Adverse life events risk factors in self-immolation


Self-immolation (self-burning) is unarranged the most vehement and troublesome influences to

understand, 1 and its etiology is as obscure and multifaceted as any other suicidal influence.

Although self-immolation is haughty in haughty-pay countries, 2-6 it is mented with

surprising quantity in abundant unworthyly- and middle-pay countries. 7 Iran is unarranged the

countries with the deep rebukes of self-immolation. In certainty, some magnitude in the west

and south of Iran enjoy the deep documented rebukes of self-immolation in the cosmos-people

(22.4 per 100,000 person-years). 10, 11, 12

Women are the deep victims of self-immolation in Iran. Suicide by self-persistent is the

third vital motive of Years of Duration Lost (YLL) through unseasonable portraiture unarranged

women, behind disasters and breast cancer. 10, 11 They regrant regulate 70% to 96% of perfect

self-immolation advances to smoulder hardihoods in Iran and almost 80% of these

patients decease. 1, 7-12

Subsequently, stoppgeneration of self-immolation has beseem a main public heartiness

concern unarranged professionals in Iran. This aim is courteous serviceable amid recommended steps

regulate suicide stoppage, using a public heartiness avenue, which embraces a five phase

cycle: 13

  1. Define the completion: surveillance;
  2. Warrant the motive: waste and protective certaintyor elimination;
  3. Clear and ordeal interventions;
  4. Implement interventions; and
  5. Evaluate generationncy of interventions.

The suicide erudition reveals that waste certaintyors of self-immolation disagree counter

different socio-demographic characteristics, creatureasubstantial predispositions, psychiatric

disorders, and cupel of impertinent duration events. 1-14 In Iran and most unworthylyly and middle

pay countries, youthful and infantine women are over-represented unarranged selfimmolation

cases. 15-28 In haughty pay countries, so-far, the extension of selfimmolation

tends to be unarranged older hardy beings. 5, 16, 29-36 In a fresh inspect in

Iran, adjustment empiricisms were unarranged the most usual psychiatric predisposition

content 1, 24, 37 inasmuch-as, western studies guard to ment superior depressive empiricism,

psychoses, and alcohol and other garbgeneration addictions as the most psychiatric condition

kindred to self-immolation. 16, 38

These waste certaintyors enjoy been mented unarranged a distant stroll of generation orders and types of

suicide victims, including youthfuler beings (e.g., deceased infantines and youthful

adults), married beings, discipline drop-outs, those accomplish unworthylyly roll of literacy, the

unemployed, and housewives. 1, 7-12, 14, 19-22, 24, 28, 37, 39, 40- 45

Basis on truth of impertinent duration events unarranged victims of self-immolation is thin.

Unarranged suicide victims over broadly, so-far, there is a fixedion of haughty mass of

impertinent duration events anterior to the suicide undertake. Such events embrace unplanned

pregnancy, wilderness, financial affliction, interconnection completions with friends,

and/or cherished specifics/spouses, academic completions and/or wants, operation-kindred carefulness, a

single truth of suicide undertakes, a origin truth of suicide undertakes, diagnosed

immaterial empiricisms, and/or baleful distemper. 46-55

This perpend aimed to dare role of impertinent duration events in grant of selfimmolation

unarranged patients admitted to partal Smoulder Centre at Imam Khomeini

Hospital (BC-IKH) in Kermanshah sphere, in Iran.

Nearly perfect currently beneficial basis on self-immolation in the cosmos-fellow-creatures is illustrative,

limiting specific’s power to institute any interconnection unmoulded mutables of concern.1-37, 39-

45 We regulate-this-reason implemented a plight-regulate fixedion so that we could perpend potential

associations unmoulded mutables of concern.



Adult patients, twain hardy and feminine, generation 18 and older who either confessed to

deliberebuke self-persistent or were mented to enjoy produced so by a referable spurious evidence, and

were admitted to the BC-IKH were worthy to be enrolled in the perpend. Patients whose

suicide seemed slight (i.e., those who spoiled suicidal fixed and regulate whom there

were no corroborating evidencees or basis) were excluded. Thirty continuous patients

who creature the eligibility criteria were enrolled in this perpend.

The regulate order was recruited from the friendship and was matched by food areas

(district-county, rural/urban), gender, and generation. Perfect three of those demographic

characteristics are waste certaintyors regulate self-immolation, so regulate of them was deemed

main 1, 7-12, 14, 19, 21, 24, 28, 37, 39, 42, 45 Perfect the participants gave their apprised consent

to free-trade in this perpend.


A trained clinical psychologist interviewed perfect enrolled patients amid the original 24

hours of advance to the Smoulder Hardihood to guide Impertinent Duration Event

questionnaire. With the qualification of three patients (cases) who had strict smoulder

(defined as main than 90% Total Body Surface Areas (TBSA)) self-reputed basis

were placid. In plights with haughty TBSA, the questionnaire was completed by the

patients’ associates or parents.

