https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article Risk Factors Associated with Suicidality in Erbil City ABSTRACT Background and Objectives: Suicide is an intentional attempt to end someone's life that results in death. Suicidality comprises suicidal thoughts, plans, and actions. Knowing the risk factors associated with suicide may help in its reduction. The study's aims were to ascertain the sociodemographic characteristics of suicidal patients and suicidality- asso- ciated risk factors. Methods: A retrospective case-control study recruited 60 participants aged between 18 and 53 years within eight months. Sociodemographic characteristics, risk factors associ- ated with suicide attempts among the studied samples such as personal, maltreatment during childhood, community- associated risk factors, and suicide methods used. The data was analyzed through binary logistic regression. Results: In total, there were (26.6%) cases in the age group 18-29; the majority of the recruits were female (38.3%); most of the participants had a university degree (23.33%), and (26.6%) had never married. Regarding their occupational status, most of the pa- tients had paid work, and populated urban areas. Among positive suicide cases, (89.3%) had experienced previous suicide attempts, mental illness; such as depression, was pre- sent in (57.1%). About )50% (of the suicidal participants experienced physical abuse and maltreatment during childhood. Binary logistic regression analysis showed that previous suicide attempts, mental illnesses such as depression, job problems or loss, and barriers to health care access P-value< 0.040, 0.008, 0.023, 0.043 had a highly significant associa- tion with suicide. Conclusions: There was no association between the sociodemographic characteristics of suicidal and non-suicidal individuals. Individuals with associated characteristics, such as a history of repeated suicide attempts and generalized anxiety disorders, require special consideration. Mental illnesses, such as depression, job loss or problems, a previous sui- cide attempt, and barriers to health care were the highest risk factors. Key words: Suicidality; Suicidal Attempt; Risk Factors; Suicidal Ideation. Ahmed Ali Rasool; Department of Nursing, Hawler Medical University, Kurdistan Region, Erbil, Iraq. (Correspondence: ahmed.rasool@hmu.edu.krd) Abdulqader Hussein Hamad; Department of Nursing, Hawler Medical University, Kurdistan Region, Erbil, Iraq. 46 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 19/04/2023 Accepted: 07/12/2023 Published: 30/05/2024 mailto:ahmed.rasool@hmu.edu.krd mailto:ahmed.rasool@hmu.edu.krd?subject=ahmed.rasool@hmu.edu.krd%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20 mailto:ahmed.rasool@hmu.edu.krd mailto:ahmed.rasool@hmu.edu.krd?subject=ahmed.rasool@hmu.edu.krd%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article Suicidality is the umbrella word for suicidal ideation, plans, and actions (SI, SP, and SA) (1). According to Posner et al. (2007), SI stands for "thoughts or wishes about ter- minating one's own life," SP for "making preparations to end one's own life" (2), and SA for "taking acts to terminate one's own life (3). Suicide has elevated to a global health concern in the twenty-first century. Over 700,000 people take their own lives each year, according to estimates from the World Health Organization (WHO) Regarding the age, gender, and socioeco- nomic condition of the people, differences exist between areas and nations. The most popular methods of suicide include hang- ing, self-poisoning with drugs and pesti- cides, and using weapons. Most suicides globally are caused by psychiatric disorders (4). In Korea, the most common suicide techniques varied between those who attempted suicide and those who succeed- ed, the most common means of suicide completion was hanging, whereas the most common way of suicide attempt was drug poisoning, and it was determined that drug poisoning, stabbing, and other chemical poisoning were less fatal than other suicide techniques (5).The suicide rate in Iran var- ies between 2.2 and 19.53 per 100,000 in- dividuals, with an average of 5.3 per 100,000. Men commit suicide more fre- quently than women (6). The most com- mon method of suicide in Iran is hanging, followed by drug overdose (7). At an esti- mated 1.7 per 100,000 individuals, Iraq's suicide rate is still far lower than that of Western countries. The most common methods of suicide are poisoning, burning, hanging, and using weapons. Although sui- cide and suicidality are likely underreport- ed, they are on the rise in Iraq. Suicidal ide- ation, attempts, and behavior