Biosci. Biotech. Res. Comm. 10(3): 419-423 (2017)
Investigations on the physical activity level of some
Iranian drug suicidal patients
Maryam Hajain MD
, Shahram Mohaghegh MD
*, Latif Gachkar MD
and Effat Barari
Community Medicine Specialist, Minimally Invasive Surgery Research Center, Iran University of Medical
Sciences, Tehran, Iran
Assistant Professor of Sports and Exercise Medicine, Clinical Research Development Center of Loghman
Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Professor of Shahid Beheshti University of Medical Sciences, Tehran, Iran
Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
As it is important to use the preventive and therapeutic effects of exercise and physical activity in the management
of suicidal patients, we primarily need to know physical activity level of suicidal patients. However there are little
data in this topic. The females to male ratio of patients were about 2.1:1. with the average age of 29.7, minimum 13
and maximum 88 years, with standard deviation of 12.1. Physical activity level of majority (76.4 percent) of patients
was in the range of low (less than 600 Metabolic equivalent/minute per week). Other variables except sex were not
associated signi cantly with the physical activity level of patients. Physical activity level was signi cantly lower in
females than males (P = 0.001, Chi square test). Low physical activity level and female sex are possible risk factors
for drug suicidal attempts in Iranian patients.
*Corresponding Author:
Received 27
Nov, 2016
Accepted after revision 26
Jan, 2017
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007 CODEN: USA BBRCBA
Thomson Reuters ISI ESC and Crossref Indexed Journal
NAAS Journal Score 2017: 4.31 Cosmos IF: 4.006
© A Society of Science and Nature Publication, 2017. All rights
Online Contents Available at:
DOI: 10.21786/bbrc/10.3/14
Suicide is a global public health problem. Annually,
almost 1 million people die in suicides worldwide
(Turecki etal. 2015). The global suicide rate in 2008 was
about 11.6 per 100,000. However, suicide has an increas-
ing incidence and it is estimated to be for more than
2% of the global burden of disease by the year 2020
(Behmanehsh Poor et al. 2014). Demographic, social,
and cultural factors can affect suicidal epidemiology
(Mirhashemi et al. 2016). As suicide is condemned in
Islam, the suicidal rate is low in most Islamic countries,
Maryam Hajain etal.
yet it has shown to have increasing rate in recent years
(Pritchard etal. 2007). According to the last WHO report,
the reported suicide rates in Iran per 100,000 was 5.3 in
both sexes: 3.6 in females and 7.0 in males (Mirhashemi
etal. 2016) but  gure nearly 2 times greater for average
suicide rate (9.9 per 100,000) was measured based on data
elucidation (Hassanian-Moghaddam et al. 2017). Suicide
and attempted suicide rates in Iran increased from 8.3
per 100,000 in 2001 to 19.4 in 2005, then declined to
16.3 in 2007 (Saberi-Zafaghandi etal. 2012). However,
the of cially reported  gures for suicide are lower than
what really occurred (Malakouti et al. 2015). Suicide
with drug and self-immolation are two most common
reported methods of suicide in Iran (Nazarzadeh et al.
2013, Poorolajal etal. 2015).
Physical training and an active lifestyle have been
used as major public health tools in the prevention and
treatment of many physical diseases including cardiovas-
cular and metabolic diseases (Peluso etal. 2005). Also, the
effects of exercise on the brain, cognitive function, and
behavior have been of interest (Deslandes 2014). Based
on several epidemiological studies, it has been shown
that exercise and physical activity can have preventive
or delaying effects on the onset of different mental dis-
orders, and also can be used as therapeutic tools solely
or in adjunct with other treatments for mental disorders
(Zschucke etal. 2013). About 90% of individuals who had
successful suicide had an identi able psychiatric disorder
before death (Arsenault-Lapierre etal. 2004) and at least
50% of suicide deaths are related to depressive episodes,
either as major depressive disorder or bipolar disorder
(Holma et al. 2014). In a Cochrane review which com-
pared exercise intervention with no treatment, or with
standard interventions (cognitive therapy and pharma-
cotherapy) in the management of depressive symptoms,
a moderate clinical effect was found for exercise, which
indicated that exercise was as effective as these standard
treatments (Rimer etal. 2012). In a recent cross-sectional
study which examined the relationship between suicidal
thoughts (ST) and suicidal attempts (SA) and the level of
physical activity (PA) among South Korean adolescents,
there was an inverse dose-response relationship between
the level of physical activity (de ned as vigorous, moder-
ate, and low) and ST and SA (Cho 2014). Also, in urban
areas of the Iran, suicide is more common than rural areas
(Shirazi etal. 2012). The cause of higher rate of suicide in
cities may be related to lifestyle factors including more
stress and lower physical activity level which can be the
result of air pollution (Hajian et al. 2015).
