1
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Pompermaier L, Steinvall I, Elmasry M, Eladany MM, Abdelrahman I, Fredrikson M, Sjöberg F. Long-term mortality after self-inflicted burns. Burns 2024; 50:252-261. [PMID: 37805374 DOI: 10.1016/j.burns.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns. METHODS All adult patients with burns admitted at the Linköping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality. RESULTS Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period. CONCLUSION Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.
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Affiliation(s)
- Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mostafa M Eladany
- Department of Anesthesiology & Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Islam Abdelrahman
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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2
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Obed D, Gruber L, Salim M, Knoedler S, Panayi AC, Krezdorn N, Dastagir K, Bingoel AS, Vogt PM. In-hospital Mortality Following Suicidal Burns: A Propensity Score-Matched Analysis. J Burn Care Res 2023; 44:1413-1418. [PMID: 36892312 DOI: 10.1093/jbcr/irad034] [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: 12/21/2022] [Indexed: 03/10/2023]
Abstract
We carried out a retrospective single-center study and analyzed all patients who have been admitted to our intensive care burn unit following suicide attempt and accidental burns within 14 years. Clinical and demographic parameters were collected and evaluated. Propensity score matching was performed in order to minimize the confounding effect of the parameters age, sex, total body surface area (TBSA), and the presence of full-thickness burns and inhalation injury. 45 burn patients following attempted suicide by burning and 1266 patients following accidental burn injury were admitted. Patients with suicidal burn injuries were significantly younger and showed significantly higher burn severity, reflected by larger TBSA affected, higher incidence of full-thickness burns and inhalation injury. They also experienced increased hospital length of stay (LOS) and longer ventilation durations. Their in-hospital mortality was significantly higher. Following propensity score matching in 42 case pairs, no differences were detected with regard to in-hospital mortality, hospital LOS, duration of mechanical ventilation, and frequency of surgical interventions. Attempted suicide by burning is associated with overall worse outcomes and higher mortality rates. Following propensity score matching, significant differences in outcomes were no longer detectable. Given the comparable survival probability compared to accidentally burned patients, life-sustaining treatment should not be withheld in burn patients following suicide attempt.
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Affiliation(s)
- Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Lisa Gruber
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Mustafa Salim
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Alperen S Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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3
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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.
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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
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4
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Smith JM, Fine JR, Romanowski KS, Sen S, Palmieri TL, Greenhalgh DG. Suicide by self-inflicted burns - A persistent psychiatric problem. Burns 2022; 49:770-774. [PMID: 35810037 DOI: 10.1016/j.burns.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
Self-inflicted burns are a relatively uncommon but profound attempt at suicide. Twenty years ago, we first reviewed our experience with self-inflicted burns. With this current study, we sought to determine whether there had been any change in the incidence or outcomes of self-inflicted burns. All burn patients admitted between January 1, 2012, and December 31, 2021, with self-inflicted burns were compared with all other admissions. The frequency of self-inflicted burns and confounding risk factors of patients with self-inflicted burns remained unchanged. A large proportion (87.4 %) of the patients had psychiatric disease. They also had larger burns and higher mortality than accidental burns. Unexpectedly, logistic regression analysis that controlled for age, total percent total body surface area (TBSA) burn, sex, and inhalation injury revealed that those patients with self-inflicted burns had 72 % lower odds of dying than the general population. In conclusion, there has been no improvement in the incidence of self-inflicted burns. They result in very severe injuries, but when age, burn size, gender, and inhalation injury are controlled for, they have at least as good a chance for survival as the general burn population.
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Affiliation(s)
- Jordan M Smith
- School of Medicine, University of California, Davis, USA
| | - Jeffrey R Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, USA
| | - Kathleen S Romanowski
- Department of Surgery, University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA
| | - Soman Sen
- Department of Surgery, University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA
| | - Tina L Palmieri
- Department of Surgery, University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA
| | - David G Greenhalgh
- Department of Surgery, University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA.
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5
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Gus E, Brooks S, Multani I, Zhu J, Zuccaro J, Singer Y. Burn Registries State of Affairs: A Scoping review. J Burn Care Res 2022; 43:1002-1014. [PMID: 35766390 DOI: 10.1093/jbcr/irac077] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Registry science allows for the interpretation of disease-specific patient data from secondary databases. It can be utilized to understand disease and injury, answer research questions, and engender benchmarking of quality-of-care indicators. Numerous burn registries exist globally, however, their contributions to burn care have not been summarized. The objective of this study is to characterize the available literature on burn registries. The authors conducted a scoping review, having registered the protocol a priori. A thorough search of the English literature, including grey literature, was carried out. Publications of all study designs were eligible for inclusion provided they utilized, analyzed, and/or critiqued data from a burn registry. Three hundred twenty studies were included, encompassing 16 existing burn registries. The most frequently used registries for peer-reviewed publications were the American Burn Association Burn Registry, Burn Model System National Database, and the Burns Registry of Australia and New Zealand. The main limitations of existing registries are the inclusion of patients admitted to burn centers only, deficient capture of outpatient and long-term outcome data, lack of data standardization across registries, and the paucity of studies on burn prevention and quality improvement methodology. Registries are an invaluable source of information for research, delivery of care planning, and benchmarking of processes and outcomes. Efforts should be made to stimulate other jurisdictions to build burn registries and for existing registries to be improved through data linkage with administrative databases, and by standardizing one international minimum dataset, in order to maximize the potential of registry science in burn care.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Brooks
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Jane Zhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Zuccaro
