Prevention of self-immolation by community-based intervention.
OBJECTIVE
To describe the effectiveness of a community-based program targeting prevention of self-immolation. Suicide by burning is rare in developed countries (0.1-1.8% of all suicides), but more frequent in developing countries (up to 41% of all suicides). Self-immolation constitutes from 0.4% to 40% of admissions to burn centers worldwide. During 2001, an average of 11 Iranians committed suicide daily, 4 of these being self-immolations (36%). Self-immolation caused from 4% to 28% of all admissions to Iranian burn centers. Approximately 80% of hospitalized self-immolation patients die. All descriptive self-immolation studies in Iran emphasize the need for implementing prevention programs.


METHODS
Quasi-experimental.


METHODS
The Iranian cities Gilangharb (intervention) and Sarpolzahab (reference).


METHODS
The populations of these communities.


METHODS
Hospital data collection on self-immolation patients and suicide attempts (all mechanisms) was made from 21 March 1999 to 20 March 2003. The first 12 months of the study provided baseline data, while the last 3 years comprised of a community-based intervention, using a mix of passive and active interventions. Videos showing victim stories were an important component in the prevention program. The interventions were particularly aimed at young women and socio-economically deprived groups, these being shown to be at high risk in earlier studies.


RESULTS
Compared to baseline, the mean self-immolation attempts rate decreased by 57% after the implementation of the intervention in Gilangharb (p=0.04, Yates corrected p=0.07). Correspondingly, the reference city rate decreased 27% (n.s.). Moreover, in Gilangharb a 19% decrease of suicide attempts (all mechanisms) was observed while the corresponding reference city rate increased by 24% (n.s.). While the suicide attempt rates were similar in the two populations during baseline, the mean rates observed during the intervention period differed significantly (p<0.0001).


CONCLUSIONS
A community prevention program targeting self-immolation can be effective. Local data and the showing of videos depicting victim stories from self-immolation attempts provided a stimulus for community action.
Ahmadi
Alireza
A
Research Affaires, Kermanshah University of Medical Sciences, Kermanshah 6718818838, Iran. ahmadiar1012@yahoo.com
Ytterstad
Børge
B
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D002056:Burns / Q000517:prevention & control* / Q000523:psychology; D002648:Child; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012307:Risk Factors; D012737:Sex Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014741:Video Recording; D000092864:Suicide Prevention