Hajain et al. (2015) compared with those in rural
areas. As it is important to use the preventive and thera-
peutic effects of exercise and physical activity in the
management of suicidal patients, we primarily need to
know physical activity level of suicidal patients in Iran.
There is no data on the physical activity level of sui-
cidal patients in Iran. So, the aim of the present study
was to investigate physical activity level of drug suicidal
patients in a referral hospital of poisoning management
in Tehran.
In the current cross-sectional study, the Persian-trans-
lated long form interview-administered International
Physical Activity Questionnaire (IPAQ) was used for
assessing physical activity level of 406 drug suicidal
patients who were admitted to poisoning ward of
Loghman Hospital (the next morning after admission)
between December 2014-April 2015. The validity and
reliability of this version of IPAQ have already been
proven in Iranian sample of individuals (Vasheghani-
Farahani etal. 2011). After obtaining the consent form,
interview was conducted by an expert with alive drug
suicidal patients who had good consciousness level and
cooperation or with close relatives of the patients who
were informed about the physical activity habits of the
patients. The results were expressed as low (less than 600
metabolic equivalent (MET). minute per week), medium
(between 600 to 3000 MET. minute per week), and high
(more than 3000 MET. minute per week) level of physi-
cal activity. Also, the patients were asked about their
age, weight, marital and educational statuses, number
of children, absence or presence, and in this case, the
type of background mental disorders, the history and
the number of previous suicide attempt(s). The data was
then analyzed using SPSS (v. 16) and related statistical
tests (ANOVA test for quantitative and Chi square test
for qualitative variables).
Totally, 406 patients were evaluated: 278 females
(68.4%) and 128 males (31.6%) with the average age of
29.7, minimum 13 and maximum 88 years, with stand-
ard deviation of 12.1. The average weight of patients
was 64.8 kilograms, minimum 37 and maximum 145
kilograms, with standard deviation of 15.6. Other epi-
demiologic characteristics of patients are provided in
Table 1. A total of 310 patients (76.4%) had low physi-
cal activity level, 80 patients (19.7%) medium, and 16
patients (3.9%) had high physical activity level. There
were no signi cant differences in weight, number of chil-
dren, and suicide history, marriage and educational status
between patients with different physical activity levels (p
value more than 0.05). There was signi cant difference
in terms of different physical activity levels between the
two sexes (p value = 0.001), which means females in low
Maryam Hajain etal.
Table 2. Physical activity levels of drug suicidal patients
according to sex of them
Physical activity Level Total
low moderate high
224 49 5 278
Percent 80.6% 17.6% 1.8% 100%
86 31 11 128
Percent 67.1% 24.2% 8.7% 100%
Total 310 80 16 406
Percent 76.4% 19.7% 3.9% 100.0%
Table 1. Demographic properties of drug suicidal
Variable Description Number Percent
Marriage status
187 46.1
Married 202 49.8
17 4.2
Number of
0-1 320 79
2-3 71 17.5
More than 3 15 3.5
Up to Diploma 305 75.1
Diploma to BSc 86 21.1
MSc and higher 15 3.6
Mental disorder
to patient’s
No disease
317 78.1
Depression 52 12.8
Anxiety 3 .7
Psychosis 2 .5
Bipolar 4 1.0
Other 20 4.9
0 245 60.3
History of
70 17.2
2 15 3.7
3 14 3.4
4 5 1.2
5 4 1.0
physical activity group had relatively higher percentage
than their male counterparts and males in moderate and
high physical activity groups had relatively higher per-
centage than their female peers.(Table 2).
