Prevalence and determinants of fatal self immolation among hospitalized burn patients in Northern Iran during an ElevenYears study

Fatal selfimmolation is a severe form of intentional burn injury with high mortality and a substantial psychosocial burden. However, limited evidence exists regarding its longterm epidemiological trends and associated factors among hospitalized burn patients in northern Iran. This study aimed to investigate the frequency, temporal trend, and determinants of fatal selfimmolation among deceased burn patients in a hospital in Northern Iran over 11 years. This retrospective study included all burnrelated deaths recorded in a referral burn center in northern Iran from March 2011 to March 2022. The study was conducted in a university- affiliated burn hospital located in Mazandaran province, which also serves as a referral center for patients from other cities. Data was collected and analyzed to assess the prevalence of selfimmolation and its associated factors. Descriptive statistics and logistic regression were performed using SPSS version 21 to examine factors associated with fatal selfimmolation. Chi-square test and multivariate logistic regression were applied; Variables with p < 0.3 in univariate analysis were entered into the final model, and model adequacy was assessed. This study reflects the proportion of selfimmolation only among fatal burn cases and does not include surviving patients; therefore, results should be interpreted within the context of a hospital based mortality cohort. Among all burn cases during the study period, 882 patients (10.65%) died The burn cause was not recorded in 203 (23%) of deceased patients. Of the 679 deceased patients with available data, 117 (17.2%) had committed selfimmolation. Among deceased patients, 399 cases (58.8%) were men, 340 (50.1%) were aged 41–60 years, 433 (63.8%) were married, and 249 (36.7%) were employed. Women had higher odds of fatal selfimmolation compared with men (OR = 2.56). Single individuals had 3.05 times higher odds of fatal self-immolation compared with married individuals. Patients from Golestan province and other provinces had 1.72 and 3.26 times higher odds, respectively, compared with those residing in Mazandaran province. Furthermore, individuals with a history of psychiatric treatment had 4.85 times higher odds of fatal selfimmolation. Fatal selfimmolation showed an increasing trend after 2018. It was independently associated with female sex, single marital status, residence outside Mazandaran province, and a history of psychiatric treatment. These findings should be interpreted in the context of a hospital-based fatal burn cohort and do not reflect incidence in the general population These results highlight the need for targeted mental health interventions and region specific preventive strategies.