Psychosocial Determinants of Burn-Rtelated Suicide: Evidence from the National Violent Death Reporting System

Psychosocial Determinants of Burn-Related Suicide:

Evidence from the National Violent Death Reporting System

Objectives: Suicide is the tenth leading cause of death in the United States, making suicide prevention a major public health issue. In 2017, over 47,000 Americans died by suicide. Suicide by burning (SSB), while one of the rarest forms of suicide, could potentially be prevented in part by early recognition and treatment of the underlying psychosocial problems that lead to self-inflicted burns. One obstacle to analyses of these occurrences is the rare instnaces of such events. In order to mitigate this issue and help fill a gap in literature, longitudinal data can be used to identify additional risk factors associated with suicide by self-immolation. Therefore, the objectives of this study were to: 1. Determine which mental health factors contribute to SBB; 2. Examine how substance use relates to SBB; 3. Determine what extent previous suicide attempts predict SBB; and 4. Examine which socio-demographic variables contribute to SBB?

Methods: The National Violent Death Reporting System (NVDRS) used to examine the differences between victims of SBB and all other suicide types. Following the coding guide developed by the CDC, a dichotomous variable was created using data from 2003-2016. Socio-demographic variables and psycho-social factors, such as mental health (e.g., bipolar disorder, schizophrenia, post-traumatic stress disorder, etc.), blood alcohol level (BAC), and other substance use (e.g., opioid use, amphetamine use, marijuana use, cocaine use, polysubstance use, etc.) were examined. Due to the relative imbalance between the sample size of suicide victims in the reference group (N₁=166,949) compared to victims in the SBB group (N₂=722), rare event data analysis was used. This process reduced potential estimation bias in the final models (King and Zeng, 1999).

Results: Prevalence estimates revealed there were significantly fewer white victims in the SBB group (74 percent) than those in the suicide reference group (89 percent). Blacks and Asian/Pacific Islanders accounted for the majority of variation among the non-white victims. Additionally, there was a significantly higher prevalence of females who committed SBB (29 percent) than other types of suicide (22 percent). The results of the multivariate analysis indicated that victims with schizophrenia (95 percent CI: 3.7–7.8, p < .001), eating disorders (95 percent CI: 1.9–8.6, p < .001), and high blood alcohol levels (95 percent CI: 1.3–2.4, p < .001). were more likely to commit SBB than victims of other types of suicide.

Conclusion and Future Research: This study fills a gap in the literature on the psychosocial determinants of SBB in the U.S. Current knowledge about suicidal burn-related behaviors offers enough evidence to support interventions that focus on curbing this insidious public health problem. The next best step is to invest in translational research that seeks to design and implement the supportive services that are currently unavailable or inaccessible before victims have attempted suicide by burning or any other means.