Background
Recently, suicide as the cause of mortality has increased across the world [
1]. The countries of the former USSR have the highest suicide rates [
2]. Pakistan has the highest suicide rate, while Bahrain has the lowest suicide rate among the countries in the region [
1]. In Iran, the suicide rate of 6.2 per 100,000 was reported in 2003 but has increased to 9.9 per 100,000 in 2017 [
3]. However, different suicide rates have been reported to vary from 0.72 per 100,000 in Qom province to 271.1 per 100,000 in West Azerbaijan province in Iran [
4]. Suicide can be viewed as an interaction of mental, physiological, clinical, social, clinical, cultural, and protective factors. [
5]. Suicide is a psychosocial response to a hostile environment, feelings of despair, addiction such as alcoholism, post-traumatic stress disorder, major depression, schizophrenia, agitation, and social isolation. Its causing factor is often correlated with financial difficulties or interpersonal problems [
6]. Family conflicts may result in suicidal ideation in young people in different ways, such as ineffective coping strategies, lack of hope in life [
7], lack of positive personality capital in the form of hope, self-efficacy, resilience, and optimism about the future [
8].
According to the community's cultural context, there are many methods of suicide, including hanging, poisoning, suffocation, and self-immolation [
9]. Self-immolation, or self-burning, is defined as a deliberate and willing sacrifice of oneself, often by fire, which is the common violent, tragic, and dramatic type of suicide in middle-aged adults [
10,
11]. It has also been observed in young married women in other Asian settings, including Iran, Iraq (Kurdish Regions), Afghanistan, Pakistan, India, and Sri Lanka (Eastern Province) [
11‐
13]. In Iran, 25–41% of all suicides are from self-immolation, making Iran one of the countries with the greatest burden of mortality and morbidity in the world [
12].
The prevalence of self-immolation in Iran makes it a socially problematic health challenge. The rate of suicide in women is higher than in men, and, unfortunately, the number of suicide attempts among adolescents in Iran has also recently increased [
13]. Most studies regarding female self-immolation are quantitative studies covering demographic characteristics; however, this social event cannot be generalized to other cultural and social settings in Iran and must be fully investigated. The victims’ motives, sociocultural issues, and experiences need to be elucidated. This study was conducted only among Iranian married women to determine the factors leading to their suicide attempts. Self-immolation is a public and preventable health problem that may have resulted from cultural, psychological, religious, emotional, social, and economic complications. The consequences of suicide may have long-lasting effects on the families and friends of suicide survivors [
14]. Prevention of suicide attempts demands collaboration among health-care providers, patients, and their family members to promote the development of new solutions that can help save lives [
15].
Category 2: ideation of self-immolation method
Participants reported no hope in overcoming their unbearable sufferings, so decisions were made without thinking of the consequences. They know some of their family members who resorted to self-immolation, so why not also follow what they did. They had the impression that it is okay, after all. The following three sub-categories further described the participants’ ideation.
A final solution to their sufferings
Choosing self-immolation was a final solution to stop women’s suffering. It was difficult for them to think that they can continue their life in difficult circumstances. This state was worse for the women who were married at an early age and those whom their family and relatives did not support.
Nobody cared what I said. So, I decided to burn myself because I thought this method would kill me faster than the other methods. (P.10)
My last hope was my parents. When I realized that they were no longer supporting me, I gave up. (P.4)
Uncertainty about the method of suicide
Some participants stated that despite the decision to commit self-immolation, they had little information about the means of self-immolation and had no idea how to attempt self-immolation. They also were unsure what method is the best choice for them to kill them fast and suffer less. Some participants shared their experience as follows:
I decided to burn myself but did not know how!? I suddenly poured gasoline on my head and then set my own body on fire. (P.14)
Feeling trapped
Some participants talked about how they felt trapped at home and not allowed to go out to prepare the means of suicide. Thus, they had no choice but to burn themselves. The availability and easy access to flammable liquids like kerosene and matches made them quickly carry out their intention.
One of the participants voiced:
… I could not go out to get pills. So, self-immolation for me was the only way to kill myself. (P3)
Discussion
This study explored the experience of self-immolation in Iranian married women. Based on our participants’ experiences, we explored some antecedents or pre-motivational factors that pushed our participants toward deliberate self-immolation. They talked about their overwhelming family situation and strict rules that gradually took them toward self-immolation. The conflict between family members, especially husbands and wives, was one of the pre-motivating factors our participants voiced when they performed self-immolation to resolve their marital conflicts. Another Iranian research also confirmed that marital conflict is a core cause of self-immolation [
22]. In previous studies, family conflicts were also a factor to self-immolate because of traditional cultural customs and values. [
7,
23]. Another study found that married women were at the greatest risk of suicide by burning, mostly due to quarrels with a family member, a relative, or a friend [
24].
