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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Suicide and deliberate self-harm in Pakistan: a scoping review

Authors: Sualeha S. Shekhani, Shagufta Perveen, Dur-e-Sameen Hashmi, Khawaja Akbar, Sara Bachani, Murad M. Khan

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

Suicide is a major global public health problem with more than 800,000 incidents worldwide annually. Seventy-five percent of the global suicides occur in low and middle-income countries (LMICs). Pakistan is a LMIC where information on suicidal behavior is limited. The aim of the review is to map available literature on determinants, risk factors and other variables of suicidal behavior in Pakistan.

Method

This study was based on Arksey and O’Malley’s methodological framework of scoping review, combining peer reviewed publications with grey literature. Ten databases including Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Trials Register (CRG), Cumulative Index to Nursing and Allied Health (CINAHL), National Library of Medicine Gateway (NLMG), ExcerptaMedica (EMBASE), National Library of Medicine’s MEDLINE (PUBMED), PSYCHINFO, Social Science Citation Index and Science Citation Index (SCI) and Pakmedinet.​com were searched from the beginning of their time frames until December 2016 using a combination of key terms. The inclusion criteria included studies of various study designs covering different aspects of suicidal behavior in English language.

Results

Six hundred and twenty three articles were initially retrieved from all ten databases. Two independent reviewers screened the titles and abstracts for relevance. One hundred and eighteen articles were read in full, out of which 11 were excluded because they did not fit the eligibility criteria. One hundred and ten articles, including two student theses and one report, were included in the final review. Most studies were descriptive in nature, with only three that used a case-control design. Majority of the studies were from urban areas, and addressed determinants rather than risk factors. Gender differences and age were predominantly reported, with more males committing suicide. Suicidal behavior was more common among individuals younger than 30 years of age. The three most common methods for suicides were hanging, poisoning and use of firearms. Mental illness as a risk factor for suicides was mentioned in only three studies.

