Trapped in fire: A qualitative systematic review and meta-synthesis of causes, challenges, and responses after self-immolation in Iran.

Abstract

Self-immolation is a serious public health problem in Iran, accounting for approximately 16% of admissions for burns, and the victims are predominantly women and young. Despite its prevalence, systematic reviews of qualitative data on the causes, challenges, and responses to self-immolation are sparse. We conducted a systematic review and meta-synthesis of qualitative studies that have assessed self-immolation in Iran. We searched the PubMed, Scopus, Web of Science, Google Scholar, Scientific Information Database, and Magiran databases until August 2025. We appraised studies based on the Critical Appraisal Skills Programme guidelines and synthesized them using Thomas and Harden's thematic synthesis approach. Eighteen studies involving 377 participants were included. Analysis revealed six primary causes, including patriarchal family control, marital and relationship violence, economic hardship, cultural and social constraints, psychological distress, and method-related factors. Self-immolation creates challenges, including individual psychological impact, social stigmatization and isolation, healthcare and treatment challenges, and family system disruption. Survivors and their families employ both positive adaptation strategies and maladaptive coping responses. Self-immolation of Iranian women is influenced by cultural and structural factors. Prevention of self-immolation requires multi-level interventions to address the needs of the survivors and the inequalities in the system. The health system should include the integration of burn care services with mental health services, addressing the issue of domestic violence, and ensuring access to safety resources. Policy interventions should ensure legal protection, economic support, and access to divorce. Community-based interventions need to address the social acceptability of self-immolation, and research needs to concentrate on intervention studies, long-term recovery, and the neglected group of male survivors.