can be influ- enced by several demographic, psychologi- cal, and environmental factors (8). The effects of various sociodemographic fac- tors on suicide have been examined in a few studies (9). Generally, suicide deaths are more common in older males, but sui- cide attempts are more frequently report- ed in women (10).In adolescents, depres- sion is considered a significant risk factor for suicidality. For instance, one study (11, 12) indicated that depression is linked to a fivefold increased risk for suicidal attempts (SA), even after adjusting for gender, age, race, and socioeconomic level. Anxiety is a risk factor associated with suicide (3). Ac- cording to Frey et al. (2023), there were over 47,000 suicide deaths in the United States in 2019, with over 37,000 of those suicides occurring among people of work- ing age 16–64 years (13). (SI) suicidal ideation (SP) suicidal planning (SA) suicidal attempt The study was done by Amin and Mal- khasian in 2019 revealed that the preva- lence of suicide in Erbil was 3.96 per 100000 in the years from 2015-2016, while in Kurdistan overall it was 3.83 per 100000. They stated that the total number of deaths due to unnatural causes of homi- cide and suicide was 1888 in the years 2015-2017, and suicide consisted of 43% of these deaths, which makes it one of the leading causes of unnatural deaths (14). This study acknowledges the possibility of generalizability limitations beyond Erbil City and sensitivity-related challenges such as underreporting and recall biases, and the possibility of underexplored relevant factors. Future research could expand the study's scope to include multiple locations, utilize diverse data sources, and facilitate collaboration among researchers, mental health professionals, and policymakers to resolve these disparities. Filling in these gaps will contribute to our understanding 47 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article the participants were notified that they were allowed to get expert assistance. The research followed the most recent version of the Declaration of Helsinki (the Declara- tion of Helsinki is a fundamental document establishing principles for conducting sci- entific research involving humans). Follow- ing erase the spaces between words 1947, the World Medical Association (WMA) published the first version of the declara- tion in 1964) (15), and the study received ethics approval from the Human Research Ethics Committee at the Hawler Medical University/ College of Nursing. Inclusion criteria included agreement to be the sub- ject of the study, good personal communi- cation, age ≥ 18 years, both sexes, and people with previous suicide attempts whereas the exclusion criteria were being children, nonverbal communication pa- tients, anybody who refused participation, psychosis and substance abuse. The ques- tionnaire of this study includes sociodemo- graphic characteristics of the patients, risk factors associated with suicidality among the studied samples, Methods of suicide attempts that the study sample used, As- sessment of the level of suicide risk (Colombia Suicide Severity Risk Scale). The sociodemographic characteristics in- cluded age group, sex, level of education, marital status, occupational status, and residency area (Appendix N 1).Risk factors associated with suicidality among the stud- ied samples were used to determine the risk factors associated with suicide. It is a tool of three questions that each of them has specific questionnaires and the main questions are about (personal, abuse, mal- treatment during childhood, and commu- nity). The higher the numbers of cases as- sociated with suicide, the worse the condi- tion is (Appendix N 2).The methods of sui- cide attempts that the study sample used as a tool comprised a set of nine question- naires, whereas respondents provided of suicidality, provide direction for inter- ventions, and support efforts to reduce sui- cide rates and promote mental health in Erbil City and beyond. The aim of this study is to investigate the demographics of sui- cidality in Erbil City and to identify the complex risk factors associated with an in- creased likelihood of suicide attempts. By examining the interplay of variables such as age, gender, socioeconomic status, men- tal health conditions, social isolation, ad- verse life events, and access to mental health services. Additionally, the study aims to shed light on the intricate dynamics underlying suicidal behavior. The findings will inform targeted prevention strategies, early intervention programs, and individu- alized mental health services in Erbil City to alleviate the burden of suicidality