Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

Safdar, Maria; Afzal, Khalid I.; Smith, Zoe R.; Ali, Filza; Zarif, Pervaiz; Baig, Zahid Farooq

doi:10.1192/bjo.2021.923

Cited by 12 publications

(15 citation statements)

References 105 publications

(146 reference statements)

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“…Our data shows a higher percentage of completed suicides in men (61.87%) compared to women (38.12%), with a male-to-female ratio of 1.6:1. This trend is comparable to previous studies done in the region (Khan & Reza, 2000 ; Safdar et al, 2021 ; Värnik, 2012 ). Most of the completed suicides were reported in individuals ages < 30 years (71.1%).…”

Section: Discussionsupporting

confidence: 92%

“…With their easy availability, low cost, lack of regulation, and high lethality, both have been established as frequently used methods in Pakistan. However, there is a geographical variation, with Kala Patthar being more prevalent in South Punjab and Sindh and wheat pills more frequently used in central and northern Punjab (Safdar et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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Sociodemographic Characteristics and Patterns of Suicide in Pakistan: An Analysis of Current Trends

Sattar

Tahir

Imran

et al. 2023

Community Ment Health J

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Suicide is a global phenomenon with about 79% of suicides occurring in low and middle-income countries. This study investigated current trends, demographics, and characteristics of completed suicides based on reports from leading Pakistani Newspapers. This study performed a qualitative analysis of completed suicides in Pakistan's four newspapers from January 1st, 2019, through December 31st, 2020. Data about socio-demographic characteristics, methods of suicide, possible motives, and associated features were analyzed. 2295 suicides were reported in Pakistan during 2019 and 2020. About 61.87% were completed by men, and 38.12% by women. The most suicides occurred in individuals ages < 30 years. The predominant method of suicide in this group was ingestion of poisonous substances. The most commonly reported reasons for suicide were domestic conflicts, financial problems, and failure in love/marriage. By providing insight into characteristics of suicide, this study highlights the need for effective suicide prevention policies and programs to tackle rising rates of suicide in Pakistan.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Sociodemographic Characteristics and Patterns of Suicide in Pakistan: An Analysis of Current Trends

Sattar

Tahir

Imran

et al. 2023

Community Ment Health J

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“…The estimated age-standardized suicide rate in Pakistan is 4.4 per 100,000 people [22]. The suicide death rates in neighboring India, Bangladesh, and Sri Lanka are 13.33, 5.73, and 7.55 per 100,000 people, respectively [23]. Despite the low estimated rate, recent data suggest that suicide is becoming a significant public health problem in Pakistan [24].…”

Section: Introductionmentioning

confidence: 99%

Mapping Institutional Interventions to Mitigate Suicides: A Study of Causes and Prevention

Ullah

Shah²,

Khan

et al. 2021

IJERPH

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Suicide is an extreme, tragic act and an important subject for social inquiry. It is the rising public health issue prevalent in the Himalayan range of Pakistan. The young and educated population is more prone to suicide instead of using this prime phase of age productively. Unfortunately, the suicide problem remains unaddressed, the causes remain undefined, solutions are not in the works, and in situations when others play a part in driving someone to commit suicide, no one is being held accountable. This study is aimed at uncovering the root causes of suicide and proposing some preventive measures to mitigate the problem. Our team studied three years’ worth of data (2017–2019) on suicides from the office of Human Rights Commission of Pakistan, Chitral. In addition, we conducted semi-structured interviews of different stakeholders, including family members, neighbors, lawyers, and police personnel. The findings revealed that extended family pressures, the power dynamic between sustainers and dependents, family conflicts, and inheritance cases were the major causes of the domestic violence that preceded suicide attempts. Mental health issues, forced marriages, academic competitions, and flawed litigation processes were also among the leading causes of suicide. Awareness through education and religious sermons, strengthening healthcare organizations, restructuring family systems, establishing police complaint centers, effective prosecution processes, and imparting lifesaving skills have been identified as measures to prevent suicide. This study has theoretical and practical implications, as it adds certain novel variables regarding the causes and solutions of suicide to the existing body of literature and guides public authorities to strengthen institutions to intervene effectively.

