Self-immolation: socioeconomic, cultural and psychiatric patterns.

INTRODUCTION Self-immolation remains a significant contemporary problem. Its epidemiology and causes, and the intervention strategies these suggest vary significantly between higher- and lower-income countries. We summarize what is known about suicide by self-immolation in terms of its demographic and psychiatric risk factors, causes, local patterns and means employed, and points of possible intervention. METHODS 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. RESULTS 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. CONCLUSION 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.