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
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6
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Irie Y, Nara T, Satoh K, Kameyama K, Kitamura T, Okuyama M, Nakae H. Survey on the current status of self-immolation attempts in Akita Prefecture: A cross-sectional survey. BURNS OPEN 2021. [DOI: 10.1016/j.burnso.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Abrams TE, McGarity SV. Psychosocial Determinants of Burn-Related Suicide: Evidence From the National Violent Death Reporting System. J Burn Care Res 2021; 42:305-310. [PMID: 32842149 DOI: 10.1093/jbcr/iraa152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Suicide is a unique phenomenon in humans. In 2017, over 47,000 Americans died by suicide, prompting a public health crisis. Suicide by burning, while one of the rarest forms of suicide, could be mitigated in part by early recognition and treatment of the underlying psychosocial factors. To date, investigators have attempted to tease out the risk factors associated with this phenomenon through the examination of burn center chart reviews and repository data, but these studies were limited by small sample sizes. In order to fill this gap in the literature, the authors analyzed 14 years of data (2003-2016) from the National Violent Death Reporting System. Suicides by burning (n = 722) were compared with a reference group containing all other suicide types (n = 166,949). Socio-demographic variables and psychosocial factors (eg, mental health, substance use, and alcohol use) were included in the model. Due to the imbalance between the target and reference groups, rare event data analysis was used to reduce potential small sample estimation bias. Results indicated that females (OR = 1.6, 95% CI: .50-2.83, P < .001), Caucasians (OR = 1.7, 95% CI: 1.1-2.7, P < .001), victims with schizophrenia (OR = 5.4, 95% CI: 3.7-7.8, P < .001), and victims with eating disorders (OR = 5.6, 95% CI: 1.9-8.6, P < .001) are significantly more likely to commit suicide by burning. These results contribute new knowledge to what is currently known about suicidal burn-related behaviors and supports interventions that focus on mitigating this insidious public health problem.
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Affiliation(s)
- Thereasa E Abrams
- College of Social Work, The University of Tennessee-Knoxville, Nashville
| | - Stephen V McGarity
- College of Social Work, The University of Tennessee-Knoxville, Nashville
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8
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Satisfaction with appearance and sexual satisfaction in women with severe burn injuries. Int J Impot Res 2021; 34:215-221. [PMID: 33495584 DOI: 10.1038/s41443-021-00407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 12/27/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Abstract
Burn, particularly in women, can cause a variety of difficulties. Women's feelings of themselves and of life satisfaction are affected by their body dimensions and satisfaction with appearance, which can be significant predictors of their sexual satisfaction. Therefore, this study aimed to investigate the relationship between satisfaction with appearance and sexual satisfaction among female patients with severe burn. The present study, adopted a descriptive-analytic approach and used a convenience sampling technique, to select 180 female patients Data collection instruments included a demographic questionnaire, the index of sexual satisfaction (ISS), and the satisfaction with appearance scale (SWAP). The results of this study showed that about 82% of women with severe burn injuries, had a lower level of sexual satisfaction. It was observed that satisfaction with appearance had a significant negative relationship with sexual satisfaction in women with burns (P < 0.001). According to the results of the present study, in order to improve appearance satisfaction and consequently sexual satisfaction, intervention attempts are essential. The findings of this study may have practical applications in the formulation of plans for patients with burn injuries.
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9
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Mohammadi AA, Karoobi M, Erfani A, Shahriarirad R, Ranjbar K, Zardosht M, Modarresi MS, Afrasiabi Z. Suicide by self-immolation in southern Iran: an epidemiological study. BMC Public Health 2020; 20:1646. [PMID: 33143680 PMCID: PMC7641801 DOI: 10.1186/s12889-020-09778-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Self-immolation, as a method of suicide, is one of the most violent and extreme ways which is usually attempted by the ignition of inflammable materials, with more than 70% fatality rate. In the literature, Iran has been reported to have a high rate of self-immolation; therefore, this study aimed to evaluate the prevalence and epidemiological features of self-immolated patients. Methods In this retrospective cross-sectional multicenter study, data from burn patients from 2007 till 2017 due to self-immolation and suicide were enrolled in our study. Results Based on our data, 657 out of 3530 burn patients (18.6%) with a mean age of 31.15 (SD = 0.452) were documented as suicidal attempts; the majority were female (63.2%) and married (66.3%). Most of the patients were from rural areas (58.3%) with an education level of under diploma (63.2%). Of the patients in our study, 22 (8.7%) had comorbid systemic diseases and 115 (50.5%) had psychiatric disorders. Conclusion Due to the high prevalence of suicide by self-immolation among the Iranian population, further studies to evaluate the risk factors and clarify the high-risk group for more targeted approaches are recommended.
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Affiliation(s)
- Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mitra Zardosht
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh-Sadat Modarresi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zari Afrasiabi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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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.
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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
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11
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Yoosefi Lebni J, Abbas J, Khorami F, Khosravi B, Jalali A, Ziapour A. Challenges Facing Women Survivors of Self-Immolation in the Kurdish Regions of Iran: A Qualitative Study. Front Psychiatry 2020; 11:778. [PMID: 32922314 PMCID: PMC7456816 DOI: 10.3389/fpsyt.2020.00778] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/21/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES Women confront many problems after self-immolation, so the purpose of this study was to explore the challenges facing women survivors of self-immolation in the Kurdish Regions of Iran. METHOD This study used a qualitative approach and conventional content analysis. Data were collected through semi-structured interviews with 19 Kurdish women who attempted self-immolation in Iran. They were sampled through purposeful sampling and snowball sampling. The Lincoln and Guba criteria were used to strengthen the research. RESULTS The results of data analysis were categorized into five main categories: 1-psychological problems, 2-lack of social and legal supportive structures, 3-incomplete treatment, 4-poor self-care, and 5-social problems. These categories consist of 19 subcategories. CONCLUSION Having been rescued from self-immolation, the women confront many challenges returning to normal life. Reducing these women's problems and paving the way for their return to life requires multi-dimensional and community-based interventions. Therefore, all social organizations and institutes can cooperate and each of them paves part of the way.
