rafsanjan University of medical sciences; Dr. Behrouz Ghanbari, assistant Professor of Nursing,; and Ida Ghaemmagham, Master of Science in Clinical Psychology.The research team is led by Dr.Seyed Kazem Malakouti. Dr. Farnaz Etesam, , in Baharloo Hospital and Dr Kourosh Sayehmiri in Ilam, Ivan, Dareh shahr cities, accompanied him as a project partner. Dr. Marjan Fathi is the manager of the program.
Terminology
The term of “Suicide, in this research, refers to an intentional act of self harm with fatal outcome. “suicide attempt” and “self harm” identify intentional death-oriented action with non-fatal outcome.
Exception : accident, relief from unbearable thoughts, self-punishment and seeking attention
Main Purposes
• Access to population-based data and development of suicide, suicide attempt and self-harm statistics and the related factors
• Improving the accuracy and precision of diagnosing, classifying, collecting, and analyzing data on suicide ,suicide attempt and self-harm
• Improvement the monitoring of changes in the suicide, suicide attempt and self-harm process and its influential social factors
• Determination of the frequency and prevalence of suicide, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Identification of factors related to suicide, suicide attempt and self-harm including demographic, social and biological factors, psychological and psychiatric factors in Tehran, Ilam, Ivan, Darehshahr
• Identification of common suicide methods, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Identification of groups at risk of suicide, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Increased coverage of suicide and self-harm cases in Tehran, Ilam, Ivan, Darehshahr cities
Objectives:
Researchers' easy access to comprehensive information of suicide, suicide attempts and self-harm can have a significant role in advancing suicide prevention at the provincial and national levels. Also, the results of research in this field based on real statistics can have practical implications for health policy makers, professionals and staff. Important research purposes can be summarized as follows:
• Identification of the most common psychiatric diagnosis related to suicide, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Identification of temporal and spatial characteristics of suicide, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Study of annual and seasonal trend of suicide, suicide attempt and self harm changes in Tehran, Ilam, Ivan, Darehshahr cities
• Identifying common patterns of suicide, suicide attempt and self harm in Tehran, Ilam, Ivan, Darehshahr cities
• Helping to estimate the results of suicide, suicide attempt and self-harm prevention interventions in Tehran, Ilam, Ivan, Darehshahr cities
• Providing the opportunity to monitor suicide, suicide attempt and self harm prevention strategies.
Methodology:
After the approval of the project and the provision of the required funding, the strategic committee will be formed to prepare the ground for intra-organizational, inter-organizational collaborations and the actualization of this system. The coverage and registration of suicide cases will be phased and done based on a certain plan.
The phases of the project include the following:
- The first phase: Baharloo and Rasool-E-Akram Hospitals, located in Tehran,and hospitals in Ilam, Eyvan and Darreh Shahr cities will be monthly and gradually covered by the system of registration.
- The second phase: After conducting the first phase, the reports and results of the project done in these two provinces, Tehran and Ilam, will be analyzed and published.
The required measures will be taken, consisting of providing and dispatching tools to the data collection centers, [determining] the method of collecting, registering and preserving data and also preparing the necessary facilities to undertake the above-mentioned procedures. A provincial center will be founded in Ilam Province as a subdivision of Vice Dean for Research Affairs at Iran University of Medical Sciences and Ilam University.
The administrative team will begin fieldwork and will collect and transfer data to the provincial registration centers at the mentioned cities. The expert in charge of registration will control, follow up and eliminate any possible imperfections of data in these centers. Collecting and registering data will be conducted actively. Data registration staff will gather data of suicide, suicide attempt and self-harm by using prepared software. The registered data will be transferred to the central registration unit at Iran University of Medical Sciences- a WHO’s collaborating center-which is equipped with web-based registration system; where the project’s epidemiologist will help to analyze the data. The concerning authorities, including the main expert in charge, the strategic committee and fundraisers will be informed about the results of data analysis, according to the determined protocol; and finally necessary decisions about the way of publishing the results and reports will be made.
Inclusion and exclusion criteria in terms of disease profile
Suicide:
- Inclusion Criteria:
According to worldwide suicide registration plans, as well as WHO recommendation, suicide deaths registered will be based on the ICD-10 International Classification of Disease Codes (I60-X84). .
- Exclusion criteria:
1. Accidental deaths, natural deaths and criminal deaths under the NASH system, as well as any overdose of drugs or drugs and alcohol that was not intended to be suicidal.
2. Severe mental retardation to the extent that the individual is unaware of the deadly consequences of their practice.
Suicide attempt and self-harm:
-Inclusion criteria:
1. All cases of self-harm (based on ICD-10 coding) in which intentional conduct is established on the basis of evidence, examination and interview.
2. All persons who have attempted suicide and are alive at the time of admission to the hospital.
- Exclusion criteria:
1. Excessive and accidental consumption of alcohol, drugs and substances not intended to be suicidal or self-harming.
2. Severe mental retardation (the individual is unaware of the deadly consequences of their attempt).
- Inclusion and exclusion criteria in terms of patient characteristics
All cases by the above criteria, regardless of patient characteristics (age and sex), will be eligible for registration.
- Inclusion and exclusion criteria in terms of time
This registration program is a prospective study, and the previous suicide attempts will not be subject of this registration project.
The target population:
All residents in the cities of Tehran, Ilam, Ivan, Darshahr will be deducted based on the data provided by the Census Bureau. The latest statistics will be provided by the Bureau of Statistics.
Resaeach Tools
In the suicide registration questionnaire, demographic information, socio-economic status, information related to suicide attempt and self-harm, the presence of underlying physical and mental illnesses, history of previous suicide attempt and self-harm, previous method of suicide attempt and self harm, history of suicide in Family, friends and classmates are being recorded.In this study, in addition to the suicide registration questionnaire, three questionnaires, including suicide severity, anger and impulsivity questionnaires are administered to those who attempt suicide and self-harm. Psychiatric diagnosis based on the psychiatrist's visit will be also be recorded.
Confidentiality
The standardized system of creating codes will be confidential and known only to those controlling the electronic database.
Confidentiality in the use of personal data in medical records is governed by both the ethical guidelines of the medical profession and the data protection legislation in each hospital. Consequently, the method of coding will be informed by the data protection legislation of each hospital. Where data protection legislation does not allow for the recording of personal data without consent, an alternative anonymized coding procedure of hospital presentations of self-harm could be agreed with the designated local office for data protection.
Follow up:
Each person will be followed up by telephone after discharge from the hospital. In the first month every week and then every month up to a year.