Self-immolation in Iran: Systematic Review and Meta-analysis

Suicide and self-harm by burns in Pakistan: a scoping review protocol

INTRODUCTION

Suicide is a global public health problem. Self-inflicted burns are one of the most severe methods of suicide, with high morbidity and mortality. Low-income and middle-income countries contribute 40% of all suicidal burns. Pakistan lacks comprehensive burns surveillance data, which prevents an understanding of the magnitude of the problem. This scoping review aims to understand the scope of the problem of suicide and self-harm burns in Pakistan and to identify knowledge gaps within the existing literature related to this specific phenomenon.

METHODS AND ANALYSIS

This scoping review will follow the methodological framework proposed by Arksey and O'Malley. We will search electronic databases (PubMed, Cochrane, Google Scholar and Pakmedinet), grey literature and a reference list of relevant articles to identify studies for inclusion. We will look for studies on self-inflicted burns as a method of suicide and self-harm in Pakistan, published from the beginning until December 2023, in the English language. Two independent reviewers will screen all abstracts and full-text studies for inclusion. The data will be collected on a data extraction form developed through an iterative process by the research team and it will be analysed using descriptive statistics.

ETHICS AND DISSEMINATION

Ethical exemption for this study has been obtained from the Institutional Review Board Committee of Aga Khan University Karachi, Pakistan. The findings of the study will be disseminated by conducting workshops for stakeholders, including psychiatrists, psychologists, counsellors, general and public health physicians and policymakers. The findings will be published in national and international peer-reviewed journals.

The epidemiology of self-immolation in Iraq: A systematic review

BACKGROUND

Self-immolation is one of the most brutal suicide methods and is a significant social and medical problem throughout the world. Self-immolation is more common in low-income countries than in high-income countries.

AIM

The aim is to evaluate the trends in self-immolation and examine its frequency in Iraq.

METHODS

The PRISMA guideline was used to conduct this systematic review study. We searched for publications in English, Arabic and Kurdish in PubMed and Google Scholar. A total of 105 publications were identified through the search; however, 92 were eliminated due to duplication and irrelevant content. Finally, 13 full articles were included for data extraction. The inclusion criteria were articles that investigated self-immolation. However, letters to editors and media reports on self-immolation were excluded. The retrieved studies were selected, reviewed and then quality assessed.

RESULTS

This study included 13 articles. According to the findings, self-immolation accounted for 26.38% of all burn admissions in the Iraqi provinces and the Kurdistan region, with 16.02% of those occurring in the middle and southern provinces of Iraq and 36.75% in the Kurdistan region. It is more common in women than in men, especially among young, married, illiterate, or poorly educated people. Sulaymaniyah had a higher percentage of self-immolation than other governorates in Iraq, accounting for 38.3% of burn admissions. Cultural and social norms, domestic violence, mental health problems, family conflicts and financial problems were identified as the most common causes of self-immolation.

CONCLUSION

The prevalence of self-immolation is high among the Iraqi population, compared to other countries, particularly among the Kurdish population and in Sulaymaniyah. Self-immolation is relatively common among women. There are sociocultural factors that could contribute to this problem. Families must be restricted from having easy access to kerosene, and high-risk individuals should have access to psychological consultation to reduce the risk of self-immolation.

Exploring the coping strategies of women after self-immolation: A qualitative study

BACKGROUND

Women confront a slew of issues following self-immolation, and it is crucial to examine how women react after self-immolation and live with their scars. Therefore, this study was conducted with the aim of exploring the coping strategies of Kurdish women following self-immolation using a qualitative methodology.

METHODS

The conventional content analysis approach was used in this qualitative investigation. Semi-structured face-to-face and phone interviews were conducted with 26 Kurdish women who had self-immolated and were chosen using purposeful sampling and snowballing for this study. To reinforce the research, Guba and Lincoln's trustworthiness criteria were fulfilled.

RESULTS

The data analysis yielded 2 categories, 11 subcategories, and 85 initial codes. Positive coping is one of the categories and subcategories (spirituality, rebuilding their body, psychological rehabilitation, hiding the scars, restoring self-confidence, changing the lifestyle, forming a new life) 2- Negative coping (separation from society, neglecting the body and mind, violence and aggression, staying in the past).

CONCLUSION

Using the capacity of religious organizations to help victims of self-immolation, providing appropriate conditions and facilities to heal the scars caused by self-immolation, and facilitating access to counseling services can provide the conditions for women to better adapt after self-immolation.

Protective factors against suicide attempt in Iranian Kurdish women: a qualitative content analysis

BACKGROUND

A proper understanding of the protective factors against suicide attempt can provide the basis for planning preventive interventions. This study aimed to identify protective factors against suicide attempt among women.

METHODS

This qualitative study was conducted in Kermanshah, Iran between January and May 2021. Participants were 20 Kurdish women, survivors of suicide attempt, selected by purposive sampling method. The data collection method was face-to face and audio-recorded semi-structured interview. Qualitative data analysis was done according to Diekelmann 7-step approach.