and pro- mote overall mental health. The present study was a retrospective case -control study that recruited 60 partici- pants aged between 18 and 53. Informed consent was obtained from all the partici- pants. The tool is a standard questionnaire, and the method is a direct questionnaire (face to face) , which was filled out by the researcher and designed by the authors of the study on sociodemographic character- istics such as age, sex, level of education, marital status, occupational status, resi- dency area, and socioeconomic status, which was known by giving them a ques- tionnaire and then asking the participants orally, and risk factors associated with sui- cide attempts among the studied samples, such as personal maltreatment during childhood, community-associated risk fac- tors, and suicide methods used. It has been attempted incorporate all the characteris- tics identified in the literature as potential risk factors for suicidality into the question- naire. The time frame for this study was eight months. Upon receiving the surveys, 48 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article responses of "YES" or "NO" to assess their engagement with specific methods associ- ated with suicidal attempts (Appendix N 3). Assessment of the level of suicide risk (C- SSRS) was used to determine the level of suicidal risk. This tool comprised a set of eight questionnaires, whereas respondents provided responses of "YES" or "NO". A positive C-SSRS is a "YES" response to items 3, 4, 5 and 8. This tool has been used in many research studies with good reliability and validity (16) (Appendix N 4). Regarding validity and reliability, the ques- tionnaire used in this study was in the Kurdish language. Firstly, the English ver- sion of this questionnaire, which had good reliability and validity, was translated into the Kurdish language. Then, for the validity and reliability of the Kurdish version, it was given to 10 professors. Moreover, two questionnaire tools were used (risk factors associated with suicidality among the stud- ied samples, methods of suicide attempts that the study sample used, and assess- ment of the level of suicide risk (Colombia Suicide Severity Risk Scale)), and they have been used in many research studies with good validity and reliability (16). • The official approval and licenses were obtained from the general director of health/ Kurdistan Region Governorate (KRG). • The letter of the introduction and the permission obtained to enter the research environment. • The aims of the study for all units were explained for all participants. • The freedom of the participants to partic- ipate in the study or to leave was consid- ered. • Oral informed consent from the partici- pants to participate in the study was taken. • Observing the principle of confidentiality of the information of the participants and using the code instead of the names of the participants in the questionnaire. • The official permissions were obtained from the ethics committee at the School of Nursing /Hawler Medical University on 7/10/2021 the code number is ;137 There was not any barrier or limitation in the study. Data are summarized and re- ported with the Statistical Package for So- cial Sciences (SPSS Version 25.0) were used for data analysis. Descriptive statistical analysis (frequency and percentage) and inferential statistical analysis of Binary Lo- gistic Regression (BLR) were used to know the risk factors associated with suicide. By utilizing BLR, the study aimed to create a predictive model, accounting for various categorical and continuous variables, to determine the relative importance and contribution of each risk factor in pre- dicting suicidality in the population under study. A P-value was considered significant at the level of P ≤ 0.05 Of the 60 cases, there were 16 males and 44 females. The subjects were divided into suicidal n= 32 and non-suicidal n=28 groups. Among the suicidal group, 82.1% were female, and 17.9% were male. Fur- ther details are presented in table (1). There was no significant difference be- tween different age groups, male and fe- male, level of education, marital status, occupational status and residency area of the suicidal and non-suicidal groups. A to- tal of 64.2% controls, and 50% cases in the age group 18-29, more than half of the study samples were females 75% controls, and 71.8% cases, most of the participants had university degrees 75% controls, and 43.7% cases, 60.7% controls, 50% cases had never married. Regarding their occu- pational status, 50% control, 31.2% cases had paid work, and n=29 control, n=22 cas- es inhabited urban areas. *Not a compara- ble group and the sample size is small. 