1
|
Abstract
BACKGROUND Self-immolation is one of the most brutal suicide methods and is a significant social and medical problem throughout the world. Self-immolation is more common in low-income countries than in high-income countries. AIM The aim is to evaluate the trends in self-immolation and examine its frequency in Iraq. METHODS The PRISMA guideline was used to conduct this systematic review study. We searched for publications in English, Arabic and Kurdish in PubMed and Google Scholar. A total of 105 publications were identified through the search; however, 92 were eliminated due to duplication and irrelevant content. Finally, 13 full articles were included for data extraction. The inclusion criteria were articles that investigated self-immolation. However, letters to editors and media reports on self-immolation were excluded. The retrieved studies were selected, reviewed and then quality assessed. RESULTS This study included 13 articles. According to the findings, self-immolation accounted for 26.38% of all burn admissions in the Iraqi provinces and the Kurdistan region, with 16.02% of those occurring in the middle and southern provinces of Iraq and 36.75% in the Kurdistan region. It is more common in women than in men, especially among young, married, illiterate, or poorly educated people. Sulaymaniyah had a higher percentage of self-immolation than other governorates in Iraq, accounting for 38.3% of burn admissions. Cultural and social norms, domestic violence, mental health problems, family conflicts and financial problems were identified as the most common causes of self-immolation. CONCLUSION The prevalence of self-immolation is high among the Iraqi population, compared to other countries, particularly among the Kurdish population and in Sulaymaniyah. Self-immolation is relatively common among women. There are sociocultural factors that could contribute to this problem. Families must be restricted from having easy access to kerosene, and high-risk individuals should have access to psychological consultation to reduce the risk of self-immolation.
Collapse
Affiliation(s)
- Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya, Kurdistan Region - F.R., Iraq
| |
Collapse
|
2
|
Obed D, Dastagir N, Salim M, Bucher F, Gruber L, Schröter A, Panayi AC, Knoedler S, Dastagir K, Vogt PM. Attempted Suicide by Burning: A Cross-sectional Analysis at a Regional Burn Center in Germany. J Burn Care Res 2023; 44:852-859. [PMID: 36370123 DOI: 10.1093/jbcr/irac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Attempted suicide by self-immolation or burning constitutes an uncommon form of attempted suicide in high income countries, presenting substantial challenges to burn units. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients treated for attempted suicide by burning. For this purpose, we examined intensive care burn patients admitted to a single major burn unit between March 2007 and December 2020. Demographic, clinical, epidemiological, and mortality data were collected and analyzed. Major psychiatric comorbidities were evaluated according to ICD-9 and ICD-10 classifications. A total of 1325 intensive care unit burn patients were included. Suicide by burning was attempted in 45 cases (3.4%). Attempted suicide victims presented with significantly higher burn severity, reflected by higher abbreviated burn severity index scores, and larger TBSA affected. Burned TBSA ≥30% and inhalation injuries were observed more frequently in suicidal patients. These patients also experienced prolonged hospital and intensive care unit length of stay, required surgical interventions and mechanical ventilation more frequently, and had significantly longer periods on ventilation, causing an overall higher mortality rate (24.4%). Psychiatric comorbidities were present in 75.6% of patients who attempted suicide. Despite the low prevalence, burn severity and mortality are considerably high in patients who attempted suicide by burning, presenting a significant challenge for healthcare providers. The majority of patients had a history of psychiatric disorder, highlighting the importance of identifying patients at high-risk who may profit from increased psychiatric intervention.
