title: Self-immolation a predictable method of suicide: a comparison study of warning signs for suicide by self-immolation and by self-poisoning.
abstract: OBJECTIVE
  Understanding warning signs for suicide is a crucial aspect of suicide prevention. This study was designed to compare warning signs prior to suicide attempt by self-immolation versus suicide attempt by self-poisoning among consecutive referrals for treatment after suicide-attempt at Kermanshah Imam Khomeini Hospital, Iran.
  
  
  METHODS
  Over a 4-month period (June-September 2008), first degree relatives of 200 consecutive patients referred to Kermanshah Imam Khomeini Hospital, Iran, following a suicide attempt were interviewed. Sixty-three patients had attempted suicide by self-immolation and 137 by self-poisoning. Interviews addressed demographic characteristics (gender, age, marital status, and educational status) and three sets of psychosocial warning signs for suicide (verbal, behavioral, and environmental).
  
  
  RESULTS
  Four significant differences in types of warning signs were found between the two groups. Those patients who had attempted suicide by self-poisoning were more likely to have shown seeking behavior for killing devices prior to the suicide (p<0.001), to have shown depressed mood and severe changes in mood (p<0.01), to have shown a lack of interest in work and education (p<0.02), and to have shown reckless behaviors (p<0.01). Other symptoms were not significantly different between the groups. Analyses considering warning signs in clusters of behavior patterns (verbal, behavioral, and environmental warning signs) indicated behavioral warning signs were more common in patients who had attempted suicide by self-poisoning. Further, the total number of warning behaviors was greater in the self-poisoning group (p<0.001), indicating that the group who attempted suicide by self-poisoning seemed to do so with more substantial planning and warning than those who attempted suicide by self-immolation.
  
  
  CONCLUSIONS
  Warning signs for suicide by self-immolation were different and fewer than warning signs for suicide by self-poisoning among this sample of 200 Iranian patients who had attempted suicide. Prediction and prevention of suicide by self-immolation may be more difficult than prevention of suicide by other methods.
authors.affiliation: Sleep Research Center, Department of Psychiatry, Kermanshah University of Medical Sciences, Iran. la_rezaie@yahoo.com
authors.forename: Leeba
authors.initials: L
authors.lastname: Rezaie
authors.forename: Habibolah
authors.initials: H
authors.lastname: Khazaie
authors.forename: Akram
authors.initials: A
authors.lastname: Soleimani
authors.forename: David C
authors.initials: DC
authors.lastname: Schwebel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002056:Burns / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D017533:Marital Status; D009042:Motivation; D011041:Poisoning / Q000523:psychology*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D012737:Sex Factors; D013405:Suicide / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult; D000092864:Suicide Prevention