49 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article 50 planned or suicidal thoughts). Further- more, the time was so limited that getting a high number of cases was im- possible in that determined time) Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. (As for the sample size, we highly appreciate the comment but we chose 60 because of the limited cases that we get in this society because there are not a lot of cases who can truly say that they had Table 1: Socio demographic characteristics of the studied samples Sociodemographic Characteristics Suicidal Groups P-Value Negative (n=32) Positive (n=28) F. (%) F. (%) Age Group (years) 18-29 18 (56.3) 16 (57.1) 0.882 30-41 8 (25) 8 (28.6) 42-53 6 (18.7) 4 (14.3) Sex Male 11 (34.4) 5 (17.9) 0.149 Female 21 (65.6) 23 (82.1) Level of Education Cannot read and write 2 (6.3) 6 (21.4) 0.143 Can read and write 2 (6.3) 5 (17.8) Primary school graduated 0 (0) 1 (3.6) Secondary school graduated 3 (9.4) 1 (3.6) High school graduated 4 (12.5) 1 (3.6) Under-graduated 21 (65.5) 14 (50) Marital Status Never married 17 (53.1) 16 (57.1) 0.400 Married 13 (40.6) 11 (39.3) Divorced 2 (6.3) 1 (3.6) Occupational Status Paid work 14 (43.8) 10 (35.7) 0.729 Self-employed (own business or farm- ing) 7 (21.9) 6 (21.4) Non-paid work (volunteer or charity) 1 (3.1) 1 (3.6) Student 3 (9.4) 2 (7.1) Keeping house/homemaker 4 (12.5) 6 (21.4) Retired 1 (3.1) 0 (0) Unemployed (health reason) 0 (0) 2 (7.1) Unemployed (other reason) 2 (6.3) 1 (3.6) Residency Area Urban 29 (90.6) 22 (78.6) 0.286 Rural 1 (3.1) 4 (14.3) Suburban 2 (6.3) 2 (7.1) The job has been classified according to (WHO). https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article physical abuse and maltreatment during childhood. Other risk factors associated with suicide among suicidal participants were easy access to lethal means such as firearms or medications, as well as unsafe media portrayals of suicide, which oc- curred in 64.3%, and 67.9%. 51 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table (2) presents the risk factors associat- ed with suicide attempts among the stud- ied samples. Among positive suicide cases, 89.3% had experienced previous suicide attempts, while mental illness, such as de- pression, was present in 57.1%. About 50% of the suicidal participants experienced Table 2: Risk factors associated with suicidality among the studied samples Risk factors associated with suicide attempts among the study sample Suicidal Groups Negative (n=32) Positive (n=28) No Yes No Yes F. (%) F. (%) F. (%) F. (%) Personal: Previous suicide attempt 12 (37.5) 20 (62.5) 3 (10.7) 25 (89.3) Mental illness, such as depression 25 (78.1) 7 (21.9) 12 (42.9) 16 (57.1) Social isolation 22 (68.8) 10 (31.3) 13 (46.4) 15 (53.6) Criminal problems 29 (90.6) 3 (9.4) 28 (100) 0 (0) Financial problems 21 (65.6) 11 (34.4) 15 (53.6) 13 (46.4) Impulsive or aggressive tendencies 22 (68.8) 10 (31.3) 24 (85.7) 4 (14.3) Job problems or loss 22 (68.8) 10 (31.3) 22 (78.6) 6 (21.4) Legal problems 28 (87.5) 4 (12.5) 27 (96.4) 1 (3.6) Serious illness 30 (93.8) 2 (6.3) 28 (100) 0 (0) Substance use disorder 29 (90.6) 3 (9.4) 24 (85.7) 4 (14.3) Abuse maltreatment during childhood like: Emotional 27 (84.4) 5 (15.6) 22 (78.6) 6 (21.4) Physical 24 (75) 8 (25) 14 (50) 14 (50) Sexual 30 (93.8) 2 (6.3) 26 (92.9) 2 (7.1) Bullying 24 (75) 8 (25) 19 (67.9) 9 (32.1) Family history of suicide 28 (87.5) 4 (12.5) 23 (82.1) 5 (17.9) Relationship problems such as a break-up, violence, or loss 24 (75) 8 (25) 23 (82.1) 5 (17.9) Sexual violence 32 (100) 0 (0) 28 (100) 0 (0) Community: Barriers to health care access 29 (90.6) 3 (9.4) 18 (64.3) 10 (35.7) Cultural and religious beliefs such as a belief that suicide is good of a personal problem 26 (81.3) 6 (18.8) 21 (75) 7 (25) Stigma associated with mental ill- ness or help-seeking 25 (78.1) 7 (21.9) 20 (71.4) 8 (28.6) Easy access to lethal means such as firearms or medications 14 (43.8) 18 (56.3) 10 (35.7) 18 (64.3) Unsafe media portrayals of suicide 17 (53.1) 15 (46.9) 9 (32.1) 19 (67.9) Someone in the community encour- age for suicide 29 (90.6) 3 (9.4) 24 (85.7) 4 (14.3) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article attempts, mental illness such as depres- sion, job problems or loss, and barriers to health care access P-value <0.040, 0.008, 0.023, 0.043 were highly significant and considered as main risk factors for suicidal- ity. Binary logistic regression analysis for the risk factors associated with suicidal thoughts and ideas was performed to identify risk factors of suicidality. Eighteen covariates were selected as shown in table (3). Of these, having previous suicide 52 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Binary Logistic Regression analysis of risk factors associated with suicidal thoughts and ideas Risk factors B S.E. Wald df P-value Odds Ratio 95% C.I. Lower Upper Previous suicide attempt 3.232 1.575 4.211 1 0.040 25.330 1.156 555.022 Mental illness, such as depres- sion 4.609 1.737 7.043 1 0.008 100.39 4 3.337 3020.004 Social isolation 0.147 1.298 0.013 1 0.910 1.158 0.091 14.760 Criminal problems -17.062 19839.3 < 0.001 1 0.999 < 0.001 < 0.001 Financial problems 0.044 1.316 0.001 1 0.973 1.045 0.079 13.801 Impulsive or aggressive tendencies -2.451 1.622 2.283 1 0.131 0.086 0.004 2.071 Job problems or loss -5.991 2.640 5.150 1 0.023 0.003 < 0.001 0.442 Legal problems -3.608 7.356 0.241 1 0.624 0.027 0.000 49491.93 Serious illness -24.416 26836.6 < 0.001 1 0.999 < 0.001 < 0.001 Substance use disorder -2.680 2.095 1.637 1 0.201 0.069 0.001 4.163 Barriers to health care access 1.525 2.226 0.469 1 0.493 4.593 0.059 360.249 Cultural and religious beliefs such as a belief that suicide is good of a personal problem 1.855 1.949 0.906 1 0.341 6.393 0.140 291.614 Stigma associated with mental illness or help-seeking -0.424 1.525 0.077 1 0.781 0.655 0.033 13.017 Easy access to lethal means such as firearms or medica- tions -2.725 1.521 3.210 1 0.073 0.066 0.003 1.292 Unsafe media portrayals of suicide 0.807 1.299 0.386 1 0.534 2.242 0.176 28.605 Someone in the community encourage for suicide 1.366 1.638 0.696 1 0.404 3.920 0.158 97.111 Barriers to health care access 4.880 2.416 4.079 1 0.043 131.69 1.155 15008.75 Constant -2.435 1.451 2.816 1 0.093 0.088 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article many factors that contribute to it. It em- phasizes the need to delve further into the phenomena by investigating risk variables outside sociodemographic, such as mental health, access to mental health treat- ments, cultural attitudes, and social sup- port networks. The type of society and cul- ture of the studied sample in my research would be the society and culture of Erbil City itself. The studied sample refers to the individuals or participants from Erbil City who was included in my study. Therefore, the focus is on understanding the risk fac- tors associated with suicidality within the specific societal and cultural context of Er- bil City and the individuals comprising the studied sample from that population. In this investigation, the constructed bina- ry logistic regression models determined the risk factors associated with suicidality. Almost three-fifths of percentage of sui- cide cases aged from eighteen to twenty- nine. This is in line with the findings of a related Iranian study (20) which found that suicide rates are higher among younger subjects. These results suggest that young- er age groups may be more vulnerable to suicide, potentially influenced by various risk factors and adverse life events. Nu- merous risk factors have been identified, and it is thought that poor life events con- tribute to the emergence of suicide tendencies in young individuals (17). The present investigation discovered a sta- tistically significant correlation between previous suicide attempts P-value= 0.040 and the suicidal ideas among the suicidal positive group. This result is consistent with that of a previous study (21) which reported the severity of suicidal ideation as a significant risk factor for suicide attempts. Moreover, another study con- ducted in Sulaimani City, Kurdistan, Iraq found that participants with a history of suicide attempts had a high incidence of suicidal ideation; thus the previous Despite the fact that suicide is a complex human behavior, a variety of socio- demographic characteristics have been linked to a higher risk of suicidal behavior in various social and cultural contexts (17). Regarding the sociodemographic characteristics of the participants of the present study, there were no significant differences P-value> 0.05 between differ- ent age groups, male and female, level of education, marital status, as well as occu- pational status and residency area of the suicidal and non-suicidal groups. These findings concur with those of a separate study conducted in Erbil City, Iraqi Kurdi- stan, in which the level of suicide idea- tion was not significantly correlated with nearly all sociodemographic factors P- value> 0.05 (18). Drawing upon these findings, it can be inferred that socio- demographic characteristics alone may not be strong predictors of suicidality in the context of Erbil City. The current re- sults were also in concordance with the results of Jha et al., (2023), in