Conclusions

This review is the first attempt to synthesize available literature on suicidal behavior in Pakistan. The evidence is limited, and calls for more robust analytical research designs, along with a focus on risk factors.
Literature
1.
2.
Khan MM, Reza H. Gender differences in non-fatal suicidal behavior in Pakistan: significance of sociocultural factors. Suicide Life Threat Behav. 1998;28:62–8.PubMed
3.
4.
Jacob K. The prevention of suicide in India and the developing world: the need for population-based strategies. Crisis. 2008;29:102–6.CrossRefPubMed
5.
Jordans MJ, Kaufman A, Brenman NF, Adhikari RP, Luitel NP, Tol WA, et al. Suicide in South Asia: a scoping review. BMC Psychiatry. 2014;14:1.CrossRef
6.
7.
8.
9.
10.
Khan MM, Ali Hyder A. Suicides in the developing world: case study from Pakistan. Suicide Life Threat Behav. 2006;36:76–81.CrossRefPubMed
11.
12.
13.
Mahmood S. The Pakistan penal code (XLV of 1880), vol. II, sections 300–374. Legal Research Centre: Lahore; 1989.
14.
Shahid M, Khan MM, Saleem Khan M, Jamal Y, Badshah A, Rehmani R. Deliberate self-harm in the emergency department: experience from Karachi, Pakistan. Crisis. 2009;30:85–9.CrossRefPubMed
15.
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Intl J Soc Res Methodol. 2005;8:19–32.CrossRef
16.
Soomro GM. Deliberate self-harm (and attempted suicide). BMJ clinical evidence. 2008;
17.
Silva RJ, Santos FA, Soares NM, Pardono E. Suicidal ideation and associated factors among adolescents in Northeastern Brazil. Sci. World J. 2014;
18.
19.
20.
Badger D, Nursten J, Williams P, Woodward M. Should all literature reviews be systematic? IJRE. 2000;14:220–30.
21.
Ahmed Z, Ahmed A, Mubeen SM. An audit of suicide in Karachi from 1995–2001. Ann Abbasi Shaheed Hosp. 2003;8:424–8.
22.
Bashir MZ. Suicidal deaths: assessment in Peshawar. The Professional. 2003;
23.
Shaikh JM, Siddiqui FG, Soomro AG. Management of acute organophosphorus insecticide poisoning: an experience at a university hospital. JLUMHS. 2008;7:96–101.
24.
Javed MA. Suicidal symptoms in depressed Pakistani patients. J Pak Med Assoc. 1996;46:69–70.PubMed
25.
Khan MM, Reza H. Methods of deliberate self-harm in Pakistan. The Psychiatrist Bulletin. 1996. Jun 1;20:367–8.CrossRef
26.
Malik S, Rana P, Rasheed A, Farrukh R, Aziz K. Self-inflicted or homicidal cut throat: a retrospective study. Ann King Edward Med Uni. 1999;5:325.
27.
Khan MM, Ahmed A, Khan SR. Female suicide rates in Ghizer, Pakistan. Suicide Life-Threat Behav. 2009;39:227–30.CrossRefPubMed
28.
Khan MM, Mahmud S, Karim MS, Zaman M, Prince M. Case–control study of suicide in Karachi, Pakistan. Br J Psychiatry. 2008;193:402–5.CrossRefPubMed
29.
Rasheed S, Sawal M, Taj R, Najam N. Relationship between suicidal ideation, social support and coping skills in female prisoners of a jail in Pakistan. J Pak Psych Soc (JPPS). 2005;2
30.
Haider S, Haider I. Deliberate self-harm. J Pak Med Sci. 2001;17:1–7.
31.
Haider S, Haider I. Suicidal Behavior (Parasuicide). Med Channel. 2002;8:9–12.
32.
Asif A, Yusuf F, Haider K, Gul H, Usman S, Akbar S, et al. Epidemiology of attempted suicides in emergency of Mayo Hospital in 2004. Ann King Ed Med Uni. 2016;11
33.
Khurram M, Mahmood N. Short communication-deliberate self-poisoning: experience at a medical unit. J Pak Med Assoc. 2008;58:455.PubMed
34.
Shoaib S, Nadeem MA, Khan ZU. Causes and outcome of suicidal cases presented to a medical ward. Ann King Ed Medic Uni. 2016.7;11(1).
35.
Babar M, Qazilbash AA. Factors associated with increased suicides among Pakistani youth: A case study of 366 attempted suicides in Sindh.
36.
Husain N, Afsar S, Ara J, Fayyaz H, Ur Rahman R, Tomenson B, Hamirani M, Chaudhry N, Fatima B, Husain M, Naeem F. Brief psychological intervention after self-harm: randomised controlled trial from Pakistan. Br J Psychitary. 2014;204:462–70.CrossRef
37.
Hussain AM, Sultan ST. Organophosphorus insecticide poisoning: management in surgical intensive care unit. JCPSP. 2005;15:100–2.PubMed
38.
