SAHAR-M
SOUTH ASIA SELF HARM & SUICIDE REDUCTION MOVEMENT
SAHAR, is ‘The morning twilight before a new dawn’
سَحَر
South Asia Harm and Suicide Reduction (SAHAR)-Movement (M) is a research program based on the was derived. Building on the last two years of work for the last two years. The movement [as it has now named] is aimed at working towards ‘Zero suicide’- a systematic framework for creating an integrated approach to prevent suicide, and bring about a quality improvement in the healthcare system
The mission of SAHAR-M is to facilitate and execute, through rigorous research methodology and governance, a range of national self-harm and suicide prevention activities with a strong focus on building capacity and capability in readiness and timely responsiveness to support people, and communities in preventing self-harm behaviour and suicide. This programme of work will support the local and national health economies in Pakistan. This process will involves ‘knowledge mobilisation’ using an integrated trans-disciplinary approach to self-harm and suicide prevention.
Mission
Work Package 1
Capacity & Capability Building
Aim: To develop world leading researchers in global mental health areas of and self-harm and suicide prevention.
Context: Lack of trained researchers, peer researchers and peer networks, limited availability of time and incentives for mental health research are potential barriers for research capability building in Pakistan.
Work Package 2
Mental Health & Wellbeing National Household Survey
This Work Package involves a nationwide household survey on the prevalence of Mental Health and Wellbeing in Pakistan. The core objective of this work package is to develop an understanding of the psychosocial determinants of mental illness and the key context for understanding mental illnesses among adults (aged 18 and over) living in private households in Pakistan.
A comprehensive interview with 11,000 adult participants from selected households across Pakistan is planned, creating opportunities for capacity and capability building for local health workers. It is a cross-sectional household survey, which includes a comprehensive interview using structured questionnaires. The questionnaires for the interview are similar to the UK Adult Psychiatric Morbidity Survey (APMS; 2014), to also help cross-examine the mental health of the Pakistani diaspora mental health in the UK.
Training
Household survey training NUMS,Rawalpindi, Pakistan
Work Package 3
Hospitals & Community Self-harm Episode Routine Data
This work package aims to study the existing system of suicide and self-harm episode records in prisons, police stations, medico-legal offices (MLOs), presentations to hospitals, and community health care facilities across Pakistan. We will conduct a mapping and linkage exercise of routinely collected data on self-harm and suicide over a period of 12 months to determine a pragmatic minimal dataset for self-harm and suicide.
The use of routine health care data is quite common in high-income countries to describe patient characteristics, risk factors identification and understanding variations in outcomes and practice across different settings. Data on suicide and self-harm will help in the understanding of factors influencing suicidal behaviour in Pakistan, and can better inform public health policies on intervention and treatment, and as well as national suicide prevention strategies.
Evaluation Of Hospital, Community & Prison Healthcare Self-Harm Episode Routine Data Across Pakistan.
- Qualitative interviews with different stakeholders including:
- Clinician/GP’s views on the role of psychological treatment, and its impact on self-harm and suicide prevention;
- Interviews with policymakers; to identify barriers/facilitators involved in policy development and implementation;
- Interviews with medico-legal officers (MLOs) to explore self-harm and suicide.
Work Package 4
Qualitative Research
The purpose of this work package is to improve mental health infrastructure, particularly for self-harm and suicide in Pakistan, by exploring stakeholders’ perspectives on the needs, gaps, and social realities of self-harm and suicide in Pakistan.
Qualitative research can play an important role in developing appropriate health services and policies. This type of research provides valuable insights into the ways of, health, illnesses; conceptualization of patients and carers’ experiences, and, study of different aspects of care delivery. Qualitative research has the potential to inform process of research itself, as these approaches can help to understand why some of the patients decline to participate in research, or how some patients experience participation in the research.
Building on the extensive joint work of PILL and the University of Manchester on self-harm and suicide prevention (CMAP, Y-CMAP) and facilitated by our Theory of Change process, the work package will help identify the core elements of, and help in developing policy, adaptive treatments, prevention strategies, and user-friendly toolkit for the wider community.
