Characteristics of self-immolation attempts in Akita Prefecture, Japan

doi:10.1016/S0305-4179(03)00065-2

Burns

Volume 29, Issue 7, November 2003, Pages 691-696

https://doi.org/10.1016/S0305-4179(03)00065-2 Get rights and content

Abstract

Akita Prefecture has had the highest suicide rate in Japan for the past 9 years. To obtain further information on suicide attempts by self-immolation in Akita, we performed a statistical analysis of patients in this prefecture who attempted to burn themselves. Over the past 6 years, 541 patients suffering from burns were transferred to medical emergency units. Of these, 35 (6.5%) attempted self-immolation, most of whom were between 20 and 60 years of age. Women over 50 years of age outnumbered men in the same age group. All 35 patients sustained flame burns. The total burn surface area (TBSA), burn index (BI), rate of inhalation injury, and mortality rate were all significantly higher in the patients who attempted self-immolation than in those with nonsuicidal burns. Most (68.6%) of the self-immolation attempts were made indoors. Because the Japanese are not generally a very religious people, training to help them cultivate a philosophy of life and educating them in moral science to help them form a personal view of life and death may be necessary to prevent suicides.

Introduction

Despite the low population density of Akita Prefecture at about 1,200,000 persons within an area of 11,613.11 km², this Prefecture has maintained the highest suicide rate in Japan each year since 1994 [1], [2], [3], [4]. The rate in this Prefecture in 2001 was 36.9 per 100,000 individuals, which was higher than that in Sri Lanka (30.1 per 100,000) [5]. The rate was especially high among elderly persons living in rural areas. This suggests that, in rural areas, underpopulation and aging contribute to the increased rate of suicide in this prefecture. The seriousness of this problem has aroused the attention of health care providers and local administrative officials. We believe it is necessary to collect data on suicides and suicide attempts to be able to accurately analyze and understand this serious social problem. Thus, we conducted a survey in which a questionnaire was sent to all fire department headquarters in the prefecture to determine the number of patients with burns who had been transferred to medical facilities [1]. We analyzed those who attempted self-immolation with respect to demographics, prognosis, and measures that could be undertaken to prevent suicide attempts.

Section snippets

Materials and methods

A questionnaire was sent to 17 fire department headquarters in Akita Prefecture to survey burn episodes occurring between 1 January 1996, and 31 December 2001. The survey questions included the victim’s age, sex, burn injury data (cause, place, time of occurrence, total burn surface area (TBSA), body surface area (BSA) of deep dermal burn, BSA of deep burn, and severity of injury), destination hospital, transport time, and treatment during transport. Victims who died during transport were

Results

Replies were received from all 17 fire department headquarters.

Discussion

Five hundred and forty-one patients (7.5 per 100,000 persons) were transferred to medical facilities because of burn in Akita Prefecture over the past 6 years, which is comparable to our previous study result of 7.1 per 100,000 persons being transferred from 1996 to 1999 [1]. In the Tokyo metropolis, 16.7 per 100,000 persons were reportedly transferred to medical facilities because of burn in 1994, which is more than twice the rate in Akita Prefecture [1]. Self-immolation attempts accounted for

Acknowledgements

We would like to express our thanks to the individual fire department headquarters for their cooperation in this survey.

