Deliberate self-harm in the emergency department experience from Karachi Pakistan

Background: Suicidal behavior is an understudied subject in Pakistan, a South-Asian developing country with a predominantly Muslim population. Aims: This study examined the characteristics and management of patients presenting with Deliberate Self-Harm (DSH) to the Emergency Department (ED) of a tertiary care teaching hospital in Karachi, Pakistan. Methods: A retrospective chart review of all patients (n = 98), over a period of 12 months was carried out. The demographic details of patients; method of DSH and, if drugs were used, their type, route, and quantity; reason for DSH; past psychiatric history; and outcome were recorded. Results: The mean age of subjects was 23.5 years. The majority of patients were female; most had used drugs for DSH. After initial treatment in the ED, 34 patients were admitted to medical wards for further treatment, 12 were discharged from ED, while 52 patients left against medical advice. The main reasons for leaving against medical advice were financial constraints and fear of legal issues. Seven patients had at least one previous episode of DSH. Conclusions: Patients who left the ED without psychosocial assessment are at increased risk for repetition of DSH as well as suicide.