Evaluating the Effectiveness of an Educational-Therapeutic Intervention Program in Reducing Suicide and Suicide Attempts in Comprehensive Health Centers of Ilam, Iran

Suicide and suicide attempts are major global public health crises with wide-ranging negative impacts on individuals, families, and communities. These issues involve social, economic, and psychological dimensions, raising serious concerns for healthcare systems. According to the World Health Organization (WHO), suicide is a leading cause of death worldwide and has shown increasing rates in some regions (1). In Iran, suicide and suicide attempts are rising social and health concerns, influenced by psychological, social, economic, and cultural factors (2). Educational and therapeutic interventions — including psychological training, individual and group counseling, social support, and lifestyle changes — effectively prevent suicide, reduce depression and anxiety, and improve the quality of life for at-risk individuals (3). Suicide prevention programs focusing on life skills and stress reduction have effectively lowered suicide attempts and deaths, particularly in high-risk areas (4). Recent global and national guidelines emphasize the importance of multi-level intervention strategies and community-based approaches in suicide prevention, such as the WHO’s LIVE LIFE initiative (5) and the US National Strategy for Suicide Prevention (6), and enhancing youths’ social and emotional skills (7, 8). National strategies, like Australia’s National Suicide Prevention Strategy 2025 - 2035, offer a framework for cross-sector coordination, emphasizing timely crisis response and improved mental health services (8). These frameworks highlight the importance of integrating educational and therapeutic interventions into primary healthcare centers, as practiced in Ilam province.

Ilam, a western Iranian province bordering Iraq, faces notable social and psychological challenges. Recent interventions — such as educational programs in health centers, support and counseling groups for at-risk individuals, and workshops for families and healthcare staff — have positively impacted suicide prevention and improved quality of life in the region (9). In Ilam, empowerment programs and stress-coping skill training for youth have been implemented to prevent suicide and enhance mental health. Psychological interventions in urban and rural health centers have helped reduce depression and anxiety among high-risk individuals (10).

One program provided training for local counselors and psychologists to better identify at-risk individuals and deliver timely interventions, leading to significant success in preventing suicide attempts. Due to its unique social and cultural characteristics and high mental health needs in certain groups, Ilam province requires targeted interventions. Comprehensive health centers have significant potential for such programs. This study evaluates the effectiveness of an educational-therapeutic intervention in reducing suicide and suicide attempts in Ilam’s health centers. Assessing the effectiveness of such programs in reducing suicide is crucial, as it offers valuable insights for policymakers and health authorities and helps design more effective local and national interventions.

Table 1 presents a comparative analysis of the prevalence and frequency of anxiety and depression disorders before and after the intervention across different age groups in Ilam, including 95% confidence intervals (CIs).

For anxiety disorders, the under-15 group increased from 0.44% (95% CI: 0.00 - 1.30) to 2.82% (95% CI: 1.71 - 3.94; P = 0.01). The 30 - 59 age group decreased from 51.54% (95% CI: 45.04 - 58.04) to 43.23% (95% CI: 39.90 - 46.56; P = 0.01), while the 60+ group rose from 8.37% (95% CI: 4.77 - 11.97) to 15.19% (95% CI: 12.78 - 17.61). No significant changes were observed in the 15 - 18 and 19 - 29 age groups. For depression disorders, the under-15 group increased from 0% (95% CI: 0.00 - 0.00) to 4.76% (95% CI: 3.20 - 6.32; P = 0.01). The 30 - 59 age group decreased from 63.95% (95% CI: 58.68 - 69.22) to 43.84% (95% CI: 40.20 - 47.48; P = 0.01), and the 60+ group increased from 5.02% (95% CI: 2.62 - 7.41) to 13.58% (95% CI: 11.07 - 16.10). No significant changes were observed in the 15 - 18 and 19 - 29 age groups.

Overall, the interventions were effective in modifying the prevalence of anxiety and depression in certain age groups, although some groups showed no significant change. These variations may reflect differences in intervention exposure, duration, and age-specific characteristics.

Table 2 outlines the changes in types of care and referrals for individuals with depression and anxiety disorders before and after the intervention in Ilam city. The data reveal significant shifts in treatment approaches, particularly in medication use and referrals to specialist centers. For depression, pharmacotherapy increased from 10.59% (95% CI: 7.23 - 13.96) to 18.10% (95% CI: 16.18 - 20.03), while psychotherapy use significantly decreased from 57.63% to 35.63%, and referrals to specialist centers dropped substantially from 22.42% (95% CI: 17.87 - 26.99) to 7.60% (95% CI: 6.18 - 9.03). Similarly, for anxiety disorders, pharmacotherapy use rose from 11.80% (95% CI: 6.82 - 16.78) to 15.61% (95% CI: 13.97 - 17.25), psychotherapy decreased from 42.23% to 33.30%, and referrals to specialist centers showed a marked reduction from 19.88% (95% CI: 13.71 - 26.04) to 5.17% (95% CI: 3.75 - 6.58).

