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Suicide and deliberate self-harm in Afghanistan
Accepted Manuscript Title: Suicide and deliberate self-harm in Afghanistan Authors: Mohammad Akbar Paiman, Murad Moosa Khan PII: DOI: Reference:
S1876-2018(16)30590-1 http://dx.doi.org/doi:10.1016/j.ajp.2017.01.004 AJP 1024
To appear in: Received date: Revised date: Accepted date:
11-12-2016 29-12-2016 9-1-2017
Please cite this article as: Paiman, Mohammad Akbar, Khan, Murad Moosa, Suicide and deliberate self-harm in Afghanistan.Asian Journal of Psychiatry http://dx.doi.org/10.1016/j.ajp.2017.01.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Suicide and Deliberate Self-harm in Afghanistan Mohammad Akbar Paimana,b* ##Email##[email protected]##/Email## aGeneral Directorate of Preventive Medicine, Ministry of Public Health, Kabul, Afghanistan bMurad Moosa Khan, Dept. of Psychiatry, Aga Khan University, Karachi, Pakistan Mohammad Akbar Paiman, Address: General Directorate of Preventive Medicine, MoPH, Kabul, Afghanistan. Tel.: 0093791966514. Declaration of conflict of interest: None. Highlights► Afghanistan, a country that has been at war since decades & there is limited data on suicide and DSH. ► Only eight studies were identified and included in the review. There appears to be an apparent increase in suicidal behavior in Afghanistan. ► DSH and suicide are understudied and underreported in Afghanistan Abstract Background Suicide and deliberate self-harm (DSH) are major public health problems globally. There is limited information on suicide and DSH from Afghanistan. Aims To review available literature on suicide and DSH in Afghanistan. Methods Using online resources and literature on suicidal behavior (suicide, DSH and suicidal ideation) was searched. Results There were only seven published studies identified on suicidal behavior in Afghanistan. Six of these have been published since 2003 and majority has focused on suicidal behavior in women. Conclusions Both DSH and suicide are underreported and understudied subjects in Afghanistan. There is need for more research in this area. Keywords: Suicide, deliberate self-harm, self-immolation, Afghanistan Introduction Deliberate self-harm (DSH) and suicide are serious public health problems globally (Bertolote and Fleischmann, 2015). According to the World Health Organisation (WHO) in 2012, an estimated 804, 000 suicide deaths occurred worldwide, representing an annual global age-standardized suicide rate of 11.4 per 100, 000 population (Webb and Kapur, 2015). The WHO also estimates that for every suicide there are at least10-20 attempts at suicide. Seventy five percent of all global suicides occur in low and middleincome countries (LMIC) (Gunnell and Eddleston, 2003). Risk factors for suicide and DSH are many and varied including physical and sexual abuse, childhood neglect and deprivation, parental separation, maternal physical and mental health problems, lack of family, personality disorder, psychiatric disorders (particularly depression), as well as current life-stressors (Gratz, 2003; Haavisto et al., 2005; Yip et al., 2011) Afghanistan is a land-locked country (current estimated population 33 million) that connects central to South Asia (Raj et al., 2008). 99% of its population is Muslims. Kabul (current estimated population 4 million) is the capital city (Andersen and Kooij, 2007; Raj et al., 2008). The country has poor social and health indicators made worse by over three decades of continuous war, which has caused enormous social, political, & economic upheaval and suffering (Abadi et al., 2012). There is little information on suicide and DSH in Afghanistan-behaviors that are strongly influenced by socio-cultural and psychological factors (Scholte et al., 2004). In this article we review the available literature on suicide and DSH in Afghanistan.
