Deliberate self-harm and suicide: a review from Pakistan

Abstract

Suicide is now considered a major public health problem, especially in low income countries. A systematic review was conducted to identify risk factors and causes of deliberate self-harm and suicide in Pakistan – a Muslim, South Asian nation. In addition, the role of emergency department-based surveillance is explored. Four electronic databases (PubMed, CINAHL Plus, MDConsult, PakMediNet) were searched and 23 studies were reviewed. Risk factors for deliberate self-harm included young age (less than 35 years), being female, occupation (housewives), being married and low socio-economic status; while reported risk factors for suicide were young age (less than 35 years), male gender, being married and low socio-economic status. Medications were commonly used for deliberate self-harm while firearm, hanging and organophosphorus poisoning were more frequent means for suicide. The most common reported cause for both health outcomes was interpersonal conflict. There is accumulating evidence that deliberate self-harm and suicide have increased in recent years in Pakistan. There is a need for greater attention and in-depth studies to elaborate on causative mechanisms for these public health issues.

Keywords:

• deliberate self-harm
• suicide
• Pakistan
• ‘intentional injury’
• violence

Acknowledgement

We gratefully acknowledge the support from the United States National Institutes of Health (NIH) John E. Fogarty International Center for Advanced Study in the Health Sciences, under the Johns Hopkins-Aga Khan Fogarty International Trauma and Injury Training Program grant (D43 TW007292). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of NIH. We are thankful to Ellen Mackenzie PhD, Gary S. Sorock PhD and Diana E. Clarke PhD for their help and encouragement and to Abdulgafoor Bachani for editorial assistance.