Epidemiology of suicide in Pakistan: determining rates in six cities
TL;DR: There is urgent need for a standard system of recording of suicides in Pakistan, so that true rates can be determined and this will help in informing policy and monitoring effectiveness of suicide prevention programs.
Abstract: In recent years suicide has become a major public health problem in Pakistan. Despite this there are no official statistics on suicide and national rates are unknown. To determine rates we carried out an analysis of suicide reports from six cities in Pakistan. Rates vary from 0.43/100,000 in Peshawar to 2.86/100,000 in Rawalpindi. Rates for men are consistently higher than women; highest rates for men were 7.06/100,000 between the ages 20-40 years in Larkana, Sindh province. Given the legal, socio-cultural, and religious stigma of suicides in Pakistan, we believe these figures to be an underestimate. There is urgent need for a standard system of recording of suicides in Pakistan, so that true rates can be determined. This will help in informing policy and monitoring effectiveness of suicide prevention programs.
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TL;DR: Examining the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention finds it more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies.
Abstract: As the largest continent in the World, Asia accounts for about 60% of World suicides. Preventing suicide by restricting access to suicide methods is one of the few evidence-based suicide prevention strategies. However, there has been a lack of systematic exploration of suicide methods in Asian countries. To amend this shortage, the current review examines the leading suicide methods in different Asian countries, their trend, their age- and sex- specific characteristics, and their implications for suicide prevention. In total, 42 articles with leading suicide methods data in 17 Asian countries/regions were retrieved. The epidemiologic characteristics and recent trends of common suicide methods reflect specific socio-cultural, economic, and religious situations in the region. Common suicide methods shift with the introduction of technologies and constructions, and have specific age- or sex-characteristics that may render the restriction of suicide methods not equally effective for all sex and age sub-groups. Charcoal burning, pesticide poisoning, native plant poisoning, self-immolation, and jumping are all prominent examples. In the information society, suicide prevention that focuses on suicide methods must monitor and control the innovation and spread of knowledge and practices of suicide “technologies”. It may be more cost-effective to design safety into technologies as a way of suicide prevention while there is no rash of suicides yet by the new technologies. Further research on suicide methods is important for public health approaches to suicide prevention with sensitivity to socio-cultural, economic, and religious factors in different countries.
136 citations
Cites background from "Epidemiology of suicide in Pakistan..."
...Due to stigmatization and legal sanctions against suicide, under-reporting of suicide rates in these Muslim countries may partly contribute to the extremely low rate [6,10]....
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TL;DR: The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates, and reports are likely to diminish rather than exaggerate the magnitude of suicide rates.
Abstract: Globally, suicide is an important cause of mortality. In low- and middle income settings, it is difficult to find unequivocal data to establish suicide rates. The objective of this review is to synthesize the reporting of suicide incidence in six south Asian countries. We conducted a scoping review combining peer-reviewed studies (PubMed, PsycINFO, EMBASE) with in-country searches for grey literature in Afghanistan, Pakistan, Sri Lanka, India, Nepal and Bangladesh. The review included mapping reported suicide rates, quality appraisals of the studies, use of definitions of suicide and means of committing suicide. In total, 114 studies and reports were included in the review, including 50 peer-reviewed publications. Reported suicide rates varied widely from 0.43/100,000 to 331.0/100,000. The average suicide rate across studies was found to be high compared to the world average, however many studies were of poor quality or not representative. The majority of studies failed to explicitly define suicide (84% of the published articles and 92% of the grey literature documents). Poisoning and hanging were consistently the most common methods of committing suicide on the sub-continent. The reported suicide rates in South Asia are high compared to the global average, but there is a paucity of reliable data on suicide rates in South Asia. Reports are likely to diminish rather than exaggerate the magnitude of suicide rates. There is an urgent need to establish new, or evaluate existing, national suicide surveillance systems in the South Asian countries.
81 citations
TL;DR: Understanding and preventing Muslim women's suicidality, and the socially sanctioned oppression it is often a response to, require system-level analyses and interventions as well as a human rights perspective.
