Salari Mehrnoosh, Hasankhani Mohammadreza Balooch, Rezaeian Mohsen
Department of Epidemiology and Biostatistics, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
BMC Public Health. 2025 May 19;25(1):1838. doi: 10.1186/s12889-025-23085-5.
Understanding the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to self-harm and analyzing their trends over time is the first step towards designing an effective suicide prevention strategy. This study aims to investigate the trend of self-harm indicators at the national level and in the provinces of Iran, by gender and age groups.
In this ecological study, the trend of self-harm indicators in Iran was examined during the period 1990 to 2021. Data were extracted from the Global Burden of Disease (GBD) database and their secondary analysis was performed with Joinpoint regression using Joinpoint 5.2 software. The spatial pattern of the indices was examined using Hot spot Analysis. The Pearson correlation coefficient was used to evaluate the correlation of indicators with the Socio-demographic index (SDI) in 1990, 2000, 2010, and 2021.
According to estimates, the incidence, death, DALY, YLDs, and YLLs due to self-harm in Iran decreased over 32 years. On average, the annual incidence rate decreased by 0.72% (AAPC = -0.72), death by 1.39% (AAPC = -1.39), DALY by 1.44% (AAPC = -1.44), YLDs by 2.07% (AAPC = -2.07), and YLLs by 1.41% (AAPC = -1.41). The incidence trend was upward in men (AAPC = 0.25) while it was downward in women (AAPC = -1.38). A downward trend was observed in all age groups, with the greatest decrease observed in the 10-19 age group. In most provinces, the indicators decreased. The largest decrease in incidence and YLDs was observed in Kurdistan Province (AAPC = -1.42 and AAPC = -2.94, respectively) and in the three indicators of death, DALY and YLLs in Chaharmahal and Bakhtiari Province (AAPC = -2.32, AAPC = -2.52 and AAPC = -2.49, respectively). Only in Sistan and Baluchestan Province, the death rate (AAPC = 0.09), DALY (AAPC = 0.18) and YLLs (AAPC = 0.22) increased. In addition, there was a significant relationship between subnational SDIs and YLDs (r = -0.401, P = 0.025) in 2021. Between 1990 and 2021, Kermanshah and Ilam consistently appeared as hot spots for all self-harm indicators. Khuzestan also exhibited significantly elevated values, except for YLD and YLL. Conversely, Qom, South Khorasan, and Semnan were identified as persistent cold spots for mortality, DALYs, and YLL.
The increasing trend of some indicators in men and some regions such as Sistan and Baluchestan province requires special attention and implementation of targeted intervention programs.
了解因自残导致的发病率、死亡率、伤残调整生命年（DALYs）、带病生存年数（YLDs）和生命损失年数（YLLs），并分析其随时间的变化趋势，是设计有效自杀预防策略的第一步。本研究旨在按性别和年龄组调查伊朗全国及各省自残指标的变化趋势。
在这项生态学研究中，对1990年至2021年期间伊朗自残指标的变化趋势进行了研究。数据从全球疾病负担（GBD）数据库中提取，并使用Joinpoint 5.2软件通过Joinpoint回归进行二次分析。使用热点分析检查指标的空间模式。采用Pearson相关系数评估1990年、2000年、2010年和2021年各指标与社会人口指数（SDI）的相关性。
据估计，伊朗因自残导致的发病率、死亡率、伤残调整生命年、带病生存年数和生命损失年数在32年间有所下降。平均而言，年发病率下降了0.72%（平均年度百分比变化率[AAPC]=-0.72），死亡率下降了1.39%（AAPC=-1.39），伤残调整生命年下降了1.44%（AAPC=-1.44），带病生存年数下降了2.07%（AAPC=-2.07），生命损失年数下降了1.41%（AAPC=-1.41）。男性的发病率呈上升趋势（AAPC=0.25），而女性则呈下降趋势（AAPC=-1.38）。所有年龄组均呈下降趋势，其中10-19岁年龄组下降幅度最大。在大多数省份，这些指标都有所下降。库尔德斯坦省的发病率和带病生存年数下降幅度最大（分别为AAPC=-1.42和AAPC=-2.94），恰哈马哈勒-巴赫蒂亚里省的死亡率、伤残调整生命年和生命损失年数这三项指标下降幅度最大（分别为AAPC=-2.32、AAPC=-2.52和AAPC=-2.49）。只有锡斯坦-俾路支斯坦省的死亡率（AAPC=0.09）、伤残调整生命年（AAPC=0.18）和生命损失年数（AAPC=0.22）有所上升。此外，2021年各地区社会人口指数与带病生存年数之间存在显著相关性（r=-0.401，P=0.025）。1990年至2021年期间，克尔曼沙赫和伊拉姆一直是所有自残指标的热点地区。胡齐斯坦除带病生存年数和生命损失年数外，其他指标也呈现出显著升高。相反，库姆、南呼罗珊和塞姆南被确定为死亡率、伤残调整生命年和生命损失年数的持续冷点地区。
男性以及锡斯坦-俾路支斯坦省等一些地区某些指标的上升趋势需要特别关注，并实施有针对性的干预计划。