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Survey on the current status of self-immolation attempts in Akita Prefecture: A cross-sectional survey
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Citation Excerpt :
Japan has a suicide mortality rate of 18.5/100,000, which ranks seventh in the World Health Organization’s country-by-country report [5], with self-immolation rates accounting for approximately 1% of the total number. Nonetheless, a limited number of surveys have been conducted on the actual situation of patients attempting self-immolation in Japan over recent years [6,7]. The current study sought to survey the actual situation of patients attempting self-immolation in Akita Prefecture.
Given the up to 70% fatality rate of self-immolation, with tragic consequences for survivors, proposals have been made for a global task force to prevent self-immolation. However, little research has recently been conducted on the actual situation of patients who attempt self-immolation in Japan. The current study aimed to investigate the actual situation of patients who attempt self-immolation in Akita Prefecture.
Within Akita Prefecture, 13 individuals had attempted self-immolation in the past 5 years, with a predominance of a history of psychiatric disorders (46%). The following three novel findings were also revealed. First, patients with low a prognostic burn index tended to commit arson, while those with a high prognostic burn index tended to self-immolate. Second, patients attempting suicide tended to have a higher incidence of carbon monoxide poisoning. Third, those whose clothes caught on fire tended have more severe burns, regardless of whether suicide was attempted.
Self-immolation tends to be serious, and prevention is imperative. In Akita Prefecture, the percentage of patients with a history of psychiatric disorders may be higher than commonly believed, and a more detailed understanding of the mental state of self-immolation is necessary in the future to develop effective prevention measures.
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Studies describing the epidemiology of severe burns (>20% total body surface area) in adults are limited despite the extensive associated morbidity and mortality. This study aimed to describe the epidemiology of severe burn injuries admitted to burn centres in Australia and New Zealand.
Data from the Burns Registry of Australia and New Zealand (BRANZ) were used in this study. Patients were eligible for inclusion if they were admitted between August 2009 and June 2013, were adults (18-years or older), and had burns of 20% total body surface area (TBSA) or greater. Demographics, burn characteristics and in-hospital mortality risk factors were investigated using multivariable Cox proportional hazards analysis.
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La prise en charge des victimes de lésions dues au feu, d’un point de vue médical ou médico-légal, incite à s’interroger sur le mode de survenue de ces lésions (acte accidentel, suicidaire ou criminel). Les caractéristiques personnelles et circonstancielles peuvent donner de nombreux éléments permettant de connaître l’origine de l’évènement. L’utilité se trouve donc tant dans les investigations médico-légales que dans le repérage d’une conduite suicidaire masquée. Notre revue de la littérature nous a permis de mettre en évidence des différences relatives aux données sociodémographiques, antécédents, circonstances et investigations médico-légales.
From a medical or legal perspective, people taking care of burn victims must think of the origin of the incident (accident, suicide, crime). Circumstantial and personal characteristics of the victims can lead to a conclusion in regards to the origin of the event. This is useful in forensic investigation to discriminate the three modes (accident, suicide, crime), but also to focus on a masked suicide attempt. This literature review highlights the differences between accidental, suicidal and criminal burns according to socio-demographical, medical, circumstantial and forensic data.
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Citation Excerpt :
Less common methods were scalding, chemical burns, setting clothing on fire, and self-electrocution [40]. Here too, cultural factors can exert an influence in ways surprising to those unfamiliar with them: Nakae and colleagues note that “unlike in most of western Europe, cremation is the preferential rite of passage for the dead in Japan” and identify this as a factor in Japan's “still low but steadily increasing number of deaths by self-immolation” [46]. Few studies mention the specific location of the act of self-immolation, but when identified, some cultural and contextual differences may be discernable.
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We reviewed the literature for all published papers on self-immolation between 1973 and 2010. Epidemiologic and psychiatric risk factors and aspects of method, locale and timing of self-immolation were compared between higher- and lower-income countries.
In higher-income countries self-immolation tends to be rare and the majority of self-immolation patients are male. In lower-income countries, the incidence of self-immolation is much higher, and the majority of patients are female. Self-immolation was more frequently associated with a history of mental illness or substance abuse history in higher-income countries than in lower-income countries.
Reports in the literature of self-immolation divide most informatively into two groups according to the higher- or lower-income of the societies affected. This classification is not arbitrary, as it correlates with other measures of development, and the epidemiologic patterns revealed show distinct differences, suggesting differing causes and intervention strategies. Analytical studies are needed to distinguish associations from underlying causes and identify efficient points of intervention.
Suicidal and criminal immolations: An 18-year study and review of the literature
2011, Legal Medicine
Citation Excerpt :
The age distribution also fits that reported in other studies [1,3,6,8,10,20,15–17,19,21]. Furthermore, in some of them [3,6,10], mean age was determined to be higher in female group. While other authors reported that most of the suicide victims had a history of a psychiatric illness [1–3,5,13,15,17,19,21–24] reaching 100% in some series, we found a psychiatric history in only 11 suicide cases (38%), despite larger inclusion criteria.
We aimed to examine our autopsy data in order to analyze epidemiological and injury characteristics in criminal and suicidal immolation cases.
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