S1876-2018(16)30590-1 http://dx.doi.org/doi:10.1016/j.ajp.2017.01.004 AJP 1024
To appear in: Received date: Revised date: Accepted date:
11-12-2016 29-12-2016 9-1-2017
Please cite this article as: Paiman, Mohammad Akbar, Khan, Murad Moosa, Suicide and deliberate self-harm in Afghanistan.Asian Journal of Psychiatry http://dx.doi.org/10.1016/j.ajp.2017.01.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Introduction Deliberate self-harm (DSH) and suicide are serious public health problems globally (Bertolote and Fleischmann, 2015). According to the World Health Organisation (WHO) in 2012, an estimated 804, 000 suicide deaths occurred worldwide, representing an annual global age-standardized suicide rate of 11.4 per 100, 000 population (Webb and Kapur, 2015). The WHO also estimates that for every suicide there are at least10-20 attempts at suicide. Seventy five percent of all global suicides occur in low and middleincome countries (LMIC) (Gunnell and Eddleston, 2003). Risk factors for suicide and DSH are many and varied including physical and sexual abuse, childhood neglect and deprivation, parental separation, maternal physical and mental health problems, lack of family, personality disorder, psychiatric disorders (particularly depression), as well as current life-stressors (Gratz, 2003; Haavisto et al., 2005; Yip et al., 2011) Afghanistan is a land-locked country (current estimated population 33 million) that connects central to South Asia (Raj et al., 2008). 99% of its population is Muslims. Kabul (current estimated population 4 million) is the capital city (Andersen and Kooij, 2007; Raj et al., 2008). The country has poor social and health indicators made worse by over three decades of continuous war, which has caused enormous social, political, & economic upheaval and suffering (Abadi et al., 2012). There is little information on suicide and DSH in Afghanistan-behaviors that are strongly influenced by socio-cultural and psychological factors (Scholte et al., 2004). In this article we review the available literature on suicide and DSH in Afghanistan. Methods We utilized several different electronic databases, which were searched from the beginning of their timeframes, 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, Science Citation Index (SCI) and Google Scholar. Keywords: used were ``Afghanistan'' and ``deliberate self-harm; ‘ para suicide’ ; or ``attempted suicide''; or ``suicide''; ``suicidal behavior'' or ``acute poisoning'' or ``self-poisoning'' or ``organophosphate poisoning'' or ``self-immolation''. Articles that reported on suicidal behavior of foreign military personnel or researches conducted on Afghan migrants in other countries were excluded. Results: Using the search strategy, only seven articles were retrieved and included in this review (Table 1). Gobar (1970) conducted the first ever review of suicides in Afghanistan, using information from three different settings and time frames: a retrospective analysis of 10 years data (1955-64) on suicide and homicide in Kabul; a study on suicides in three provinces (Bamyan, Lagor and Ghor) over three years (1962-64) and an analysis of all suicides in Afghanistan in 1968 (Gobar, 1970). There were 30 recorded cases of suicides in Kabul during the study period (1955-64), giving a rate of 0.25/100,000 population (Gobar, 1970). 57% were reported from the rural areas of Kabul and 80% were males. Hanging (33.4%), shooting (23.4%) and stabbing (20.0%) were the three most common methods(Gobar, 1970). Data from the three provinces showed there were only six recorded suicides (one female) in three years (1962-64), giving a rate of 0.2/100,000. Data on suicides in Afghanistan in 1968 showed there were 32 suicide cases (4 females) with a female to male ratio 1:7 and suicide rate of 0.2/100,000. 29 (91%) suicide cases were in the age group 25-55 years, with only two cases (6%) less than 25 years old. Methods of suicide included hanging 11 (34%), shooting 7 (22%), medication overdose 5 (16%), stabbing 4 (13%), jumping from height 3 (9%) and drowning 2 (6%) (Gobar, 1970). There appears to be a long hiatus of over 30 years before any other publication on suicidal behavior. However, since the early 2000s, a number of studies have been published. Amowitz et al. (2003) compared the health status of women living in Taliban-controlled areas to those in non-Taliban controlled areas. Sixty-five percent of women living in a Taliban-controlled area exposed to Taliban policies expressed suicidal ideation, compared with 18% of those in a non-Taliban controlled area (Amowitz et al., 2003). Self-immolation as a method