Bibliographic record
Abstract
Introduction: Voluntary ballistic facial injuries present major surgical, relational, and emotional challenges for both patients and caregivers. The destruction of the face affects not only appearance but also the sense of identity and social integration. This study aims to assess the impact of disfigurement on the quality of life of individuals who attempted suicide by firearm and the role of surgical strategies in the adaptation mechanisms developed by these patients. Materials and methods: A cohort of 110 patients who survived a suicide attempt by firearm and were treated at the Amiens University Hospital between 2004 and 2024 was analyzed. The data collected allowed for the measurement of survival and recurrence rates as well as an epidemiological study of pre- and peritraumatic characteristics. The study was then supplemented by nine semistructured interviews conducted by a psychiatrist-surgeon team to shed light on the origins and aftermath of such a radical act. This qualitative study was supported by quantitative scales: HAD, C4, and FACT-MBIS/McGill. Results: The suicide recurrence rate was only 3%, with an immediate mortality rate of 10%. Among survivors, 57.8% underwent complex and extensive facial reconstructions. The interviews revealed that early family trauma was the starting point for a flawed identity construction, amplified by a deep-seated and disrupted sense of shame, leading the patient to seek to "kill" their face in order to resurrect a visage they could reclaim. Scores on the scales highlighted good individual and social adaptation despite the disability.Discussion: The results show that disfigurement allows for the reshaping of a previously unstable social environment, becoming a decisive step in the identity reconstruction process. Furthermore, surgery acts as a guide, helping the patient in their development by creating a secure environment. Surprisingly, patients with fewer facial sequelae seem less inclined to reinvent themselves than those with major disfigurement, perhaps because the process of deconstruction/reconstruction could not fully conclude. Conclusion: The clinical profile of patients who attempt suicide by ballistic facial trauma is counterintuitive, as our study highlights a paradoxical improvement in the quality of life for disfigured patients. The surgical journey allows them to progressively reimagine themselves, both literally and figuratively.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.021 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".