Collapse
Affiliation(s)
- Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Nadjib Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Mustafa Salim
- Department of Human Genetics, Hannover Medical School, Germany
| | - Florian Bucher
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Lisa Gruber
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Andreas Schröter
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Germany
| |
Collapse
|
3
|
O'Donovan S, van den Heuvel C, Baldock M, Byard RW. An overview of suicides related to motor vehicles. MEDICINE, SCIENCE, AND THE LAW 2023; 63:151-158. [PMID: 36000305 DOI: 10.1177/00258024221122187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although vehicles may be used in a wide variety of suicides, this has not been a focus in the forensic literature. Thus, an analysis of coronial autopsy reports at Forensic Science SA, Adelaide, South Australia over a 16-year period from January 2005 to December 2020 was undertaken to provide an overview of cases in which it was considered that a vehicle had been integral to the successful completion of a suicide. De-identified details were collected from all cases in which a vehicle had facilitated or been used as a method of suicide. A number of different types of vehicle-related suicide methods were identified, including cases where vehicles had been used as secure places for suicide or where the vehicle had been used to cause significant blunt force trauma or to enter a lethal environment such as water. Specific examples were taken from the following categories: (1) inhalation of gas, (2) drug toxicity, (3) hanging or ligature strangulation, (4) self-immolation, (5) drowning, (6) vehicle collision, (7) driving off a cliff, (8) jumping or lying in front of a vehicle and (9) the use of more than one method (i.e. complex). This report is not intended to provide an epidemiological analysis of car-related suicides. Instead, the details of selected cases have been used to illustrate the spectrum of methods that may be used in vehicle-assisted suicides.
Collapse
Affiliation(s)
- Siobhan O'Donovan
- The School of Biomedicine, 1066The University of Adelaide, Adelaide, SA, Australia
- Forensic Science SA, Adelaide, SA, Australia
| | | | - Matthew Baldock
- Centre for Automotive Safety Research, 1066The University of Adelaide, Adelaide, SA, Australia
| | - Roger W Byard
- The School of Biomedicine, 1066The University of Adelaide, Adelaide, SA, Australia
- Forensic Science SA, Adelaide, SA, Australia
| |
Collapse
|
4
|
El-kholy HM, Mubarak AAELR, Elheniedy MA, AL-Deeb FA. Socioeconomic status and psychiatric comorbidity associated with suicidal behavior among a sample of Egyptian patients who attended Tanta University emergency hospital for suicide-related problems. MIDDLE EAST CURRENT PSYCHIATRY 2023. [DOI: 10.1186/s43045-023-00290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Abstract
Background
Many studies found association between psychosocial factors and suicidal behavior; this association differs from one community to another, and this difference could affect the risk assessment and the management of suicidal behavior. The aim of this work was to evaluate the role of socioeconomic, cultural, and psychosocial profile including psychiatric comorbidity on individuals with suicidal behavior who attended Tanta University emergency hospital.
Results
Family troubles were the commonest cause of suicidal behavior (28%), and drug overdose was the commonest method of attempt (38%). Positive correlation is between age and score of Beck scale for suicidal ideation (p = 0.000) which indicates that suicidal ideation increases with age. Significant association is between psychiatric comorbidity and Beck’s scale for suicidal ideation (p = 0.019), with size of association (η = 0.58).
Regression analysis showed that older age, female sex, illiterates, widows, cases with psychiatric illness, and low socioeconomic status when act altogether are the significant predictor of suicidal ideation of our studied sample.
Conclusions
Our study demonstrated that studying psychosocial factors in individuals who came to emergency hospital of Tanta University could be a reflection of the community visiting this hospital asking for medical emergency service; the comprehensive and multifactorial assessment we have been adopted in this work could help in better understanding of the suicidal risk factors in this community and consequently help in part in tailoring the clinical service for this sector of patient.
