Suicide attempts by burning

Setting oneself ablaze is an uncommon method of attempting suicide. Ten patients with deliberate thermal injuries had been evaluated by a consultation psychiatry service over a 15-year period. Schizophrenia and major depression were the more common diagnoses, and most patients had prior psychiatric histories. When compared to 1,864 people who attempted suicide by other means, the burn subjects were older, comprised a larger percentage of African Americans, and resembled those who had jumped from high places. Stresses encountered by recovering burn patients involved dependency, body image concerns, exacerbation of pre-existing depression, pain, flashbacks of the incident, and guilt intensified by their proximity to accidentally burned victims. Problems for burn unit staff included feelings of discomfort with difficult, potentially suicidal individuals, and responsibilities to perform painful procedures. Recommendations for psychiatric care include pharmacotherapy for depression or psychosis, visitation by previously self-burned individuals who serve as role models, patients' visualization of their injuries, and behavioral techniques to diminish reliance on analgesic drugs and to increase a personal sense of control. Suggestions for assisting staff include liaison support, personnel debriefing sessions, and inservice presentations on emotional aspects of burn management.