Shahid M, Hyder AA. Deliberate self-harm and suicide: a review from Pakistan. Int J Inj Control Saf Promot. 2008;15:233–41.CrossRef
39.
Khan MM, Reza H. Benzodiazepine self-poisoning in Pakistan: implications for prevention and harm reduction. J Pak Med Assoc. 1998;48:293–5.PubMed
40.
Jamil H, Khan A, Akhtar S, Sultana N. Patients with acute poisoning seen in the department of intensive care-Jinnah postgraduate medical Centre, Karachi. J Pak Med Assoc. 1977;27:358–60.PubMed
41.
Kahn DL, Lester D. Efforts to decriminalize suicide in Ghana, India and Singapore. Suicidology Online. 2013;4:96–104.
42.
Farooq U, Majeed M, Bhatti JA, Khan JS, Razzak JA, Khan MM. Differences in reporting of violence and deliberate self harm related injuries to health and police authorities, Rawalpindi, Pakistan. PLoS One. 2010;5:e9373.CrossRefPubMedPubMedCentral
43.
McLean J, Platt S, Harris F, Repson R. Risk and protective factors for suicide and suicidal behaviour: a literature review. 2008.
44.
45.
Shah A, De T. Suicide and the elderly. Intl J Psych Clinical Pract. 1998;2:3–17.CrossRef
46.
Shahid M, Iqbal R, Khan MM, Khan MZ, Shamsi US, Nakeer R. Risk factors for deliberate self-harm in patients presenting to the emergency Departments of Karachi. J Coll Physicians Surg Pak. 2015;25:50.PubMedPubMedCentral
47.
Qadir F, Khan MM, Medhin G, Prince M. Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age-a life course perspective. BMC Pub Health. 2011;11:1.CrossRef
48.
Raja KS, Fazal MO, Bilal A, Qurashi FS, Shaheen M. Organophosphorus compound poisoning; epidemiology and management (atropinization vs pralidoxime) a descriptive analysis, in allied hospital Faisalab. Professional Med J. 2008;15:518–23.
49.
Syed EU, Khan MM. Pattern of deliberate self-harm in young people in Karachi, Pakistan. Crisis. 2008;29:159–63.CrossRefPubMed
50.
Haider S, Haider I. Deliberate self-poisoning (unemployment and debt). J Pak Med Sci. 2002;18:122–5.
51.
Sathar ZA, Kazi S, Mahmood A. Pakistani couples: different productive and reproductive realities. The Pakistan Development Review. 2000:891–912.
52.
Pearson M, Konradsen F, Gunnell D, Dawson AH, Pieris R, Weerasinghe M, Knipe DW, Jayamanne S, Metcalfe C, Hawton K, Wickramasinghe ARA. Community-based cluster randomised trial of safe storage to reduce pesticide self-poisoning in rural Sri Lanka: study protocol. BMC Public Health. 2011;11:879.CrossRefPubMedPubMedCentral
53.
54.
Tahir M, Raja J, Haq I. Acute Organophosphorous poisoning-an experience. PAMFJ. 2006;56
55.
Tahir SM, Memon AR, Kumar M, Ali SA. Self inflicted burn; a high tide. J Pak Med Associ. 2010;60:338.
56.
Jamil H, Kundi A, Akhtar S, Sultana N. Organo-phosphorus insecticide poisoning-review of 53 cases. J Pak Med Assoc. 1977;27:361–3.PubMed
57.
Ahmed SH, Zuberi H. Changing pattern of suicide and parasuicide in Karachi. J Pak Med Assoc. 1981;31:76–8.PubMed
58.
Noor NA, Qazi NA, Chaudhry GM, Masood M, Hashmat MA, Asif AH. Acute poisoning in adults in Multan. JPMA. J Pak Med Assoc. 1988;38:305–6.PubMed
59.
Jamil H. Acute poisoning: a review of 1900 cases. J Pak Med Assoc. 1990;40:131–3.PubMed
60.
Khan MM, Islam S, Kundi A. Parasuicide in Pakistan: experience at a university hospital. Acta Psychiat Scan. 1996;93:264–7.CrossRef
61.
Waseem T, Raza T, Nasir N, Khan A. Myocardial damage after suicidal ingestion of wheat preservative Aluminium phosphide. PJC. 1997;8:43–8.
62.
Aziz K, Awan NR. Pattern of suicide and its relationship to socio-economic factors/depressive illness in the city of Lahore. Specialist Quarterly karachi. 1999;15:289–94.
63.
Bashir MZ, Malik AR, Malik SA, Rana PA, Aziz K, Chaudhry MK. Pattern of fatal compression of the neck. A five year study in Lahore. Annals. 2000;6:396–8.
64.
Rana PA, Farrukh R, Malik SA, Rasheed A. Incidence of fatal poisoning in the city of Lahore: a retrospective study during 1984-88 Lahore. Ann KE Med Coll. 2000;6:112–5.
65.
Khalid N. Pattern of suicide: causes and methods employed. JCPSP. 2001;11:759–61.
66.
67.
Bunggush RA, Anwar T. Preliminary survey for pesticide poisoning in Pakistan. Pak J Biol Sci. 2000;3:1976–8.CrossRef