of self-harm appears to be used increasingly by young Afghani women. Hospital medical records showed there were 35, 3 and 37 cases of self-immolation in women in the provinces of Kabul (2005-2006), Wardak (2000-2006) and Herat (2003-2006) respectively (Raj et al., 2008). In Kabul and Herat, the number of cases more than doubled between 2005 and 2006. Most of the victims has no formal education, more than half (55%) were between the ages of 16-19 years and majority (80%) were married- highlighting early age of marriage in Afghani women (Raj et al., 2008). Another study of 532 burn patients admitted to Estiqlal Hospital in Kabul (March 2007 to June 2008) showed there were 21 cases of self-immolation, the majority of whom (90%) were females, with a mean age of 22 years (Loredo and Manalai, 2014). A study on women (n=172) in three drug abuse treatment (DAT) centers across Afghanistan showed that 27% had attempted suicide in the month prior to admission to the centers (Padovese et al., 2010). Recently, a case report of a suicide attempt in an Afghan male highlighted the fact that suicidal behavior was a problem for the Afghan population as a whole and not just for women (Loredo and Manalai, 2014). In 2014, the Ministry of Public Health (MoPH) of Afghanistan published a report on suicide and DSH in Afghanistan with 4466 cases of self-poisoning and 707 cases of self- immolation being registered in
various health facilities of Kabul, while 4136 cases of self-immolation and 166 confirmed suicides were reported from another 30 provinces of the country(MOPH, 2014a). In addition to the above published studies, there have been a large number of reports on suicidal behavior in Afghani population (particularly self-immolation in young Afghani women) in the lay press (CAPS, 2013). 1 <1**1**>Discussion:
This review shows that incidence of suicide and DSH may have increased in Afghanistan but also there is a paucity of information of the subject. The prolonged war and the socio-political turmoil in Afghanistan has all but destroyed the social order of the country and this may be reflected in the suicide and DSH statistics of the country (Trani et al., 2013). Rezaeian (2015) draws attention to acts of self-immolation by young Afghani women, highlighting factors such as ‘arranged and forced marriages, trading women with the intention of marriage and the outdated and illegal practice of ``baad'' (the giving away of a female to settle a dispute)’(Rezaeian, 2015). The lack of family (of origin) support in many cases appears to the final ‘tipping point’ as, according to Rezaeian ``in some cases and before self-immolation the victims try to put across their problems to their family but this only makes the situation worse'' (Billaud, 2012; Rezaeian, 2015). Billaud (2012) argues that suicidal behavior in Afghani women is a form of social protest against the oppression they face (Billaud, 2012). Suicide and DSH are strongly prohibited in Islam. Attempting or committing suicide stigmatizes the whole family socially and could be one of the reasons why suicide and DSH are underreported and under-researched in Afghanistan (MoPH, 2014b). 2 Conclusions More than three decades of almost continuous conflict in an impoverished country of Afghanistan has severely compromised the mental health status of the population. From the small number of scientific reports (and a growing number of media reports), it appears suicidal behavior has become a serious public health problem in Afghanistan. This is neither unexpected nor surprising. However, in order to understand the problem better and to inform policy for developing suicide prevention programs, there is need for more and better research. Our review is an attempt to draw attention to this problem in Afghanistan References Abadi, M.H., Shamblen, S.R., Johnson, K., Thompson, K., Young, L., Courser, M., Vanderhoff, J., Browne, T.,;1; 2012. Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan. International journal of women's health 4, 155. Amowitz, L.L., Heisler, M., Iacopino, V.,;1; 2003. A population-based assessment of women's mental health and attitudes toward women's human rights in Afghanistan. Journal of women's health 12, 577587. Andersen, S.M., Kooij, C.S.,;1; 2007. Adult literacy education and human rights: a view from Afghanistan. Globalisation, Societies and Education 5, 315-331. Bertolote, J.M., Fleischmann, A.,;1; 2015. A global perspective in the epidemiology of suicide. Suicidologi 7. Billaud, J.,;1; 2012. Suicidal performances: voicing discontent in a girls’ dormitory in Kabul. Culture, Medicine, and Psychiatry 36, 264-285.
