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Home , Suicidal ideation

ISSN: 2347-3215 Volume 2 Number 6 (June-2014) pp. 188-196 www.ijcrar.com

Self-immolation Oriented Behaviors in young Militaries A Review article

Fatemeh Mashayekhi1, Abdollah Soltaninejad2*, Ali Reza Nikmorad3, Hediye Sadat Mirsharafoddini4 and Mahrokh Bagheri Moghadam5 1Master of Enterpreneurship, Jiroft University of Medical Sciences, Jiroft, Iran 2Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran 3Tehran Delaram Psychiatric Center, Tehran, Iran 4Department of Economic, Firoozkooh Branch, Islamic Azad University, Firoozkooh, Iran 5Department of Laboratory Science, North Tehran Branch, Islamic Azad University, Tehran, Iran

*Corresponding author

KEYWORDS A B S T R A C T

Self-immolation, Self-immolation oriented behavior is one of the most important problems in mental Self-immolation health field. self-mutilation, suiside thinking, Self-immolation attempt and complete oriented Self-immolation are behaviors that investigated in as oriented behavior. behavior, Military and police are Self-immolation subject due to long term encounter to stress, self-mutilation, adaptation problems, access to weapons and distinct position. The aim of this review article is investigation of different aspect of Self-immolation oriented behavior in Police and police and military. This article is a review study that prepared with research in military library source using reliable scientific documents and article. Some parts of this soldiers article are results from author PhD thesis in Self-immolation oriented behavior. Self- immolation is not a sickness, but it is the sickness outcome and the consequence of cooperation between biological , psychological, social and organizational traumas. Self-immolation and its related behaviors have destructive effect on survivors, victim s family, comrades and commanders. Self-immolation is a preventable event and with a suitable council , it can be control. The aim of Self-immolation prevention program is to minimize Self-immolation oriented behavior as low as possible. Screening and identification of personnel with Self-immolation risk, attend to soldier mental health, stress management in unit and encouragement of help-seeking behaviors of soldiers are the more important strategies for prevention of Self- Introduction

Self-immolation oriented behavior is a mutilation that make competent a person world spread problem and there are for Self-immolation. Self-immolation evidence for its global enhancement(1). oriented behavior has wide range and Also there aren t indication for reduction includes any think and action that shows a of its related behaviors such as self- person is going to hurt himself. Self-

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immolation thinking, Self-immolation is other view about Self-immolation attempt and complete Self-immolation are oriented behavior definition. This vision some example of this behaviors. Self- divided SOBs into 2 categories the first one immolation thinking and previous Self- is death tendentious and other is life immolation attempt are two major factors tendentious SOBs. In is death tendentious in Self-immolation possibility. Self- SOBs that include Self-immolation attempt immolation oriented behavior has complex and complete Self-immolation, a person pathology and includes wide range of either died due to Self-immolation or his familiar, biological, psychological, social, /her predisposition for Self-immolation is cultural and spiritual factors. Military evaluated high(4). In life tendentious SOBs forces due to access to weapons, distinct the person is not going to Self-immolation situation, young age and high level of stress himself, but repetition of this actions are subject of Self-immolation risk. Self- directs person to the Self-immolation. self- immolation oriented behavior in any form mutilation and repetitive self-mutilation and level has destructive effect on people, are two sample of life tendencious SOBs. survivors and managers of mental health. There aren t any purpose for Self- Studies showed that family relative of immolation in self-mutilation. Also in Self-immolation military have repetitive self-mutilation that shows a symptoms, Self-immolation thinking and person is encountered to very stressful Posttraumatic Stress Disorder (2-3). situation, there e is not intend for Self- Among Self-immolation oriented behavior, immolation too, however repetition of this Self-immolation is a outstanding mental action prone to person for Self- hurt in militaries that led to great damage immolation.(5) Researchers that studied in for military forces .Identification of Self- SOB field are believed that SOBs are in immolation oriented behavior s reasons, opposite side of non SOBs. This action incidence and its preventer factors has are distinct from non non SOBs due to important role in design and existence of Self-immolation intent (6,7). implementation of precautionary programs. Epidemology of SOBs in Iran and world Self-immolation oriented behavior in psychological literature Self-immolation is an important problem in public health in world spread. About one Although in psychology and million people were died due to Self- psycomedicine Self-immolation oriented immolation in 2000. Self-immolation is one behavior debate is focused on Self- of the 10 leading cause of death in public immolation and self-mutilation, but population and is the second or third cause science, especially in recent of death in 15-34 years olds(8). The global decade, emphasizes on Self-immolation rate of Self-immolation is 16 in 100000, in oriented behavior as an actions that have previous decade it is estimated that disease common trauma and ultimately led to burden due to Self-immolation was 1.8%. similar outcome such as death. When we Recently disease burden due to Self- speak about Self-immolation oriented immolation is growing and this rate behavior, we noticed to wide range of possibly reaches to 2.4 in 2020. In past half actions which include actions and thinks century Self-immolation rate has grown that can be conclude that a person is going about 60% (9). Based on WHO estimation to harm or Self-immolation himself .there about 1530000 people will die in 2020 due