their study also, there were no significant relation- ships between being unmarried or low family income and suicide (19). This sug- gests that factors beyond sociodemo- graphic, such as psychological, cultural, and social factors, might play a more prominent role in contributing to suicid- ality in this population. This is consistent with the findings of a similar study from Iran (20) in which younger subjects ac- count for a greater proportion of suicide cases. Their results also showed that al- most all the sociodemographic character- istics were non-significantly associated with suicide ideation P-value> 0.05. This study's findings, together with those from the current literature, highlight the need for gaining a deeper appreciation for the complexity of suicidality and the 53 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. DISCUSSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article suicide (26). For both men and women, a significant increase in the risk of suicide following a job loss was found to be as- sociated with a prior dread of job loss (27). People who commit suicide are more likely to have died from job-related stress or financial difficulties than those who attempted suicide. (28). Another study indicated that a reduction in work protection laws (29) and job loss in- creased the probability of suicide death among men (30). According to our knowledge, no previously published studies have examined the relationship between job loss and suicidality in our region. This is due to not taking suicide as an actual problem and not taking into great consideration. According to the study of Cooper et al., (2015), only sev- enteen percent of those individuals who had lost their job took their lives within a month of job loss, and fifty percent died six months or longer after job loss. Only two five percent of the ‘recession- related’ suicides were related to fears of job loss (31) which disagrees with our results. The present study results show that there was no correlation between the sociodemographic characteristics of the suicidal and non-suicidal groups. People who exhibit related symptoms, such as a history of repeated suicide attempts, need to receive extra care. Mental ill- ness, including depression, troubles at work or job loss, prior suicide attempts, and barriers to accessing health care, were the top risk factors. 54 Copyright ©2024 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. attempts, if not managed, probably will lead to more aggressive actions (22). How- ever, these results underscore the im- portance of addressing and managing pre- vious suicide attempts to mitigate the risk of further escalation. Depression is strong- ly related to both suicidal ideation and attempt, but little is known about the char- acteristics that increase the risk of suicide among people with depression (23). The current study found a highly statistically significant relationship between mental illness, such as depression (p= 0.008) and suicidal thoughts and ideas. Therefore, more attention should be Paid to people with mental Illnesses, especially depres- sion. This outcome is in line with those of Dazzi et al. (2014), who found that suicidal thought is more substantially associated with depression severity than with its ab- sence (24). The present study's findings are also in line with those of (21), showing that people who reported the highest lev- els of depression also had the highest rates of severe suicidal thoughts by four fifths of a percentage. Thus, these findings empha- size the critical importance of addressing mental illness, particularly depression, as part of suicide prevention efforts. In addi- tion, another analysis looked at how des- pair can lead to actions of self-harm. These findings are similar to previous ones show- ing that the degree of depression is a strong predictor of suicidality (25). A statistically significant correlation be- tween job issues or loss was discovered in the current investigation p-value= 0.023, and the risk of suicidality. Generally, this could be attributed to the difficulties and struggles that someone will face in their effort to live a good life. In the absence of a job, family problems will also increase, which may lead to suicidal ideation, attempt and a suicidal act. This result is similar to the previous studies that discov- ered a link between unemployment and CONCLUSION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2024.05 Erbil j. nurs. midwifery, Vol. 7, No. (1), May 2024 Original Article [10] Sáenz-Aldea M, Zarrabeitia MT, García Blanco A, Santurtún A. 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