CAPS,;1; 2013. Women Comprise 95 Percent of Suicides in Afghanistan: Officials http://www.caps.af/detail.asp?Lang=e&Cat=2&ContID=14293 Gobar, A.H.,;1; 1970. Suicide in Afghanistan. The British Journal of Psychiatry 116, 493-496. Gratz, K.L.,;1; 2003. Risk factors for and functions of deliberate self‐ harm: An empirical and conceptual review. Clinical Psychology: Science and Practice 10, 192-205. Gunnell, D., Eddleston, M.,;1; 2003. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. International journal of epidemiology 32, 902-909. Haavisto, A., Sourander, A., Multimäki, P., Parkkola, K., Santalahti, P., Helenius, H., Nikolakaros, G., Moilanen, I., Kumpulainen, K., Piha, J.,;1; 2005. Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. Social psychiatry and psychiatric epidemiology 40, 912-921. Loredo, J., Manalai, P.,;1; 2014. Suicide in men is systematically underreported in Afghanistan. Journal of Medicine in the Tropics 16, 109. MOPH,;1; 2014a. Ministry of Public Health, Ministry of Women’s Affairs and UN call for efforts to strengthen suicide prevention in Afghanistan. MoPH,;1; 2014b. Suicide Report Press report MoPH, Kabul, Afghanistan https://moph.gov.af/en/news/ministry-of-public-health-ministry-of-womens-affairs-and-un-call-forefforts-to-strengthen-suicide-prevention-in-afghanistan Padovese, V., De Martino, R., Eshan, M.A., Racalbuto, V., Oryakhail, M.A.,;1; 2010. Epidemiology and outcome of burns in Esteqlal Hospital of Kabul, Afghanistan.B urns 36, 1101-1106. Raj, A., Gomez, C., Silverman, J.G.,;1; 2008. Driven to a fiery death—the tragedy of self-immolation in Afghanistan. New England journal of medicine 358, 2201-2203. Rezaeian, M.,;1; 2015. Self-immolation in Afghan females. Burns 3, 642-643. Scholte, W.F., Olff, M., Ventevogel, P., de Vries, G.-J., Jansveld, E., Cardozo, B.L., Crawford, C.A.G.,;1; 2004. Mental health symptoms following war and repression in eastern Afghanistan. Jama 292, 585-593. Trani, J.-F., Biggeri, M., Mauro, V.,;1; 2013. The multidimensionality of child poverty: Evidence from Afghanistan. Social indicators research 112, 391-416. Webb, R.T., Kapur, N.,;1; 2015. Suicide, unemployment, and the effect of economic recession. Lancet Psychiatry 2, 196-197. Yip, P.S., Hawton, K., Liu, K., Liu, K.-s., Ng, P.W.,;1; Kam, P.-m., Law, Y.-w., Wong, T.-w., 2011. A study of deliberate self-harm and its repetition among patients presenting to an emergency department. Crisis. Tables < No.
Title
Reference
Type of article
Sample size
Main findings
1.
Suicide In Afghanistan
Gobar, 1970
-Suicide cases in 10years (1955-64) in Kabul
- Suicide in
3 provinces (196264)
-
30 cases [6] cases woman)
[32]
cases
Suicide rate 0.25/100,000; rural (one (57%); male (80%)
(4
women) Suicide rate: 0.2/100.000
- Suicide cases in Afghanistan in 1968 Cross sectional study, 2003
1277 (724 women Suicide attempts- 65 & 553 male vs. 18 living under Taliban & nonrelatives) Taliban controlled areas respectively
Raj et al., 2008
Retrospective analysis of women self-immolation
77 women
Married formal (95%)
Examining human rights & mental health In women in drug treatment centers in Afghanistan
Abadi et al., 2012.
Interviews with women with drug addiction.
176 women
Suicidal ideation (41%); 27%attempted suicide one month prior to admission
5.
Suicidal Performances: Voicing Discontent in a Girls’ Dormitory in Kabul
Billaud, 2012
Ethnographic study of female students, Kabul
NA
Suicide seen as a form of protest
6.
Suicide in men is systematically underreported in Afghanistan
Loredo & Manalai, 2014
Case report of DSH Single case in a male
Under reporting of suicide in both men and women
7.
