Deliberate self harm and suicide in Pakistan: A systematic review of literature

Objective: The objective of this systematic review of the literature was to identify risk factors and causes of deliberate self harm (DSH) and suicide in Pakistan. Data Sources: Four electronic databases (PubMed, CINAHL Plus, MDConsult and PakMediNet) were searched to identify potentially relevant articles. A combination of text words like (deliberate self harm, suicide, poisoning, depression, South Asian women, Emergency Department, Pakistan, Islam) were used to search the relevant literature. Study Selection: Thirty studies were selected for this review. Both indexed and non indexed journal articles were included. Data Extraction: The data summarized included study design, data sources, participants, risk factors, outcomes and results. Results: Most of the studies were descriptive mostly based on retrospective record review of in-patient hospital populations, police reports or newspaper reports. Risk factors for DSH in Pakistan included characteristics young females, housewives, married and low socioeconomic status. Risk factors of suicide in most studies were young males, married and low socioeconomic status. Medications like benzodiazepines or organophosphorus were most commonly used for DSH. Firearm, hanging, organophosphorus use were the commonest methods used for suicide. Interpersonal relationship problem was the most common reason for both DSH and suicide. Conclusions: Accumulating evidence suggests that incidences of both DSH and suicide have increased in recent years. There is a need for prospective studies (case control and cohort) as well as interventional studies to help people at individual, family and state levels.