{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:53:50Z","timestamp":1790164430410,"version":"4.1.0"},"reference-count":202,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec id=\"S2056472421009236_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Suicide is one of the leading mental health crises and takes one life every 40 seconds. Four out of every five suicides occur in low- and middle-income countries. Despite religion being a protective factor against suicide, the estimated number of suicides is rapidly increasing in Pakistan.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472421009236_sec_a2\"><jats:title>Aims<\/jats:title><jats:p>Our review focuses on the trends of suicide and means of self-poisoning in the past three decades, and the management of commonly used poisons.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472421009236_sec_a3\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>We searched two electronic databases (PubMed and PakMediNet) for published English-language studies describing agents used for suicide in different regions of Pakistan. A total of 46 out of 85 papers (<jats:italic>N<\/jats:italic>= 54 747 cases) met our inclusion criteria.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472421009236_sec_a4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Suicidal behaviour was more common among individuals younger than 30 years. Females comprised 60% of those who attempted suicide in our study sample, although the ratio of completed suicides favoured males. There were regional trends in the choice of agent for overdose. Organophosphate poisoning was reported across the nation, with a predominance of cases from the agricultural belt of South Punjab and interior Sindh. Aluminium phosphide (\u2018wheat pills\u2019) was a preferred agent in North Punjab, whereas paraphenylenediamine (\u2018<jats:italic>kala pathar<\/jats:italic>\u2019) was implicated in deaths by suicide from South Punjab. Urban areas had other means for suicide, including household chemicals, benzodiazepines, kerosene oil and rat poison.<\/jats:p><\/jats:sec><jats:sec id=\"S2056472421009236_sec_a5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Urgent steps are needed, including psychoeducational campaigns on mental health and suicide, staff training, medical resources for prompt treatment of self-poisoning and updated governmental policy to regulate pesticide sales.<\/jats:p><\/jats:sec>","DOI":"10.1192\/bjo.2021.923","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T08:31:33Z","timestamp":1623918693000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":21,"title":["Suicide by poisoning in Pakistan: review of regional trends, toxicity and management of commonly used agents in the past three decades"],"prefix":"10.1192","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4987-3972","authenticated-orcid":false,"given":"Maria","family":"Safdar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8498-8914","authenticated-orcid":false,"given":"Khalid Imran","family":"Afzal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4803-2744","authenticated-orcid":false,"given":"Zoe","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filza","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8620-6939","authenticated-orcid":false,"given":"Pervaiz","family":"Zarif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7434-1647","authenticated-orcid":false,"given":"Zahid Farooq","family":"Baig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"S2056472421009236_ref93","first-page":"72","article-title":"Trends and patterns of suicide in people of Chitral, Khyber Pakhtunkhwa, Pakistan","volume":"8","author":"Ahmed","year":"2016","journal-title":"Khyber Med Univ J"},{"key":"S2056472421009236_ref126","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511489822"},{"key":"S2056472421009236_ref127","first-page":"415","article-title":"Perspectives on domestic violence: case study from Karachi, Pakistan","volume":"14","author":"Rabbani","year":"2008","journal-title":"East Mediterr Health J"},{"key":"S2056472421009236_ref125","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v4i0.7448"},{"key":"S2056472421009236_ref97","doi-asserted-by":"publisher","DOI":"10.1007\/s11356-018-3987-6"},{"key":"S2056472421009236_ref107","doi-asserted-by":"publisher","DOI":"10.1080\/09603123.2014.980781"},{"key":"S2056472421009236_ref55","first-page":"11","article-title":"The pattern of organophosphorus poisoning and it's short term outcomes in various socioeconomic groups","volume":"7","author":"Bilal","year":"2014","journal-title":"Khyber Journal of Medical Sciences (KJMS)"},{"key":"S2056472421009236_ref3","unstructured":"3 World Health Organization (WHO). 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