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The Estimation of Survival and Associated Factors in Self- Immolation Attempters in Ilam Province of Iran (2011-2015)

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The Estimation of Survival and Associated Factors in Self- Immolation Attempters in Ilam Province of Iran (2011-2015) Open Access Maced J Med Sci electronic publication ahead of print, published on November 15, 2018 as https://doi.org/10.3889/oamjms.2018.327 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2018.327 eISSN: 1857-9655 Clinical Science The Estimation of Survival and Associated Factors in Self- Immolation Attempters in Ilam Province of Iran (2011-2015) Jafar Bazyar1, Katayoun Jahangiri2, Hamid Safarpour2*, Meysam Safi Keykaleh2, Saeideh Varasteh3, Leila Malekyan4, Ehsan Mohammadi5 1Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Department of Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran; 4Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran; 5Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran Abstract Citation: Bazyar J, Jahangiri K, Safarpour H, Keykaleh BACKGROUND: Self-immolation is the most common method of suicide in Ilam province. MS, Varasteh S, Malekyan L, Mohammadi E. The Estimation of Survival and Associated Factors in Self- AIM: This study aimed to estimate the survival rate in self-immolation attempters in Ilam and identify the Immolation Attempters in Ilam Province of Iran (2011- 2015). Open Access Maced J Med Sci. associated factors. https://doi.org/10.3889/oamjms.2018.327 Keywords: Self-immolation; Suicide; Survival; Burn METHODS: A descriptive-analytic study was conducted based on data collected at Taleghani Hospital in Ilam, Surface Iran. All persons passed away due to self-immolation or those hospitalised in the centre of the self-burned *Correspondence: Hamid Safarpour. Department of patients located in Ilam during 2011 to 2015 were assessed. Survival rate was calculated based on Kaplan-Meier. Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical To compare the survival rate between groups, Univariate Log Rank and for multivariate analysis, the Cox test of Sciences, Tehran, Iran. E-mail: [email protected] STATA12 software was used. Received: 26-Aug-2018; Revised: 13-Oct-2018; Accepted: 16-Oct-2018; Online first: 15-Nov-2018 RESULTS: During 2011 to 2015, 236 persons including 168 females and 69 males committed self-immolation. Copyright: © 2018 Jafar Bazyar, Katayoun Jahangiri, The mean and median of survival time in attempters were 32.2 ± 4.7 and 3 ± 0.33 days, respectively. In Univariate Hamid Safarpour, Meysam Safi Keykaleh, Saeideh Log-Rank test, the following variables including age, sex, burn degree, Total Body Surface Area (TBSA), and Varasteh, Leila Malekyan, Ehsan Mohammadi. This is an open-access article distributed under the terms of the burns in neck and head and lower limbs had a significantly meaningful relation with survival, while in multivariate Creative Commons Attribution-NonCommercial 4.0 Cox Regression test only two variables including Total Body Surface Area and age remained in the model. International License (CC BY-NC 4.0) Funding: This research did not receive any financial CONCLUSION: The mean and median survival rate in self-attempters are very low. Quickly hospitalisation support without waste of time should be considered. Providing prompt treatments and compensating dehydration in early Competing Interests: The authors have declared that no hours especially within the first 24 hours of self-immolation are very vital. Younger persons and those with lower competing interests exist burn surface have more chance for longer survival and recuperation. Introduction and personal history of suicide attempts was risk factors for self-immolation [3]. Palacio et al., [4] in their study showed that those who reported adverse life- Suicide is a major and one of the most events in the last six months, and those who had a important public health problems with an incidence family history of suicide, had a higher risk of suicide. which varies worldwide [1]. Suicide is an act where a In another study, Zhang and colleagues [5] reported person consciously attempts to end his/her life. The that hopelessness, negative life events, and family increasing rate of suicides at the beginning of the third history of suicide were risk factors of attempted millennium is so alarming that the World Health suicide. Also Zhao et al. showed the work and study Organization and the International Association for problems, marriage frustration, family conflict and Suicide Prevention have designated the tenth day of fanaticism, somatic disease, and history of mental September as World Suicide Prevention Day [2]. disorders were all significantly associated with suicide Suicide is an indicator of a society mental health [1]. attempts [6]. Committing suicide has had an increasing rate in recent years which not only has Suicides have many socio-demographic and caused tension and concern among communities to psychopathological risk factors. Some studies showed rise but also has affected the whole world [7]. The the financial hardship, intimate relationship break-ups, _______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 1 Clinical Science _______________________________________________________________________________________________________________________________ methods of choice for suicide attempt vary across of the patients. The researcher introduced her and the countries and sometimes regions and have a study purpose, and then explained ethical significant cultural and ethnic influence [8]. The rate of considerations such as secrecy of data and suspected death due to suicide in Iran has been permission to leave the study at any time they want. reported 4.7 cases per hundred thousand people [9]. Oral consent was obtained for all participants. This One of the violent and dramatic ways of suicide is research was reviewed and approved by the Ethics self-immolation [10]. Self-immolation, the purposely Committee of Ilam University of Medical Sciences. act of self-inflicting burns, is among the most lethal The patient who had data of medical records of self- means of attempting suicide [11]. It is expected that immolation attempting in the hospital and forensic self- harm caused by self-immolation, is the most medicine were included to study. If the patient was not damaging method of self-destruction [12] [13]. In referred to the hospital and self-immolation is reported addition to the high probability of mortality, due to self- by relatives or other persons, his profile was recorded immolation, even if the victims survive, mutilation and in the judiciary and forensic medicine. Therefore, to cosmetic changes can lead to pain and discomfort of investigate all cases of self-immolation and to the person and family [14]. The high rate of mortality increase the accuracy, after removing duplicates, the (70-90%) and morbidity caused by self-immolation is data of medical records were used in forensic considerable in Middle East countries in which self- medicine. The patients who were readmitted to the immolation is a common method for suicide [15]. Self- hospital due to self-immolation side-effects such as a immolation in Iran is a common method of suicide scar or for plastic surgery were excluded. among young adults, who were mostly women, well- Three established and commonly used educated and mentally healthy [10]. In Iran, from 1.39 estimation methods for the burn surface area are Rule to 40 per cent of the suicides are due to self- of Palm, Rule of Nines, and Lund-Browder Chart [18]. immolation [16]. Evaluation of absolute and relative The estimation of patients’ burn surface area was frequencies of suicide cases based on sex and the extracted out of the charts available in their records method of suicide in Ilam province shows that in both which were calculated according to Lund and sexes, self-immolation with 71% has been the most Browder’s method [19]. All the self- immolators were common suicide method [16] [17]. The Khankeh et al., followed until death or recuperation. The ultimate fate the study showed that there were five main motives of people sent to burn centres outside the province for attempting self-immolation: cultural context, mental was also followed through those medical centres. The health problems, family conflicts, self-immolation as a rate of survival was calculated using the Kaplan threat, and distinct characteristics of the suicidal method. In the univariate analysis of survival of the method [11]. The main concern of the government is groups, Log-Rank test was used. In the multivariate to prevent self- harm through different kinds of analysis of survival, the factors which were suicide. The next phenomenon faced by the significantly less than 2.0 in the Log-Rank method government after prevention is treatment because were analysed within the Cox model using the when people commit suicide, saving their life is a “forward” method. Then the most important factors priority. Therefore this study aimed to estimate the associated with survival were identified. All analyses survival rates and the associated factors in self- were carried out by the help of STATA12 software by immolation attempters in
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