SUICIDE ATTEMPTED BY BURNING

Haberal M., Oner 1, GOlay K, Bayraktar U., Bilgin N.

Hacettepe University Hospital Burn Center-Turkish Transplantation and Burn Foundation Hospital, Ankara, Turkey.

SUMMARY. Sixteen patients who had attempted suicide by burning were admitted to Hacettepe Univerity Hospital Burn Center over the 9 years' period. Five of these patients were psychiatric and two of them had previously attempted to commit suicide. The mean age was 32 years and th4 overall mortality rate was 50%. This study shows that suicide by self-burning is giving a serious problem with high mortality rate. Therefore, prevention and education are involved in this matter.

Suicides are increasing steadily, mainly due to psycho-social problems. Of all forms of self-harm, burning by fire is perhaps the most dramatic, rare and potentially fatal, and it needs to be distinguished in its clinical and psycho-social aspects from other forms of self-harm. To outline the features and outcome in this group of patients, a 9 years' retrospective study was carried out on the patients admitted to our Bum Centre, following suicide attempts by burning.

The records of all patients admitted to the Unit with self-burning as a method of attempting suicide over the period 1979-1988 inclusive were reviewed and within, the framework of this study, the following data were obtained: age, sex, the method of burn injury, past history of psychiatric illness.
Previous attempted suicide, the size of bum and death in hospital were recorded.
From~ January 1, 1979 to January 1, 1988, 811 patients were admitted to our Bum Centre. Sixteen (1.97 %) of them had attempted suicide. Of these, ten were males, and six were females, with mean age 32 years (18 to 58 years). The cause of burn was flame in 15 patients (93.75 %) and boiling water in one patient (6.25%).
Analysis of the 15 flame burns was as follows: eight patients used petrol, three patients used liquid gas, one used alcohol, one used cigarettes, and two used matches (Table 1).
The body surface area burnt ranged from 15 per cent to 96 per cent with a mean area of 54.50 per cent.
Previous psychiatric illness was found in five of the patients (31.25%) and two of these had previously attempted suicide. Two patients attempted to commit suicide due to reaction to their husbands. Another man who is a refugee attempted to bum himself in order to contest the United Nations. In eight patients, we cannot find any specific reason for their attempt to commit suicide (Table II).
The information was obtained directly from the patients in four cases and from relatives in the other four.

Table I Table II

16 burn patients were admitted to our Burn Units as a result of self-inflicted burns in a 9 years' period of time; they represented 1.97% of the total number of 811 admissions to our burn units. Most of them were males (10); 31.25% were previously psychiatric.
Following the hospitalization, all the patients were treated with routine protocol (1) but, unfortunately, 50% died in spite of our close monitoring and follow-up.

Suicide attempted by self-burning is uncommon and perhaps the most dramatic form of self-harm. Self-burning has been reported rarely (1%) both in the UK (2) and in the USA (3). However, it is relatively common (77 per cent) as a method of suicide in Israel (4).
In our series, it occurred as 1.97% of admissions at our Centre over a 9-year-period and we found a male preponderance (10 cases).
Ashton, Dorman et al. (5), in their series, found a history of psychiatric or personality disorder in all but one of 36 patients. In our series, previous psychiatric illness was found in five out of 16 patients (31.25%) and two of these had previously attempted suicide. One suicide was attempted by burning which occurred in a protest against the United Nations.
In a study (6), the mortality rates were analysed and found to be 48%. In our study, the overall mortality rate was 50%. We also had anticipated a high mortality, due to longer delay before receiving first aid, associated injury, greater surface and depth of burn, or adverse psychological factors.
This serious problem must be regarded as a preventable tragedy and all attempts must be directed to prevention, by recognition of at-risk patients with psychiatric illness or a history of attempted suicide. Provision of psychiatric social support for at-risk patients may be very important to prevent this tragic event.

RÉSUMÉ. Pendant une période de 9 ans, 16 patients qui avaient tenté de se suicider ont été hospitalisés dans le Centre des Brûlés de l'Hôpital Universitaire Hacettepe. Cinq de ces patients étaient des cas psychiatriques et deux d'entre eux avaient déjà attenté à leurs jours. L'âge moyen était de 32 ans et le taux complessif de mortalité était 50 pour cent. Cette étude indique que le suicide par brûlure est un grave problème avec un taux de mortalité élevé. Il faut donc à l'égard un travail de prévention et d'éducation.

BIBLIOGRAPHY

1. Haberal M., Oner Z., Bayraktar N., Bilgin N.: Epidemiology of adults' and children's bums in a Turkish Burn Center. Bums, 13: 136-140, 1987.
2. Ashton J.R., Dorman S.: Suicide by burning as an epidemic phenomenon: an analysis of 82 deaths and inquests in England and Wales in 1978-9. Psychol. Med., 11: 735, 1981.
3. Andreasen N.C., Noyes R.: Suicide attempted by self-immolation. Am. J. Psychiatry, 132: 554, 1975.
4. Modan B., Nissenkom I., Lewkowski S.R.: Comparative epidemiological aspects of suicide and attempted suicide in Israel. Am. J. Epidemiology, 91: 383, 1970.
5. Ashton J.R., Dorman S.: Suicide by burning: a current epidemic. Br. Med. J.: 2: 769, 1979.
6. Davidson T.I., Brown L.C.: Self-inflicted bums: a 5 year retrospective study. Bums, 11: 157-160, 1985.