Increased self-immolation frequency and severity during the COVID-19 pandemic

Abstract

Objective To determine whether the increased restrictions, isolation and stressors associated with COVID-19 led to an increase in rates or severity of self-immolation burn injuries. Design Retrospective review of a prospectively-collected database of New South Wales burn patients, comparing 2020 data with the preceding 5 years. Setting Both adult units in the New South Wales Statewide Burn Injury Service (Concord Repatriation General Hospital and Royal North Shore Hospital). Participants All adult patients in New South Wales with self-inflicted burn injuries between 1st January 2015 and 31st December 2020. Outcome measures Demographic information, precipitating factors, burn severity, morbidity and mortality outcomes. Results There were 18 episodes of self-immolation in 2020, compared to an average of 10 per year previously. There were statistically significant increases in burn size (43% total body surface area vs 28%) and revised Baux score (92 vs 77). Most patients had a pre-existing psychiatric illness. Family conflict and acute psychiatric illness were the most common precipitating factors. Conclusion 2020 saw an increase in both the frequency and severity of self-inflicted burn injuries in New South Wales, with psychiatric illness a major factor.

Trend of suicide by self-immolation in a 13-year timeline: was the COVID-19 pandemic a potentially important stressor?

“…While COVID-19 pandemic was proven as a significant cause of psychological distress in the general population, consequences of isolation, anxiety, fear of illness and death, lack of sustenance, lack of access to health care and many other factors that accompanied the COVID-19 pandemic played a rather unfavorable role in exacerbating the existing mental illnesses, subsequently leading to the increase of suicide attempts among psychiatric patients by self-immolation ( 9 – 11 , 22 , 23 , 32 – 34 ). Furthermore, these results are consistent with recent findings that reported increased frequency of pre-existing psychiatric illness among admitted patients during the pandemic period due to self-immolation ( 14 , 15 ). Most importantly, survivors of self-inflicted burn injuries face an increased risk of recurrent suicide attempts, due to the side effects of burns such as disfigurement and disability ( 35 ).…”

“…The authors reported 18 cases of self-immolation in 2020, compared to an average of 10 cases per year. Similar to our study, an increased presence of psychiatric disorders was found as a major contributing factor ( 14 ). In our study frequency of patients with a psychiatric diagnosis compared to those without a psychiatric diagnosis was higher during than before the COVID-19 pandemic (66.7 vs. 41.7%, respectively).…”

“…Recent studies have indicated that a lack of physical activity and a higher carbohydrate diet during isolation have led to poorer sleep patterns, indirectly affecting mental health ( 13 ). Finally, the association between the COVID-19 pandemic and frequency of suicidal thoughts, as well as the rise of suicide rates is being examined extensively, but only few have analyzed the incidence of self-immolation during the COVID-19 pandemic ( 14 , 15 ).…”

“…Self-immolation is an uncommon way of attempting and committing a suicide. The demographic characteristics and risk factors in self-immolation victims vary depending on socioeconomic factors, cultural factors as well as religious beliefs (14)(15)(16)(17)(18). Comprising from 0.4 to 40% of total burn center admissions worldwide, it is accompanied by high mortality of up to 80%, prolonged hospitalizations, frequent complications, as well as serious physical and psychological consequences in surviving patients (14,15,17,18).…”

Challenges and reactions of families of women survived self-immolation: A qualitative study in western Iran.

“…Self-immolation is common in Africa, India, the Middle East, and Iran (El Hayek et al, 2022; Mohammadi et al, 2020). Women in developing countries are more likely to choose this method of suicide, which accounts for between 40% and 70% of suicide attempts (Jackson et al, 2022; Smith et al, 2022; Yazdi-Ravandi et al, 2023).…”