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      What factors play a role in preventing self-immolation? Results from a case-control study in Iran

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          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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          The science of prevention. A conceptual framework and some directions for a national research program.

          J Coie, N Watt, S West … (1993)
          A conceptual framework for studying the prevention of human dysfunction is offered. On the basis of recent advances in research on the development of psychological disorders and methods of preventive intervention, generalizations about the relation of risk and protective factors to disorder are put forward, along with a set of principles for what may be identified as the science of prevention. Emerging themes from the study of human development, in general, need to be incorporated in the models for explaining and preventing serious problems of human adaptation. The article concludes with a set of recommendations for a national prevention research agenda.
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            Self-immolation in Iran.

            Alireza Ahmadi, Reza Mohammadi, Despina Stavrinos … (2015)
            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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              Prevention of self-immolation by community-based intervention.

              Alireza Ahmadi, Børge Ytterstad (2007)
              To describe the effectiveness of a community-based program targeting prevention of self-immolation. Suicide by burning is rare in developed countries (0.1-1.8% of all suicides), but more frequent in developing countries (up to 41% of all suicides). Self-immolation constitutes from 0.4% to 40% of admissions to burn centers worldwide. During 2001, an average of 11 Iranians committed suicide daily, 4 of these being self-immolations (36%). Self-immolation caused from 4% to 28% of all admissions to Iranian burn centers. Approximately 80% of hospitalized self-immolation patients die. All descriptive self-immolation studies in Iran emphasize the need for implementing prevention programs. Quasi-experimental. The Iranian cities Gilangharb (intervention) and Sarpolzahab (reference). The populations of these communities. Hospital data collection on self-immolation patients and suicide attempts (all mechanisms) was made from 21 March 1999 to 20 March 2003. The first 12 months of the study provided baseline data, while the last 3 years comprised of a community-based intervention, using a mix of passive and active interventions. Videos showing victim stories were an important component in the prevention program. The interventions were particularly aimed at young women and socio-economically deprived groups, these being shown to be at high risk in earlier studies. Compared to baseline, the mean self-immolation attempts rate decreased by 57% after the implementation of the intervention in Gilangharb (p=0.04, Yates corrected p=0.07). Correspondingly, the reference city rate decreased 27% (n.s.). Moreover, in Gilangharb a 19% decrease of suicide attempts (all mechanisms) was observed while the corresponding reference city rate increased by 24% (n.s.). While the suicide attempt rates were similar in the two populations during baseline, the mean rates observed during the intervention period differed significantly (p<0.0001). A community prevention program targeting self-immolation can be effective. Local data and the showing of videos depicting victim stories from self-immolation attempts provided a stimulus for community action.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Inj Violence Res
                Journal ID (iso-abbrev): J Inj Violence Res
                Journal ID (pmc): kums
                Title: Journal of Injury and Violence Research
                Publisher: Kermanshah University of Medical Sciences
                ISSN (Print): 2008-2053
                ISSN (Electronic): 2008-4072
                Publication date (Print): July 2015
                Volume: 7
                Issue: 2
                Pages: 59-63
                Affiliations
                a Department of Cardiology, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
                b Department of Psychology, University of Alabama at Birmingham, USA.
                c Department of Psychiatry, College of Medicine, Charles Drew University of Medicine and Science, Los Angeles, CA. USA.
                d Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA , CA. USA.
                e Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden.
                f Department of Anesthesiology, Critical Care and Pain Management, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
                Author notes
                [* ] Corresponding Author at: Alireza Ahmadi: MD, Department of Anesthesiology, Critical Care and Pain Management, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fax: +98-83-34282670, Email: ahmadiar1012@ 123456yahoo.com (Ahmadi A.).
                Article
                DOI: 10.5249/jivr.v7i2.550
                PMC ID: 4522316
                PubMed ID: 26081518
                SO-VID: 2e707e06-5f3c-41f8-a536-f7aff9c2253f
                Copyright © Copyright © 2015, KUMS
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 September 2013
                Date accepted : 07 October 2014
                Categories
                Subject: Injury &Violence

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: case control,self-immolation,impulsivity ,counseling services ,burn
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: case control, self-immolation, impulsivity , counseling services , burn

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