Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
BMC Psychiatry. 2018 Feb 12;18(1):44. doi: 10.1186/s12888-017-1586-6.
Suicide is a major global public health problem with more than 800,000 incidents worldwide annually. Seventy-five percent of the global suicides occur in low and middle-income countries (LMICs). Pakistan is a LMIC where information on suicidal behavior is limited. The aim of the review is to map available literature on determinants, risk factors and other variables of suicidal behavior in Pakistan.
This study was based on Arksey and O'Malley's methodological framework of scoping review, combining peer reviewed publications with grey literature. Ten databases including Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Trials Register (CRG), Cumulative Index to Nursing and Allied Health (CINAHL), National Library of Medicine Gateway (NLMG), ExcerptaMedica (EMBASE), National Library of Medicine's MEDLINE (PUBMED), PSYCHINFO, Social Science Citation Index and Science Citation Index (SCI) and Pakmedinet.com were searched from the beginning of their time frames until December 2016 using a combination of key terms. The inclusion criteria included studies of various study designs covering different aspects of suicidal behavior in English language.
Six hundred and twenty three articles were initially retrieved from all ten databases. Two independent reviewers screened the titles and abstracts for relevance. One hundred and eighteen articles were read in full, out of which 11 were excluded because they did not fit the eligibility criteria. One hundred and ten articles, including two student theses and one report, were included in the final review. Most studies were descriptive in nature, with only three that used a case-control design. Majority of the studies were from urban areas, and addressed determinants rather than risk factors. Gender differences and age were predominantly reported, with more males committing suicide. Suicidal behavior was more common among individuals younger than 30 years of age. The three most common methods for suicides were hanging, poisoning and use of firearms. Mental illness as a risk factor for suicides was mentioned in only three studies.
This review is the first attempt to synthesize available literature on suicidal behavior in Pakistan. The evidence is limited, and calls for more robust analytical research designs, along with a focus on risk factors.
自杀是一个严重的全球公共卫生问题，全球每年有超过 80 万人自杀。全球 75%的自杀事件发生在中低收入国家（LMICs）。巴基斯坦是一个 LMIC，关于自杀行为的信息有限。本综述的目的是绘制巴基斯坦自杀行为的决定因素、风险因素和其他变量的现有文献。
本研究基于 Arksey 和 O'Malley 的范围综述方法论框架，结合同行评审出版物和灰色文献。使用 ASSIA、Cochrane Trials Register（CRG）、Cumulative Index to Nursing and Allied Health（CINAHL）、National Library of Medicine Gateway（NLMG）、ExcerptaMedica（EMBASE）、National Library of Medicine 的 MEDLINE（PUBMED）、PSYCHINFO、Social Science Citation Index 和 Science Citation Index（SCI）和 Pakmedinet.com 等十个数据库，从其时间框架开始到 2016 年 12 月，使用关键词组合进行搜索。纳入标准包括各种研究设计的研究，涵盖自杀行为的不同方面，语言为英语。
从所有十个数据库中最初检索到 623 篇文章。两名独立审查员筛选标题和摘要的相关性。阅读了 118 篇全文文章，其中 11 篇因不符合资格标准而被排除。最终综述包括 110 篇文章，其中包括两篇学生论文和一篇报告。大多数研究是描述性的，只有三项研究采用病例对照设计。大多数研究来自城市地区，主要涉及决定因素而不是风险因素。性别差异和年龄主要被报道，男性自杀更多。自杀行为在 30 岁以下的人群中更为常见。自杀的三种最常见方法是上吊、中毒和使用枪支。只有三项研究提到了精神疾病是自杀的一个风险因素。
这是首次尝试综合巴基斯坦自杀行为的现有文献。证据有限，需要更强大的分析研究设计，并关注风险因素。
