Suicide and Self-Harm by Burns in Pakistan

Background: Burns are a major global public health issue, causing 180,000 deaths worldwide each year. Self-inflicted burns are more prevalent in low- and middle-income countries and are associated with high morbidity and mortality. Understanding its frequency, demographics, and contributing factors is critical for prevention. Aims: To determine the frequency, demographic distribution, methods, and outcomes of self-inflicted burns (self-harm and suicide) in Pakistan. Methods: This scoping review followed Arksey and O'Malley's framework. We searched MEDLINE (PubMed), Google Scholar, SCOPUS, PakMediNet, and gray literature via Open Access Theses and Dissertations up to December 2023. Studies on self-inflicted burns in Pakistan were included without date restrictions. Two reviewers independently screened articles, and data were extracted using a structured form and analyzed descriptively. Results: A total of 67 studies were included, comprising 1,684 cases of self-inflicted burns of 50,283 total burn cases (3.35%). Of 67 studies, two focused solely on self-inflicted burns, 19 on burns generally, and 46 on suicide/self-harm involving burns. Of these, 39% (n = 661) were suicide and 61% (n = 1,023) were self-harm. Sex distribution was reported in 33 studies, with 443 males and 564 females affected. The method of self-inflicted burns was specified in 21 studies, including 11 studies on self-immolation and 10 on fire/flame burns. Mortality data were reported in eight studies, indicating a 42% mortality rate (143/340 cases) and a 54.7% survival rate (186/340 cases). Only 25% of the studies had authors from a mental health background, and psychiatric comorbidities or referrals to psychiatric services were rarely documented. Sociodemographic and clinical variables (age, occupation, marital status, burn extent) were frequently not reported. Limitations: A key limitation is the reliance on authors' classification of intent, which may be subject to misclassification. Discussion: Self-inflicted burns are a significant public health concern in Pakistan, particularly among females. Incomplete reporting of age, occupation, and burn extent limits understanding of at-risk groups. A national surveillance system is needed to track trends and identify high-risk populations. Integrating psychiatric evaluations into burn care can enhance outcomes and suicide prevention.