According to the  ndings of the present study, from
among 406 drug suicidal patients admitted to Loghman
Hospital, the majority (76.4% percent) had low physical
activity level. In a randomized cross over trial in high-
level suicide risk patients, regular endurance training in
the form of mountain hiking was shown to reduce hope-
lessness, depression, and suicide ideation (Sturm et al.
2012). Moreover, the moderate level of evidence has
been reported for the inverse dose-response relationship
between mental disorders (depression and distress) and
physical activity level in the latest guideline for exercise
testing and prescription of American College of Sports
Medicine (ACSM) (Ferguson 2014).
The mechanisms whereby exercise and physical
activity induce positive psychological health are diverse
and complex. Broadly, it can be divided into reducing
stress response, minimizing excessive in ammation, and
enhancing growth factor expression and neural plastic-
ity. Physical  tness, achieved through regular exercise
and/or spontaneous physical activity blunts stress reac-
tivity, protects against potentially adverse behavioral
and metabolic consequences of stressful events of life
(Silverman etal. 2014).
Physical activity level of the patients of the preset
study was measured by IPAQ includes both physical
activity and exercise, i.e. a type of physical activity that
is planned, structured, repetitive, and purposeful (Carek
et al. 2011). Although much of the research on posi-
tive psychological effects of exercise has been done on
aerobic exercise, resistance exercise or strength training
can also induce many physiological and psychological
advantages. Increase in cognition and self-esteem, and
decrease in depression and anxiety after both single-
bout sessions and long-term resistance training have
been identi ed in growing body of literature (Strickland
etal. 2014). Also there are evidences that indicate that
outdoor physical activity interventions such as moun-
tain hiking, stimulates higher positive and lower nega-
tive affective responses compared to an indoor physical
activity condition(Niedermeier etal. 2017).
In our study, the majority (68.4 percent) of drug sui-
cidal patients were female. Also, the female to male ratio
was higher in low physical activity level group. These
sexual differences have been seen in the previous studies
(Esteghamati etal. 2011, Koohpayehzadeh etal. 2014),
as well, and may be due to Iranian cultural and social
backgrounds which encourage men to be more physi-
cally active compared with women.
The most common underlying mental disorder in
our study was depression. Depression was also found
in other studies as a risk factor for suicide and suicidal
thought and self-destructive behavior in Iranian people
(Ekramzadeh et al. 2012, Dabaghzadeh et al. 2015). It
has been reported that the risk of suicide is increased by
more than 50 percent in depressed individuals and it is
about 20 times that of the general population in people
Maryam Hajain etal.
with major depression (Baek etal. 2015). There is now
compelling evidence that lifestyle factors including diet,
physical activity and exercise, relaxation and meditative
techniques, quality of sleep, environmental pollutants,
and social support are signi cant in the pathogenesis
and treatment of depression; moreover, epidemiological
studies have shown that low physical activity can be a
risk factor for the development of depressive symptoms
and that regular physical activity in early years of life
is linked with reduced risk of experiencing depression in
adulthood (Sarris etal. 2014).
Therefore, prevention of depression and other mental
disorders by doing regular physical activity and exercise
is a cost-effective approach for people who experience
higher rates of mental illness compared with the general
population. Indeed, mandatory physical exercise for the
prevention of mental illness has been proposed for medi-
cal students in USA (Bitonte etal. 2014) as high prevalence
of depression and anxiety has been reported among USA
and Canada medical students, with levels of overall psy-
chological distress indicators consistently higher than that
in the general population and age-matched peers (Dyrbye
etal. 2006). This approach can be used in the public sui-
cide prevention programs too, as exercise has been shown
to improve stress management ability, general feelings of
well-being, and self-esteem and can act as a nonspeci c
psychological therapy (Kaminsky etal. 2006).
Low physical activity level and female sex are possible
risk factors for drug suicidal attempts in Iranian patients.
More precisely designed studies are needed to evaluate
the relationship between physical activity and suicidal
attempts in females. Promotion of increasing physical
activity and exercise for patients at risk of suicide espe-
cially females, are recommended.
The study was done in a drug poisoning management
center and suicidal patients with causes other than drug
poisoning were not included. Also the cases were alive
patients and the dead ones were not included.
The fund of this study was provided by research pro-
posal number 4589 of Shahid Beheshti university of
medical sciences, Clinical Research Development Center
of Loghman Hakim Hospital.