Additionally, screening services increased for both disorders. These shifts highlight the positive impact of the educational and therapeutic interventions on enhancing healthcare delivery, with a notable focus on increased access to medication and reduced reliance on specialist referrals. These positive outcomes may partly be attributed to the structured training workshops provided to healthcare staff, focusing on CBT, stress management, and coping skills. Furthermore, the identification of at-risk individuals using standardized screening tools such as PHQ-9 and GAD-7 enabled targeted interventions. Improved access to counseling services and increased medication prescriptions for anxiety and depression disorders, prescribed by licensed physicians within the health centers, reflect the enhanced diagnostic and referral capacities developed through these trainings.

Table 3 shows a significant reduction in suicide rates in Ilam county after the intervention across genders and age groups. Male suicides decreased from 429 (49.20%) to 271 (53.66%), and female suicides from 443 (50.80%) to 234 (46.34%), both statistically significant. The largest reductions occurred in the 15 - 24 and 25 - 34 age groups, while some groups showed minimal changes. Overall, the intervention positively impacted suicide rates. Effect sizes (Cohen’s d) for significant reductions ranged from moderate to large, indicating meaningful clinical improvements in suicide rates and mental health disorder prevalence.

Table 4 shows a significant reduction in suicides after the intervention across all periods and both genders. Total suicides decreased from 1,443 in the "Before Intervention" period to 1,039 in the "After Intervention" period, representing a 28% reduction. Reductions were observed in all quarters, including 22.8% in Q4 2019, 37.9% in Q1 2020, 27.6% in Q2 2020, and 22% in Q3 2020. Male suicides dropped from 700 to 512 (26.8%), and female suicides from 743 to 527 (29.1%). The consistent decline across genders and quarters highlights the positive impact of the interventions and related social or psychological changes, supporting the effectiveness of preventive measures and suicide prevention programs.

Table 5 compares suicide attempts before and after the intervention across counties in Ilam province. Most counties experienced a decrease, with Ilam county showing the most significant reduction of 367 cases (from 872 to 505). Other counties, including Abdanan, Chardaval, and Malekshahi, also showed declines, while Darehshahr and Dehloran experienced increases. Total suicide attempts in the province decreased from 1,443 to 1,039, a reduction of 404 cases. Although the intervention was effective overall, increases in some counties warrant further investigation, indicating the need for additional regional analysis.

Table 6 shows a significant reduction in suicide attempts in Ilam county following the intervention. Male attempts decreased from 429 to 271, with their share of total attempts changing from 49.20% to 53.66% (P = 0.01). Female attempts decreased from 443 to 234, reducing their share from 50.80% to 46.34%, which is also statistically significant. The most considerable reductions occurred in the 15 - 24 and 25 - 34 age groups, previously accounting for most suicides: 15 - 24 decreased from 394 to 220 cases, and 25 - 34 from 330 to 166 cases. Other age groups (35 - 44, 45 - 54, and 55+) also saw reductions. These results highlight the positive impact of the intervention, particularly among younger populations and across genders, with a significant overall decrease in suicide attempts post-intervention.

Table 7 shows a significant reduction in suicide cases in Ilam province following the intervention, comparing data across suicide actions (attempts, deaths, and referrals). Total cases decreased by 42%, from 872 before the intervention to 505 after. Suicide attempts dropped by 41% (from 836 to 490), suicide deaths decreased by 55% (from 33 to 15), and referrals to medical centers were eliminated (from 3 to 0). The suicide rate per 100,000 population fell by 41%, from 345.6 to 202.5. These findings highlight the effectiveness of the intervention in reducing both the frequency and severity of suicides, demonstrating the success of preventive and therapeutic efforts in the region.

This study evaluated the effectiveness of an educational-therapeutic intervention program in reducing suicides and suicide attempts at comprehensive health centers in Ilam. The results indicate a positive impact of these interventions in lowering the frequency of suicides and attempts across Ilam province, consistent with previous research demonstrating the effectiveness of psychological and educational interventions in suicide prevention. This study provides statistical evidence of a significant reduction in suicide and suicide attempt rates following the intervention. It can be concluded that preventive programs, particularly at the public, selective, and individual levels, positively impact this crisis.