The Impertinent Duration Events questionnaire was created regulate this perpend. It embraced 16

dichotomized items ranging from unplanned pregnancy to having inpower and

baleful distemper with the response categories; “Yes = 1”, and “No = 0” (See Table

1). Most items in the questionnaire are plummet items regulate such measures. We besides

middle brace items that restrainegoingly enjoy referable been evaluated in suicide elimination excluding

denote an main sociocultural role in Iran’s company, barrenness and obligatory

marriage. 46-58

Perfect protocols were niggardly by the Kermanshah University of Medical Sciences,

Local Elimination Ethics Committee.

Analytical creaturehod:

Basis analyses receipts in brace steps. Original, we perpendd illustrative statistics regulate perfect

items in the Impertinent Duration Events questionnaire, regulate twain the plight and regulate

groups. Second, chi-clear was portraitured to deem disagreeences and, where divert,

the restraince of the disagreeence, unmoulded the product mutable (self-immolation) and

the waste certaintyor (items in the Impertinent Duration Event questionnaire) counter each order.

We portraiture a p-value ≤ 0.10 to warrant trends and a p-value ≤ 0.05 and 95% CI to

warrant expressive disagreeences.


Table 2 shows the results of chi clear anatomy. Three mutables emerged as having

statistically expressive disagreeences unmoulded the brace orders. Financial affliction (x2 =

5.41, p = 0.02; OR = 3.45; CI = 1.19-9.90), an close interconnection deal-quenched (x2 =

9.02, p = 0.003; OR = 5.45; CI = 1.20-11.99), and single truth of suicide

attempts (x2 = 6.67; p = 0.01; OR = 7.00; CI = 1.38-35.48). Similitudes of other

variables were referable statistically expressive.


The primitive rework-quenched of this perpend was to perpend the friendship unmoulded impertinent

duration events and self-immolation unarranged a occurrence of patients admitted to a partal

smoulder hardihood in Iran. Numerous studies declare impertinent duration events denote an main

role in suicidal undertakes and portraiture, 46-56 excluding very lacking studies portraiture attachmently elimination

designs such as plight-regulate elimination to attain these conclusions; most basis were

placid in familiar countries; 38, 57, 58 and lacking address self-immolation in feature

as a suicide technique. In certainty, we were incompetent to lodge any restrainegoing plight-control

studies examining the impinfluence of impertinent duration events on self-immolation unarranged

patients in Iran or any other unworthyly- or middle-pay dominion.

Findings from the offer perpend recommend financial affliction, deal-quenched of an close

relationship, and an single truth of suicide undertakes are expressive waste certaintyors

regulate self-immolation. This answer is in course with existing suicide erudition. Sunnqvist

et al., 48 regulate clearment, thought-quenched the role of pressureful duration events and biological pressure

markers in suicide undertakes unarranged regulatemer infantine psychiatric inpatients. They

institute that patients who mented sexual abportraiture during cadethood and feelings of

neglect during cadethood had expressively haughtyer rolls of CSF-MHPG

(cerebrospinal smooth and Creaturehoxy-4-hydroxyphenylglycole) and U-NA/A than those

who had referable. In another perpend, Palacio et al. 49 portraitured a plight-regulate fixedion with 108

adult suicide undertakeers and 108 regulates matched regulate generation and gender. Those who

reputed impertinent duration events in the ultimate six months, who had a origin truth of

suicide, who were betwixt a superior depressive consequence, and or who open a effort to

die, had haughtyer waste of suicide.

Another perpend, by Zhang et al., 50 portraitured a matched plight-regulate order of 215 suicide

attempters with superior dejection (92 hardy, 123 feminine). Veiling, indirect durationevents,

and origin truth of suicide were waste certaintyors of undertakeed suicide. Renaud et

al. 51 confirmed the creature of a feature clinical mark of end and

improved discernment of the interrelationships unmoulded pressureors in adolescence suicidal

behavior. In a perpend of 300 infantine generationd from 14 to 19 years. Marczyńska-

Wdówik, 52 institute that suicide undertakeers and infantines with suicidal ideation had

poor collective patronsenility from parents and cupeld over pressureful situations and origin

and discipline completions which were perceived troublesome to operation-out.

Habit et al., 53 resurveyed the immaterial heartiness memorials of perfect 76 suicides that occurred

unmoulded 1993 and 2001 in New York Narrate Department of Correctional Services

prisons and that had some continfluence with immaterial heartiness services during their

incarceration. He institute niggardly pressureors anterior the suicide were inmate-toinmate

conflict, fresh disciplinary influenceion, dismay, substantial complaint, and impertinent duration

events such as missing of cheerful era or dissension of origin/friendship interconnections in the

community. Finally, Chiou et al. 54 demonstrated that the most niggardly precipitating

characteristics unarranged infantine suicide undertakeers who were admitted to an sharp

psychiatric guard in Taiwan were discipline pressure, parent-cadet fight, and

psychopathology, including feelings of veiling, psychotic symptoms, substance

abuse, or trembling symptoms.

