Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center

  • Subash Ghimire B.P. Koirala Institute of Health Sciences
  • Sagar Devota B.P. Koirala institute of Health Sciences
  • Rasmita Budhathoki B.P. Koirala Institute of Health sciences
  • Nidesh Sapkota B.P. Koirala Institute of Health Sciences
  • Akhilesh Thakur B.P. Koirala Institute of Health Sciences


Introduction: Deliberate self-harm is one of the common psychiatric emergencies in medical practice. It has become a global health problem with rates increasing over time. This hospital based study may help in understanding the cause, methods and psychiatric comorbidities present in such patients. The aim of this study was to (i) study the relationship between major socio-demographic variables and deliberate self-harm (ii) evaluate methods and precipitating cause (iii) determine the nature and prevalence of psychiatric and personality disorders in deliberate-self harm patients.

Methods: This retrospective observational study was performed on 200 cases of deliberate self-harm in a tertiary referral centre in Eastern Nepal by the data collected from the medical records of these patients. Various sociodemographic data and psychiatric comorbidities prevalent in them were analysed.

Results: Majority of the suicide attempters (77%) were less than 35 years of age. The female-to-male ratio was 1.35:1. 76% of the patients had received formal education. Majority (73.5%) were married. By occupation, 38% were housewives and 25.5% were students. 72.5% of cases had consumed organophosphates/-chlorides. Interpersonal conflict (72%) was the major cause of DSH. ICD-10 psychiatric disorders were diagnosed in 37% of cases and premorbid personality problems were present in 20% of cases. The most common diagnosis was adjustment disorder (13.5%) followed by mood disorder (11%).

Conclusions: Majority of DSH cases were of younger generation. Psychiatric disorders and comorbid personality problems are common in DSH patients. This has important implications for proper assessment and management.

Keywords: Deliberate self-harm; Organophosphorous; Para suicide; Psychiatric co-morbidities.

Author Biographies

Subash Ghimire, B.P. Koirala Institute of Health Sciences
MBBS Intern
Sagar Devota, B.P. Koirala institute of Health Sciences
MBBS Intern
Rasmita Budhathoki, B.P. Koirala Institute of Health sciences
MBBS Intern
Nidesh Sapkota, B.P. Koirala Institute of Health Sciences

