Suicide by self-immolation: comprehensive overview, experiences and suggestions.

Suicide by burning is a rare condition in the developed countries (0.06-1% of all suicides) but is more frequent in the developing countries (accounting for as many as 40.3% of all suicides). In different parts of Iran, between 1.39% and 9.50% of patients that attempted suicide and 25.0% and 40.3% of patients who committed suicide were via deliberate self-burning. Self-burning (immolation) comprises between 0.37% and 40% of total burn center admissions around the world and, in Iran, it comprises between 4.1% and 36.6% of admissions in Iranian burn centers. Approximately 80% of hospitalized self-immolation patients die. The goal of this study was to identify the epidemiologic features, causes, and potential protective factors regarding suicide by burning in Kermanshah province, in the west of Iran, and to develop the effective intervention programs based on the Public Health Approach to Prevention. During the course of a year, from March 21, 2004, to March 20, 2005 (based on the Iranian calendar), the author examined all the suicidal patients who were admitted to the emergency department of hospitals in Kermanshah University of Medical Science. Examination included a retrospective cross-section study, via demographic questionnaires and suicidal checklists. During the period of study, 1820 patients who attempted suicide and 90 patients who successfully committed suicide were admitted. A total of 41% (37 cases) of patients who committed suicide were via self-immolation. Of these, 81% of self-immolation patients were female (P < .0005), and the female:male ratio was 4.3:1. A total of 86.5% of the patients were in the 11 to 30 years of age group. The mean age was 24.9 years (range, 14-50 years). Forty-nine percent of cases were single, 84% were illiterate or had a low level of education, 78.5% were housewives, and 14% were unemployed. Also, most of the patients (53%) were living in rural area, 97% did not have a previous history of suicide attempt, and 67.5% regretted their self-immolation act. The majority of the self-immolations (64.8%) occurred during daylight hours, and the most common self-immolation motivation factor was marital conflict (32.5%). Overall, this study demonstrates that self-immolation should be considered as a mental health problem in our society, and it is necessary to implement programs and strategies to prevent it. The public health approach provides a framework for a National Prevention Strategy to address this serious national problem. Local data on victims and victim stories from self-immolation provided the stimulus for community action.