Call for efforts to strengthen suicide prevention in Afghanistan
Ministry of Health, Afghanis tan , 2014
Suicide & selfimmolation cases in one year (2014)
Suicidal behavior has increased in Afghanistan
2.
Population assessment of mental health
based women
3.
Driven to a Fiery Death
4.
Amowitz al, 2003
et
Suicide rate: 0.2/100,000
Kabul: 4466 self-poisoning cases & 707 selfimmolation cases;
[30] provinces: 4136 selfimmolation; 166 suicides
TDENDOFDOCTD
Table>Table 1. Published studies on suicidal behavior in Afghanistan
(80%); no education
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, Science Citation Index (SCI) and Google Scholar.
various health facilities of Kabul, while 4136 cases of self-immolation and 166 confirmed suicides were reported from another 30 provinces of the country(MOPH, 2014a). In addition to the above published studies, there have been a large number of reports on suicidal behavior in Afghani population (particularly self-immolation in young Afghani women) in the lay press (CAPS, 2013).
1 <1**1**>Discussion:
This review shows that incidence of suicide and DSH may have increased in Afghanistan but also there is a paucity of information of the subject. The prolonged war and the socio-political turmoil in Afghanistan has all but destroyed the social order of the country and this may be reflected in the suicide and DSH statistics of the country (Trani et al., 2013). Rezaeian (2015) draws attention to acts of self-immolation by young Afghani women, highlighting factors such as ‘arranged and forced marriages, trading women with the intention of marriage and the outdated and illegal practice of ``baad'' (the giving away of a female to settle a dispute)’(Rezaeian, 2015). The lack of family (of origin) support in many cases appears to the final ‘tipping point’ as, according to Rezaeian ``in some cases and before self-immolation the victims try to put across their problems to their family but this only makes the situation worse'' (Billaud, 2012; Rezaeian, 2015). Billaud (2012) argues that suicidal behavior in Afghani women is a form of social protest against the oppression they face (Billaud, 2012). Suicide and DSH are strongly prohibited in Islam. Attempting or committing suicide stigmatizes the whole family socially and could be one of the reasons why suicide and DSH are underreported and under-researched in Afghanistan (MoPH, 2014b). 2 Conclusions More than three decades of almost continuous conflict in an impoverished country of Afghanistan has severely compromised the mental health status of the population. From the small number of scientific reports (and a growing number of media reports), it appears suicidal behavior has become a serious public health problem in Afghanistan. This is neither unexpected nor surprising. However, in order to understand the problem better and to inform policy for developing suicide prevention programs, there is need for more and better research. Our review is an attempt to draw attention to this problem in Afghanistan References Abadi, M.H., Shamblen, S.R., Johnson, K., Thompson, K., Young, L., Courser, M., Vanderhoff, J., Browne, T.,;1; 2012. Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan. International journal of women's health 4, 155. Amowitz, L.L., Heisler, M., Iacopino, V.,;1; 2003. A population-based assessment of women's mental health and attitudes toward women's human rights in Afghanistan. Journal of women's health 12, 577587. Andersen, S.M., Kooij, C.S.,;1; 2007. Adult literacy education and human rights: a view from Afghanistan. Globalisation, Societies and Education 5, 315-331. Bertolote, J.M., Fleischmann, A.,;1; 2015. A global perspective in the epidemiology of suicide. Suicidologi 7. Billaud, J.,;1; 2012. Suicidal performances: voicing discontent in a girls’ dormitory in Kabul. Culture, Medicine, and Psychiatry 36, 264-285.
