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Self immolation: an Uncommon Suicidal Method in Sri Lanka

4 June 2012 06:30 pm - 0     - {{hitsCtrl.values.hits}}

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Prof. Ravindra Fernando
Suicide is a complex behaviour that has biological, psychological and social implications. Marital disharmony, dispute among family members, broken love affairs, socio economical problems and underlying psychiatric disorders are some of the key reasons, for the higher incidence of suicide in Sri Lanka. Deaths from suicide reached a peak in Sri Lanka in 1995. Several interventions reduced the suicide rate of 48.7 per 100,000 in 1995 to 24.1 per 100,000 in 2005 (from the first in the world in 1995, we came down to seventh position in 2002). However it is still a major socio-economic problem.

In Sri Lanka, self immolation is an uncommon, but dramatic method of committing suicide. Although uncommon, it is a significant source of morbidity and mortality. Most of those, who commit suicide by this method, tend to be females with severe psychopathology. Self immolation has been considered a serious mental health problem throughout the world and especially in economically developing countries. Ritual self immolation has been long practised in India, though it is not practised in Sri Lankan context. In addition, suicide by burning and other self injurious behaviour which involve burning are sometimes considered to have religious overtones, which too is not relevant in Sri Lankan context.

In a study sponsored by the South Asian Clinical Toxicology Research Collaboration performed at Coroner’s court, Colombo, all deaths where a verdict of ‘suicide’ was given were studied for a period of one year Close relations or friends who attended the inquest were interviewed by medical officers. Age, sex, educational level, marital status, cause of death and reasons for the suicide were studied.

In this study, 151 deaths were documented and analysed. Out of that 51 deaths (34%) were due to self immolation. When deaths due to self immolation were analysed there were 39 females and 12 males, male/ female ratio being 0.315. Age/sex distribution of this group shows a predominance of females 76%. The majority (53%) were below 30 years of age.

45% had school education up to grade 6 — 11. Altogether 14% had studied beyond the Ordinary Level Examination. Another 14% had no education at all.



Study of the employment status showed that 64.71% were unemployed and 22% had been working as skilled, semiskilled or unskilled workers. Only 4% were involved in Professional, Technical or Clerical related works. No one who committed suicide by self immolation was working in administrative and managerial sections. 82% were living with their families while only 8% were living alone. Self immolation took place inside their own residence in 70.5 9% of the cases and most attempts were made indoors (80%). 4 people (8%) had attempted suicide prior to this. However, out of them only one person had used the self immolation as the method in the previous attempt too. The others had used self poisoning, cut injuries and drowning as the method, during the previous attempt of suicide.

Commonest reason for suicide was dispute with the spouse/marital disharmony (45%). Other reasons were dispute with parents (10%), financial matters (6%), psychiatric illnesses (4%), unemployment (4%) broken love affair (4%) and organic diseases (4%).

Self immolation was the second commonest method used to commit suicide, and it is a major health and social problem, leading to slow and very painful death or horrific disfigurement. Poisoning (44%) is reported as the most common method, followed by hanging, jumping in front of a train, and drowning. Self immolation is generally thought to be less common. However, with at least 51 deaths in one year, it shows that burn suicide represents a very significant method of suicide. The true number of self immolation cases is probably higher than the 51 reported here.

The victims who committed suicide by self immolation were mostly young, married women who had interpersonal problems with their husbands which they could not handle. Marital disharmony was the main reason.

In conclusion, effective prevention policies are necessary, if this increasing problem of suicide is to be curtailed. Overall, suicide should be considered an increasing health, mental and socio-economic problem in our society. Therefore, it is necessary to implement prevention programmes and strategies to reduce the incidence rate of this problem. Future interventional activities should include empowering people to manage anger and conflicts, recognise and treat alcoholism and psychiatric illnesses.
The better treatment of mental illness in the population might ultimately save the high cost of the burn injuries and the deaths caused due to burns. The management requires a multidisciplinary approach and significant medical, psychological, occupational and social support. Increased awareness and education of the vulnerable individuals may be of benefit to prevent self inflicted injuries and deaths by burning.

Courtesy: Ceylon Medical Journal
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