Associate Professor

Department of Psychiatry


1. WHO. Summary report, working group in preventive practices in suicide and attempted suicide 1986.
2. Hawton, K. & Fagg, J. Suicide and other causes of death, following attempted suicide. British Journal of Psychiatry 1988; 152:359-366
3. Barraclough B, Bunch J, Nelson B, et al. A hundred cases of suicide: clinical aspects. British Journal of Psychiatry 1974; 125:355-373.
4. Ennis J, Barnes RA, Kennedy S, et al. Depression in self-harm patients. British Journal of Psychiatry 1989; 154:41-47.
5. Suominen K, Isometsa E, Henriksson M, et al. Consultation versus research diagnoses of mental disorders among suicide attempters. Nordic Journal of Psychiatry 1999; 53:253-256.
6. Ferreira de Castro E, Cunha M, Pimenta F, et al. Parasuicide and mental disorders. ActaPsychiatricaScandinavica 1998; 97:25 -31.
7. Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry 1997; 170:447-452.
8. Weissman M M. The epidemiology of suicide attempts. Archives of General Psychiatry 1974; 30: 737-746.
9. Government of India (1994) Accidental deaths & suicide in India, National crimes records Bureau, New Delhi: Ministry of home affairs.
10. Roy A. Suicide. In : Kaplan and Sadock’s Comprehensive Text of Psychiatry, vol.11, 7th edition Lippincott Wilkins 2000.p. 2031-2040
11. Shukla G D, Varma B L , Mishra D N. Suicide in Jhansi city. Indian Journal of Psychiatry; 32: 44-52
12. Ponnudurai R, Jayakar J. Attempted suicide in Madras. Indian Journal of Psychiatry; 28: 59-62.
13. Thapa B &Carlough M C . Suicide Incidence in the Lalitpur District of Central Nepal. Tropical doctor 2000; 30:200-203
14. Platt S, Bille-Brahe U, Kerkhof A, et al. Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. Introduction and preliminary analysis for 1989. ActaPsychiatricaScandinavica 1992; 85:97-104.
15. Rao K N, Kulkarni RR, Begum S. Comorbidity of psychiatric and personality disorders in first suicide attempters. Indian J Psychol Med 2013;35:75-9
16. Shailaja S Patil , Mallikarjun C Yadavannavar , Chaukimath S P. Deliberate Self Harm and Psychiatric Co Morbidity: A Hospital Based Study.Asian J. Exp. Biol. Sci. 2011;2(2):367-371
17. Sapkota N et al . Hundred psychiatric outpatients presented with attempted suicide. Health Renaissance2011; Vol 9 (No.3):162-167
18. Joshi D, Sen B, Shyangwa P M. Intentional self-harm: A study of the sociodemographic profile, associated morbidities, suicidal intent and its relationship with stressful life events. Thesis submitted to the faculty of BPKIHS, July, 2004.
19. Pokhrel D et al . A comparative, retrospective study of poisoning cases in central, zonal and district hospitals. Kathmandu University journal of science, engineering and technology 2008;I(V):40-48
20. P. K Kiran Kumar et al. Epidemiology of psychiatric disorders in deliberate self-harm victims. Journal of Evolution of Medical and Dental Sciences 2013;2(7):738-744
21. Khadka SB, Ale SB. A study of poisoning cases in emergency Kathmandu Medical College Teaching Hospital. Kathmandu University Med J 2005; 3:388-91.
22. Lonnqvist J K. Epidemiology and causes of suicide. In: Gelder et al’s New oxford textbook of Psychiatry, vol 1, 1st edn, Oxford University Press; 2000. P.1033-1038.
23. Sobhani AR, Shojaii-Tehrani H, Nikpour E, Noroozi-Rad N. Drug and Chemical Poisoning in Northern Iran. Iranian Journal of Medical Sciences 2002 Mar 5; 01: 27.
24. Sato T, Takeichi M, Hara T. Suicide attempts by agricultural chemicals. Indian Journal of Psychiatry 1993; 35: 209-210
25. Marahatta et al. poisoning cases attending emergency department in Dhulikhel Hospital- Kathmandu University Teaching Hospital. Kathmandu University Medical Journal 2009;7:152-156
26. Singh DP, Acharya RP. Patterns of poisoning in Nepal. J Inst Med. 2006; 28:3-6.
27. Gulohglu C, Kara IH. Acute poisoning cases admitted to a university hospital emergency department in Diyarbakir, Turkey. Human & experimental toxicology 2005; 24: 49-54.
28. Stanley B, Gameroff MJ, Michalsen V, Mann JJ. Are suicide attempters who self-mutilate a unique population? Am J Psychiatry 2001; 158:427–432.
29. Briere J, Gil E. Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 1998; 68:609–620.
30. Gupta S C, Singh H. Psychiatric illness in suicide attempters. Indian Journal of Psychiatry 1981;23:69-74
31. Kafle KK, Nepal MK, Sharma SR, Pokharel RP. Poisoning cases at T.U. Teaching Hospital.JInst Med. 1989; 11: 297-301.
32. Phillips MR, Li X, Zhang Y. Suicide rates in China, 1995-99. Lancet 2002 Mar 9; 359: 835-40.
33. Sethi et al. Psychosocial factors and personality characteristics in cases of attempted suicide. Indian Journal of Psychiatry 1978;20: 25-30
34. Dieserud G. Loeb M, Ekeberg O. Suicide behavior in the municipality of Baerum, Norway: a 12-year prospective study of parasuicide and suicide. Suicide Life Threat Behavior 2000; 30: 61-73.
35. Khan MM, Islam S, Kundi AK. Parasuicide in Pakistan: experience at a university of hospital. ActaPsychiatrScand in 1996; 93 : 264-267.
36. Murthy, R.S. Urbanization and mental health. Indian J. Soc. Psyciatry;9:16-9
37. Gupta, B. &Trzepacz, P. Serious overdosers admitted to a general hospital: comparison with nonoverdose self-injuries and medically ill patients with suicidal ideation.General Hospital Psychiatry 1997 ;19: 209-215 .
38. Vajda J et al. Factors associated with repeat suicide attempts among adolescents. Australian and New Zealand Journal of Psychiatry 2000;24, 3: 437-44
39. Manian T. Suicide and parasuicide in a hill Resort of Malaysia. British J of Psychiatry 1998; 153:222-225
How to Cite
Ghimire, S., Devota, S., Budhathoki, R., Sapkota, N., & Thakur, A. (2014). Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center. Journal of Nepal Medical Association, 52(193), 697-701.
Original Article