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to Self-immolation and 10 to 20 fold will immolation or self-mutilation because of have Self-immolation attempt(10). risk factors for Self-immolation (young age, access to weapons, stress, certain Review of SOBs in Iran has heterogeneous positions and aggressive people in military results due to cultural and economical and forces). Some experts believe that Self- social variation, and also different immolation in military forces should be methodology. The review of 19 sequential less than the general population due to Self-immolation in Iran By Ghoraishi et al screening and access to mental health showed that the age range of operators are services for soldiers (12), but there is 19-29 and the average of Self-immolation another viewpoint against this one and attempt is 39 and 61% in men and claims that high aggression and access to women(11)based on this study results the guns increase the risk of Self-immolation in rate of Self-immolation in Iran is 9.4 in military forces. It seems that some 100000 that is lower than global rate. The evidences support the second view (13). results of this study showed that the rate of Self-immolation is considered as the men Self-immolation incidence in second cause of death in America and one Hamedan, Ilam and Lorestan is higher than of the leading causes of death in Russian other regions. Also women Self- army. Self-immolation in the United States immolation in Ilam, Kermanshah and military is constantly rising. This statistics Lorestan is higher than other province. The has approximately increased from 9.6 per common method for Self-immolation in hundred thousand people in 2004 to 21.9 Iranian is hanging and self-burning in Men per hundred thousand people in 2009 and and women respectively. This study declare has approximately reached 22.9 per wide spectrum of variables as Self- hundred thousand people between 2009 and immolation risk factor including low 2010. Mental health status, problems income, low teaching, no logical believed, related to substance abuse, problems mental disorders especially behavior associated with physical health such as disorder, addiction, history of previous cancer or chronic pain and problems related Self-immolation, married situation and to financial, legal and communication gender. Although there are not clinical issues have been identified as risk factors evaluation in 70% of SOBs studies, but for Self-immolation among urban there is a significant relation between populations and military personnel (14). and Self-immolation Studies have shown that over the past attempt so that 45% of Self-immolation decade, the rate of Self-immolation among attempts have mental disorder(11). United States military has increased by 71% and reached from 9.1 per hundred of SOBs in militaries thousand people in 2001 to 15.6 per hundred thousand people in 2010 (15). Self-immolation in military personnel is an Studies by mental anatomical methods to important mental health issue due to the identify risk factors in Yugoslav Army access to weapons and familiarity with its during 1998-2007 have shown that being use, high stress and positions distinct from single, heritable psychiatric disorders, others. Although military forces have a ineffectiveness of psychiatric treatments, proper mental health and physical fitness heavy physical exercise, not giving transfer and are mentally assessed during the to the other posts, low motivation to serve service period, they are at the risk of Self- in the military profession, incompletion

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military education and the indebtedness of of Sepah Ground Forces have shown that households are regarded as the risk factor the most important risk factors for soldiers' for Self-immolation (16). In a field study Self-immolation include previous Self- among American navies and marine forces immolation attempt, depression, addiction, it was found that the ratio of Self- conflicts with work environment, family immolation leading to death to failed Self- problems, aberrant humiliation and immolation attempt is one-seventh among punishment, service in line units, the navies and one-fifth among marine forces presence of personality traits such as (17-18). introversion, neurosis and psychotic disorder (20). The results of Soltaninezhad The rate of Self-immolation attempts for and colleagues on 1659 soldiers in one of women was two to three times more than the Armed Forces in country's six men. In 95 % of psychological disorder provinces in 2012 have shown that the cases, it was diagnosed that the main incidence rate of Self-immolation oriented diagnoses were (53%), behaviors including suicidal thoughts and followed by substance abuse (36 %). Study the history of Self-immolation attempts is in United States Army Air Force during 15.9% in this population (4). Studies of 1990-1994 has shown that twenty-three Roohani and colleagues on 321 employees percent of all deaths among Air Force in NEZAJA garrison in Tehran have shown active personnel have been Self- that 15.3 % of studied sample had suicidal immolation. The results of a study on the thoughts and approximately 1.9 % of them Polish armed forces in the period 1989- had a history of Self-immolation attempts. 1998 have shown that the number of Based on the results of this review, 5.9 % completed Self-immolations has been 437 of participants have reported a history of cases in these ten years that among these, psychiatric disease. This review has shown 163 cases have occurred in officers and 273 that the prevalence of suicidal thoughts has cases in soldiers (19). been 19.8 % in draftees and 84.2% in soldiers with psychiatric disorder (21). The There is no exact number of Self- study of Matinsadr and colleagues on 327 immolations in Iranian armed forces, but soldiers has shown that 15.1 % of studied unofficial statistics indicate the incidence sample have suicidal thoughts and 8.4% of 9 per hundred thousand people. Studies have the history of one to seven Self- of Anisi and colleagues on the prevalence immolation attempts (22). The study of of suicidal thoughts in ground force Soltaninezhad and colleagues on 1659 soldiers have shown that the incidence of soldiers of one of the Armed Forces in suicidal thoughts among soldiers is 5.8 country's 6 provinces has shown that the percent (4). The results of this study have prevalence of suicidal thoughts in the shown that higher prevalence of Self- sample is 10.9 % and the prevalence of immolation thoughts is related to being Self-immolation attempts 5.7% and total single, drug abuse, and previous history of incidence rates of Self-immolation-oriented Self-immolation, Self-immolation in behaviors in this group is 15.9% (23). family, primary and guidance education, lack of mental health, serving in border Risk factors for Self-immolation areas and serving in service and security jobs (4). The results of Noori about the risk Numerous studies around the world have factors for Self-immolation in the soldiers identified several risk factors for Self-