FINDINGS

According to the results, the main topic was protective factors against suicide attempt in women, with two categories; "Individual factors" and "Social factors". "Individual factors" had five subcategories including coping strategies, reasons for living, resilience, religious beliefs, and fear of death, and "social factors" had two subcategories including social support and effective communication.

CONCLUSION

This study showed that women who intend to commit suicide may encounter some individual and social factors that play a protective role against suicide. It is recommended to identify and strengthen these protective factors for the effectiveness of suicide prevention interventions.

Suicide attempts and deaths by self-immolation: A population-based study in Fars (Iran), 2011-2019

Background: Self-immolation is a leading public health challenge with a relatively high mortality, especially in some low- and middle-income countries. This study aimed to investigate epidemiological factors of attempts and completed suicide by self-immolation during 2011-2019 in Fars province (Iran). Materials and methods: This retrospective cross-sectional study included 506 cases of attempted self-immolation suicide during 2011-2019 in Fars province (Iran). Demographic characteristics and suicide information were collected from the Fars Suicide Surveillance System. The first fatality rate and age-standardized mortality rates were calculated. Then, chi-square tests were performed to evaluate suicide trends and examine differences between qualitative variables and outcomes. Logistic regression was used to identify factors associated with self-immolation death. Result: The mean age of study participants was 32.11 ± 14.04 years. The highest age-standardized rates of attempt and completed self-immolation suicide were seen in the age group 25-34 years. The fatality rate of suicide by self-immolation was 61.89%, and the risk of death was around three times higher in people with a history of suicide attempts compared to those who had no history of suicide attempts. However, a family history of suicide attempts was shown to be a protective factor against completed self-immolation suicide. Conclusion: The rate of self-immolation is higher in women and young adults. The results of our study can assist health policy-makers to design comprehensive plans and determine the necessary strategies aimed at identifying vulnerable people, then preventing self-immolation suicide.

Self-immolation in the Arab world: A systematic review

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.

Traumatizing Oneself-Deep Wrist Injuries Self-Inflicted with Suicidal Intention are Associated with More Severe PTSD Symptomatology than Similar Injuries from Accidents

OBJECTIVE

As suicide attempts by definition entail at least some threat to physical integrity and life, they theoretically qualify as an A1 criterion for posttraumatic stress disorder (PTSD). This study uses the unique opportunity of deep wrist injuries to quantify the effect of intentionality on PTSD rates by comparing suicide attempt survivors with patients who sustained accidental injuries similar in mechanism, localization, and extent.

METHOD

Patients who had been admitted with an acute deep wrist injury from 2008 to 2016 filled out the revised Impact of Event Scale and reported other known PTSD risk factors. Mental morbidity and intentionality of the injury were determined by psychiatric consultation during the index hospitalization.

RESULTS

Fifty-one patients were followed up (72.5% male, 92.2% Caucasian, mean age at injury 42.3 ± 17.5 years, 72.5% accidental injuries), on average 4.2 ± 2.9 years after their injury. The intentionality of the injury alone predicted the severity of intrusions, avoidance, hyperarousal, and probable PTSD (aOR = 14.0).

CONCLUSIONS

Traumatization in the context of a suicide attempt may be a hitherto unknown PTSD risk factor. Patients after suicide attempts, especially medically serious attempts, should be monitored for PTSD symptoms.

Associated factors with self-inflicted burns among women in reproductive age in baghdad, iraq: a case control study

BACKGROUND

Self-inflicted burns are a regular source of admissions to burns unit's worldwide. However, there is limited evidence regarding risk factors that associated with self-inflicted burn.

AIMS

To determine factors that associated with self-inflicted burn (SIB) among women in reproductive age in Baghdad, Iraq.

METHOD

Sex, age and time matched case-control study was conducted among females with the age range 15 to 45 years in Baghdad, Iraq. Each case was individual matched to two controls in the similar age (± 1), sex and time when SIB happened. Controls were selected from the same hospital where the cases have been admitted in the same period. Data was collected on the variables age, occupation, education, marital status, socioeconomic status (SES), etc. Crude and adjusted odds Ratio (OR) were estimated by simple and multiple conditional logistic regression model.

RESULTS

We found a positive association between poor SES (AOR = 3.61; 95% CI (2.04 to 6.11)), family history of SIB (AOR = 1.6; 95% CI (1.14 to 4.18)), homelessness (AOR = 3.9; 95% CI (2.07 to 5.48)), subjected to physical (AOR = 2.0; 95% CI (1.35 to 2.95)) and sexual violence (AOR = 1.1; 95% CI (1.17 to 4.51)), having the history of health problem (AOR = 2.63; 95% CI (1.55 to 6.14)), feeling discrimination (AOR = 3.11; 95% CI (1.10 to 5.03)) and dissatisfaction with unstable living condition (AOR = 3.12; 95% CI (1.90 to 6.41)) with SIB.

CONCLUSIONS

Several and interlinked socioeconomic and behavioral factors were associated with SIB in women. Implementing multifaceted intervention is vital to prevent SIB among women with poor SES, living in temporary accommodation, and subjected to domestic violence.