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

Abstract

BackgroundSuicide 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.MethodThis 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.ResultsSix 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.ConclusionsThis 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.

Association Between Suicidal Behavior and Clinical Features of Premenstrual Syndrome and Menstrual History: A Cross Sectional Study

“…Adjustment of OR for age, presence of mental illness, and residence area was performed because these factors might influence the frequency of suicide behavior. For instance, in a review about suicide and deliberate self-harm in Pakistan, suicide behavior was more common in individuals younger than 30 years of age [ 23 ]. In some mental disorders (postpartum depression or psychosis, bipolar disorder), it has been reported a higher risk of suicide behavior [ 24 ].…”

A Protective Model for Suicidal Behaviors in American and Pakistani College Students

“…Pakistani women often express distress resulting from a confluence of social and economic pressure. For instance, social strain resulting from expectations to marry and have children early, curtail educational pursuits, and take on demanding familial and domestic responsibilities may increase engagement in nonlethal and lethal forms of suicidal behaviors (Shekhani et al., 2018). Overall, these results call for immediate action regarding the creation and implementation of suicide prevention efforts for college students in both countries, but especially for young Pakistani women.…”

“…Each model controlled for age and gender. Age and gender were chosen as covariates because previous research highlights gender and age-based differences in reports of depression and suicide-related outcomes among U.S. and Pakistani samples (Lamis & Lester, 2013; Shekhani et al., 2018; Stephenson, Belesis, & Balliet, 2005). Our dependent variable (suicidal behaviors) was transformed (log 10 ) for all regression analyses to correct for its nonnormal distribution.…”

Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan, Pakistan

“…There is need for training of healthcare as well as nonhealth personals (lay workers, caregivers, affected individuals) in detection and referral of people with MH problems [36]. The system of investigation and diagnosis of suicide cases in Pakistan needs improvement urgently through of police, medical doctors, forensic medical, and medico-legal personnel [37].…”