Collapse
|
5
|
El Hayek S, Cherro M, El Harake N, Ghossoub E. Self-immolation in the Arab world: A systematic review. Burns 2022; 49:757-769. [PMID: 37129972 DOI: 10.1016/j.burns.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Abstract
Self-immolation is the act of setting fire to oneself. Recent spikes in self-immolation events have been noticed in the Arab world, specifically in the aftermath of the Arab Spring in 2011. We aimed to examine the literature assessing the characteristics and patterns of suicide by self-immolation in the Arab world. We registered our systematic review in Prospero. We searched PubMed, Medline, PsycInfo, Embase, and Scopus databases from inception until 9 July 2022, along with other sources, following the PRISMA 2020 guidelines. We collected relevant articles tackling suicide by self-immolation in the Arab world via title and abstract screening followed by full-text screening. We then conducted a narrative synthesis of the results. Out of 326 records from databases and 17 additional records identified through other sources, 31 articles (27 quantitative and 4 qualitative) were included. The studies came from Iraq (n = 16), Tunisia (n = 6), Kingdom of Saudi Arabia (n = 3), Jordan (n = 2), Libya (n = 2), Bahrain (n = 1), and Egypt (n = 1). The quantitative studies had a sample size ranging from 22 to 600 self-inflicted burn victims. Studies showed that self-immolators were mostly married women with low educational level and low socioeconomic status. Self-immolation was more likely to happen at home, usually following marital conflicts. Kerosene was the accelerant used the most. Depression was the most comorbid mental health diagnosis. Studies highlighted that self-immolation was being increasignly used as a form of protest. Self-immolation is not uncommon in the Arab world. Specific interventions directed at the population at risk are warranted.
Collapse
Affiliation(s)
- Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michele Cherro
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadia El Harake
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elias Ghossoub
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
6
|
Mohammadi M, Nedjat S, Dargahpour M, Mehri A, Majdzadeh R. Factors Associated With Self-Burning Among Women in Reproductive Age of Ilam: A Case-Control Study in a Western Part of Iran. Arch Suicide Res 2022; 26:707-715. [PMID: 33017267 DOI: 10.1080/13811118.2020.1823917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Self-burning is one way that some people choose to commit suicide, and it has been seen in many nations. This problem is considered as an uncommon method in developed countries and a common method of suicide in developing countries. The present study aimed to identify the factors associated with self-burning among Iranian women in reproductive age. METHOD This case-control study was conducted among 228 (57 cases and 171 controls) women in reproductive age from the Imam Khomeini Hospital of Ilam. A self-report questionnaire was used to determine factors associated with self-burning, including job status, domestic violence, mental health status, education levels, smoking and alcohol use, forced marriage, socioeconomic status, drug history, and family history of self-burning. Data analysis was performed using simple and multiple logistic regression to control the effects of possible confounders. RESULTS There was a significant positive association between self-burning and being unemployed and a housewife. Also, the presence of self-burning was increasingly associated with high domestic violence and having history of forced marriage and decreasingly associated with post-diploma education level and a high socioeconomic level. CONCLUSION It is recommended that health and social policy makers pay attention to the social and economic aspects that cause self-burning in women to prevent this problem.
Collapse
|
7
|
Byard RW, Heath KJ. Delayed familial self-immolation: A rare memorial event. Leg Med (Tokyo) 2021; 50:101865. [PMID: 33640835 DOI: 10.1016/j.legalmed.2021.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
Self-immolation suicides refer to lethal situations where a victim has intentionally set themselves on fire using an accelerant, or has deliberately stepped into a fire. These are rare events in Western countries accounting for only 0.6-1% of suicides. Two cases are described of familial self-immolation with features of an anniversary/memorial event: Case 1: The charred body of a 66-year-old woman was found beside a suburban waterway with evidence of self-immolation using methylated spirits. Death was attributed to incineration; Case 2: Twenty five years later the charred body of another 66-year-old woman was found on the banks of a nearby suburban river. Analysis of clothing revealed ethanol, a major component of methylated spirits. Death was due to the combined effects of inhalation of products of combustion and incineration. Review of the history revealed that the decedent in case 2 was the daughter of the victim in case 1. This, therefore, represents an extremely rare event, that of familial self-immolation suicides with the daughter choosing the same method that had been used by her mother, at an identical age and in a similar location. These cases add to the potential complexities of familial suicides.
