Suicide by self-inflicted burns

doi:10.1016/0305-4179(95)00172-7

Burns

Volume 22, Issue 5, August 1996, Pages 381-383

https://doi.org/10.1016/0305-4179(95)00172-7 Get rights and content

Abstract

Eighty-nine patients who had made an attempt on their life by self-burning were reviewed. For 12 years (1983–94) these patients were treated at the Institute of Emergency Medicine ‘Pirogov’, Sofia (Bulgaria). The gender distribution was almost equal (48 males: 41 females); the most vulnerable age was 20–40 years (57 patients) (64.05 per cent). Flame was the preferred thermal agent of attempted suicide (chosen by 72 patients), followed by electricity (11 patients). Thirty-one of the injured persons died (34.8 per cent). Forty-six of those who survived were operated on (116 surgical interventions: an average of 2.52 operations per patient) the mean length of treatment was 56.3 days. Eleven of the operated patients died subsequently (average stay in the hospital 8.20 days). There were some difficulties in collecting data about this method of self-harming. Twenty-three of the patients had recognized psychic disorders, in 43 of the patients the accident was preceeded by an agitated depression; in 15 by severe alcoholism. Emphasis is placed on the role of joint teams of physicians, psychologists and sociologists, for the treatment of these difficult patients.

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Post-mortem computed tomography (CT) can provide useful insights into coronial and forensic pathological investigation of the fire-damage victim. Understanding the pathological changes that can occur in fatalities caused by fire, particularly in relation to fire damage to the body, is paramount in attempting to distinguish ante-mortem and peri-mortem blunt traumatic injuries from fire-related damage to the body. Understanding the fire-damage features on post-mortem CT may also assist in determining cause of the fire and associated fire-damage. Although the requirements of radiological evaluation in post-mortem imaging are very different to those of day-to-day clinical ante-mortem imaging, foremost is a high-resolution CT protocol of the entire body in order to fulfil the requirements and expectations of such imaging and radiological interpretation.
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Suicide attempted by self-inflicted burns are associated with lower survival rates compared to accident related burns.
We investigate the relation between self-inflicted burns (SIB) and survival rates and how this relation is moderated by variables used to predict survival rates in the ABSI score, a widely used measure. Additionally, we compare the predicted survival rates by the ABSI score to the actual rates in our sample for SIB and accident patients.
In this prospective multicenter study data from the German Burn Registry are statistically analyzed using two sided t-test and multivariate linear regression models.
5330 patients (214 with SIB) met our inclusion criteria. We find a 6.8 percentage points lower survival rate for patients with SIB when we control for patient condition with the five ABSI components as covariates. These higher mortality rates can be explained by the higher rate of therapy restrictions for patients with self-inflicted burns. Additionally, different ABSI modifications can improve the predictive power of the score.
Patients with SIB have lower survival rates compared to accident patients. Recently proposed modifications of the ABSI score can improve the accuracy of survival rate prediction for SIB.
The role of self-immolation in complex suicides: A neglected topic in current literature
2020, Forensic Science International
Citation Excerpt :
The data are summarized in Table 4. Victims of self-immolation are often affected by psychiatric disorders [18–21,24–26,41,44,48,50,51,55,56], especially depression and schizophrenia [22,57,58]. Deliberate self-harm syndrome (DSHS) often involves self-burning even if it usually results in less damage [54].
Suicides involving more than one suicide method are termed “complex suicides” and need to be differentiated from murders. Self-immolation is the action of setting fire to oneself and is an infrequent method of suicide method in Western countries. However, burned corpses must be carefully examined because setting fire to a body after death can be a way of covering up a crime. Complex suicides involving self-immolation are rare, but careful analysis is necessary if we are to identify the manner of death. A systematic search of the literature concerning self-incineration in cases of complex suicides was carried out. This covered the age, gender and psychiatric condition of the victims, any history of previous suicide attempts, the existence of suicide notes, evidence of fire accelerants, signs of vital exposure to the fire, toxicology, the other suicide methods used in combination with burning and the characteristics of the burns. 46 cases were found in 22 papers published since 1985, but few of these studies provide any detailed analysis and in several cases many important data were missing. There is, therefore, a need to study this topic and to use an approach based on careful examination of the corpse, detailed investigation of the scene, toxicological examination and an evaluation of the victim’s physical and psychiatric state.
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2017, Psychosomatics
Intentional self-inflicted burn injuries are a rare occurrence in the United States, but they represent a considerable portion of all burn injuries in the developing world. Compared to nonintentional burns, patients with intentional self-inflicted burns have increased rates of higher total body surface area involvement and associated complications, including overall mortality.
We present 2 representative cases and review the available literature on the topic of self-inflicted burns. We review epidemiologic, social, and cultural factors of importance, and also provide an overview of most common psychiatric pathologies encountered in patients with self-inflicted burns.
The patient demographics and motivation for intentional self-inflicted burn injuries differ considerably across the world. Although self-immolation is commonly associated with women experiencing domestic stress in the developing world, most cases of self-immolation in higher-income countries are males. Psychiatric pathologies, including primary mood and thought disorders and substance use, play a significant component in latter cases, while most patients in the developing world lack any premorbid psychiatric diagnosis, or carry diagnosis of adjustment disorder.
Nonlethal self-burns present a distinct subset of intentional self-burn injuries, often occurring in the context of significant personality pathology, or with potential secondary gain.
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There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies.
We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given.
A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005–2014 inclusive) was conducted. Patients were identified through IBID database coded as either ‘self-inflicted’ or ‘suicidal.’ We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival.
We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1–130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n = 19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically.
Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend.
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2014, Forensic Science International
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Scientific and clinical paperSuicide by self-inflicted burns

Abstract

Burns

Burns

Burns

Burns

Burns

Emergency medicine and the psychiatrist: reflections about suicide substance abuse and social marginalization

An epidemic of suicide attempts by burning in a psychiatric hospital

Br J Psychiatr

Suicide by burning

Am J Psychiatr

Burns as a result of violence and self-inflicted injury

Ann Medit Burns Club

Scientific and clinical paper
Suicide by self-inflicted burns