Madam, Deliberate self harm (DSH) is defined as harming oneself intentionally; with or without suicidal intent.1 In Pakistan there is accumulating evidence that incidences of both suicide and DSH have increased in recent years.2 The prevailing issues of poverty, unemployment, corruption, human rights violation, denial of justice, discriminations, violence, loosening of cohesion in society may be contributing to rise in suicidal tendencies in Pakistan.3 The WHO estimates that for every suicide, there are at least 10-20 DSH acts.4 A 7-year (1995-2001) review of all autopsies for suicide in Karachi gave an average of 198.5 suicides per year.5 By this estimate there should be at least 2000 to 4000 cases of DSH in Karachi annually.

A retrospective study was conducted to observe the characteristics and outcome of patients admitted in hospital with drug overdose from January to December 2005.
Demographic details of patients, type, route and quantity of drug used, reason of drug ingestion, past psychiatric history, psychiatric consult, six months follow up with the psychiatrist were recorded on a specially devised data extraction form. The data was subjected to a descriptive statistics analysis.

During the study period 60 patients were admitted with drug overdose. Mean age of subjects was 31 years. Majority of patients 41 (66.1%) were females and 20 (32.3%) were housewives. Nine (14.5%) had previous 1 attempt, 3 (4.8%) had previous 2 attempts and 10 (16.1%) had more than 2 previous attempts of DSH. Twenty seven (43.5%) of the patients had underlying depression, 5 (8.1%) had bipolar disorder, 4 (6.5%) had stress related disorder, 1 (1.6%) had personality disorder and 1 (1.6%) had schizophrenia in their past medical history. Benzodiazepines were the most commonly used drug found in 50 (80.7%) patients. Domestic problems were the most common reason of DSH seen in 36 (58%) patients. During hospital stay psychiatric consult was generated in 90.3% cases. Forty three (69.4%) patients did not come for follow up in the psychiatry clinic after 6 months.

We conclude that depression is more common in housewives and they have the tendency of DSH with drugs. Many people did not show up in the psychiatry clinic. A specialist Consultation-Liaison psychiatrist might improve the engagement with services besides improving the quality of care.

Muhammad Shahid1, Junaid Patel2, Haider Naqvi3, Muhammad Shoaib Khan4
Department of Medicine1,2 and Psychiatry3, Aga Khan University, Karachi.

1. Pattison EM, Kahan J. The deliberate self-harm syndrome. Am J Psychiatry 1983; 140:867-72.

2. Khan MM, Prince M. Beyond rates: the tragedy of suicide in Pakistan. Tropical Doctor 2003; 33:67-9.

3. Khalid N. Pattern of suicide: causes and methods employed. J Coll Physicians Surg Pak 2001; 11:759-61.

4. World Health Organization. The World Health Report 2001. Mental Health: New Understanding, New Hope, Geneva: WHO 2001.

5. Ahmed Z, Ahmed A, Mubeen SM. An audit of suicide in Karachi from 1995-2001. Ann Abbasi Shaheed Hosp 2003; 8:424-8.