Collapse
Affiliation(s)
- Roger W Byard
- Forensic Science SA and Adelaide Medical School, The University of Adelaide, Frome Road, Adelaide, South Australia 5005, Australia.
| | - Karen J Heath
- Forensic Science SA and Adelaide Medical School, The University of Adelaide, Frome Road, Adelaide, South Australia 5005, Australia
| |
Collapse
|
8
|
Papadodima SA, Karakasi MV, Pavlidis P, Nastoulis E, Fragkou K, Dimitriou K, Alexandri M, Markopoulou M, Douzenis A, Spiliopoulou C. Self-immolation Suicide in Greece: A Forensic Psychiatric Autopsy Study between 2011 and 2019. J Forensic Sci 2020; 65:1656-1668. [PMID: 32658387 DOI: 10.1111/1556-4029.14498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/08/2020] [Accepted: 06/05/2020] [Indexed: 01/26/2023]
Abstract
Self-immolation is a rare suicide method in the developed countries of the western world (0.06-1%); however, it has relatively higher prevalence rates in the developing countries of Asia and Africa (6-57%). The present study aims to examine self-immolation suicides within the Greek mainland (Attiki, Thrace, and Peloponnese) over a period of 9 years (2011-2019) in order to investigate the phenomenon in the Greek population forensically, identify the characteristics and motivations of suicide victims, explore its associations to socio-cultural or psychiatric factors, and describe a fatal case of suicide by self-immolation that was partially recorded on camera. The medical files (autopsy reports) of cases performed at the Departments of Forensic Medicine of the National and Kapodistrian University of Athens, Democritus University of Thrace, and the Forensic Service of Messinia-Peloponnese were retrospectively examined yielding 19 cases of suicides by self-immolation. A 3.7% prevalence of suicide by self-immolation among suicide fatalities within the Greek population was estimated. A distinctive feature of the Greek population regarding self-immolation was disclosed that it is being practiced predominantly by the elderly (mean age 2-3.5 decades higher than other countries). The phenomenon correlated strongly with poorly controlled mental disorders (mostly affective and adjustment disorders). Unlike other countries, there was no significant association with domestic or sexual violence, social or political protest, or religious issues. Therefore, the suicide victims preferred secluded or private outdoor locations (not public). Findings deriving from the examined variables localize Greek population culturally between the Western European and Asian African countries, but with its own idiosyncrasies.
Collapse
Affiliation(s)
- Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria-Valeria Karakasi
- Third University Department of Psychiatry, AHEPA University General Hospital - Department of Mental Health, Aristotle University - Faculty of Medicine, Thessaloniki, GR 54124, Greece.,Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Evangelos Nastoulis
- Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, GR 68100, Greece
| | - Kallirroi Fragkou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Konstantinos Dimitriou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria Alexandri
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| | - Maria Markopoulou
- Department of Forensic Psychiatry, Psychiatric Hospital of Thessaloniki, Stavroupolis, Thessaloniki, GR 56429, Greece
| | - Athanassios Douzenis
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, GR 12462, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Goudi, Athens, GR 11527, Greece
| |
Collapse
|
9
|
Cleary M, Singh J, West S, Rahkar Farshi M, Lopez V, Kornhaber R. Drivers and consequences of self-immolation in parts of Iran, Iraq and Uzbekistan: A systematic review of qualitative evidence. Burns 2020; 47:25-34. [PMID: 31928787 DOI: 10.1016/j.burns.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The prevalence of self-immolation is significantly higher in some Middle Eastern and Central Asian Islamic countries than in Western countries. Self-immolation typically occurs among females and can be either an attempt at suicide or an act of protest. This systematic review examined the drivers and consequences of self-immolation in Asian Islamic countries from the perspective of those affected by it, including survivors, family and health care staff in order to understand its higher prevalence in these countries. METHOD A systematic review of qualitative studies was conducted in June 2018, using five electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus and PsycINFO. Of the 236 papers identified, seven met the inclusion criteria. Authors independently rated the reporting of included qualitative studies and thematic analysis was used to analyse the data. RESULTS The drivers of self-immolation included marital and familial conflict, male-dominated culture, mental health disorders and economic and social factors. Survivors chose self-immolation in order to express their sense of a lack of control and mostly utilised this method due to its accessibility. The consequences of self-immolation were social isolation, regret, and physical and psychological impacts. CONCLUSIONS The reasons for self-immolation, its prevalence and the demographics of those who choose this means vary significantly between Asian Islamic and Western countries. This review confirmed the impact of culture, tradition, and societal structures and relationships on people's decisions to self-immolate. Education about the consequences of self-immolation may reduce the use of this method.