Based on the present interviews, it was observed that ignoring women’s rights by their family and society, along with a dominant cultural and social context’s restriction and prohibitions, triggered self-immolation [
25]. They had no choice about what they like to do or even whom they want to marry, which deteriorated even more after they got pregnant. A study found that forced marriage led to suicide even without psychological problems [
26]. Suicide attempts resulting from forced and early marriage were also reported in two separate studies in Turkey and Sri Lanka [
27,
28]. Domestic violence and marital conflicts in rural areas with unfair male dominance consisted of unresolvable problems for our participants. In line with previous studies, our participants who resorted to self-immolation were less educated, and half of them just completed primary education. Low literacy is among other negative psychosocial factors such as high family conflict and lack of social support that may put the young married women at higher risk of self-immolation [
28]. Their overwhelming family situation and strict rules made them feel disappointed, angry, deprived, depressed, shame, and grief. These feelings were triggered when the cultural and social context of obedience to the family’s male members was expected [
27]. When participants could not solve their problems, they tried to find a way to make their family feel guilty. This motivated these suffering women to burn themselves to punish their families. These factors and triggering events support the pre-motivation phase in the IMV model [
16].
Participants entered the motivational phase after they had a hard time handling the stressful situation. As reported by our participants, a self-immolation attempt is a final solution to their sufferings. Most of our participants believed that they performed self-immolation to resolve marital conflicts, forced marriage, and the age gap between them. They deliberately burn themselves to overcome their distressing situation, mainly enforced by family-arranged marriage. For some women, the option of self-immolation was a way not only to get out of their prison-like situation but also to make their husbands and family feel guilty about the way they were treated [
29]. Some participants were hesitant about choosing the means of suicide because they did not have enough information about suicide methods. Since the self-immolation method is so painful and affects the family further, some women use it to induce more guilt in their family; namely, they punish their husbands or families and take revenge for their behavior [
30]. Some women probably take this suicide method because it is an easy method and they do not need to leave the house to provide some materials to commit suicide. Our participants felt trapped and deprived of all freedom as some were not allowed to leave the house. The easy access and availability of some flammable liquids and matches made the suffering women burn themselves
. Thus, our participants chose self-immolation because it was the fast and easiest way and sometimes the only way to kill themselves with less suffering [
24,
30]. According to the IMV model, our participants' psychological issues lead to suicidal ideation, beginning with feelings of defeat and entrapment [
18].
The final act of self-immolation supports the phase three volitional phase of the IMV model [
16]. Our participants had access to the means of suicide and were exposed to the suicidal behavior of their family members, who also resorted to self-immolation [
19]. However, what was lacking in the IMV model was the aftermath of the attempted self-immolation as our participants had no real intention to die and did not realize that self-immolation is a dangerous means of suicide with many adverse consequences [
31]. Our participants accepted that they regretted performing self-immolation and learned the best way to recover. However, there are also examples in which people in challenging situations can choose to stay alive or perform suicide. A study reported that people who feel that they have a certain purpose in life, e.g., a child to care for, choose to stay alive even if their circumstances are at odds [
32]. They tried to seek family support and satisfy them by cleaning their dark past and taking proper actions to make up for their mistakes. These people try to establish a warm and supportive relationship with their family members to be more resistant to stress and more easily adapt to existing conditions [
23,
33]. Other studies have confirmed the advantages of social support in self-immolation survivors through support from family members and friends [
32,
34]. Thus, it is important that women who survived self-immolation be supported by their family and other support networks.
Limitations
The study was limited because of the small sample size and the need for husbands and the family to consent for the young married women to participate in the study. This could have hampered the in-depth accounts of their experiences. However, even with this small sample size, the findings have provided insightful data on the reasons for, consequences of, and recovery from attempted self-immolation.
Conclusions
The study revealed that married women who have been under psychological pressure from their families and whose needs were ignored attempted suicide by self-immolation. They tried to make their voices heard by the family and society. If their voices were ignored, they would suffer from anger, despair, hopelessness, and depression. These women’s last resort to get rid of stress and suffering was to set foot on the road to self-immolation. The study highlights the need for health professionals to focus on self-immolation survivors to encourage them to continue normal lives. According to survivors’ needs, a comprehensive supportive program is recommended to support their pathways to recovery in all its complexities. Family members in a male-dominated society, husbands, fathers, and brothers are urged to take part in protective practices towards self-immolation and other suicide methods. Health professionals should also not forget that the family of the suicide survivors will also need help to overcome this trauma. In addition, preventive strategies such as family counseling services and teaching coping skills to women in stressful family situations may reduce the risk of suicide by self-immolation.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.