A key finding was the reduction in suicide cases in Ilam county, especially among individuals aged 25 - 34, with a significant decrease in both suicides and suicide attempts compared to the pre-intervention period. These findings are consistent with numerous studies on suicide prevention, indicating that preventive programs can significantly reduce suicides by teaching life skills, building support networks, and providing psychological counseling. The study demonstrated the positive effects of life skills training, coping strategies, and psychological interventions in reducing symptoms of depression and anxiety, key contributors to suicidal thoughts. These findings align with global and regional research, indicating that psychological and educational interventions, especially in early stages and for at-risk groups, can significantly prevent suicidal behaviors. For example, previous studies have shown that psychological interventions, such as CBT and coping skills training, can reduce symptoms of depression and anxiety in individuals at risk of suicide (3, 4).

Furthermore, these results are consistent with the most recent global and national suicide prevention frameworks, such as the WHO LIVE LIFE initiative (7) and the US National Strategy for Suicide Prevention (6), which emphasize multi-level interventions including restriction of access to lethal means, responsible media engagement, and strengthening social and emotional skills — strategies aligned with the interventions conducted in this study (5). The Australian National Suicide Prevention Strategy (2025 - 2035) also highlights the importance of community engagement and culturally sensitive approaches, which supports the need for tailored interventions noted in our regional findings (8).

Based on the findings of this study, a significant reduction in the frequency of suicide and suicide attempts in Ilam county indicates the effectiveness of the educational and therapeutic interventions. However, the study also found an increase in suicide attempts in certain areas, such as Dareh-Shahr and Dehloran, despite program implementation. The actual number of attempts may be higher due to underreporting caused by social stigma, non-fatal or less severe attempts, and failure to seek medical care. These regional differences highlight the potential influence of cultural, social, and healthcare access factors on intervention effectiveness, suggesting the need for tailored, region-specific strategies. Specifically, the data show that in Ilam county, the suicide rate per thousand population decreased from 13.5 to 6.2 percent. This change is particularly significant for high-risk populations.

These findings are consistent with similar studies conducted in other parts of the world; for example, a systematic study in the United States demonstrated that life skills-based interventions can significantly reduce suicide risk (3). Furthermore, pre- and post-intervention evaluations across different age groups also indicate the positive impact of these programs in reducing suicides within specific age groups. Due to the positive effects of educational-therapeutic interventions on suicide prevention, it is recommended to implement similar programs nationwide and monitor their long-term impact, while future research should focus on improving risk identification and referral, especially in areas with limited healthcare access.

The largest reduction in suicide cases occurred in the 25 - 34 age group, likely due to their greater receptivity to psychological and social interventions. Additionally, a significant decrease in suicide attempts was observed in the 15 - 24 age group, which is generally at higher risk, underscoring the importance of preventive interventions for this population. The program’s success largely stems from empowering at-risk groups and teaching coping skills, including stress management, problem-solving, and resilience enhancement (4). Raising public awareness of suicide signs and empowering healthcare staff to identify and promptly refer at-risk individuals have been key factors in the program's success.

In Dareh Shahr, Dehloran, and Mehran, suicide attempts increased after the intervention, likely due to cultural, social, or healthcare access challenges. The increase in suicide attempts in Dareh Shahr and Dehloran may result from cultural resistance, implementation barriers, or limited mental health access, highlighting the need for culturally sensitive strategies and improved healthcare. Gender differences were also noted, with a larger reduction among females (29.1%) than males (26.8%), suggesting the importance of exploring gender-specific responses in future studies.

The findings of this study are consistent with national and international research highlighting the significant effectiveness of educational, therapeutic, and psychological interventions in suicide prevention. This study highlights the need for comprehensive, multi-level suicide prevention strategies, including public education, empowerment of at-risk individuals, and stronger social support systems. A study in western Iran found that life skills training and psychological counseling programs effectively reduced suicide rates in both rural and urban areas (9). Similarly, the present study also confirms the significant impact of psychological interventions in reducing suicides in the Ilam province. However, contrasting our findings with those of Mann et al. (4), community engagement emerges as a prevention program. The absence of a control group may have introduced confounding factors, such as health policy changes or social influences, affecting the results.

Additionally, in some counties, such as Mamassani, where zero suicides were reported, it remains unclear whether this outcome reflects effective intervention or possible data limitations. Further research is needed to clarify these points and optimize future programs.