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“…Case fatality amongst those who ingest aluminium phosphide tablets is greater than 50% despite treatment [ 155 – 159 ]. Wheat pill poisoning is common in north Pakistani wheat-growing areas such as Peshawar [ 48 ], Lahore [ 109 ], Rawalpindi and Sahiwal [ 145 ], while such poisonings have not been noted in the southern Sindh region where wheat is not a key crop [ 21 ], showing again the importance of agent availability for self-poisoning. Similarly, aluminium phosphide tablets are a major problem in north India but not the south where they are little used in agriculture [ 156 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pakistan’s progressive step in December 2022 to decriminalize suicide should improve suicide reporting. Taking into consideration the unreported suicides, it is likely that more than 19,331 suicides occur every year in Pakistan, with poisoning, firearms, and hanging being the top three means of suicide [ 19 , 21 , 22 ]. Pesticides are likely to be the most important means of suicide by poisoning.…”

Section: Introductionmentioning

confidence: 99%

Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation

et al. 2023

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Introduction Suicide is a major public health problem in Pakistan, accounting to approximately 19,331 deaths every year. Many are due to consumption of acutely toxic pesticides; however, there is a lack of national suicide data, limiting knowledge and potential for intervention. In this paper, we aimed to review the literature on pesticide self-poisoning in Pakistan to identify the most problematic pesticides in relation to national pesticide regulations. Methods Information on the currently registered and banned pesticides was obtained from Ministry of National Food Security and Research while data on pesticide import and use was extracted from FAOSTAT. We searched the following sources for articles and research papers on poisoning in Pakistan: Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, Applied Social Sciences Index and Abstracts (ASSIA), Excerpta Medica (EMBASE), National Library of Medicine’s MEDLINE (PUBMED), PS102YCHINFO and Pakmedinet.com using the search terms ‘self-poisoning’, ‘deliberate self-harm’, ‘suicide’, ‘methods and means of suicide’, ‘organophosphate’, ‘wheat pill’, ‘aluminium phosphide’, ‘acute poisoning’, OR ‘pesticides’, AND ‘Pakistan’. Results As of May 2021, 382 pesticide active ingredients (substances) were registered in Pakistan, of which five were WHO hazard class Ia (extremely hazardous) and 17 WHO hazard class Ib (highly hazardous). Twenty-six pesticides, four formulations, and seven non-registered pesticides had been banned, of which two were WHO class Ia and five Ib. We identified 106 hospital-level studies of poisoning conducted in Pakistan, of which 23 did not mention self-poisoning cases and one reported no suicidal poisoning cases. We found no community or forensic medicine studies. Of 52,323 poisoning cases identified in these papers, 24,546 [47%] were due to pesticides. The most commonly identified pesticide classes were organophosphorus (OP) insecticides (13,816 cases, 56%) and the fumigant aluminium phosphide (3 g 56% tablets, often termed ‘wheat pills’; 686 cases, 2.7%). Few studies identified the particular pesticides involved or the resulting case fatality. Conclusion We found pesticide poisoning to be a major cause of poisoning in Pakistan, with OP insecticides and the fumigant aluminium phosphide the main pesticides identified. Withdrawal of Class I pesticides (as proposed to occur nationally in 2022) and high concentration aluminium phosphide tablets should rapidly reduce suicidal deaths by reducing the case fatality for low-intention poisoning cases. National cause of death data and forensic toxicology laboratory data identifying the pesticides responsible for deaths will be important to assess impacts of the proposed national ban.

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Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades

Cited by 12 publications

References 105 publications

Sociodemographic Characteristics and Patterns of Suicide in Pakistan: An Analysis of Current Trends

Sociodemographic Characteristics and Patterns of Suicide in Pakistan: An Analysis of Current Trends

Mapping Institutional Interventions to Mitigate Suicides: A Study of Causes and Prevention

Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation

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