68.
Agha, S. Suicidal behavior as a function of psychosocial risk factors in Pakistan. 2001.
69.
Khan MZ, Naeem A, Mufti KA. Prevalence of mental health problems in acne patients. J Ayub Med Coll Abbottabad. 2001;13:7.PubMed
70.
Ghazanfar S, Leghari A, Qureshi S, Niaz SK, Quraishy MS. Corrosive esophageal strictures: behavior, pattern and response to dilatation. J Gastroenterol Hepatol. 2010;1(25):A129–30.
71.
Ahmad R, Ahad K, Iqbal R. Acute poisoning due to commercial pesticides in Multan. Pak J Med Sci. 2002;18:227–31.
72.
Sultana K. Proportion of suicidal deaths among autopsy. Ann Abbasi Shaheed Hosp. 2002;7:317–8.
73.
Hasan Z, Rehman A, Khurram M, Shah W. Self-inflicted injuries: the standing medical board experience. JCPSP. 2002;12:18–21.
74.
Saeed A, Bashir MZ, Khan D, Iqbal J, Raja KS, Rehman A. Epidemiology of suicide in Faisalabad. J Ayub Med Coll Abbottabad. 2002;14:34–7.PubMed
75.
Muhammad NK, Shamim H. Deliberate self harm due to organophosphates. JPIMS. 2003;14:784–9.
76.
Ali SM, Bashir MZ, Hussain Z, Kaheri GQ, Khalil IU. Unnatural female deaths in Peshawar. JCPSP. 2003;13:198–200.PubMed
77.
Ali SM, Khalil IU, Saeed A, Hussain Z. Five years audit for presence of toxic agents/drug of abuse at autopsy. JCPSP. 2003;13(9):519–21.PubMed
78.
Safdar A, Saeed A, Muhammad NR. Organophosphorus poisoning: emergency management in intensive care unit. Prof. 2003;10:308–14.
79.
Farooqi YN. Comparative study of suicide potential among Pakistani and American psychiatric patients. Death studies. 2004 Jan 1;28:19–46.CrossRefPubMed
80.
Valika R, Jalbani AA. Suicide Trends: Incidences from Pakistan. JISR. 2004;2:44.
81.
Farooqi AN, Tariq S, Asad F, Abid F, Tariq O. Epidemiological profile of suicidal poisoning at Abbasi Shaheed hospital. Ann Abbasi Shaheed Hosp Med & Dental Coll. 2004;9:502–5.
82.
Waseem T, Nadeem MA, Irfan K, Waheed I. Poisonings in patients of medical coma and their outcome at Mayo Hospital Lahore. Ann King Edward Med Uni. 2016 May;16:10(4).
83.
84.
Kermani F, Ather NA, Ara J. Deliberate self harm: frequency and associated factors. J surg Pak. 2006;11:34–6.
85.
Aziz K, Afridi HK, Khichi ZH. Psychological autopsy study of suicide pattern and its relationship to depressive illness. Ann King Ed Med Uni. 2006;12
86.
Suliman MI, Jibran R, Rai M. The analysis of organophosphates poisoning cases treated at Bahawal Victoria hospital, Bahawalpur in 2000–2003. Pak J Med Sci. 2006;22:244–9.
87.
Rathore R, Muhammad U. Morbidity, mortality and Management of Wheat Pill Poisoning. J services Inst Med Sci. 2007;2:14–8.
88.
Ahmad M, Hussain SS, Khan MI, Malik SA. Experience of burn injuries at the Pakistan institute of medical science, Islamabad, Pakistan. Annals of burns and fire Disasters. 2007;20:7.PubMedPubMedCentral
89.
Shahid M, Khan MM, Naqvi H, Razzak J. Cost of treatment of deliberate self-harm: a study from Pakistan. Crisis. 2008 Jul;29:213–5.CrossRefPubMed
90.
Karmaliani R, Irfan F, Bann CM, Mcclure EM, Moss N, Pasha O, Goldenberg RL. Domestic violence prior to and during pregnancy among Pakistani women. Acta Obstet Gynecol Scand. 2008;87:1194–201.CrossRefPubMed
91.
Patel MJ, Shahid M, Riaz M, Kashif W, Ayaz SI, Khan MS, Samdani AJ, Sorathia AL, Furqan M. Drug overdose: a wake up call! Experience at a tertiary care centre in Karachi, Pakistan. J Pak Med Assoc. 2008;58:298.PubMed
92.
Zakiullah N, Saleem S, Sadiq S, Sani N, Shahpurwala M, Shamim A, Yousuf A, Khan MM, Nayani P. Deliberate self-harm: characteristics of patients presenting to a tertiary care hospital in Karachi, Pakistan. Crisis. 2008;29:32–7.CrossRefPubMed
93.
Khan, Z. Causes of high rate of suicide among women in Chitral. n.d.
94.
Farooq IA, Afzal W, Salman M. Medicolegal aspect of burn victims: a ten years study. Pak J Med Sci. 2009;25(5):797–800.
95.
Ayub N. Measuring hopelessness and life orientation in Pakistani adolescents. Crisis. 2009;30:153–60.CrossRefPubMed
96.
Khalil ZH, Naeem M, Adil M, Khan MZ, Abbas SH. Analysis of autopsy record of unnatural deaths in Peshawar district. J Postgrad Med Inst. 2013;27
