Case–control study of suicide in Karachi, Pakistan

Abstract

Suicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated. The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan.

Suicide and poverty in low-income and middle-income countries: a systematic review

“…We assessed 29 (78%) studies to be of high [30][31][32][33][34][35][36][37][38][39][40][41][42][43] or acceptable [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] quality (Table 3). Eight studies [59][60][61][62][63][64][65][66] were of low quality due to problems with risk of bias: performance, attrition and detection bias (interrupted-time series); selection bias, unclear case definitions, detection bias, lack of adjustment for confounding factors (case-control studies); detection bias, lack of adjustment for confounding factors (cross sectional and ecological studies).…”

“…Six 31,38,49,51,59,62 focused on completed suicide and six 30,32,39,41,46,54 on non-fatal SIB, with one 52 looking at both dimensions. Among the seven studies reporting on completed suicide, three 31,51,62 reported a positive and one 38 a null association between completed suicide and unemployment using bivariate analysis.…”

“…Six 31,38,49,51,59,62 focused on completed suicide and six 30,32,39,41,46,54 on non-fatal SIB, with one 52 looking at both dimensions. Among the seven studies reporting on completed suicide, three 31,51,62 reported a positive and one 38 a null association between completed suicide and unemployment using bivariate analysis. Results were mixed when studies used multivariate analysis, with one 59 showing a positive association with female low labour force participation in Iran (r=-0•38),one 52 reporting null association with unemployment rates amongst the working age population in Sri Lanka (IRR=1•29, 95% CI 0•96-1•72), and another 49 unclear association with unemployment rates amongst men and women in Belarus.…”

Prevalence and risk factors of suicide in a rural area of Shandong province in mainland China: a case control study

“…Married status as a protective factor and a risk factor for suicide has also been reported in other countries. In India, Pakistan, and Iran, being married appeared to a risk factor for suicide, especially for women [21][22][23] . However, most studies from Asia, Europe, New Zealand, and the United States have shown that married status had some protective effect against suicide, especially for men [6,[16][17][18][19][28][29][30][31] .…”

“…Similarly, being unmarried has also been identified as a risk factor for suicide in the majority of previous studies [1,[16][17][18][19][26][27][28][29][30][31] . However, in India, Pakistan, and Iran, majority of suicide victims were married and being married was even a risk factor for suicide, especially in women [21][22][23] . History of mental illness has also been reported as a robust risk factor for suicide in developed counties [1,25] , but in China, more than 47% suicide victims did not have a psychiatric diagnosis at the time of death [4,[32][33][34] .…”