SUICIDE ATTEMPTED BY BURNING: A THREE-YEAR STUDY

Haddad S.Y., Haddadin K.J., Abu-Samen M., Wreikat M.W., Haddad A.I.

Department of Plastic and Reconstructive Surgery, Farah Royal Jordanian Rehabilitation Center, King Hussein Medical Center, Jordan

SUMMARY. This is a prospective study of 20 patients with documented self-inflicted burns out of a total of 564 admissions treated at the Burn Unit of Farah Royal Jordanian Rehabilitation Center, King Hussein Medical Center, Jordan over a three-year period from 1 January 1993 to 31 December 1995. The commonest method used by these suicidal patients was to pour kerosene over themselves and to set light to it (18 patients out of 20). A high proportion of females (16/20) was found in this series. Eight patients had previous psychiatric illness and five, all females, were involved in recent family or marital feuds. The average total body surface area burned was 48% and the overall mortality rate 70%.

Introduction

Burning is considered to one of the most violent methods of suicide in the westem world, although it is uncommon. In a British study it was demonstrated that burning with the intent of suicide by Asian women residing in Britain was carried out mainly owing to cultural differences and interpersonal disputes, especially in relation to marriage.'Similar studies elsewhere have shown that the highest incidence of attempted suicide by burning was among Asian and African women.` Our study was conducted in order to investigate the magnitude of the problem in our country (Jordan), to find out which individuals are most prone to this method of suicide, and to investigate the outcome of self-inflicted burns.

Materials and methods

This is a prospective study of self-inflicted burns treated at the burn Unit of Farah Royal Jordanian Rehabilitation Center, King Hussein Medical Center, Jordan, over a threeyear period from I January 1993 to 31 December 1995. This forms part of a continuing audit of all burn admissions to our unit. Out of a total number of 564 admissions over the period, twenty patients (3.5%) were positively identified as having attempted suicide by burning. These patients were analysed with respect to age, sex, method used, place of burn, psychiatric history, family relations, total body surface area (TBSA) burned, and outcome.

Results

The commonest method used by suicidal patients in this series was to pour kerosene over themselves and to set light to it (18/20 patients = 90%). Two patients used domestic gas to cause an explosion. Eighteen (= 90%) of the suicide attempts occurred at home. A high proportion of females (16/20 = 80%) was found in this series. The mean age for both males and females was 28 yr. The commonest age group involved was that of young adults, with 12 patients (60%) between the ages of 15 and 24 yr (Table 1).

Suicidal burns tend to be major injuries with a high TBSA, as previously reported. The TBSA burned in the suicidal burns in this series varied from 20 to 95% (average, 48%). Most patients suffered deep second- and third-degree burns. Head burns (12/20 = 60%) were common in this group, as in other groups. Four patients also presented inhalation injuries and had to be ventilated on admission.
The mortality rate for these suicidal burns was 14/20 (70%), compared with 72/544 (13%) for non-suicidal burns treated over the same period at our institution; for patients with less than 60% TBSA the mortality rate was 7/13 (54%) for suicidal burns, compared with 48/520 (9%) for non-suicidal burns treated over the same period. These findings are similar to others in the literature.
The past medical history of all the patients was reviewed. Eight patients (40%) were found to have a previous psychiatric history; of these, five patients had documented endogenous depression and three patients were known to have schizophrenia. All the patients were receiving anti psychotic treatment at tit c I iin c oft I icir at I erupted suicide. Five patients (25%), all fernalcs, were involved in recent family or marital feuds and one patient was suffering from post-partum depression. The reiriaining six patients were riot known to have air prior psychiatric illness, altliou"h y a social problem could not be excluded (Table II). this series 14 patients (701/,~) (fie(] ill hospital after an average hospital stay of 12 days. The six survivors had an avera-e stay of 35 days. The font- pai icrits with associated inhalation in.juries all died.

Discussion

A previous psychiatric history aniong attempted suicidal burns was found to be common, as previously reported. Our series showed a 40% prevalence ofprevious psychiatric illness among persons atteruptino suicide. Closer evaluation and assessment for psychiatric patients is advised, particularly ill view of' the fact that all our psychiatric patients were being treated at the tinic of their burn.
The study also shows that attempted suicide hy burnino is still frequent in out- society.adult females, because of the dramatic nature of file. incident. A disturbing finding is that some women with social problems may resort to self-inuitolation as a inethod of expressing their anger and dissatisfaction at their current social state. These women do not realize that this nielliod of buriling is a sure way to conninit suicide because of- tile high TBSA burned and the increased depth of' burns resulting from pouring kerosene over dicinselves and setting light to it. The high mortality rate for suicidal burn patients compared with non-suicidal patients, especiili)l, those with less than 60% TBSA burned, may, also be attributed to the overall state of mine] of tlicse palicilts, coupled with an unwillingness to survive.
Increased public awareness of the very Serious nalUre of such maJor burns may help to dissuall, Some. persolls front attempting suicide by burnim, as a nictliod of parasuicidal behaviour to express a strong point of view.

Conclusions

Burning by kerosene is a comnion, tradifional and dramatic way of attempting suicide in Jordan. The highest suicide rate was found among young women. Suicidal burns were found to have a high TBSA and a high mortality rate compared with other burns of similar magnitude. Increase(] public awareness that parasuicidal behaviour by burnino has serious consequences and is riot Just a cry lot- lielp may reduce the incidence of' such cases.

RESUME. Les Auteurs oui effectué une étude prospective de 20 patients atteints de brûlures volontaires sur le numéro total (le 564 patients hospitalisés dans l'Unité (les Brülures du Centre Royal Jordanien de Réhabilitation Farali-Centre Médical Roi Hussein, Jordanie, pendant la période triennale 1° janvier 1993-31 décembre 1995. La méthode la plus commune utilisée par les patients qui avaient l'intension de se suuicider était de verser sur soi du pétrole et d'y mettre le l'eu (18 patients sur 20). Une haute proportion des patients dans cette série était du sexe féminin (16 sur 20). Huit patients avaient une histoire de maladies psychiatriqucs, et cinq patients (tous du sexe féminin) étaient impliqués dans des querelles de famille ou avec leurs maris. La surface corporelle totale brûlée était 48% et la inorialité complessive était 70%.

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