Stoppgeneration strategies

Results of this perpend patronsenility restrainegoing answers that self-immolation compromises a

obscure knead of intrapsychic, interpersonal, and environimmaterial waste certaintyors, including

impertinent duration events. Culturally easily-affected interventions should be familiar to target atrisk

beings and communities regulate self-immolation stoppage. These interventions

could clear quenched of friendship participatory elimination to compromise guide friendship

members and their inputs. It could standpoint on friendship quenchedattain influenceivities such as

media campaigns, or discipline-based interventions to attain infantine population.

Local friendship-exercise orders and nongovernment organizations are besides main

entities regulate self-immolation stoppgeneration influenceivities. Interventions aimed at improving

immaterial heartiness through cognitive-behavioral or intersingle therapy strategies enjoy

besides shown to diminish the semblance of suicide in other cultures 1 and are slight to be

helpful in neutralizeing suicide by self-immolation in Iran.

Limitations and Advenient Directions

This perpend offers distinct restrainces. Most mainly, it is unarranged the original studies to

portraiture a plight-regulate fixedion to perpend waste certaintyors associated with self-immolation.

Further, it was conducted in a part with self-immolation rebuke that are unarranged the

deep in the cosmos-people. Nonetheless, plight-regulate studies enjoy some inbred shynesss.

Specific pertains to the consequence of suitably matching subjects unmoulded the plight and regulate

groups. In this perpend the regulate order was clarified from the similar friendship and

matched by generation and gender to continuous-referral plights to gain accurebuke matching.

It is mysterious if other demographic certaintyors, such as pay, may enjoy multitudinous counter

the orders. Another shyness of the perpend concerns publicizability. The occurrence regulate

this perpend was recruited from specific part of Iran, and regulate-this-reason results cannot

necessarily be publicized to other magnitude of Iran or to other nations. We end this operation

to be a lead perpend from which prefer exploration is warranted.

In Iran and fur of the cosmos-people, suicide is stigmatized and condemned regulate divine or

cultural reasons. In some countries, suicidal proceeding is a sinful sin punishable

by adjudication.1 Regulate-this-reason, regulate manifold reasons, suicide repeatedly is a settled influence that is

deliberately mysterious and considered taboo. Identification of at-waste populations, which

this manuscript contributes to, accomplish agree precious referableice regulate targeted

matter and stoppgeneration programs. As discussed in the portico, advenient operation

should arise to propel toguard matter and stoppgeneration programs.13


The results of this perpend recommend financial affliction, deal-quenched of an close

relationship, and an single truth of suicide undertakes are waste certaintyors regulate selfimmolation.

Other mutables, including unplanned pregnancy, wilderness, financial

hardship, interconnection completions with friends, and/or cherished specifics/spouses, academic

problems and/or wants, operation kindred carefulness, single truth of suicide undertakes,

origin truth of suicide undertakes, diagnosed immaterial empiricisms, and baleful distemper,

did referable denote a role as singlely protective or waste certaintyors regulate self-immolation.

Intervention strategies to neutralize duration impertinent events and ground at-waste beings

abquenched completion-solving avenuees and coping skills should be familiar and



The authors would enjoy to cheer perfect fellow-creatures who participated in this perpend.

Ethical approval:

Perfect protocols were niggardly by the Kermanshah University of Medical Sciences,

Local Elimination Ethics Committee.


Financial patronsenility of this perpend was agreed by Kermanshah University of Medical


Competing concerns

Nspecific apparent.


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Table 1. Measures of impertinent duration events waste certaintyors

· unplanned pregnancy(yes vs. no)

· barrenness(yes vs. no)

· wilderness(yes vs. no)

· financial affliction(yes vs. no)

· completions with friends(yes vs. no)

· a interconnection deal-quenched (with attachment or associate) (yes vs. no)

· discipline or university want(yes vs. no)

· carefulness abquenched discipline/university exploit(yes vs. no)

· completions at operation(yes vs. no)

· obligatory espousals(yes vs. no)

· single truth of suicide undertakes(yes vs. no)

· sibling or parents truth of suicide undertakes(yes vs. no)

· single truth of immaterial empiricisms(yes vs. no)

· having inpower and baleful distemper(yes vs. no)

Table 2. Demographic basis of plight (n=30) and regulate (n=30) orders






Gender; N (%)


4 (13)

4 (13)

8 (13)





Marital narrate; N (%)


12 (40)











Mean of generation;(year)




Mean of TBSA*; (%)


* Total Body Surface Area

Table 3. Disagreeences  unmoulded self-immolation and mutables (cases n =30; regulates n=30)


p-value a

Odds Ratio

95% CI

Unplanned pregnancy




















Financial affliction





Problems with friends





A interconnection deal-quenched (with attachment or associate)





Discipline or university want





Carefulness abquenched discipline/university exploit





Problems at operation





Obligatory espousals





Single truth of suicide undertakes





Sibling or parents truth of suicide undertakes





Single truth of immaterial empiricisms





Having inpower and baleful distemper





a.  Fisher’s exinfluence ordeal is portraitured when N<5 

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