Abstract: . Background: The literature on Muslim women's suicidality has been growing. Comprehensive reviews are, however, unavailable, and theory needs development. Aims: This article reviews and integrates theories and findings about Muslim women's suicidality. Method: Two databases (PsycINFO and Web of Science) were searched for publications about Muslim women's suicidality. Results: There is significant variability in Muslim women's patterns of suicidality across Muslim-majority communities and countries. Muslim women represent half to nearly all cases of nonfatal suicidal behavior. According to the official records of Muslim-majority countries, women's suicide mortality is lower than that of men. Community studies, however, show that in some areas, Muslim women have significantly higher suicide rates than Muslim men. Both nonfatal and fatal suicidal behaviors are most common among uneducated and poor rural young women. Muslim women's typical suicide methods vary by locale, and include self-burning, han...
65 citations
Cites background from "Epidemiology of suicide in Pakistan..."
...Islam’s condemnation of suicide likely impacts suicide records as well (Karam et al., 2007; Khan et al., 2008)....
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Journal Article•
TL;DR: Suicide behaviors' statistics is susceptible to underestimation presumably due to the socio-cultural, religious and legal barriers, not to mention the lack of well-organized registries and methodologically sound community-based surveys.
Abstract: This systematic review aimed to help better to understand the epidemiology of suicidal behaviors among Eastern Mediterranean Region (EMR) countries. The PubMed, EMR medex, Scopus, PsychInfo, ISI, and IMEMR were searched with no language limitation for papers on the epidemiology of suicidal behaviors in the general population, published up to August 2013. A total of 13 articles were reviewed. The incidence (per 100.000) of committed suicide ranged from 0.55 to 5.4. The lifelong prevalence of attempted suicide, suicidal plan and thoughts were 0.72-4.2%, 6.2-6.7%, and 2.9-14.1%, respectively. The figures for suicide are higher than those officially reported. Suicide behaviors' statistics is susceptible to underestimation presumably due to the socio-cultural, religious and legal barriers, not to mention the lack of well-organized registries and methodologically sound community-based surveys.
37 citations
Cites background from "Epidemiology of suicide in Pakistan..."
...5 (2015) deliberate self harm in some countries of the region (5)....
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...Acta Medica Iranica, 2015;53(5):257-265....
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...The Islamic religion explicitly forbids taking one’s life which is a major deterrent against suicide (5), But the low rates are not just yielded by the protective role of religious believes....
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TL;DR: The need for a standardized system of registration of suicides in Pakistan is highlighted and there is also urgent need to address high psychological distress in women in Pakistan.
Abstract: Suicide is an understudied subject in Pakistan. There are many social, legal, and religious sanctions against it. National rates of suicides are not known. We calculated suicide rates of women in the Ghizer District of the remote Northern Areas of Pakistan. During years 2000 to 2004, 49 women committed suicide. Taking average mean population for women for 5 years as 65,783, we calculated annual crude suicide rates for women as 14.89/100,000/year. For women over the age of 15 years, rates were 33.22/100,000/year; age-specific rates for 15–24 years were 61.07/100,000 per year. These figures are considerably higher than suicide rates in other parts of Pakistan and may be related to high psychiatric morbidity in Pakistani women. This study underscores the need for a standardized system of registration of suicides in Pakistan. There is also urgent need to address high psychological distress in women in Pakistan.
31 citations
References
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TL;DR: The methods used to produce the first estimates of healthy life expectancy (DALE) for 191 countries in 1999 are described, suggesting that reductions in mortality are accompanied by reductions in disability.
550 citations
01 Jan 2002
403 citations
"Epidemiology of suicide in Pakistan..." refers background in this paper
...Suicide is one of the ten leading causes of death in the world today, accounting for almost a million deaths worldwide annually (Bertolote and Fleischmann, 2002)....
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...Suicide rates in Islamic countries are considerably lower than other countries (Bertolote & Fleischmann, 2002)....
