Demographic risk factors of self-immolation: A case–control study Alireza Ahmadi a, *, Reza Mohammadi b , David C. Schwebel c , Habibolah Khazaie d , Naser Yeganeh a , Afshin Almasi a a Department of Anesthesiology, Critical Care and Pain Management, Kermanshah University of Medical Sciences, Iran b Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden c Department of Psychology, University of Alabama at Birmingham, USA d Department of Psychiatry, Kermanshah University of Medical Sciences, Iran 1. Introduction Self-immolation (self-burning) may be among the most dramatic, most violent, and most difficult personal acts to understand [1]. This method of completed suicide is rare in high-income countries [2–6], but is reported more frequently in low- and middle-income countries [7]. Iran is among the countries with the highest rates of self-immolation. In fact, some areas of Iran have the highest documented rates of self-immolation in the world (22.4 per 100,000 person-years) [11,12]. In different parts of Iran, between 1.39 and 9.50% of patients that attempted suicide and 25.0 and 71% of patients who committed suicide were via self-immolation [1,7–10]. The burns 35 (2009) 580–586 article info Article history: Accepted 30 June 2008 Keywords: Case–control Risk factors Self-immolation Deliberate self-inflicted burns Suicide Iran abstract Objective: To investigate demographic risk factors for self-immolation patients. Methods: In a case–control study, 30 consecutive cases of deliberate self-inflicted burns admitted to the regional Burn centre (Imam Khomeini hospital in Kermanshah province, Iran) were compared with 30 controls who were selected from the community and matched by gender, age, and living area. All cases and controls were reviewed for demographic variables, including: age, gender, living area, family size, marital status, bearing and number of children, Body Mass Index (BMI), birth order, employment state, educational status, early school drop-out, and parent/guardian employment status. Results: Two variables emerged as related to risk of self-immolation. Being the first or last child in family birth order was associated with increased risk of self-immolation. Moreover, among the married participants, having children was associated with decreased risk of self- immolation. The comparisons of other variables were not statistically significant. In multi- variate analyses, none of the variables predicted risk for self-immolation. Conclusion: This study suggests that being the first or last child of a family might be a risk factor for self-immolation. For married persons, having children might serve as a protective factor from self-immolation. Other variables such as family size, marital status, number of children, BMI, employment state, educational status, early school drop-out, and parent/ guardian employment status did not play a role as individually protective or risk factors for self-immolation. # 2008 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author. Tel.: +98 831 7240890. E-mail address: ahmadiar1012@yahoo.com (A. Ahmadi). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2008 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2008.06.012