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Affiliation(s)
- Javad Yoosefi Lebni
- Health Education and Health Promotion, School of Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Jaffar Abbas
- Antai College of Economics and Management (ACEM), and School of Media and Communication (SMC), Shanghai Jiao Tong University (SJTU), Shanghai, China
| | - Farhad Khorami
- Master of Clinical Psychology, Islamic Azad University, Kermanshah Branch, Kermanshah, Iran
| | - Bahar Khosravi
- Master of Women Studies, Shahid Madani University of Azerbaijan, Azerbaijan, Iran
| | - Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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12
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How self-inflicted injury and gender impacted the outcome following a severe burn. Burns 2019; 45:621-626. [DOI: 10.1016/j.burns.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/30/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
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13
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Saadati M, Azami-Aghdash S, Heydari M, Derakhshani N, Rezapour R. Self-immolation in Iran: Systematic Review and Meta-analysis. Bull Emerg Trauma 2019; 7:1-8. [PMID: 30719460 PMCID: PMC6360006 DOI: 10.29252/beat-070101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of self-immolation epidemiology and characteristics in Iran. METHODS This was a systematic review and meta-analysis study. PubMed, Scopus, Web of science and Science Direct were searched for English literature and SID and Magiran for Persian in the time period of 2000 to 2016. The retrieved studies were screened and reviewed then quality assessed. Random Effect model was applied for meta-analysis. The qualitative data were analyzed by content analysis method. RESULTS After literature screening, 39 studies included in the analysis. Women were subject to self-immolation more than men. The rate of self-immolation estimated to be 4.5 cases in every 100,000 populations and it was the reason of 16% of hospitalized burns. The average length of hospital stay calculated to be 12.24 (95% CI: 8.85-15.59) days. The total burnt surface area was 65.3% (95% CI: 56.71-73.89). Death due to self-immolation was 62.1%. The major risk factors of self-immolation were having mental health issues, family problems and characteristics and problems in relation/communication with spouses. CONCLUSION Despite the low rate of self-immolation in Iran, it comprises one sixth of the hospitalized burns. The mortality rate of self-immolation also is high and this highlights the importance of providing special care. Psychological consultations and mental health screening in the primary health care would help to prevent the self-immolation.
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Affiliation(s)
- Mohammad Saadati
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- TabrizHealth Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahdieh Heydari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Derakhshani
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ramin Rezapour
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Bazyar J, Jahangiri K, Safarpour H, Keykaleh MS, Varasteh S, Malekyan L, Mohammadi E. The Estimation of Survival and Associated Factors in Self-Immolation Attempters in Ilam Province of Iran (2011-2015). Open Access Maced J Med Sci 2018; 6:2057-2061. [PMID: 30559860 PMCID: PMC6290456 DOI: 10.3889/oamjms.2018.327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Self-immolation is the most common method of suicide in Ilam province. AIM This study aimed to estimate the survival rate in self-immolation attempters in Ilam and identify the associated factors. METHODS A descriptive-analytic study was conducted based on data collected at Taleghani Hospital in Ilam, Iran. All persons passed away due to self-immolation or those hospitalised in the centre of the self-burned patients located in Ilam during 2011 to 2015 were assessed. Survival rate was calculated based on Kaplan-Meier. To compare the survival rate between groups, Univariate Log Rank and for multivariate analysis, the Cox test of STATA12 software was used. RESULTS During 2011 to 2015, 236 persons including 168 females and 69 males committed self-immolation. The mean and median of survival time in attempters were 32.2 ± 4.7 and 3 ± 0.33 days, respectively. In Univariate Log-Rank test, the following variables including age, sex, burn degree, Total Body Surface Area (TBSA), and burns in neck and head and lower limbs had a significantly meaningful relation with survival, while in multivariate Cox Regression test only two variables including Total Body Surface Area and age remained in the model. CONCLUSION The mean and median survival rate in self-attempters are very low. Quickly hospitalisation without waste of time should be considered. Providing prompt treatments and compensating dehydration in early hours especially within the first 24 hours of self-immolation are very vital. Younger persons and those with lower burn surface have more chance for longer survival and recuperation.
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Affiliation(s)
- Jafar Bazyar
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Safarpour
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Safi Keykaleh
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeideh Varasteh
- Department of Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Leila Malekyan
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Ehsan Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
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Chatelain S, Serror K, Chaouat M, Mimoun M, Boccara D. Immolation dans notre centre de traitement des brûlés de 2011 à 2016. ANN CHIR PLAST ESTH 2018; 63:41-46. [DOI: 10.1016/j.anplas.2017.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
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Amadasi A, Boracchi M, Gentile G, Maciocco F, Maghin F, Zoja R. Observations on self-incineration characteristics in 24 years (1993-2016) of autopsies in the city of Milan. MEDICINE, SCIENCE, AND THE LAW 2018; 58:32-38. [PMID: 29256331 DOI: 10.1177/0025802417748284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Self-incineration is one of the most dramatic and lethal suicide methods. It is rarely reported in Western countries and is more frequent in developing regions. We illustrate the forensic cases of self-immolation occurring over 24 years in the city of Milan, Italy, highlighting the main issues of such a complex and rare suicide. We selected 33 cases of self-incineration among 23,417 autopsies (4022 suicides) performed at the Department of Legal Medicine of the University of Milan over a period of 24 years (1993-2016). Several parameters were included and analysed: gender and age of the victims, pathological history, previous suicide intentions/attempts, duration of burning, place of death or discovery of the corpse, circumstantial data of fatal events and autopsy findings, with particular attention to thermal injuries. Self-incineration was found in 0.8% of total suicides and 0.14% of total autopsies. One of these cases involved a complex modality (association with plastic-bag suffocation). The typical characteristics of the victim were an Italian man with psychiatric illness, frequently moved by passion, existential discomfort and economic problems. During the 24-year period, the number of cases of self-incineration progressively reduced. This study provides a general overview in one of the biggest metropolitan Italian areas and is one of the few works performed on this topic. It may be helpful in understanding and studying such an unusual manner of suicide.
