Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015
Open accessAbstract
BACKGROUND: Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015. METHODS: All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death. RESULTS: Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine. CONCLUSION: In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities. TRIAL REGISTRATION: Not applicable.
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In Iran, pesticides were involved in 84.2% of suicide by poisoning cases, followed by opiates (6.8%), methamphetamines (2.74%), ethanol (1.3%), strychnine (1.3%), and minor drugs.
“Toxicological examinations found that pesticides were involved in 84.2% of the cases, followed by opiates (6.8%), methamphetamines (2.74%), ethanol (1.3%), strychnine (1.3%), and minor drugs.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [26]
Table 3 (Results > Forensic toxicology analysis results; page unavailable) lists detections that broadly match the quoted percentages when calculated against its total of 764 detections. But the paper investigated 674 self-poisoning deaths in Tehran during 2011–2015, and some cases involved multiple substances. The percentages therefore describe detections, not percentages of suicide-by-poisoning cases across Iran. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn Iran, suicide by poisoning accounted for 45.8% of 1667 autopsies.
“A retrospective study conducted in Iran [26] examined 1667 autopsies and found that suicide by poisoning accounted for 45.8% of the sample.”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [26]
The Results (Demographic characteristics; page not available) report 1,667 suicide cases investigated in Tehran, of which 674 (40.43%) were self-poisoning deaths with positive toxicology results. The sample size matches the claim, but the reported proportion is 40.43%, not 45.8%. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe autopsy rate in deaths by suicide and poisoning is still low.
“The autopsy rate in deaths by suicide and poisoning is still low [21,22,23,24,25,26,27,28].”
From Toxicological Findings of Self-Poisoning Suicidal Deaths: A Systematic Review by Countries (2022) · cites this paper as [26]
The Background says studies of postmortem samples from completed self-poisoning suicides are scarce, but that is not an autopsy rate. The Discussion says Iranian legal authorities demand autopsies in suspicious poisoning and suicide deaths; it does not report how often those autopsies occur. Searches for an autopsy rate or percentage found no such measure in our copy. (LLM, conf=0.76)
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Result
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1 of the 69 references couldn’t be matched to a known paper.
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Self-citationForensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview
Akhgari, M., Amini-Shirazi, N., & Iravani, F. S. (2017) · Basic & Clinical Pharmacology & Toxicology · doi:10.1111/bcpt.12930 · Cited by 29 · see citing works
Self-citationMahdavi, S. A., Kolahi, A., Akhgari, M., Gheshlaghi, F., Gholami, N., Moshiri, M., Mohtasham, N., Ebrahimi, S., Ziaeefar, P., McDonald, R., et al. (2021) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14680 · Cited by 29 · see citing works
Self-citationPublic health risks associated with methadone in Iran: A systematic review and meta-analysis
Abadi, Y. R., Gholami, J., Noroozi, A., Ansari, M., Baheshmat, S., Hamzehzadeh, M., Ghadirzadeh, M. R., Vahdani, B., Ekhtiari, H., Mojtabai, R., et al. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103529 · Cited by 26 · see citing works
Mahdavi, S. A., Zamani, N., McDonald, R., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-14007-1 · Cited by 25 · see citing works
Self-citationAnalyses of Child and Youth Self-Poisoning Hospitalizations by Substance and Socioeconomic Status
Pawer, S., Rajabali, F., Zheng, A., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18137003 · Cited by 24 · see citing works
“Self-poisoning among children and youth has been identified as a critical public health concern in many areas across the globe, for example, in c untries such as England [5] and Iran [23], as well s th oughout North America [7,24].”
BackgroundAn alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018
Paknahad, S., Akhgari, M., & Ghadipasha, M. (2020) · Forensic Science Medicine and Pathology · doi:10.1007/s12024-020-00339-9 · Cited by 25 · see citing works
Self-citationDrug-facilitated crime caused by drinks or foods
Gharedaghi, F., Hassanian‐Moghaddam, H., Akhgari, M., et al. (2018) · Egyptian Journal of Forensic Sciences · doi:10.1186/s41935-018-0100-8 · Cited by 21 · see citing works
“For toxicological analysis, urine samples were extracted by liquid–liquid extraction (LLE) in systematic toxicological analysis (STA) manner for screening drugs, poisons, and opioids (Kordrostami et al. 2017).”