Collapse
Affiliation(s)
- Michelle Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia.
| | - Jaskaran Singh
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Sancia West
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Mahni Rahkar Farshi
- Department of Pediatrics, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Violeta Lopez
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| | - Rachel Kornhaber
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, NSW, Australia
| |
Collapse
|
10
|
Houschyar KS, Tapking C, Duscher D, Maan ZN, Sheckter CC, Rein S, Chelliah MP, Nietzschmann I, Weissenberg K, Reumuth G, Schulz T, Branski LK, Siemers F. Optimising management of self-inflicted burns: a retrospective review. J Wound Care 2019; 28:317-322. [PMID: 31166860 DOI: 10.12968/jowc.2019.28.6.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. METHODS A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. RESULTS There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). CONCLUSION Attempted suicide by self-inflicted burns represents <1% of burn admissions. This population demonstrates a high incidence of prior psychiatric disorders. Successful treatment includes multidisciplinary management of acute medical, surgical, and psychiatric care.
Collapse
Affiliation(s)
- Khosrow S Houschyar
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Christian Tapking
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany
| | - Dominik Duscher
- Department of Plastic Surgery and Hand Surgery, Technical University Munich, Munich, Germany
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Malcolm P Chelliah
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, US
| | - Ina Nietzschmann
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Kristian Weissenberg
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Georg Reumuth
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Torsten Schulz
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospital for Children-Galveston, University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, US
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost Halle, Germany
| |
Collapse
|
11
|
Toppi J, Cleland H, Gabbe B. Severe burns in Australian and New Zealand adults: Epidemiology and burn centre care. Burns 2019; 45:1456-1461. [DOI: 10.1016/j.burns.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/04/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022]
|
12
|
Yoosefi Lebni J, Mansourian M, Hossain Taghdisi M, Khosravi B, Ziapour A, Demir Özdenk G. A study of Kurdish women's tragic self-immolation in Iran: A qualitative study. Burns 2019; 45:1715-1722. [PMID: 31202529 DOI: 10.1016/j.burns.2019.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 01/22/2023]
Abstract
Self-immolation is one of the most painful methods of suicide which is widespread among women in Kurdish regions of Iran. The present study aimed to explore the causes and sociocultural groundwork of choosing self-immolation methods by women in Kurdish regions of Iran. This present study was conducted using a qualitative approach and conventional content analysis. The research population included women who self-immolated and were rescued in Kurdish regions of Iran. The data collection method was a deep interview as well as observation. The sampling method was based on objective and snowball sampling. The data collection continued to theoretical saturation, the number of participants reached 25 in the end, and Lincoln and Guba criteria were used to strengthen the research. From the analysis of the data obtained in this study, the 8 sub-themes related to cause of suicide attempt from the participants' viewpoints including unbridled coherence, lack of supportive social and environmental structures, economic pressure, aggravation of violence, humiliated ego, dominance of modern values over the local and indigenous ones, incoherent family, and giving up on changing conditions as well as 6 sub themes based on the cause of choosing the method of self-immolation including protesting, frightening the family, catching more attention, championing and showing courage, inducing more guilty feelings in the family and society, fashion or imitation, and easy access were revealed. Self-immolation is one of the most important problems in the Kurdish regions of Iran, which is rooted in various economic, social, psychological and cultural causes. To reduce this social harm, there is a need for comprehensive programs that cover all dimensions.
Collapse
Affiliation(s)
- Javad Yoosefi Lebni
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Mansourian
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Bahar Khosravi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Ph.D Student of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Gülcan Demir Özdenk
- Vocational School of Health Services in Ahi Evran University, Kırsehir, Turkey
| |
Collapse
|
13
|
Ahmadpanah M, Rahighi AH, Haghighi M. Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts. Neuropsychobiology 2018; 76:51-58. [PMID: 29649810 DOI: 10.1159/000487859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/21/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs). METHOD Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background. RESULTS A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI. CONCLUSIONS The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.