In-depth qualitative interviews will be conducted with individuals having with a history of self-harm and their carers using a 1:1 semi-structured interview , to explore their lived experiences. We will also carry out these in-depth interviews with other health professionals, medico-legal officers, police, and policymakers to identify the barriers/ challenges in working with people who self-harm, and with people who are bereaved by suicide.
Work Package 5
Evidence Synthesis
The primary focus of work package 5 is on Evidence Synthesis. Its aim is to provide the best available evidence on self-harm and suicide in Pakistan, and if the evidence is unavailable, to mandatorily highlight areas where further original research is required.
Our team is working on a wide range of systematic reviews listed below:
1)Prevalence and risk factors of self-harm in substance misuse in South Asia: A systematic review:
Globally, self-harm and suicide is a serious public health problem with long-term harmful effects on individuals, families and communities. The incidences of self-harm and suicide have been increasing worldwide. However, substance use disorder carries a comparatively increased risk for self-harm and suicide as compared to the general population. This review aims to better understand the prevalence and risk factors of self-harm in people with substance misuse to address this global public health problem. The review will include qualitative study designs with participants aged 16 and above, having a problem of substance misuse and self-harm.
2)Prevalence of Pandemic-Related Distress and the Suicidal Ideation: A Systematic Review and Meta-Analysis
In this review, researchers will establish the prevalence of COVID-19 pandemic related distress in association with self-harm. Meta-analysis will be performed for the studies, which will be deemed homogenous by the research to identify their combined effect.
3)Prevalence and risk factors of self-harm, suicidal ideation & suicide among prisoners in Low-and-lower-middle-income countries (LLMICs): A Systematic Review and Meta-Analysis
This review aims to determine the prevalence and risk factors of self-harm, suicidal ideation & suicide among prisoners in Low-and-Lower middle-income countries.
4)Family dynamics and deliberate self-harm (with/without suicide intention) in adolescents: a systematic review
In the family dynamic review, we aim to synthesize the research exploring the impact of family dynamics, such as family conflict or tension (between parents, between parents and children, and between siblings); family cohesion; family supportiveness; parenting style or behavior (e.g. authoritarian, authoritative, permissive, neglectful) on self-harm in adolescents aged 10-19 years.
5)Prevalence of self-harm and suicide in individuals with severe mental illnesses in South Asia
Presently, the Asian region is at peak of suicide all over the world, the literature reports that 68 to 97% of suicide are due to psychiatric illness but only 35 to 40% received diagnosis. This systematic review will explore the prevalence of self-harm and suicide among people with severe mental illnesses in South Asia.
6)Relationship between internet use, SH, and Suicidal behaviour in youth in South Asia
This review aims to understand the relationship between internet use, self-harm and suicidal behaviours in youth in South Asia. To identify any relevant information on the association between internet use and any type of self-harm, suicidal ideation and suicide.
7)Systematic Review: Protocol on the topic of similarities and differences in mental health policy in LMICs
There is a great need to understand the experience and research evidence from other low and lower-middle-income countries to help inform future mental health policies and initiatives in Pakistan about where patients with more severe mental and neurological disorders are treated. To achieve this, we plan to examine national mental health policies, and articles that study or review these policies in significant depth.
8)Prevalence of mental health issues among immediate family members bereaved by suicide: a systematic review
This review aims to identify the risk of depressive symptoms and suicidal ideation in immediate family members bereaved by suicide as compared to bereavement by other causes , and to assess the association between bereavement by suicide and depressive symptoms/suicidal ideation variation between LMIC and High-Income Countries.
9)Risk factors and Prevalence of suicidal behaviour and suicidal ideation during the perinatal period in LMICs
This review aims to identify the risk factors for suicidal behaviour and suicidal ideation among women during the perinatal period in LIMICs, and to assess the prevalence of suicidal behaviour and suicidal ideation among women during the perinatal period in LIMICs.