There is no con ict of interest.
Arsenault-Lapierre, G., Kim, C. Turecki, G. (2004).Psychiatric
diagnoses in 3275 suicides: a meta-analysis.BMC Psychiatry
4: 37-37.
Baek, J. H., Park, J.-I., Ahn, J., Roh, S.-w., Heo, J.-Y., Fava, M.,
Mischoulon, D. Jeon, H. J. (2015).Review of Suicide Prevention
Programs: Massachusetts, United States, in Comparison with
Seoul.Psychiatry Investigation 12(3): 281-287.
Behmanehsh Poor, F., Tabatabaei, S. M. Bakhshani, N. M.
(2014).Epidemiology of Suicide and its Associated Socio-
demographic Factors in Patients Admitted to Emergency
Department of Zahedan Khatam-Al-Anbia Hospital.Int J High
Risk Behav Addict 3(4): e22637.
Bitonte, R. A. DeSanto, D. J., 2nd (2014).Mandatory physical
exercise for the prevention of mental illness in medical stu-
dents.Ment Illn 6(2): 5549.
Carek, P. J., Laibstain, S. E. Carek, S. M. (2011).Exercise for
the treatment of depression and anxiety.Int J Psychiatry Med
41(1): 15-28.
Cho, K. O. (2014).Physical Activity and Suicide Attempt of South
Korean Adolescents - Evidence from the Eight Korea Youth Risk
Behaviors Web-based Survey.J Sports Sci Med 13(4): 888-893.
Dabaghzadeh, F., Jabbari, F., Khalili, H. Abbasian, L. (2015).
Associated Factors of Suicidal Thoughts in HIV-Positive Indi-
viduals.Iran J Psychiatry 10(3): 185-191.
Deslandes, A. C. (2014).Exercise and Mental Health: What did
We Learn in the Last 20 Years?Frontiers in Psychiatry 5: 66.
Dyrbye, L. N., Thomas, M. R. Shanafelt, T. D. (2006).Systematic
review of depression, anxiety, and other indicators of psycho-
logical distress among U.S. and Canadian medical students.
Acad Med 81(4): 354-373.
Ekramzadeh, S., Javadpour, A., Draper, B., Mani, A., Withall, A.
Sahraian, A. (2012).Prevalence and correlates of suicidal thought
and self-destructive behavior among an elderly hospital popula-
tion in Iran.Int Psychogeriatr 24(9): 1402-1408.
Esteghamati, A., Khalilzadeh, O., Rashidi, A., Kamgar, M., Mey-
samie, A. Abbasi, M. (2011).Physical activity in Iran: results of
the third national surveillance of risk factors of non-communi-
cable diseases (SuRFNCD-2007).J Phys Act Health 8(1): 27-35.
Ferguson, B. (2014).ACSM’s Guidelines for Exercise Testing
and Prescription 9th Ed. 2014.The Journal of the Canadian
Chiropractic Association 58(3): 328-328.
Hajain, M. Mohaghegh, S. (2015).Indoor air pollution in exer-
cise centers.Int J medical toxicology and forensic medicine
5(1): 22-31.
Hassanian-Moghaddam, H. Zamani, N. (2017).Suicide in Iran:
The Facts and the Figures from Nationwide Reports.Iranian
Journal of Psychiatry 12: 5.
Holma, K. M., Haukka, J., Suominen, K., Valtonen, H. M., Man-
tere, O., Melartin, T. K., Sokero, T. P., Oquendo, M. A. Isom-
etsa, E. T. (2014).Differences in incidence of suicide attempts
between bipolar I and II disorders and major depressive disor-
der.Bipolar Disord 16(6): 652-661.
Maryam Hajain etal.
Kaminsky, L. A. Medicine, A. C. o. S. (2006). ACSM’s resource
manual for guidelines for exercise testing and prescription,
Lippincott Williams & Wilkins Baltimore, MD.
Koohpayehzadeh, J., Etemad, K., Abbasi, M., Meysamie, A.,
Sheikhbahaei, S., Asgari, F., Noshad, S., Hafezi-Nejad, N.,
Rafei, A., Mousavizadeh, M., Khajeh, E., Ebadi, M., Nakhjavani,
M. Esteghamati, A. (2014).Gender-speci c changes in physical
activity pattern in Iran: national surveillance of risk factors
of non-communicable diseases (2007-2011).Int J Public Health
59(2): 231-241.
