Antecedents, clinical and psychological characteristics of a large self-harm sample from primary care and hospital settings in Pakistan

Objectives: To establish the antecedents, clinical and psychological correlates of selfharm in individuals from a lower middle-income country presenting to hospital and community settings following an episode of self-harm.

Methods: This study is a cross-sectional baseline analysis of participants from a large multi-centre randomised controlled trial of self-harm prevention in Pakistan.

Results: A total of 901 participants with a history of self-harm were recruited from primary care clinics, emergency departments and general hospitals from five major cities in Pakistan. The Beck Scale for Suicidal Ideation (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and Suicide Attempt Self Injury Interview (SASII) assessment scales were completed. Most participants recruited were females (n=544, 60.4%) in their 20’s. Females had lower educational attainment and higher unemployment rates than males. Females reported higher severity scores on BSI, BDI and BHS than males. Interpersonal conflict was the most cited antecedent to self-harm, followed by financial difficulties in both community and hospital settings. Suicide was the most reported motive of self-harm (N=776, 86.1%). Suicidal intent was proportionally higher in community presenting patients (Community: N=318, 96.9% vs. Hospital: N=458, 79.9%; p<0.001). The most reported methods of self-harm
were the ingestion of pesticides and toxic chemicals.

Conclusions: Young females are the dominant demographic group in this population and are more likely to attend community settings to seek help. Suicide intent as the motivator of self-harm and use of potentially lethal methods may suggest that this population is at high risk of completed suicide.