Deliberate self harm and suicide: A review from Pakistan

The specific objectives of this paper are to identify risk factors for active mechanisms of Deiberate self harm (DSH) and suicide in Pakistan; to assess the burden of DSH and suicide in Pakistan; and to explore (the potential) role of an Emergency Department in DSH and suicide treatment and control in Pakistan. A systematic review was conducted to identify risk factors and causes of deliberate self harm and suicide in Pakistan- a Muslim, South Asian nation. In addition, the role of emergency department based surveillance is explored. Four electronic databases (PubMed, CINAHL Plus, MDConsult, PakMediNet) were searched and 23 studies were reviewed. Risk factors for deliberate self harm included young age (less than 35 years), being female, occupation (housewives), being married, and low socioeconomic status; while reported risk factors for suicide were young age (less than 35 years), male gender, being married, and low socioeconomic status. Medications were commonly used for deliberate self harm while firearm, hanging and organophosphorus poisoning were more frequent means for suicide. The most common reported cause for both health outcomes was interpersonal conflict. There is accumulating evidence that deliberate self harm and suicide have increased in recent years in Pakistan.  There is a need for greater attention and in-depth studies to elaborate on causative mechanisms for these public health issues. Preventive strategies should be adopted at national level such as restricted access to lethal means of suicide, reduction of sale of certain toxic pesticides, and controls on Benzodiazepines prescription.