CAPS,;1; 2013. Women Comprise 95 Percent of Suicides in Afghanistan: Officials http://www.caps.af/detail.asp?Lang=e&Cat=2&ContID=14293 Gobar, A.H.,;1; 1970. Suicide in Afghanistan. The British Journal of Psychiatry 116, 493-496. Gratz, K.L.,;1; 2003. Risk factors for and functions of deliberate self‐ harm: An empirical and conceptual review. Clinical Psychology: Science and Practice 10, 192-205. Gunnell, D., Eddleston, M.,;1; 2003. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. International journal of epidemiology 32, 902-909. Haavisto, A., Sourander, A., Multimäki, P., Parkkola, K., Santalahti, P., Helenius, H., Nikolakaros, G., Moilanen, I., Kumpulainen, K., Piha, J.,;1; 2005. Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. Social psychiatry and psychiatric epidemiology 40, 912-921. Loredo, J., Manalai, P.,;1; 2014. Suicide in men is systematically underreported in Afghanistan. Journal of Medicine in the Tropics 16, 109. MOPH,;1; 2014a. Ministry of Public Health, Ministry of Women’s Affairs and UN call for efforts to strengthen suicide prevention in Afghanistan. MoPH,;1; 2014b. Suicide Report Press report MoPH, Kabul, Afghanistan https://moph.gov.af/en/news/ministry-of-public-health-ministry-of-womens-affairs-and-un-call-forefforts-to-strengthen-suicide-prevention-in-afghanistan Padovese, V., De Martino, R., Eshan, M.A., Racalbuto, V., Oryakhail, M.A.,;1; 2010. Epidemiology and outcome of burns in Esteqlal Hospital of Kabul, Afghanistan.B urns 36, 1101-1106. Raj, A., Gomez, C., Silverman, J.G.,;1; 2008. Driven to a fiery death—the tragedy of self-immolation in Afghanistan. New England journal of medicine 358, 2201-2203. Rezaeian, M.,;1; 2015. Self-immolation in Afghan females. Burns 3, 642-643. Scholte, W.F., Olff, M., Ventevogel, P., de Vries, G.-J., Jansveld, E., Cardozo, B.L., Crawford, C.A.G.,;1; 2004. Mental health symptoms following war and repression in eastern Afghanistan. Jama 292, 585-593. Trani, J.-F., Biggeri, M., Mauro, V.,;1; 2013. The multidimensionality of child poverty: Evidence from Afghanistan. Social indicators research 112, 391-416. Webb, R.T., Kapur, N.,;1; 2015. Suicide, unemployment, and the effect of economic recession. Lancet Psychiatry 2, 196-197. Yip, P.S., Hawton, K., Liu, K., Liu, K.-s., Ng, P.W.,;1; Kam, P.-m., Law, Y.-w., Wong, T.-w., 2011. A study of deliberate self-harm and its repetition among patients presenting to an emergency department. Crisis. Tables < No.
Title
Reference
Type of article
Sample size
Main findings
1.
Suicide In Afghanistan
Gobar, 1970
-Suicide cases in 10years (1955-64) in Kabul
- Suicide in
3 provinces (196264)
-
30 cases [6] cases woman)
[32]
cases
Suicide rate 0.25/100,000; rural (one (57%); male (80%)
(4
women) Suicide rate: 0.2/100.000
- Suicide cases in Afghanistan in 1968 Cross sectional study, 2003
1277 (724 women Suicide attempts- 65 & 553 male vs. 18 living under Taliban & nonrelatives) Taliban controlled areas respectively
Raj et al., 2008
Retrospective analysis of women self-immolation
77 women
Married formal (95%)
Examining human rights & mental health In women in drug treatment centers in Afghanistan
Abadi et al., 2012.
Interviews with women with drug addiction.
176 women
Suicidal ideation (41%); 27%attempted suicide one month prior to admission
5.
Suicidal Performances: Voicing Discontent in a Girls’ Dormitory in Kabul
Billaud, 2012
Ethnographic study of female students, Kabul
NA
Suicide seen as a form of protest
6.
Suicide in men is systematically underreported in Afghanistan
Loredo & Manalai, 2014
Case report of DSH Single case in a male
Under reporting of suicide in both men and women
7.
Call for efforts to strengthen suicide prevention in Afghanistan
Ministry of Health, Afghanis tan , 2014
Suicide & selfimmolation cases in one year (2014)
Suicidal behavior has increased in Afghanistan
2.
Population assessment of mental health
based women
3.
Driven to a Fiery Death
4.