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Affiliation(s)
- Alberto Amadasi
- 1 Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense, Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - Michele Boracchi
- 1 Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense, Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - Guendalina Gentile
- 1 Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense, Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - Francesca Maciocco
- 1 Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense, Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
| | - Francesca Maghin
- 2 Medicina Legale - Azienda Ospedaliera Spedali Civili di Brescia, Italy
| | - Riccardo Zoja
- 1 Sezione di Medicina Legale e delle Assicurazioni, Laboratorio di Istopatologia Forense, Dipartimento di Scienze Biomediche per la Salute, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Italy
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Nisavic M, Nejad SH, Beach SR. Intentional Self-inflicted Burn Injuries: Review of the Literature. PSYCHOSOMATICS 2017; 58:581-591. [DOI: 10.1016/j.psym.2017.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/25/2017] [Accepted: 06/05/2017] [Indexed: 11/28/2022]
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18
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Bahar MA, Pakyari M, Bahar R. Burns in Tehran: demographic, etiological, and clinical trends. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0802.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Burns are a major public health problem. They often require intensive care and long periods of hospitalization. In Tehran, about 5% of all hospitalized injuries are burns. There are no published long-term epidemiological studies regarding burn injuries of adults in Iran.
Objective: To identify risk factors for burn injuries and provide a starting point for the establishment of an effective prevention plan.
Methods: We analyzed the demographic, etiological, and clinical data of 1860 burn patients admitted to a major acute care hospital in Tehran between March 2010 and April 2011. Data were obtained from the registry recorded in Shahid Motahari Trauma Hospital and evaluated using a chi-square test.
Results: Males were more than twice as likely to be burn patients than females (72.0% vs. 28.0%). Second and third-degree burns with a body surface area of 21%-30% constituted the highest injury reported (75.3%). The most common causes of the recorded burns were natural gas, gasoline (42%) and open fire (10.2%). Unintentional burns were reported in 85% of the cases, and 15% of the burn victims were suicide-related incidents; mainly among women. In 75% of suicide attempts, women set themselves on fire to commit suicide. The mean duration of hospitalization was 25 days and the mortality rate was 10.7%. Mean age of reported deaths was 38.6 years; with a mean of 30 years among women and 51.5 years among men.
Conclusion: The group at highest risk was young men 21-30 years old. However, an astonishing finding was that 75% of suicidal-related incidents involved women setting themselves on fire. Those with the highest mortality rate were victims of burns with gas, gasoline, and kerosene; with a mean age of 30 years of death among women.
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Affiliation(s)
- Mohammad Ali Bahar
- Burn Research Center, Iran University of Medical Sciences and Health Services, Tehran 14155-6559, Iran (Islamic Republic of)
| | - Mohammadreza Pakyari
- Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
| | - Rayeheh Bahar
- Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
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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]
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Carlsson AH, Rose LF, Fletcher JL, Wu JC, Leung KP, Chan RK. Antecedent thermal injury worsens split-thickness skin graft quality: A clinically relevant porcine model of full-thickness burn, excision and grafting. Burns 2016; 43:223-231. [PMID: 27600980 DOI: 10.1016/j.burns.2016.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/01/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
Current standard of care for full-thickness burn is excision followed by autologous split-thickness skin graft placement. Skin grafts are also frequently used to cover surgical wounds not amenable to linear closure. While all grafts have potential to contract, clinical observation suggests that antecedent thermal injury worsens contraction and impairs functional and aesthetic outcomes. This study evaluates the impact of antecedent full-thickness burn on split-thickness skin graft scar outcomes and the potential mediating factors. Full-thickness contact burns (100°C, 30s) were created on the backs of anesthetized female Yorkshire Pigs. After seven days, burn eschar was tangentially excised and covered with 12/1000th inch (300μm) split-thickness skin graft. For comparison, unburned wounds were created by sharp excision to fat before graft application. From 7 to 120days post-grafting, planimetric measurements, digital imaging and biopsies for histology, immunohistochemistry and gene expression were obtained. At 120days post-grafting, the Observer Scar Assessment Scale, colorimetry, contour analysis and optical graft height assessments were performed. Twenty-nine porcine wounds were analyzed. All measured metrics of clinical skin quality were significantly worse (p<0.05) in burn injured wounds. Histological analysis supported objective clinical findings with marked scar-like collagen proliferation within the dermis, increased vascular density, and prolonged and increased cellular infiltration. Observed differences in contracture also correlated with earlier and more prominent myofibroblast differentiation as demonstrated by α-SMA staining. Antecedent thermal injury worsens split-thickness skin graft quality, likely by multiple mechanisms including burn-related inflammation, microscopically inadequate excision, and dysregulation of tissue remodeling. A valid, reliable, clinically relevant model of full-thickness burn, excision and skin replacement therapy has been demonstrated. Future research to enhance quality of skin replacement therapies should be directed toward modulation of inflammation and assessments for complete excision.