Malakouti, S. K., Davoudi, F., Khalid, S., Ahmadzad Asl, M.,
Moosa Khan, M., Alirezaei, N., Mirabzadeh, A. DeLeo, D. (2015).
The Epidemiology of Suicide Behaviors among the Countries
of the Eastern Mediterranean Region of WHO: a Systematic
Review.Acta Med Iran 53(5): 257-265.
Mirhashemi, S., Motamedi, M. H., Mirhashemi, A. H., Taghipour,
H. Danial, Z. (2016).Suicide in Iran.Lancet 387(10013): 29.
Nazarzadeh, M., Bidel, Z., Ayubi, E., Asadollahi, K., Carson, K.
V. Sayehmiri, K. (2013).Determination of the social related fac-
tors of suicide in Iran: a systematic review and meta-analysis.
BMC Public Health 13: 4.
Niedermeier, M., Einwanger, J., Hartl, A. Kopp, M. (2017).
Affective responses in mountain hiking—A randomized crosso-
ver trial focusing on differences between indoor and outdoor
activity.PloS one 12(5): e0177719.
Peluso, M. A. Guerra de Andrade, L. H. (2005).Physical activity
and mental health: the association between exercise and mood.
Clinics (Sao Paulo) 60(1): 61-70.
Poorolajal, J., Rostami, M., Mahjub, H. Esmailnasab, N. (2015).
Completed Suicide and Associated Risk Factors: A Six-Year
Population Based Survey.Archives of Iranian Medicine 18(1):
Pritchard, C. Amanullah, S. (2007).An analysis of suicide and
undetermined deaths in 17 predominantly Islamic countries
contrasted with the UK.Psychol Med 37: 421-430.
Rimer, J., Dwan, K., Lawlor, D. A., Greig, C. A., McMurdo, M.,
Morley, W. Mead, G. E. (2012).Exercise for depression.Cochrane
Database Syst Rev 7: CD004366.
Saberi-Zafaghandi, M. B., Hajebi, A., Eskandarieh, S.
Ahmadzad-Asl, M. (2012).Epidemiology of suicide and
attempted suicide derived from the health system database in
the Islamic Republic of Iran: 2001-2007.East Mediterr Health
J 18(8): 836-841.
Sarris, J., O’Neil, A., Coulson, C. E., Schweitzer, I. Berk, M.
(2014).Lifestyle medicine for depression.BMC Psychiatry 14:
Shirazi, H. R., Hosseini, M., Zoladl, M., Malekzadeh, M., Mome-
ninejad, M., Noorian, K. Mansorian, M. A. (2012).Suicide in the
Islamic Republic of Iran: an integrated analysis from 1981 to
2007.East Mediterr Health J 18(6): 607-613.
Silverman, M. N. Deuster, P. A. (2014).Biological mechanisms
underlying the role of physical  tness in health and resilience.
Interface Focus 4(5): 20140040.
Strickland, J. C. Smith, M. A. (2014).The anxiolytic effects of
resistance exercise.Frontiers in Psychology 5: 753.
Sturm, J., Ploderl, M., Fartacek, C., Kralovec, K., Neunhauserer,
D., Niederseer, D., Hitzl, W., Niebauer, J., Schiepek, G. Farta-
cek, R. (2012).Physical exercise through mountain hiking in
high-risk suicide patients. A randomized crossover trial.Acta
Psychiatr Scand 126(6): 467-475.
Turecki, G. Brent, D. A. (2015).Suicide and suicidal behaviour.
Vasheghani-Farahani, A., Tahmasbi, M., Asheri, H., Ashraf, H.,
Nedjat, S. Kordi, R. (2011).The Persian, last 7-day, long form of
the International Physical Activity Questionnaire: translation
and validation study.Asian J Sports Med 2(2): 106-116.
Zschucke, E., Gaudlitz, K. Ströhle, A. (2013).Exercise and Phys-
ical Activity in Mental Disorders: Clinical and Experimental
Evidence.Journal of Preventive Medicine and Public Health
46(Suppl 1): S12-S21.