MethodInfluentialSelf-citationTrend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015
Ghodsi, Z., Moghaddam, S. S., Saadat, S., Yoosefi, M., Rezaei, N., Ostadrahimi, H., Mehdipour, P., Khalafi, B., Sobhani, S., Haghshenas, R., et al. (2019) · Public Health · doi:10.1016/j.puhe.2019.02.025 · Cited by 19 · see citing works
Fusaroli, M., Pelletti, G., Giunchi, V., Pugliese, C., Bartolucci, M., Necibi, E. N., Raschi, E., Ponti, F. D., Pelotti, S., & Poluzzi, E. (2023) · Drug Safety · doi:10.1007/s40264-022-01269-x · Cited by 21 · see citing works
A retrospective study of poisoning deaths from forensic autopsy cases in northeast China (Liaoning)
Wang, L.-L., Zhang, M., Zhang, W., Li, B.-X., Li, R.-B., Zhu, B.-L., Wu, X., Guan, D.-W., Zhang, G.-H., & Zhao, R. (2019) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2019.02.008 · Cited by 23 · see citing works
Hadeiy, S. K., Parhizgar, P., Hassanian‐Moghaddam, H., et al. (2021) · Drug and Chemical Toxicology · doi:10.1080/01480545.2021.1903486 · Cited by 16 · see citing works
“In a similar study conducted in the same center between 2006 and 2011, narcotics and pesticides were the most prevalent causes of death, a result also compatible with the study by Kordrostami et al. (2017).”
ResultStimulant use in suicides: A systematic review
Mantinieks, D., Schumann, J., Drummer, O. H., Woodford, N. W. F., & Gerostamoulos, D. (2022) · Forensic Science International · doi:10.1016/j.forsciint.2022.111391 · Cited by 15 · see citing works
Patočka, J. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-819090-6.00016-7 · Cited by 13 · see citing works
Fakoor, M., Akhgari, M., & Shafaroodi, H. (2019) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_490_18 · Cited by 10 · see citing works
“International Journal of Preventive Medicine 2019, 10: 36 2 and health consequences of opium abuse.[8] Pyrimidine 5′‐nucleotidase (P5N) is an essential enzyme for erythrocyte integrity and akin described for pathogenesis of hereditary P5N deficiency.”
BackgroundSelf-citationAkhgari, M., Iravani, F. S., & Ghadipasha, M. (2021) · PubMed Central · doi:10.22122/ahj.v13i1.296 · Cited by 10 · see citing works
Self-citationNia, H. S., Heidari, M., Naghavi, N., Lehto, R. H., Haghdoost, A. A., Jafari-Koulaee, A., Matbue, Y. H., Yaghoobzadeh, A., Goudarzian, A. H., & Sharif, S. P. (2020) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222820966934 · Cited by 9 · see citing works
“…al., 2017; Hossini et al., 2013; Izadi et al., 2018; Kashfi et al., 2016; Kashfi & Yazdankhah, 2015; Kazemi et al., 2016; Kheirabadi et al., 2012; Kordrostami et al., 2017; Mazaheri et al., 2019; Mehrpour et al., 2012; Mirahmadizadeh et al., 2019; Momeninejad et al., 2012; Moradi et al., 2012;…”
BackgroundDai, J., Liu, J., Zhang, M., et al. (2022) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-022-03753-4 · Cited by 9 · see citing works
Chen, C.-K., Chan, Y., & Su, T. (2020) · PLoS ONE · doi:10.1371/journal.pone.0244438 · Cited by 9 · see citing works
El-Farouny, R., & Helmy, M. S. (2021) · The Egyptian Journal of Forensic Sciences and Applied Toxicology · doi:10.21608/ejfsat.2021.49489.1177 · Cited by 8 · see citing works
“Selfpoisoning throughout all ages was listed as one of the major causes of unnatural deaths (Kordrostami et al., 2017).”
BackgroundResultInfluentialZinc Phosphide Poisoning: From A to Z
Juárez-Martínez, A., Madrigal-Anaya, J. D. C., Rodríguez-Torres, Y. P., et al. (2023) · Toxics · doi:10.3390/toxics11070555 · Cited by 7 · see citing works
Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths
Valipour, R., Shekari, A., Setareh, M., & Soltaninejad, K. (2020) · American Journal of Forensic Medicine & Pathology · doi:10.1097/paf.0000000000000607 · Cited by 7 · see citing works
“Men often choose more violent suicide methods that will assure to reach their desired aim.(13,14) An explanation of this result in present study due to investigation only on completed suicides and the rate of nonfatal suicide attempts were not included in this regards.”
