In our study, it was determined that nearly half of the cases (45.45 %) were children under 18 years old and nine (13.6 %) were under 15 years old. Suicide frequency was not affected by lunar periods or seasonal changes, and most of the married cases (59 %) were fellow wives or married through bride exchange. Additionally, 78.8 % of the cases did not have any children and 86.4 % of the cases were financially troubled. The most common suicide method was hanging.
Because completed suicides (suicides that end in death) are seen more frequently among males in Turkey, it is notable that in Van the reverse is true. A total of 431 suicide and attempted suicide cases recorded from 2000 to 2003 in Van were assessed by Sancak from the Van Yüzüncü Yıl University Research Center for Women Studies. According to the reports of the provincial security directorate for incidents from the city centre and provincial gendarmerie command for incidents from towns or villages, 151 of 431 cases (80 females, 71 males) were completed suicides [18]. Similarly, in our study, we analysed the suicide deaths (completed suicides) in Van city centre from 2005 to 2011, and the number of female cases was higher than the number of male cases, with 66 females and 57 males out of a total of 123 suicide cases. It is also remarkable that the number of completed suicides from 2000 to 2003 (n = 151) was higher in the study by Sancak [18] when compared to our study, which involved six years of data on suicide deaths (n = 123). We attribute this result to the fact that our study involved suicide cases mainly in the city centre whereas Sancak’s study involved suicide cases in both the city centre and towns or villages.
Suicide is rare in childhood, and the incidence increases with age [16]. Adolescence is a high-risk period for suicide attempts [19]. In the study by Sancak, 80 female suicides occurred in Van in 2000–2003. Of these cases, 15 (18.7 %) were 15 years old and younger, 33 (41.3 %) were between 16 and 20 years old and only six (7.5 %) cases were 35 years old and older [18]. The percentages for these age groups in our study were 13.6 %, 45.5 % and 7.5 %, respectively. The findings indicate that female suicides increase in childhood and adolescence and are much less common among those over 35 years old. Due to the patriarchal culture of the Van area, girls are married at a young age, cannot have an occupation and are not allowed to work [20]. Sancak also reported that the high rate of childhood and adolescent female suicide could be the result of the closed structure of the society, which means continuation of large families and forcing girls to stay at home, to drop out of school and to marry at a very young age [18]. The dramatic decrease in suicide rates as age increases is thought to be due to the respect for elderly people in the cultural and traditional family structure of Van. In other words, women who had no right to speak when they were young become more respected and recognized in the family and society as they get older.
The cause, origin and region of the death cases show seasonal variations in almost every country all over the world [21–23]. According to a study that evaluated homicides and suicides in India, deaths from homicide and suicide were most common in summer, suicides peaked in April and May and homicides peaked in October [24]. A study from Japan reported that suicides reached peaks in April and the fall, whereas the seasonal effect was minimal for deaths resulting from cancer or homicide [5]. Ramadan is a lunar calendar month in which Muslims refrain from eating, drinking and sexual intercourse from dawn to sunset, and it has been reported that, although there is a significant decline in traumatic deaths during Ramadan, the incidence of suicides increases, particularly among females [25]. In our study, 32 suicides (48.48 %) occurred in July, September, October and December. There were no statistically significant differences between suicide periods and moon phases (p > 0.05). Some previous studies also found no correlation between female and male suicides and moon phase [26, 27].
Depression; being single, divorced, or widowed; young age; considering an abortion; and low educational and socioeconomic status are suicide risk factors [28]. According to a study performed in Hungary, a typical female who attempts suicide could be characterized as follows: retired or economically inactive, widowed or divorced, or having depression in her personal history [29]. Additionally, severe conflicts caused by a troubled marriage are known to increase suicide tendency [30].
According to a study conducted in Adıyaman, a province in the eastern part of Turkey, 41.72 % of the females who committed suicide were married [31]. In our study, 33.3 % (n = 22) of the cases were married in an official or religious way, and five cases (7.6 %) were divorced. It is also notable that 13 (59 %) of the married cases were fellow wives or married through bride exchange.
In addition, it is known that having a child decreases suicide attempts and death ideation [32, 33]. In our study, only 14 cases (21.2 %) had a child, whereas almost 80 % of the cases were females who did not have any children. It is also interesting that 39 (75 %) out of 52 females who did not have children were single, and the comparison of age vs. marital status and age vs. number of children revealed statistically significant results.
Migration to the city centre has increased due to evacuation of villages in Van because of terrorism. The differences between village and city life make the adaptation of emigrating people more difficult. Families who lived by breeding livestock in their villages were left unemployed in the city centre and therefore had severe financial problems [18]. Low socioeconomic status, being retired and being economically inactive are among suicidal risk factors for women [28, 29]. In our study, only one (1.5 %) of the cases was employed, 87.9 % were housewives and 10.6 % were students, for a total of 98.5 % who did not have financial independence. Thus, the economic status was very poor for 86.4 % of the cases in our study and poor for 3 %.
The relationship between violence against women and suicide is well known in countries with moderate and low socioeconomic status [14]. Violence affects women in more negative ways than it does men [34]. In our study, the presence of new or old traumatic findings in 12 cases (18.2 %) indicated that the women had probably been exposed to violence.
Suicidal thoughts can be related to serious depression, being abused during childhood, early onset of a major depressive disorder or poor living conditions [35]. The assessment of suicide risk in patients diagnosed with depression is a major step toward precautionary measures [36]. The history of a previous suicide attempt increases the possibility of a successful suicide [16]. In our study, five (7.6 %) cases were undergoing depression treatment, and 12 (18.2 %) had previously attempted suicide. The fact that seven cases (10.6 %) were students indicated the importance of psychological counselling and guidance on addressing problems for students.
In a study from Persia, the percentage of suicides committed at home was 75 % [37]. In our study, the predominant suicide location was a house (59.1 %) or a barn (24.2 %), which is used as an extension of the house in Anatolian culture, and constituted 83.33 % of the incidents.
The lethality of the methods that were preferred in incomplete female suicides is generally lower than that of the methods used in successful suicides, the latter are more traumatic. Hanging is the most frequently seen method in developing countries, whereas firearm use is more frequent in developed countries [38, 39]. According to Turkish Statistical Institute data for 2002–2009, of 21,752 suicide cases in Turkey, 14,012 (35.6 %) were females, and 42.9 % of them committed suicide by hanging [40]. In a study conducted in Kahramanmaras City, Turkey from 1992 to 2002, of 128 suicide incidents, 49 cases were females, and the most frequently used method was hanging [41]. Concordantly, in our study, the most frequently seen suicide method was hanging, for 44 cases (66.7 %).
Sometimes, suicide victims leave suicide notes to their acquaintances or the people who will find them. The notes can be written on paper, on materials similar to paper or, extraordinarily, on the suicide victim’s own body [42]. As mentioned above, there was a suicide note on the body of one of our cases.
The limitations of this study include the kind of autopsies reviewed; autopsies of cases that occurred in the city centre were reviewed, but the autopsy reports belonging to the county prosecution offices were not included. Therefore, an analysis of these county cases could not be performed. In addition, because the autopsy reports that constituted the study material did not contain the cause of suicide or the victim’s educational background, these two parameters were not included.
