Prehospital suicide mortality in the Lake Van basin: rural-urban disparities from three-year EMS dispatch surveillance in eastern Turkiye

BMC Emerg Med. 2026 Jul 13. doi: 10.1186/s12873-026-01677-7. Online ahead of print.

ABSTRACT

BACKGROUND: Eastern Türkiye records high suicide mortality; however, prehospital emergency medical services (EMS) dispatch records from this region have not been systematically evaluated as a surveillance source. We aimed to describe EMS-attended suicide and self-harm cases in Van Province and to quantify the association between rural residence and prehospital suicide mortality.

METHODS: We conducted a retrospective population-based surveillance study of all ‘suicide’-coded records in the Van Province 112 EMS database (ASOS) from January 2023 to December 2025. After excluding duplicates and miscoded entries, 848 physically enacted cases formed the primary sample; 41 ideation/threat records were described separately and excluded from the primary mortality model. Prehospital death was defined as death recorded before hospital handover. Associations were estimated using multivariable logistic regression adjusted for age, sex, and method lethality, with inverse probability of treatment weighting (IPTW) as a sensitivity analysis. Daily meteorological associations were examined using Poisson regression with harmonic seasonality controls.

RESULTS: Among 848 physical-act cases (57.7% female; mean age 28.7 ± 12.7 years), the estimated crude annual EMS-attended rate was 25.7 per 100,000 population. Drug/chemical ingestion predominated (52.6%), whereas hanging accounted for 62.1% of prehospital deaths. The rural prehospital death rate was 24.7% compared with 10.8% in urban areas (adjusted odds ratio [aOR] 2.18, 95% CI 1.38-3.44, p < 0.001). Females constituted 33.9% of prehospital deaths (national average: 26.7%). Temperature showed a nominally significant but practically small association (incidence rate ratio [IRR] 1.006/°C, p = 0.022) that did not survive Bonferroni correction. No association with lunar phase was detected.

CONCLUSIONS: In this dispatch-based surveillance study, rural residence was associated with approximately twofold higher odds of prehospital suicide mortality even after adjustment for age, sex, and method lethality. The findings support the value of 112 dispatch data for prehospital surveillance and generate hypotheses regarding geographic access, delayed discovery, EMS resource constraints, and method lethality that require confirmation through linked dispatch-hospital data and studies with measured response intervals.

PMID:42443761 | DOI:10.1186/s12873-026-01677-7