BackgroundMethodThe Prognostic Factors of Aluminum Phosphide Poisoning in Urmia: A-five-years Cross-sectional Study
Majidi, M., Jamalpour, M., & Nekoueifard, S. (2021) · International Journal of Medical Toxicology and Forensic Medicine · doi:10.32598/ijmtfm.v11i2.32663 · Cited by 7 · see citing works
Mohammadinejad, A., rizi, K. S., Oskuee, R. K., Aryan, E., Meshkat, Z., Ulianas, A., & Rezayi, M. (2021) · Biotechnology and Applied Biochemistry · doi:10.1002/bab.2190 · Cited by 6 · see citing works
The mortality rate from self-harm in Iran
Ghodsi, Z., Moghaddam, S. S., Vezvaei, P., Yoosefi, M., Rezaei, N., Saadat, S., Sheidaei, A., Sharif-Alhoseini, M., Sadeghian, F., Ahmadi, N., et al. (2020) · Public Health · doi:10.1016/j.puhe.2020.06.015 · Cited by 6 · see citing works
Epidemiology of Suicide by Medication Overdose: A Population–based Study 2011–2019
Azarbakhsh, H., Moftakhar, L., Amiri, S., & Mirahmadizadeh, A. (2021) · Archives of Medical Research · doi:10.1016/j.arcmed.2021.10.006 · Cited by 5 · see citing works
Niknahad, H., Heidari, R., Jangjou, A., et al. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e22165 · Cited by 5 · see citing works
Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region
Erlangsen, A., Khan, M. M., Su, W., Alateeq, K., Charfi, F., Madsen, T., Qin, P., Morthorst, B. R., Thomsen, M., Malik, A., et al. (2023) · Archives of Suicide Research · doi:10.1080/13811118.2023.2262532 · Cited by 5 · see citing works
Assessing Substances Abuse-Induced Mortality Rates by Autopsy Method in Iran
Baberi, F. K. S., Kavousi, A., Mirtorabi, D., et al. (2021) · International Journal of Medical Toxicology and Forensic Medicine · doi:10.32598/ijmtfm.v11i2.32400 · Cited by 3 · see citing works
“The highest mortality rate was observed among the 20-40-year-old age group; this result was consistent with those of the previous studies [15, 17].”
ResultIntoxication-Related Deaths in a Poisoning Center in Isfahan
Dorooshi, G., Meamar, R., Kalantar, K., & Amini, Z. (2022) · Advanced Biomedical Research · doi:10.4103/abr.abr_61_21 · Cited by 3 · see citing works
“,[20] from 2011 to 2015, it was stated that 1667 of suicides were investigated by Tehran Forensic Medicine Organization in Iran, of which 674 (40.”
BackgroundEisa, G., Ebrahem, N. E., Abdel-Hady, R. H., & Shaltout, E. (2024) · Zagazig Journal of Forensic Medicine · doi:10.21608/zjfm.2023.232730.1162 · Cited by 3 · see citing works
Postmortem toxicological findings in child suicides: A 23-year retrospective study in Sweden
Junuzovic, M., Rietz, A., & Jönsson, A. (2025) · Forensic Science International · doi:10.1016/j.forsciint.2025.112784 · Cited by 2 · see citing works
“Some studies with mixed age groups focus on suicide methods [15,23,25,29], or specific substances [22,27], but few have examined combination of drugs and alcohol [9], with exceptions in Ireland [26], Iran [23], and Sweden [15,29].”
Iroanya, O. O., Egwuatu, T. F., & Ekwedike, C. (2022) · Journal of Current Biomedical Research · doi:10.54117/jcbr.v2i4.3 · Cited by 2 · see citing works
Metal phosphide poisoning in a disaster‐stricken area. Can early hemodialysis improve outcomes?
Abdo, N., Mohamed, S., Luyckx, V. A., et al. (2024) · Hemodialysis International · doi:10.1111/hdi.13168 · Cited by 2 · see citing works
Global poisoning of aluminum phosphide with its emphasis in Iran: A review
Akbari, M., & Dehghani, R. (2021) · Journal of Entomological Research · doi:10.5958/0974-4576.2021.00127.4 · Cited by 2 · see citing works
Suicidal poisoning in Alexandria, Egypt-An updated statement
Hussein, H. A. S. M., & Elsawaf, H. E. (2021) · The Annals of Clinical and Analytical Medicine · doi:10.4328/acam.20484 · Cited by 2 · see citing works
“On the other hand, in their study, Kordrostami et al (2017) [1] found that in a five-year study period, 1667 suicide cases were investigated in Legal Medicine Organization, Tehran, Iran, of which, 674 cases (40.43”
ResultInfluentialHamedi, F., Mirzaee, Z., Ghasemi, H., et al. (2024) · Journal of Archives in Military Medicine · doi:10.5812/jamm-159475 · Cited by 1 · see citing works
Zavolovich, A. (2021) · Sudovo-medična ekspertiza · doi:10.24061/2707-8728.2.2021.3 · Cited by 1 · see citing works
“[1-3] Вважається, що ця причина смерті притаманна дорослій верстві населення, переважно чоловікам працездатного віку.”
