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. Design Quasi-experimental. Setting The Iranian cities Gilangharb (intervention) and Sarpolzahab (reference). Participants 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.