Due to its high transmission rate and higher lethality, when compared to other common respiratory syndromes, the new coronavirus pandemic has led to the introduction of strong restrictive measures worldwide. Public health behaviors such as social distance emerged as important acts to reduce the spread of the virus, having a substantial effect on the world economy and a significant impact on freedom of movement [1,2]. These stressful events, causing sudden changes in the individual’s life functioning, can significantly affect mental health [3]. It can lead to the development or exacerbation of symptoms in particular depression and anxiety in vulnerable populations, including individuals with pre-existing psychiatric disorders and people unable to develop adequate coping measures [1,4].
The feeling of abandonment, financial instability, fear of contagion, loss of access to basic and mental health support, reduction of social activities, and impoverished living conditions reflected in an increased incidence of stress, anxiety, depression, insomnia, drug addiction, self-mutilation, and suicides observed in the same period [3,5].
A study carried out at the Burn Unit from the Ribeirão Preto Medical School, University of São Paulo, Brazil, from December 2019 to June 2020, showed an increase in self-inflicted burn injuries in the pandemic period in the region of Ribeirão Preto, São Paulo, Brazil. There were 54 new admissions (20 in the pre-pandemic period and 34 at the beginning of the pandemic) at our Burn Unit during the study period, with 37 male patients (68.5%) and 17 females (31.5%). The mean age of these patients was 32.7 years old in the pre-pandemic period (from 1 to 74 years), and 30.5 in the pandemic period (from 1 to 70 years). The mean total body surface area (TBSA) burned in the pre-pandemic period was 10.99% (from 1 to 65%), and 12.4% in the pandemic period (from 1 to 47%). History of psychiatric illness was present in four patients (20%) in the pre-pandemic period, and in six patients (17.6%) in the pandemic period. The most prevalent agents were flammable liquids (55.6%), and the main mechanism was flame burn (68.5%) overall. Before the pandemic period, there had been no admission for a self-inflicted burn. However, after the outset of the Covid-19 pandemic, seven patients (21.2%) had a self-inflicted burn trauma due to a suicide attempt. These rates observed in both periods (before and during the beginning of the pandemic) showed a statistically significant difference (p = 0.035) according to Fisher’s statistical test.
Analyzing this subgroup who self-inflicted burn, it was found that five patients (71.4%) were female and two (28.6%) were male, six patients (85.7%) had psychiatric diseases, and four patients (57.15%) reported drug addiction. The mean age was 39 years old (from 21 to 63 years) and the mean TBSA burned was 20.36% (from 4% to 47%). Regarding the agent, three patients (42.85%) used ethyl alcohol, three (42.85%) used gasoline, and one (14.3%), acetone. All patients had a flame as a burn mechanism and required a surgical approach. The most prevalent complication was wound infection in three patients (42.85%) and pneumonia associated with mechanical ventilation in two patients (28.6%). One patient (14.3%) had an unfavorable evolution and died.
Since the beginning of the coronavirus pandemic, our Burn Unit has also experienced an outbreak of Covid-19 and its impact on the health system [6]. In addition, we noted that physical distancing measures (such as quarantine) collaborated to increase the incidence of ethyl alcohol burns [7].
In the present study, most patients (85.7% — six in seven patients) in the pandemic period who self-inflicted burns had some previous psychiatric illness (compared to none of the other 27 patients with unintentional burns in the same period). Factors like gender, mood disorders, drug addiction, personality disorders, depression, and schizophrenia are the most prevalent [8]. These individuals generally come from lower social classes, with poor social and family support. It seems that the pandemic, being an acute predisposing factor, works to enhance these events [9].
Intentional self-injuries represent a significant medical problem worldwide [10]. Self-inflicted burns tend to be greater in terms of extent and depth, and they have been associated with a significantly increased risk of mortality during admission and clinical evolution of the patient [9]. Considering the great psychological impact related to the Covid-19 pandemic on individuals, there is a need for extensive mental health support during this period.
Conflict of interest
All authors have nothing to disclose.
No funding was received for this article.
Financial disclosure
All authors have nothing to disclose. No funding was received for this article.
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