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Erlangsen A, Khan M, Su W, Alateeq K, Charfi F, Madsen T, Qin P, Morthorst BR, Thomsen M, Malik A, Bandara P, Fleischmann A, Saeed K. Situation Analysis of Suicide and Self-Harm in the WHO Eastern Mediterranean Region. Arch Suicide Res 2024; 28:760-778. [PMID: 37837375 DOI: 10.1080/13811118.2023.2262532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVE An estimated 41,000 lives are lost to suicide each year in World Health Organization Eastern Mediterranean Region Office (WHO EMRO) countries. The objective of this study was to conduct a situation analysis for suicide and self-harm in the WHO EMRO region. METHODS Data on suicide were obtained from the WHO Global Health Estimates for the years 2000-2019. Information on risk groups efforts to prevent self-harm and suicide in the EMRO region were retrieved through scientific studies, grey literature, and public websites. RESULTS During 2000-2019, the age-standardized suicide rate was 6.7 per 100,000 inhabitants, albeit there are concerns regarding data quality. Self-harm and suicide remain criminal acts in more than half of the countries. Few countries have a national plan for prevention of suicide. Toxic agents, such as pesticides and black henna, are easily available and frequently used for suicide in some areas, as are firearms and self-immolation. Successful prevention measures include means restriction and psychosocial interventions after self-harm. CONCLUSION Many WHO EMRO countries remain underserved in terms of mental health care. Decriminalization of suicide and means restriction might be further promoted. Online-based tools for mental health literacy and psychosocial therapy are other options to explore.
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Ben Abderrahim S, Belhaj A, Bellali M, Hmandi O, Gharbaoui M, Harzallah H, Naceur Y, Ben Khelil M, Allouche M. Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018). Pediatr Dev Pathol 2022; 25:635-644. [PMID: 36503303 DOI: 10.1177/10935266221132884] [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: 12/14/2022]
Abstract
BACKGROUND AND AIMS The problem of unnatural death in children is still relevant because of their vulnerability. This work aimed to describe the epidemiological profile and patterns of these medicolegal deaths in children and adolescents in northern Tunisia. METHODS We conducted a retrospective study from January 2011 to December 2018, within the Forensic Department of Charles Nicolle Hospital in Tunis. All children who died of unnatural causes were included (767 cases). RESULTS An overall male predominance was observed (sex ratio = 2.4). Accidental deaths represent the most common manner of death (81.4%) involving most frequently domestic accidents occurring in children aged between 1 and 4 years. In cases of suicide, the highest risk profile was a female child aged between 15 and 18 years. The suicide occurred most often in the victim's home with hanging representing the common means of suicide. For the criminal form, the most common means in those cases were stabbing and blunt injuries. CONCLUSION Our study delivered a broad picture of unnatural deaths among children in Tunisia. These deaths, largely absent from child survival initiatives presently on the global agenda, can be prevented if they are addressed strategically, as their injury prevention strategies differ from adults.
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Affiliation(s)
- Sarra Ben Abderrahim
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Azza Belhaj
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Mohamed Bellali
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Ons Hmandi
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Hana Harzallah
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia.,Department of Forensic Medicine, Habib Bougatfa University Hospital, Bizerte, Tunisia
| | - Yomn Naceur
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia.,Regional Hospital Béja, Béja, Tunisia
| | - Mehdi Ben Khelil
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
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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.
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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.
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The differences - and similarities - in self-immolation patterns around the globe. In response to: "Drivers and consequences of self-immolation in parts of Iran, Iraq and Uzbekistan: A systematic review of qualitative evidence" Cleary et al. 2021. Burns 2021; 47:1465-1466. [PMID: 33858715 DOI: 10.1016/j.burns.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
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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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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.
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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
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