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TL;DR: Islamic suicide rates varied widely and the high OVD rates, especially the Middle Eastern, may be a repository for hiding culturally unacceptable suicides, according to the latest WHO mortality data.
Abstract: Background. Suicide is expressly condemned in the Qu'ran, and traditionally few Islamic countries have reported suicide. Undetermined deaths are classified by the World Health Organization (WHO) as Other Violent Deaths (OVD) in ICD-9, or Other External Causes (OEC) in ICD-10. It has been suggested that to avoid under-reporting of suicides, both formal suicide verdicts and OVD should be considered together because OVD may contain 'hidden' suicides.Method. The latest WHO mortality data, by age and gender, were analysed and tested by chi2 tests. Levels of suicide and OVD in 17 Islamic countries were examined and contextually compared with UK rates. The regional Islamic cultural differences in Middle Eastern, South Asian, European Islam countries and those of the former Union of Socialist Soviet Republics (FUSSR) were analysed separately to test the hypotheses that there would be no difference between regional suicide and OVD rates per million (pm) and 17 Islamic countries and UK rates.Results. Suicide rates were higher for males than females, and 'older' (65+) higher than 'younger' (15-34) rates in every country reviewed. The rate for Middle Eastern males was 0-36 pm, South Asian 0-12 pm, European 53-177 pm and FUSSR 30-506 pm, with three countries exceeding the UK rate of 116 pm. The Western male average OVD rate was 22 pm; the UK 55 pm rate was highest. Middle Eastern OVD was 1-420 pm, South Asian 0-166 pm, European 1-66 pm and FUSSR 11-361 pm. OVD rates in 10 Islamic countries were considerably higher than the Western average and eight had OVD rates considerably higher than their suicide rates.Conclusions. Islamic suicide rates varied widely and the high OVD rates, especially the Middle Eastern, may be a repository for hiding culturally unacceptable suicides. Language: en
137 citations
"Epidemiology of suicide in Pakistan..." refers background in this paper
...…suicidal deaths may be hidden in the ‘‘Other Violent Death (OVD)’’ category, thereby artificially lowering suicide rates in these countries (Pritchard & Amanullah, 2007) Our study highlights that suicide not only occurs regularly in Pakistan but rates are not as negligible as generally…...
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...In a recent study of suicide and undetermined deaths in 17 Islamic countries, Pritchard and Amanullah (2007) argue that in many Islamic countries culturally unacceptable suicidal deaths may be hidden in the ‘‘Other Violent Death (OVD)’’ category, thereby artificially lowering suicide rates in these…...
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TL;DR: High prevalence of self-burning in the young population, the pattern of demographic factors, their motivations and high prevalence of adjustment disorders highlights the need for making preventive measures, which should be focused on family structure, particularly in relation to marriage.
125 citations
"Epidemiology of suicide in Pakistan..." refers background in this paper
...However, there is good evidence from a number of Islamic countries such as Iran (Zarghami & Khalilian, 2002), Turkey (Altindag, Ozkan, & Oto, 2005) and Bangladesh (Yusuf, Akhter, Rahman et al., 2000) that suicide occurs regularly in Islamic countries....
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...However, there is good evidence from a number of Islamic countries such as Iran (Zarghami & Khalilian, 2002 ), Turkey (Altindag, Ozkan, & Oto, 2005 ) and Bangladesh (Yusuf, Akhter, Rahman et al, 2000 ) that suicide occurs regularly in Islamic countries....
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119 citations
"Epidemiology of suicide in Pakistan..." refers background in this paper
...This has been a major deterrent against suicide, evidenced by the relatively low rates in Muslim countries compared to non-Muslim countries (Simpson & Conklin, 1989)....
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...Simpson and Conklin (1989) carried out a 71 nation cross-national analysis and showed when factors such as social, economic, and 158 VOLUME 12 NUMBER 2 2008 demographic modernity are controlled, Islam has an independent effect on lowering suicide rates (Simpson & Conklin, 1989)....
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