Collapse
|
14
|
Lévy BT, Prudent C, Liétard F, Evrard R. From Querulous to Suicidal: Self-immolation in Public Places as a Symbolic Response to the Feeling of Injustice. Front Psychol 2017; 8:1901. [PMID: 29163282 PMCID: PMC5671484 DOI: 10.3389/fpsyg.2017.01901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
Aim: This paper sheds light on the context that leads some querulous patients to self-immolate in front of, or into, public buildings (e.g., tribunals, city halls, and employment agencies). Method: The author defines paranoid querulousness. A psychoanalytic perspective, but also a judicial and a psychiatric point of view, over querulous claimants is presented. The links between political or social claims and self-immolation are studied. The expression of suicidal thoughts voiced by four querulous subjects is analyzed. Eight examples of self-immolation are presented. Results: The querulous subjects' self-aggressive behaviors seem to be caused by a loss of hope to obtain compensation for a prejudice they allegedly suffered. Querulous individuals tend to self-immolate in front of, or into, public buildings when no answer is given to their claims. These gestures may be both a consequence of some personal distress and triggered by a difficult social or professional context. Discussion: Five sets of assumptions derived from Freudian and Lacanian psychoanalytic theories are advanced. The status of the object over which the querulous claimants wish to assert their rights is clarified. The meaning of self-aggressive gestures is outlined by making reference to the concepts of instinct for mastery, symbolic other, chain of signifiers, masochism, pleasure principle, and reality principle. Conclusion: Prevention of self-immolation could involve that members of the legal professions, social workers, civil servants, and mental health professionals in contact with querulous subjects openly show their will to listen to these claimants' voice: self-aggressive gestures might be avoided by supporting the querulous person's hope to obtain compensation for the prejudice allegedly suffered.
Collapse
Affiliation(s)
- Benjamin T. Lévy
- Interpsy Laboratory, Department of Psychology, University of Lorraine, Nancy, France
| | - Cécile Prudent
- Interpsy Laboratory, Department of Psychology, University of Lorraine, Nancy, France
| | - Florian Liétard
- Loria Laboratory and Élie Cartan Institute, University of Lorraine, Nancy, France
| | - Renaud Evrard
- Interpsy Laboratory, Department of Psychology, University of Lorraine, Nancy, France
| |
Collapse
|
15
|
Ben Khelil M, Zgarni A, Zaafrane M, Chkribane Y, Gharbaoui M, Harzallah H, Banasr A, Hamdoun M. Suicide by self-immolation in Tunisia: A 10 year study (2005–2014). Burns 2016; 42:1593-1599. [DOI: 10.1016/j.burns.2016.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
|
16
|
Verbrennungstod nach suizidaler Eröffnung der Bauchhöhle. Rechtsmedizin (Berl) 2015. [DOI: 10.1007/s00194-015-0054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
17
|
Shakeri J, Farnia V, Abdoli N, Akrami MR, Arman F, Shakeri H. The Risk of Repetition of Attempted Suicide Among Iranian Women with Psychiatric Disorders as Quantified by the Suicide Behaviors Questionnaire. Oman Med J 2015; 30:173-80. [PMID: 26171123 DOI: 10.5001/omj.2015.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/07/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The factors associated with repetition of attempted suicide are poorly categorized in the Iranian population. In this study, the prevalence of different psychiatric disorders among women who attempted suicide and the risk of repetition were assessed. METHODS Participants were women admitted to the Poisoning Emergency Hospital, Kermanshah University of Medical Sciences following failed suicide attempts. Psychiatric disorders were diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom checklist. Risk of repetition was evaluated using the Suicide Behaviors Questionnaire-Revised (SBQ-R). RESULTS About 72% of individuals had a SBQ-R score >8 and were considered to be at high risk for repeated attempted suicide. Adjustment disorders were the most common psychiatric disorders (40.8%). However, the type of psychiatric disorder was not associated with the risk of repetition (p=0.320). Marital status, educational level, employment, substance use, history of suicide among family members, and motivation were not determinant factors for repetition of suicide attempt (p=0.220, 0.880, 0.220, 0.290, 0.350 and 0.270, respectively). Younger women were associated with violent methods of attempted suicide, such as self-cutting, whereas older individuals preferred consumption of poison (p<0.001). Drug overdose was more common among single and married women whereas widows or divorcees preferred self-burning (p=0.004). CONCLUSION About 72% of patients with failed suicide attempts were at high risk for repeated attempts. Age, marital status, and type of psychiatric disorder were the only determinants of suicide method. Adjustment disorders were the most common psychiatric disorders among Iranian women. However, this did not predict the risk of further attempts.