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Affiliation(s)
- Anders H Carlsson
- Q-SCARR™ (Quality Skin Collaborative for Advanced Reconstruction and Regeneration) Research Program, United States; Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States.
| | - Lloyd F Rose
- Q-SCARR™ (Quality Skin Collaborative for Advanced Reconstruction and Regeneration) Research Program, United States; Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - John L Fletcher
- Q-SCARR™ (Quality Skin Collaborative for Advanced Reconstruction and Regeneration) Research Program, United States; Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States; Clinical Division and Burn Center, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - Jesse C Wu
- Q-SCARR™ (Quality Skin Collaborative for Advanced Reconstruction and Regeneration) Research Program, United States; Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - Kai P Leung
- Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
| | - Rodney K Chan
- Q-SCARR™ (Quality Skin Collaborative for Advanced Reconstruction and Regeneration) Research Program, United States; Dental and Craniofacial Trauma Research and Tissue Regeneration, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States; Clinical Division and Burn Center, US Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, United States
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Caine PL, Tan A, Barnes D, Dziewulski P. Self-inflicted Burns: 10 year review and comparison to national guidelines. Burns 2015; 42:215-221. [PMID: 26603912 DOI: 10.1016/j.burns.2015.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/27/2015] [Accepted: 09/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given. METHODS A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival. RESULTS We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically. CONCLUSION Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend.
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Affiliation(s)
- P L Caine
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
| | - A Tan
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - D Barnes
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - P Dziewulski
- St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
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Karim H, Schwebel DC, Bazargan-Hejazi S, Mohammadi R, Choubsaz M, Heidari Zadie Z, Ahmadi A. What factors play a role in preventing self-immolation? Results from a case-control study in Iran. J Inj Violence Res 2015; 7:59-63. [PMID: 26081518 PMCID: PMC4522316 DOI: 10.5249/jivr.v7i2.550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/07/2014] [Indexed: 11/22/2022] Open
Abstract
Background: To investigate factors related to prevention of self-immolation in west of Iran. Methods: In a case-control study, 30 consecutive cases of deliberate self-inflicted burns admitted to the regional burn center (Imam Khomeini hospital in Kermanshah province, Iran) were compared with controls selected from the community and matched by sex, age, district-county of residence, and rural vs urban living environment. The following characteristics relevant to preventing self-immolation were collected from all cases and controls: main domestic fuel used in the household, awareness about complications of burn injuries, and use of counseling services. Results: Descriptive analyses revealed that kerosene was the main domestic fuel in the household for 83% of cases. Not surprisingly, the main means of self-immolation in 93% of the patients was kerosene, with other fuels such as petrol and domestic gas used in remaining cases. The majority of cases and controls were aware of the potential complications of burn injuries. Use of counseling services was more common in controls. Conclusions: All three aspects of preventing self-immolation – having kerosene and other fuels in the home, being aware of the complications of burn injuries, and using counseling services were present in both the cases and controls. This suggests a large portion of residents in rural Iran are potential self-immolation victims. Increasing preventive strategies may reduce risk of suicide by self-immolation.
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Affiliation(s)
| | | | | | | | | | | | - Alireza Ahmadi
- Department of Anesthesiology, Critical Care and Pain Management, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. E-mail:
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Lama BB, Duke JM, Sharma NP, Thapa B, Dahal P, Bariya ND, Marston W, Wallace HJ. Intentional burns in Nepal: a comparative study. Burns 2015; 41:1306-14. [PMID: 25716765 DOI: 10.1016/j.burns.2015.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/19/2022]
Abstract
AIMS Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002-2013. METHODS A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance. RESULTS There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%). CONCLUSIONS The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.
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Affiliation(s)
| | - Janine M Duke
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia.
| | | | | | | | | | | | - Hilary J Wallace
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia
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Wu JC, Rose LF, Christy RJ, Leung KP, Chan RK. Full-Thickness Thermal Injury Delays Wound Closure in a Murine Model. Adv Wound Care (New Rochelle) 2015; 4:83-91. [PMID: 25713750 DOI: 10.1089/wound.2014.0570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/17/2014] [Indexed: 11/12/2022] Open
Abstract
Objective: The contemporary treatment of a full-thickness burn consists of early eschar excision followed by immediate closure of the open wound using autologous skin. However, most animal models study burn wound healing with the persistence of the burn eschar. Our goal is to characterize a murine model of burn eschar excision to study wound closure kinetics. Approach: C57BL/6 male mice were divided into three groups: contact burn, scald burn, or unburned control. Mice were burned at 80°C for 5, 10, or 20 s. After 2 days, the eschar was excised and wound closure was documented until postexcision day 13. Biopsies were examined for structural morphology and α-smooth muscle actin. In a subsequent interval-excision experiment (80°C scald for 10 s), the burn eschar was excised after 5 or 10 days postburn to determine the effect of a prolonged inflammatory focus. Results: Histology of both contact and scald burns revealed characteristics of a full-thickness injury marked by collagen coagulation and tissue necrosis. Excision at 2 days after a 20-s burn from either scald or contact showed significant delay in wound closure. Interval excision of the eschar, 5 or 10 days postburn, also showed significant delay in wound closure. Both interval-excision groups showed prolonged inflammation and increased myofibroblasts. Innovation and Conclusions: We have described the kinetics of wound closure in a murine model of a full-thickness burn excision. Both contact and scald full-thickness burn resulted in significantly delayed wound closure. In addition, prolonged interval-excision of the eschar appeared to increase and prolong inflammation.