97.
Rizwan, M. Self-esteem deficits and suicidal tendencies among psychiatric patients. 2010.
98.
Faruqui R, Bashir A, Taj A, Khan A, Yousaf F, Waheed F, Ayub Z, Bibi A. Prevalence of suicidal ideation and desire for death in a group of female muslim students one year after exposure to suicide bomb attack in Pakistan. Eur Psychiatry. 2011;26:1663.CrossRef
99.
Naz R. Lethality of suicidal Organophosphorous poisoning in Karachi in 2010. Medical Forum. 2012;
100.
Ali TS, Krantz G, Mogren I. Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan. Int J Womens Health. 2012;4:577.CrossRefPubMedPubMedCentral
101.
Kumar K, Chand H, Shaikh SA. Spectrum of Medicolegal Cases in Physical Injury at Chandka Medical College, Larkana, Pakistan. Thorax. 487:4–81.
102.
Lakhair AL, Shaikh MA, Kumar S, Zafarullah, Bano R, Maheshwari BK. Frequency of Various Clinical and Electrocardiac Manifestation in Patients with Acute Organophosphorous Compound (OPC) Poisoning. JLUMHS. 2012;11:34.
103.
Mirza FH, Memon AA, Adil SE, Paryar HA. Audit of custodial deaths in Karachi—an autopsy-based study. J Pak Med Assoc. 2012;62:752.PubMed
104.
Ali P, Anwer A, Bashir B, Jabeen R, Haroon H, Makki K. Clinical pattern and outcome of organophosphorus poisoning. J Liaq Uni Med Health Sci. 2012;11:15–8.
105.
Khetran AK, Rehman S, Khan Z, Baloch MU. Incidence of deaths due to gunshot injuries at district Barkhan, Balochistan. JLUMHS. 2012;11:90.
106.
Riaz R, Agha S. Efficacy of cognitive behavior therapy with deliberate self-harm in incarcerated women. Pak J Psychol. 2012;27:21.
107.
Tahir MN, Akbar AH, Naseer R, Khan QO, Khan F, Yaqub I. Suicide and attempted suicide trends in Mianwali, Pakistan: social perspective/Tendances des suicides et des tentatives de suicide à Mianwali (Pakistan)^ sup o^: perspective sociale. East Mediterr Health J. 2013;19:S111.
108.
Ali TS, Mogren I, Krantz G. Intimate partner violence and mental health effects: a population-based study among married women in Karachi, Pakistan. Int J Behav Med. 2013;20:131–9.CrossRefPubMed
109.
Ayub M, Mushtaq I, Mushtaq S, Hafeez MA, Helal N, Irfan M, Hassan B, Tiffin P, Naeem F. Domestic violence, mental illness and suicidal ideation–a study from Lahore, Pakistan. J Ment Health. 2013;22:474–81.CrossRefPubMed
110.
Raza MS, Jaffery SA, Khan FA. Flexor zone 5 cut injuries: emergency management and outcome. J Coll Physicians Surg Pak. 2014;24:194–7.PubMed
111.
Shaikh MA. Prevalence and correlates of suicidal expression among school attending adolescents in Pakistan. J Pak Med Assoc. 2014;64:99–100.PubMed
112.
Salman S, Idrees J, Hassan F, Idrees F, Arifullah M, Badshah S. Predictive factors of suicide attempt and non-suicidal self-harm in emergency department. Emergency. 2014;2:166.PubMedPubMedCentral
113.
Saaiq M, Ashraf B. Epidemiology and outcome of self-inflicted burns at Pakistan Institute of Medical Sciences, Islamabad. Plast Reconstr Surg. 2014 Jul;3:107.
114.
Osama M, Islam MY, Hussain SA, Masroor SM, Burney MU, Masood MA, Menezes RG, Rehman R. Suicidal ideation among medical students of Pakistan: a cross-sectional study. J Forensic Legal Med. 2014;27:65–8.CrossRef
115.
Shagufta S, Boduszek D, Dhingra K, Kola-Palmer D. Criminal social identity and suicide ideation among Pakistani young prisoners. Int J Prison Health. 2015;11:98–107.CrossRefPubMed
116.
Rao S, Shah N, Jawed N, Inam S, Shafique K. Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals. BMC Public Health. 2015;15:431.CrossRefPubMedPubMedCentral
117.
Asad N, Karmaliani R, Sullaiman N, Bann CM, McClure EM, Pasha O, Wright LL, Goldenberg RL. Prevalence of suicidal thoughts and attempts among pregnant Pakistani women. Acta Obstet Gynecol Scand. 2010;89:1545–51.CrossRefPubMedPubMedCentral
Metadata
Title
Suicide and deliberate self-harm in Pakistan: a scoping review
Authors
Sualeha S. Shekhani
Shagufta Perveen
Dur-e-Sameen Hashmi
Khawaja Akbar
Sara Bachani
Murad M. Khan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1586-6

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