Pattern of deliberate self-harm in young people in Karachi, Pakistan

Globally, suicide remains one of the leading causes of death among individuals aged 10 to 64 years and it ranks between second and fourth among those age 10 to 45 years. Data on suicidal behavior from Pakistan is sparse, especially for children and adolescents. A retrospective descriptive case note study was carried out of all patients under the age of 18 years (n = 69) admitted with deliberate self-harm (DSH) to a university hospital in Karachi, Pakistan. Females (63.8%) outnumbered males by 1.7:1. The mean age of the group was 16 years (+/- 2.2). The most frequent method used was benzodiazepine overdose (30.4%). "Family conflicts" was the main stressor reported by 66.7%. The most frequent diagnosis made was major depressive disorder in 18%. Despite the fact that 98% of our sample was Muslims and suicide is strictly forbidden in Islam, 76.8% expressed their intent to die. Multivariate logistic regression found current stressor to be significantly associated with an intention to die. Patients with nonfatal suicidal behavior form a pool for future suicides. Preventive efforts should be directed at this group. School based programs would be an effective way of addressing this.