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Affiliation(s)
- Jesse C. Wu
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Lloyd F. Rose
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | - Kai P. Leung
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Rodney K. Chan
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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Gauthier S, Reisch T, Bartsch C. Self-burning – A rare suicide method in Switzerland and other industrialised nations – A review. Burns 2014; 40:1720-6. [DOI: 10.1016/j.burns.2014.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/06/2014] [Accepted: 02/11/2014] [Indexed: 11/17/2022]
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Ahmadi M, Ranjbaran H, Azadbakht M, Heidari Gorji M, Heidari Gorji A. A survey of characteristics of self-immolation in the northern iran. Ann Med Health Sci Res 2014; 4:S228-32. [PMID: 25364594 PMCID: PMC4212382 DOI: 10.4103/2141-9248.141964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Suicide is an action deliberately initiated and performed by a person with complete awareness of its fatal outcome, prevalence of which is very rare in developed countries, but it is reported with more frequency in Middle East including Iran. Aim: This study was carried out to analyze the characteristics, mortality, and related factors of burned patients who attempted to suicide by self-immolation in Northern Iran. Materials and Methods: In this retrospective study, the archived files of 101 cases that referred to the main burn care center located in northern Iran (Included: Mazadaran, Golestan cities) - cause of suicide attempting by self-immolation during 2 years 2010-2011, analyzed. A record sheet designed to extract data such as: Age, education, occupation, gender, residence, marital status, drug abuse, and extent of the burn injuries as a percent of burned total body surface area (TBSA). Results: The incidence rate of suicide attempted cases were 1.98/100,000 person-years. The mean ages for cases were 31.8 (13.6). The mean age for males and females were 36.1 (14.8) and 30.1 (12.9) years, respectively. In, about 84% (84/101) of the patient's burned TBSA was more than 40% (41/101). Burn injuries were more frequent, larger, and included higher mortality in females than males. Kerosene was the most common used material to self-burning. The mortality rate was about 74% (74/101), which showed a high mortality rate in this study. Other social factors such as marital status, employment, and education level have a role as individually protective or risk factors for self-burning. Conclusion: Finding of the current study manifested high rate of suicide by self-immolation among young, married, and low educated women in Northern Iran. It implies a social problem, and need to an arrangement of a cultural program aimed to improving health, psychological habits and educational level.
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Affiliation(s)
- M Ahmadi
- Department of Health Affairs, Mazandaran University of Medical Sciences, Sari, Iran
| | - H Ranjbaran
- Department of Health Affairs, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Azadbakht
- Department of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ma Heidari Gorji
- Education and Development Centre, Mazandaran University of Medical Sciences, Sari, Iran
| | - Am Heidari Gorji
- Department of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran ; Department of Traditionaland Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Rezaie L, Hosseini SA, Rassafiani M, Najafi F, Shakeri J, Khankeh HR. Why self-immolation? A qualitative exploration of the motives for attempting suicide by self-immolation. Burns 2014; 40:319-27. [DOI: 10.1016/j.burns.2013.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/10/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
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Attempted suicide by self-immolation is a powerful predictive variable for survival of burn injuries. J Burn Care Res 2013; 33:642-8. [PMID: 22245801 DOI: 10.1097/bcr.0b013e3182479b28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Up to 9% of all burn victims in western countries are reported to have been caused by self-immolation with suicidal intent and usually involve extensive injuries. The authors sought to identify differences between suicide burn victims as opposed to those who sustained their injuries accidentally with regard to injury severity and mortality and determine the possible impact of suicide as a prognostic variable in the context of a scoring system such as the Abbreviated Burns Severity Index (ABSI). The data of all burns patients treated at the Specialist Burns Intensive Care Unit, University Hospital Zürich, between 1968 and 2008 were analyzed retrospectively. Of the 2813 patients included in the study, 191 were identified as attempted suicides, most commonly involving the use of accelerants. Thirty percent of all suicide victims had preexisting psychiatric diagnoses. Suicide victims presented with significantly more extensive burns (53.7%, ±0.98 SEM vs 21.4 %, ±0.36 SEM, P < .0001), had higher total ABSI scores (8.4, ±0.23 SEM vs 6.6, ±0.05 SEM, P < .0001), and had higher mortality rates (42.9% [83/191] vs 16.3% [426/2622]) than accident victims. Furthermore, logistic regression revealed suicide to be a significant predictor of mortality as inhalation injury (odds ratio 2.2, 95% confidence interval 1.4-3.5, P < .0003 and odds ratio 2.4, 95% confidence interval 1.4-4.0, P < .0009, respectively). The odds of dying from an attempted suicide are twice as high compared with those of accident patients in the same ABSI category, making suicide a powerful predictor of mortality. The authors therefore suggest including it as a fixed variable in scoring systems for estimating a patient's mortality after burn injuries such as the widely used ABSI.
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Ghaleiha A, Afzali S, Bazyar M, Khorsand F, Torabian S. Characteristics of hospitalized patients following suicide attempt in hamadan district, iran. Oman Med J 2012; 27:304-9. [PMID: 23071883 DOI: 10.5001/omj.2012.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/08/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Limited research has been undertaken on suicide in developing countries. This paper aims to investigate characteristics of suicide attempts in Hamadan district of Iran. METHODS A prospective study was conducted in all university hospitals in the Hamadan district of Iran and patients admitted for attempted suicides were included. All cases were assessed by psychiatrists and visited by two trained interns of Medicine. RESULTS The incidence rate per 100,000 persons of attempted suicides was 228.6 for males and 263.1 for females; moreover, 344.9 for rural areas and 222.7 for urban areas. The suicide attempt was the highest in the 15 to 24 age category for both sexes and regions. CONCLUSIONS Suicide is a complex, long-term outcome that requires multifaceted theoretical constructs for the appropriate study of its antecedents. Findings of this study along with other studies in Iran revealed that unemployed men, housewives, and rural women, high-school students, and those with a low level of education were at higher risk of suicidal behaviors.