Amowitz al, 2003
et
Suicide rate: 0.2/100,000
Kabul: 4466 self-poisoning cases & 707 selfimmolation cases;
[30] provinces: 4136 selfimmolation; 166 suicides
TDENDOFDOCTD
Table>Table 1. Published studies on suicidal behavior in Afghanistan
(80%); no education
CAPS,;1; 2013. Women Comprise 95 Percent of Suicides in Afghanistan: Officials http://www.caps.af/detail.asp?Lang=e&Cat=2&ContID=14293 Gobar, A.H.,;1; 1970. Suicide in Afghanistan. The British Journal of Psychiatry 116, 493-496. Gratz, K.L.,;1; 2003. Risk factors for and functions of deliberate self‐ harm: An empirical and conceptual review. Clinical Psychology: Science and Practice 10, 192-205. Gunnell, D., Eddleston, M.,;1; 2003. Suicide by intentional ingestion of pesticides: a continuing tragedy in developing countries. International journal of epidemiology 32, 902-909. Haavisto, A., Sourander, A., Multimäki, P., Parkkola, K., Santalahti, P., Helenius, H., Nikolakaros, G., Moilanen, I., Kumpulainen, K., Piha, J.,;1; 2005. Factors associated with ideation and acts of deliberate self-harm among 18-year-old boys. Social psychiatry and psychiatric epidemiology 40, 912-921. Loredo, J., Manalai, P.,;1; 2014. Suicide in men is systematically underreported in Afghanistan. Journal of Medicine in the Tropics 16, 109. MOPH,;1; 2014a. Ministry of Public Health, Ministry of Women’s Affairs and UN call for efforts to strengthen suicide prevention in Afghanistan. MoPH,;1; 2014b. Suicide Report Press report MoPH, Kabul, Afghanistan https://moph.gov.af/en/news/ministry-of-public-health-ministry-of-womens-affairs-and-un-call-forefforts-to-strengthen-suicide-prevention-in-afghanistan Padovese, V., De Martino, R., Eshan, M.A., Racalbuto, V., Oryakhail, M.A.,;1; 2010. Epidemiology and outcome of burns in Esteqlal Hospital of Kabul,
Title
Reference
Type of article
Sample size
Main findings
1.
Suicide In Afghanistan
Gobar, 1970
-Suicide cases in 10years (1955-64) in Kabul
- Suicide in
3 provinces (196264)
-
30 cases [6] cases woman)
[32]
cases
Suicide rate 0.25/100,000; rural (one (57%); male (80%)
(4
women) Suicide rate: 0.2/100.000
- Suicide cases in Afghanistan in 1968 Cross sectional study, 2003
1277 (724 women Suicide attempts- 65 & 553 male vs. 18 living under Taliban & nonrelatives) Taliban controlled areas respectively
Raj et al., 2008
Retrospective analysis of women self-immolation
77 women
Married formal (95%)
Examining human rights & mental health In women in drug treatment centers in Afghanistan
Abadi et al., 2012.
Interviews with women with drug addiction.
176 women
Suicidal ideation (41%); 27%attempted suicide one month prior to admission
5.
Suicidal Performances: Voicing Discontent in a Girls’ Dormitory in Kabul
Billaud, 2012
Ethnographic study of female students, Kabul
NA
Suicide seen as a form of protest
6.
Suicide in men is systematically underreported in Afghanistan
Loredo & Manalai, 2014
Case report of DSH Single case in a male
Under reporting of suicide in both men and women
7.
Call for efforts to strengthen suicide prevention in Afghanistan
Ministry of Health,
Suicide & selfimmolation cases in one year (2014)
Suicidal behavior has increased in Afghanistan
2.
Population assessment of mental health
based women
3.
Driven to a Fiery Death
4.
Amowitz al, 2003
et
Suicide rate: 0.2/100,000
Kabul: 4466 self-poisoning cases & 707 selfimmolation cases;
[30] provinces: 4136 selfimmolation; 166 suicides
TDENDOFDOCTD
Table>Table 1. Published studies on suicidal behavior in Afghanistan
(80%); no education