Collapse
Affiliation(s)
- Jalal Shakeri
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Abdoli
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad R Akrami
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Arman
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hania Shakeri
- Psychiatry Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
18
|
Gauthier S, Reisch T, Ajdacic-Gross V, Bartsch C. Road Traffic Suicide in Switzerland. TRAFFIC INJURY PREVENTION 2015; 16:768-772. [PMID: 25793638 DOI: 10.1080/15389588.2015.1021419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine details of road traffic suicides in Switzerland between 2000 and 2010 and to look at our results in relation to studies from other countries. METHODS Retrospective data analysis of road traffic suicides extracted from the database of all suicides investigated by Swiss institutes of forensic medicine between 2000 and 2010 using a standardized assessment sheet. RESULTS Out of 4,885 suicides in Switzerland, we identified 76 cases (1.56%) of road traffic suicide. Twenty-three cases had to be excluded because, although the forensic medical experts suspected suicide, they could not establish it for sure. That left 53 cases (1.02% of all suicides), mostly unmarried men, who were on average 9 years younger than the study population as a whole. Most collided with other vehicles, mainly other cars, and usually on main highways or country roads. In most cases, the cause of death was multiple injuries. Other persons were killed 4 times more often than with other suicide methods. Toxicology screening was performed significantly more frequently than with other methods but more often proved negative. Acute psychiatric problems were commonly assumed to be the underlying reasons. Suicide notes were left by only 20%, a lower proportion than in the study population as a whole. CONCLUSIONS Road traffic suicides account for approximately 1% of all suicide methods used in Switzerland, although unclassifiable cases indicate that the rate might be higher. Every road traffic crash should therefore be routinely investigated by an interdisciplinary team and suicide should be considered as the possible cause.
Collapse
Affiliation(s)
- Saskia Gauthier
- a Institute of Forensic Medicine, University of Zurich , Zurich , Switzerland
| | - Thomas Reisch
- b Hospital for Psychiatry , Münsingen , Switzerland
- c University Hospital of Psychiatry Bern , Bern , Switzerland
| | | | - Christine Bartsch
- a Institute of Forensic Medicine, University of Zurich , Zurich , Switzerland
| |
Collapse
|
19
|
Abstract
Background: Suicide is the leading cause of death in Swiss prisons. The Federal Statistics Office provides numbers but no further details. Previous studies worldwide have focused on identifying suicide risk factors in prisoners, but very few have looked at the methods used in relation to prevention strategies. Aims: To obtain details of Swiss prison suicides, determine new findings in an international context, and establish prevention strategies based on the information acquired. Method: Retrospective data analysis of prison suicides extracted from the database of all suicides investigated by Swiss institutes of legal medicine between 2000 and 2010, using a standardized assessment sheet. Results: Out of 4,885 suicides investigated in the institutes of legal medicine in Switzerland, we identified 50 (1.02%) inmate suicides. Most were unmarried Swiss men, with a median age of 32 years. The two most common methods used were hanging and tricyclic antidepressant overdose. Two died due to self-immolation. Conclusion: Swiss prison suicides do not differ from those in other countries regarding sociodemographic details and the most common method of hanging. Anchoring devices, even low ones, should be avoided to prevent hanging and medication intake should be monitored. As prisoners use tricyclic antidepressants to die by suicide, we recommend the general monitoring of intake.
Collapse
Affiliation(s)
- Saskia Gauthier
- Institute of Forensic Medicine, University of Zurich, Switzerland
| | | | | |
Collapse
|