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Affiliation(s)
- Ali Ghaleiha
- Associate Professor of Psychiatry, Behavioral Disorders and Substance Abuse Center of Hamadan University of Medical Sciences, Hamadan, Iran
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Peck MD. Epidemiology of burns throughout the World. Part II: intentional burns in adults. Burns 2012; 38:630-7. [PMID: 22325849 DOI: 10.1016/j.burns.2011.12.028] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/28/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.
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Suicide attempt by self-burning associated with ingestion of S-adenosylmethionine: a review of the literature and case report. J Nerv Ment Dis 2012; 200:99-101. [PMID: 22210371 DOI: 10.1097/nmd.0b013e31823fafdf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment of major depressive disorder continues to be challenging in many cases. The high nonresponse rates as well as the poor tolerability of some antidepressants often prompt patients to seek other forms of treatment. S-Adenosylmethionine (SAMe) is one of the most popular over-the-counter antidepressants currently sold in the United States. SAMe's antidepressant effect has been clearly demonstrated, but safety and tolerability remain understudied at this time. This report describes the case of a 61-year-old woman with no previous history of suicidal ideations who self-prescribed SAMe for her depressive symptoms and attempted suicide 4 days later by burning herself. Given the rise in the use of over-the-counter antidepressants, further research should be performed regarding the safety of these products, including a need for warnings to the public and adequate labels if necessary.
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Poeschla B, Combs H, Livingstone S, Romm S, Klein MB. Self-immolation: Socioeconomic, cultural and psychiatric patterns. Burns 2011; 37:1049-57. [DOI: 10.1016/j.burns.2011.02.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/21/2011] [Accepted: 02/27/2011] [Indexed: 11/25/2022]
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Moniz P, Casal D, Mavioso C, Videira-Castro J, Angélica-Almeida M. The self-inflicted burns-Typology and its prognostic relevance in a 14-year review of self-inflicted burns in a tertiary referral centre. Burns 2011; 37:322-7. [DOI: 10.1016/j.burns.2010.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/21/2010] [Accepted: 07/22/2010] [Indexed: 11/29/2022]
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Franchitto N, Faurie C, Franchitto L, Minville V, Telmon N, Rougé D. Self-inflicted burns: the value of collaboration between medicine and law. J Forensic Sci 2011; 56:638-42. [PMID: 21361934 DOI: 10.1111/j.1556-4029.2011.01706.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-inflicted burns are rare in France, but they lead to major, often life-threatening complications. The authors reviewed medical data for patients hospitalized in a burn center from January 2004 to December 2008. Thirty-eight cases of self-inflicted burns were compared with 220 accidental burns. Women were predominantly affected (57.9%, n = 22). A psychiatric history (71%, n = 27) was more frequent in this population. The mean age of the victims was 38 years. The leading method of suicide was flame (94%, n = 36) associated with gasoline used as an accelerant (77.7%, n = 28). Mean total burn surface area (41.5%) and mortality (36.9%) were higher in the self-inflicted burn population. By recognizing epidemiological characteristics and patients at risk, we can better classify lesions related to self-immolation. It is important for the forensic physician to consult survival details to correlate these data with the results of autopsy.
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Affiliation(s)
- Nicolas Franchitto
- Department of Legal Medicine, Toulouse-Rangueil University Hospital, 1 Avenue Jean Poulhès, 31059 Toulouse, France.
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Rezaie L, Khazaie H, Soleimani A, Schwebel DC. Is self-immolation a distinct method for suicide? A comparison of Iranian patients attempting suicide by self-immolation and by poisoning. Burns 2011; 37:159-63. [DOI: 10.1016/j.burns.2010.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 07/09/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
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Cimino PJ, Williams TL, Fusaro A, Harruff R. Case series of completed suicides by burning over a 13-year period. J Forensic Sci 2010; 56 Suppl 1:S109-11. [PMID: 20950319 DOI: 10.1111/j.1556-4029.2010.01597.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide by burning is an extreme act that is uncommon in the United States and throughout the Western world. The characteristics of people who complete such acts are not well understood. To address this issue, we examined the death records of the King County Medical Examiner's Office in Washington State over the 13 years from 1996 to 2009. Twenty-five cases of suicide by burning were identified and used to characterize decedent demographics, circumstances of death, and motivating factors. Compared to other methods of suicide, burning demonstrated a significant overrepresentation of decedents who were women, 40-59 years of age, and Asian/Pacific Islander. They also tended to have previous psychiatric illness and/or substance abuse issues. Self-burning predominantly occurred at the decedent's residence with the intent of suicide given. There was no unifying theme in motivating factors. Together, these data represent the characteristics of people whose death is because of suicide by burning in King County, Washington.
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Affiliation(s)
- Patrick J Cimino
- King County Medical Examiner's Office, Seattle, WA 98104-2499. USA
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Abstract
Deliberate self-harm (DSH) is a widespread yet often hidden problem in adolescents and young adults. Though most DSH can be classified as "non-suicidal self-cutting", some do go on to commit suicide. In this paper, deliberate self-harm is examined, including its prevalence, etiology, management, and future research directions using self-cutting and self-burning as examples. This article reviews recent literature to help understand what is known about self-cutting behavior and its potential relationship to suicide as well as provide direction for research. Research shows that different ecological factors at the individual, family, peer, and societal levels are related to deliberate self-harm. Although there is an association between some self-injurers and drug abuse (including alcohol abuse) as well as eating disorders, there are various subgroups of self-cutters and most are not at high risk for suicide. However, all acts of self-injury should be taken seriously by health care professionals and comprehensive therapy offered to any adolescent with a history of DSH. Future research directions on deliberate self-harm are also discussed.