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immolation-oriented behaviors. Although factors are stable and non-adjustable risk in these studies, that each one has been factors, adjustable and predisposing risk done with specific objectives, have been factors, auxiliary risk factors, acute risk used different methods, there is a high factors and starter risk factors (28). agreement on identifying risk factors for Self-immolation-oriented behaviors (24, Stable and non-adjustable risk factors of 25, and 26). Self-immolation According to the International Health, -Demographic factors including being Hemmati and colleagues have categorized white, male gender, ageing, divorce, and presented specific risk factors separation, early widowhood associated with a high risk of Self- -Previous suicidal thoughts, history of immolation in three categories. repeated Self-immolation attempts, history of self-mutilation, history of Self- These factors are: immolation in family 1. Demographic factors: male gender, age -History of injury or physical or sexual between 25-44 years old, living in the abuse, history of psychiatric countryside, being members of minority hospitalization, history of repeated groups, refugees, homeless people and relocation, history of violent behaviors and sexual identity conflict history of impulsive behaviors. 2. Groups at risk of Self-immolation: history of previous Self-immolation Adjustable and Predisposing Risk Factors attempts, previous self-mutilation, history -Psychiatric disorders axis 1, especially of mental illness, especially depression, disorders, , drug or schizophrenia and other psychotic alcohol abuse, eating disorders, body disorders, personality disorders, history of dysmorphic disorders, , drug or alcohol abuse, or -Disorders axis 2 including personality both, diseases or severe physical disorders, especially personality disorders disabilities, imprisonment or detention cluster B 3. Recent risk factors: having psychological -Disorders axis 3, especially medical characteristics such as helplessness, disorders, especially if causes malfunction hopelessness, , shame, feelings of or be associated with chronic pain, minor guilt, shyness, psychotic thoughts, brain injuries interpersonal conflicts, being excluded -Being accompanied of disorders axis 1, 2, from a particular person, the recent loss of and 3. someone or something, feeling bad luck or misfortune and recent , Auxiliary Risk Factors alcohol consumption, chronic and painful disease, financial difficulties, being fired -Easy access to weapons, unemployment, and recent unemployment, to commit a stress in the field of occupation, marriage, crime, disintegration of the family , custody school, interpersonal relationships of a family member, lack of networks, reluctance to seek help and lack Acute Risk Factors of access to mental health services. -Recent divorce or separation, especially if Self-immolation Society of America has it is accompanied with the feel of and identified and introduces five categories of being victim. risk factors for Self-immolation. The