Alibeigi, M., Mousavi‐Roknabadi, R. S., Goli, N. A., et al. (2021) · International Journal of Medical Toxicology and Forensic Medicine · doi:10.32598/ijmtfm.v11i4.34976 · Cited by 1 · see citing works
Antidotal Effect of Dihydroxyacetone in Aluminum Phosphide-Intoxicated PatientsPreprint
Heidari, R., Niknahad, H., Jangjoo, A., et al. (2023) · Preprints.org · doi:10.20944/preprints202303.0231.v1 · Cited by 1 · see citing works
Medico-Legal Autopsy & Forensic Science Laboratory: Vital Tools of Criminal Justice System
Ag, V. K., Kumar, U., Shivaramu, M., et al. (2018) · Journal of Forensic Medicine · doi:10.4172/2472-1026.1000125
“Roya K, Maryam A, Maryam A, Masoud G, Kamran A. (2017) Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015.”
BackgroundМоканюк, О. І., Musiienko, D. V., Zhuk, V. V., et al. (2019) · Clinical & experimental pathology · doi:10.24061/1727-4338.xviii.2.68.2019.24
Re: ‘Trend of fatal poisoning at national and provincial levels in Iran from 1990 to 2015’
Hassanian‐Moghaddam, H., Zamani, N., & Kolahi, A. (2019) · Public Health · doi:10.1016/j.puhe.2019.09.018
Modern possibilities of forensic medical evaluation and differentiation of acute intoxications
Dunaiev, O., Козлов, С. В., Oliynyk, I., et al. (2021) · Sudovo-medična ekspertiza · doi:10.24061/2707-8728.1.2021.2
Chary, M. A. (2022) · Hawaii International Conference on System Sciences (HICSS) · doi:10.24251/hicss.2022.489
An Analysis of Suicidal Deaths (Hanging and Poisoning): A Cross-Sectional Examination
Tasnim, Z., Nargis, F., Roy, D. A., Osmany, D. M. A., & Maksud (2024) · Archives of Psychiatry and Behavioral Sciences · doi:10.22259/2638-5201.0501001
The Role of Green Chemistry in the Management of Self-harm and Suicides by Hazardous Chemicals
Utembe, W., & Tlotleng, N. (2024) · Integrated science · doi:10.1007/978-3-031-64288-3_6
Ahmadi, T. A. (2025) · International Journal of Forensic Medicine · doi:10.33545/27074447.2025.v7.i1a.93
Yousefi, P., Rastegar-Kashkouli, A., Jafari, M., Barahimi, M., Tabandeh, M., Soleymanpour, A., Otroshi, A., & Eizadi‐Mood, N. (2024) · Journal of Renal Endocrinology · doi:10.34172/jre.2024.25178
Zamankhani, F., & Mousavifar, A. (2025) · Shiraz E-Medical Journal · doi:10.5812/semj-149091
Ferrer, F., Richard, D., Authier, N., Kerckhove, N., Pereira, B., Lopez, V. A., Abriat, F., Boyer, B., & Bertin, C. (2026) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2026.103079
The hidden toll: Mapping poisoning patterns and challenges in Egyptian forensic toxicology
Abdelmaksoud, S. M., Moawad, A. M., & Abdrabou, Y. K. (2026) · Annales de Toxicologie Analytique · doi:10.1016/j.toxac.2026.02.007
- Authors
- Kordrostami, R., Akhgari, M., Ameri, M., Ghadipasha, M., & Aghakhani, K.
- Affiliations
- Iran University of Medical Sciences (IR)
- Iranian Legal Medicine Organization (IR)
- Corresponding author
- Akhgari, Maryam
- Venue
- DARU Journal of Pharmaceutical Sciences
- Published
- 2017-06-13
- Volume
- 25
- Issue
- 1
- Pages
- 15-15
- ISSN
- 1560-8115 (ISSN-L)
- 2008-2231
- PMC
- PMC5470324
- OpenAlex
- W2625251858
- Semantic Scholar
- 9fe15bd996aca66aebd7da0bd0d26ea5697c354e
- Cited by
- 55
- References
- 69
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 15 · 2020: 6 · 2019: 5 · 2018: 5 · 2017: 1
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- DARU Journal of Pharmaceutical Sciences (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- self-poisoning, suicide, forensic toxicology, postmortem toxicology, aluminum phosphide, phosphine, opioids, methamphetamine, organophosphates, cyanide, strychnine, suicide methods, Tehran
- MeSH terms
- Adolescent, Adult, Age Factors, Child, Female, Humans, Iran, Male, Middle Aged, Risk Factors, Sex Factors, Suicide, Forensic Toxicology, Young Adult, Drug Overdose
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