Lived experiences of adolescents with recent history of self-harm – A qualitative study from Pakistan

Aim: Suicide is serious global public health problem and is the 3rd leading cause of death in 15-35 years old. The World Health Organization (WHO) reported that >70% of suicide deaths are in developing countries. There is limited evidence on self-harm (SH) and suicide from developing countries like Pakistan because these acts are socially and religiously condemned, and are considered as criminal acts. Aim of this study was to explore lived experiences of adolescents with a history of self-harm and their perception about psychosocial intervention. Methods: In depth qualitative interviews were conducted with 17 adolescents (age 12-18 years) with a history of SH recruited from the different public hospitals of Rawalpindi, Pakistan. A semi-structured topic guide was prepared based on existing literature and findings from discussions of mental health professionals. Framework analysis was done. Results: The over-arching themes that emerged from analysis were; predisposing (impulsivity, aggression) and precipitating factors (escape from current situation, interpersonal conflicts) of SH, reaction of the family (troublesome, grief), perception of CBT based interventions (perceived as helpful, pictorial worksheets as more effective, involvement of family members). Conclusion: This study may help in refining a contextual and cultural based explanatory model of selfharm in adolescents. Qualitative data collection and analysis may plays critical role in suicide prevention research by highlighting the perception of target population regarding psychological interventions.