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-Suicidal thoughts, Self-immolation plan, strengthening skills to deal with mental threat to Self-immolation or being ready for health problems, especially skills in seeking Self-immolation help from others in dealing with mental -Recent self-mutilation, recent Self- health problems and also religious coping immolation attempt skills (29-35). Self-immolation prevention -Indulgence in substance abuse programs in military personnel are also -Psychological pain (sever distress affected by national strategies for Self- following exclusion, loss or failure) immolation prevention in countries. Self- -Anger, wrath, aggressive behavior, immolation prevention programs in the seeking for revenge United States Air Force are mental health -Lack of enjoyment, anxiety, restlessness, awareness and to encourage help-seeking pain, insomnia, frequent or persistent behaviors, to attract the participation of , commanders and staff in the field of Self- -Imperative illusions with the subject of immolation prevention, to train mental insistence on Self-immolation health professionals, to establish Self- -Severe emotional moods such as immolation-oriented behaviors research depression, self-blame, unbearable center, to launch intervention teams in loneliness, excessive mood changes traumatic crisis and Self-immolation and to Starter and Detector Risk Factors, identify Self-immolation risk factors. The conditional on personal vulnerability to results of evaluating the Self-immolation Self-immolation prevention programs have shown that about -Any event that causes shame, frustration a third of those whom the program is and feelings of guilt a applied, have shown decrease in domestic -To stand accused, conflict with the law, , homicide and Self-immolation custody, business failures, being excluded risk factors (36). Self-immolation from an important person prevention program in the United States -To witness the death of a friend or relative Army is based n four overall strategies. The who had died of Self-immolation or watch first strategy for Self-immolation the same events in media prevention is based on identifying those at risk for Self-immolation. Screening soldiers Self-immolation Prevention to identify those who are at risk of Self- immolation is the first step in implementing Self-immolation and its related behaviors Self-immolation prevention programs. The can be prevented. The aim in Self- second strategy is to attract the immolation prevention is to minimize the participation of commanders and managers, Self-immolation oriented behaviors. There especially commanders and leaders who are are several main strategies in Self- at the first line of communication with immolation prevention that play a pivotal soldiers. According to this strategy, role in Self-immolation prevention plans. commanders and managers should be well These strategies include: promoting mental trained about the risk factors and protective health level and prevention of mental health factors of Self-immolation and be able to problems, treatment of patients with mental identify those at risk and refer them. disorders, especially those with mental Mental health administrators should disorders related to Self-immolation consider identifying Self-immolation oriented behaviors, restriction of access to starters and symptoms of people involved weapons and lethal tools and also in crisis as an important issue in training

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commanders and managers. The third IMMOLATION RATES. Psychiatria strategy is to promote and disseminate the Danubina. 2012 ; 24(1) : 82 85. culture of asking for help. All commanders 3.Jong-Min Woo, Olaoluwa Okusaga and should encourage soldiers and their Teodor T. Postolache. Seasonality of subordinates to seek help without of its Suicidal Behavior. Int J Environ Res consequences. Feeling guilt, shame, Public Health 2012 ; 9 (3) : 531-547. embarrassment and fear of disciplinary or 4.Anisi et al . Prevalence and factors retaliation actions are serious obstacles for associated with suicidal ideation soldiers on the way to seek help. The fourth among soldiers. Journal of Military strategy is to increase the mental strength Medicine , 2008 ; 8 (2) , 113-118. and resilience through coping skills 5.Edward A. Selby, Michael D. Anestis, training. Theodore W. Bender, Jessica D. Ribeiro, Matthew K. Overcoming the Discussion and Conclusion fear of lethal injury: Evaluating suicidal behavior in the military Self-immolation-oriented behaviors are through the lens of the Interpersonal affected by individual, family and social, Psychological Theory of Self- physiological, psychological, cultural, immolation. Clinical Psychology economic and spiritual factors (30, 34 and Review. 2010 ; 30(7) : 298 307. 390. In addition to the risk factors known in 6.Mary Jane Alexander,Gary Haugland, the etiology of Self-immolation in the Peter Ashenden, Ed Knight. Coping general population, soldiers youth, poor With Thoughts of Self- coping skills, economic and family immolation:Techniques Used by problems, characteristics of the military Consumersof Mental Health Services. environment, aggression and access to Ps psychiatryonline org. 2009 ; 60(9) : guns, the discount rate for officers, mental 121-125. disorders, dissatisfaction with the military, 7.Joseph Logan. Nancy A. Skopp,. Debra poor quality relationship with commander Karch, , Mark A. Reger, and Gregory are among the factors playing a role in A. Gahm, Characteristics of Self- suicidal behaviors in the military forces immolations Among US Army Active (28, 38 and 41). Self-immolation is Duty Personnel in 17 US States From preventive, provided that Self-immolation 2005 to 2007. American Journal of prevention plans to be based upon the Public Health . 2012 ; 102(1) : 56-60. pathology of trauma and developed by 8.Yanhong Gong, Ling Zhang, , Zhiqing taking into account the cultural and social Wang, Yuan Liang. Pathway Analysis factors and unit's capabilities and following of Risk Factors for Severe Suicidal the multi-dimensional approach. Ideation;A Survey in Rural China. J Public Health 2011;102(6):472-75. References 9.World Health Organization,(2008). Available from www.WHO.com 1.Columba Mclaughlin (2007). Self- 10.Jose Manoel Bertoolote,and Alexander immolation Related Behavior. John Fleischmann. A global Perspective in Wily& Sons, Ltd. the epidemidemiology of Self- 2. Helena Korosec Jagodic, Mark Agius & immolation. Suicidologi 2002 arg Peter Pregelj.INTER REGIONAL ,7.nr.2. VARIATIONS IN SELF-

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