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McKibben JBA, Ekselius L, Girasek DC, Gould NF, Holzer C, Rosenberg M, Dissanaike S, Gielen AC. Epidemiology of burn injuries II: psychiatric and behavioural perspectives. Int Rev Psychiatry 2009; 21:512-21. [PMID: 19919204 DOI: 10.3109/09540260903343794] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.
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Affiliation(s)
- Jodi B A McKibben
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
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Titscher A, Lumenta D, Belke V, Kamolz L, Frey M. A new diagnostic tool for the classification of patients with self-inflicted burns (SIB): The SIB-Typology and its implications for clinical practice. Burns 2009; 35:733-7. [DOI: 10.1016/j.burns.2008.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
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Ahmadi A, Mohammadi R, Schwebel DC, Yeganeh N, Soroush A, Bazargan-Hejazi S. Familial Risk Factors for Self-Immolation: A Case-Control Study. J Womens Health (Larchmt) 2009; 18:1025-31. [DOI: 10.1089/jwh.2008.1192] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alireza Ahmadi
- Kermanshah University of Medical Sciences, Iran
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Reza Mohammadi
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Alabama
| | | | - Ali Soroush
- Kermanshah University of Medical Sciences, Iran
| | - Shahrzad Bazargan-Hejazi
- Department of Psychology, College of Medicine at Charles Drew University of Medicine and Science and David Geffen School of Medicine at UCLA, Los Angeles, California
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Ahmadi A, Mohammadi R, Schwebel DC, Khazaie H, Yeganeh N, Almasi A. Demographic risk factors of self-immolation: A case–control study. Burns 2009; 35:580-6. [DOI: 10.1016/j.burns.2008.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 06/30/2008] [Indexed: 11/29/2022]
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Abstract
Deliberate self-inflicted burn is rare in high-income countries, but is reported more frequently in low- and middle-income countries, especially in Asia and Africa. Rates in Iran are among the highest in the world, with up to 71% of committed suicides conducted via self-immolation in some regions. The objective of this study was to identify the epidemiologic features and factors of self-immolation in Iran to aid in development of effective intervention programs. In a review study, two national databases were analyzed to identify demographic, geographic, cultural, economic, and health-related aspects of self-immolation that may vary across regions of Iran. Demographic information revealed that 27% of suicide cases in Iran were via self-immolation. Of those, 71% were female. The mean age was 29 years. Geographical features of self-immolation indicated that the self-immolation rate was higher in rural areas and in provinces that border the country. Provinces that were involved more intensively in postwar problems feature higher rates of self-immolation. People of Kurdish ethnicity were more likely to engage in self-immolation. Unemployment was a risk factor for self-immolation, while mental disorders and lack of access to health and treatment facilities did not play an important role for increasing the rate of self-immolation. Overall, this study demonstrates that self-immolation is a significant public health problem in some parts of Iran. This study clearly and consistently shows that self-immolation is a complex phenomenon with multiple causes. Various intervention options are discussed to increase coping skills on the individual and community levels. During the long-term, programs and strategies should focus on "macrosocial-based" interventions.
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Mortality risk and length of stay associated with self-inflicted burn injury: evidence from a national sample of 30,382 adult patients. Crit Care Med 2008; 36:118-25. [PMID: 18090371 DOI: 10.1097/01.ccm.0000293122.43433.72] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Existing studies report contradictory findings regarding characteristics and outcomes of patients admitted with self-inflicted burn injuries. The objective of this study was to report demographic and medical characteristics of patients admitted to burn centers with self-inflicted burn injuries and to assess mortality risk and length of stay compared with patients whose injuries were not self-inflicted. DESIGN Retrospective, cohort study. SETTING A total of 70 burn centers from the United States that contributed data to the American Burn Association National Burn Repository. PATIENTS A total of 30,382 adult patients (593 with self-inflicted injuries) who were admitted with a thermal injury from 1995 through 2005. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographics, comorbidities, burn injury severity variables (total body surface area burned [TBSA], TBSA burned third degree, inhalation injury), hospital mortality, intensive care length of stay, and total hospital length of stay were ascertained. Patients with self-inflicted injuries had larger TBSA burned (32.0% vs. 12.8%, p < .01) and larger third-degree TBSA burned (20.6% vs. 4.9%, p < .01) and were more likely to incur an inhalation injury (37.3% vs. 12.8%, p < .01). Before matching, patients with self-inflicted injuries were at greater risk of mortality (23.6% vs. 6.8%, p < .01) and required longer intensive care (median of 4 days vs. 0 days, p < .01) and total hospital stays (median of 23 days vs. 8 days, p < .01). After propensity score matching on demographic, medical, and burn injury variables, they were not more likely to die of their injuries (23.6% vs. 23.1%, p = .84), did not require longer intensive care stays (4 days vs. 3 days, p = .75), and did not require longer total hospital stays (23 days vs. 18 days, p = .50). CONCLUSIONS Compared with patients with similar demographic, health, and injury characteristics whose injuries are not self-inflicted, patients with self-inflicted burn injuries are not at greater risk of mortality and do not require longer durations of intensive care or total hospitalization.
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