title: A comparison of suicidal behavior by burns five years before and five years after the 2011 Tunisian Revolution.
abstract: BACKGROUND
  In Tunisia, the phenomenon of self-immolation has increased dramatically since the self-burn of Mohamed Bouazizi which occurred on 17 December 2010. The aim of our study was to compare the casualties' profile of suicide by self-immolation before and after the Tunisian Revolution over a period of 10 years (2006-2015).
  
  
  METHODS
  We conducted a retrospective review including all the cases of self-immolation suicides that occurred in Northern Tunisia five years before and five years after the January 2011 Revolution. We excluded cases of self-immolations committed in governorates other than the north of Tunisia as well as casualties of accidental or criminal burns and those where the context could evoke suicidal immolation but the self-inflicted nature has not been confirmed. The study sample was subdivided in two groups according to the Revolution date: before the Revolution (2006-2010) and after the Revolution (2011-2015). We compared for each group data related to the age, gender, marital status, employment, mental disease history, previous suicide attempts and threats, place of suicide and its motive, the type of fire accelerator, the hospitalization and the average body surface area burned.
  
  
  RESULTS
  The number (n=48/24.5% before 2011) of suicide by self-immolation has tripled during the post-revolution period (2011-2015) with a stable trend. The average age (35.6±13.4) has not changed. The male remained predominant before and after the Revolution (sex ratio of respectively 1.67 and 3.23). Marital status (victims being single in n=81 cases/41.3%) and the employment (unemployed in n=128/65.3%) of the casualties have not changed either after 2011. Fewer cases with psychiatric history were reported (n=21/43.7% before against n=52/35.1% after). Self-immolation increased in public places (n=9/18.7% before against n=50/33.8% after) and in an administration (n=2/4.2% before against n=19/12.8% after). More suicides after 2011 were due to financial problems (n=2/4.2% before against n=30/20.3% after) or due to a conflict with a state representative (n=2/4.2% before against n=18/12.2% after) with fewer cases due to a decompensation of mental illness (n=18/37.5% before against n=22/26.4% after).
  
  
  CONCLUSIONS
  Our study highlighted modifications of the casualties' profile of self-immolation after the Tunisian Revolution represented essentially by less psychiatric history and more suicides occurring in public places and in front of public administrations as well as suicides motivated by financial problems or conflicts with a state representative. Specific preventive measures should target young unemployed males.
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia; Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia. Electronic address: benkhelilmehdi@yahoo.fr.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Ben Khelil
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia.
authors.forename: Amine
authors.initials: A
authors.lastname: Zgarni
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia.
authors.forename: Mounir
authors.initials: M
authors.lastname: Ben Mohamed
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia; Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Allouche
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia; Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Anis
authors.initials: A
authors.lastname: Benzarti
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia; Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Banasr
authors.affiliation: Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia; Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.
authors.forename: Moncef
authors.initials: M
authors.lastname: Hamdoun
mesh_terms: D000328:Adult; D017677:Age Distribution; D002056:Burns; D005260:Female; D005390:Fires; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009042:Motivation; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014416:Tunisia / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Burns; Media; Revolution; Self-immolation; Suicide; Tunisia