Psychosocial factors associated with deliberate self-harm in adult patients presenting to tertiary care hospitals in Afghanistan: a matched case-control study
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Deliberate Self-Harm (DSH) is a strong indicator of psychological distress and one of the major risk factors for future suicides. There has been very little research on DSH or suicides in Afghanistan, a country that has faced a four-decade long war. Due to this social support and other coping strategies for dealing with life stresses in Afghan society have been seriously undermined. This study determined the association of psychosocial factors with DSH in adult patients in Afghanistan. Methods: A total of 185 cases with 555 age (+5yrs) and gender-matched controls participated in the study through convenience sampling technique. Patients of DSH aged 16 and above were taken as cases and patients with the general medical condition (other than DSH) were taken as controls. The study was conducted from 15 Feb to 10 May 2015 in four tertiary care hospitals in Kabul. Conditional logistic regression was used to determine the association of psychosocial factors with DSH. Results: The median ages of the cases and controls were 20 (1QR18-24) & 20 (IQR18- 23) years respectively. The majority of the study participants were females (85%), with 60% of them being housewives and 29% students. The majority of the participants were ethnically Tajik (47%), followed by Pashtun (32%) and Hazara (13%). Most of the participants were unemployed (93%) and single (49%). The majority of the families (60%) were nuclear. Forty five percent of the participants had monthly family income of Afs 5000-10,000, 32% had monthly family income of Afs 11000-20000 and 20% of them had a monthly family income of Afs 21000-30000. Family conflict MOR 6.18 (2.56, 15.24), domestic violence MOR 6.42 (2.71, 17.30), fighting with someone in the past one year MOR 3.00 (1.22, 7.52) and living in extended families MOR 2.51(1.34, 5.22) were risk factors for DSH. Conclusions: Family conflict, domestic violence, fighting with someone and living in extended families were risk factors for DSH in patients age 16 and above presenting to tertiary care hospitals in Kabul Afghanistan. DSH in Afghanistan appears to be related to interpersonal and family conflicts. Due to strong family set up in Afghanistan, many of the societal psychosocial stresses may be played out in the family context. The evidence gained from such research can help inform policy to develop programs for primary and secondary prevention of DSH in the country. There is also need for further research in this area in Afghanistan. Key words: Psychosocial Factors, Deliberate self-harm, Afghanistan.
Akbar, M. (2015). Psychosocial factors associated with deliberate self-harm in adult patients presenting to tertiary care hospitals in Afghanistan: a matched case-control study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.