The staggering figure of annual toll of around one million suicides across the world and 6,000 in Pakistan, according to World Health Organization (WHO), is no doubt one of the biggest challenges for rulers, economists, psychologists and sociologists. 

Suicide is the second leading cause of death among 15-29-year-olds worldwide. The recent episodes of suicide cases which surfaced in Chitral - mostly of depressed students who were either failed in securing good grades or obtaining passing marks in schools are dreadful. Earlier last month, another three students living in different areas of the valley attempted to end their lives after receiving their intermediate exam results. However, majority of suicide cases go unreported due to police inaction.

A recent study “Psychological autopsy review on mental health crises and suicide among youth in Pakistan” thoroughly investigated the possible causes of suicide among the youth (aged 12-26 years) and comprehensively evaluated clinical and psycho-social factors potentially associated with suicide in 63 youth from Khyber Pakhtunkhwa. The data examined mental health clinical files, forensic reports and qualitative psychological autopsy interviews from multiple sources for each youth who died of suicide between May 1st and December 31st, 2015 in the province.

This is the second psychological autopsy study undertaken in Pakistan and the first where interviews were conducted with several information sources and mental health clinical notes examined. Internationally, the most common methods of death by suicide are noted as hanging, drowning or jumping from a height. Contrary to it, due to high accessibility to firearms in the province, it is perhaps not surprising that this method was most commonly employed. In another region of the country, where a lower access to firearms is evident (Faisalabad), the most common method of suicide was reported as hanging.

The research thoroughly investigated the peculiar characteristics of the individuals (suicide victims) and clinical causes of the deaths along with the region specific strategies for committing suicide. The study finds that in majority cases, males were found to use firearm while females were found to use self-poisoning by pesticides as the two most common methods of suicide. The most common mental health difficulties were found either major depressive disorders or harmful use of psycho-active substances. The other clinical features particularly evident included thoughts of self-harm, irritability and aggression, low-self-esteem, treatment non-adherence, family dispute and financial distress. 

The study also identified significant clinical, psycho-social and environmental factors that were present prior to the individuals' death including factors noted as easy access to firearms and limited mental health support services. The region has the third largest population (approximately 27.5 million people) in Pakistan and shares a border with Afghanistan as access to firearms has widely been reported with young people often possessing firearms without license.

Other socio-demographic factors in this region include relatively low literacy levels (50- 60%) high unemployment rate of 8.5% particularly in females 16.3%, both previously noted to be associated with higher rates of suicide. In addition, the region has the highest rate of psycho-active substance use in the country (10.9%), with cannabis (4.7%), opiate analgesics (4.4%), tranquilisers or sedatives (2.4%) heroin (1.0%) and opium use (0.6%). Furthermore, dearth of mental health facilities and limited access to mental health care are also some of the factors responsible for suicides. 

The abuse or dependence of alcohol and/or psycho-active substances and a diagnosis of a personality disorder (particularly borderline personality disorder) have also highlighted as putative risk factors for suicide. In addition to male gender; other demographic factors associated with an increased rate of suicide include low educational attainment and/or low socio-economic class. 

The research interviews allowed data pertaining to a wide range of socio-demographic (employment, relationship and socio-economic status) and clinical factors (recent mental health status, expressed thoughts of self-harm, treatment adherence, psycho-social stressors, substance use) to be attained. A multitude of psychosocial factors have been linked with an increased risk of suicide. These include childhood traumas such as exposure to family violence, the loss of a parent or separation of parental figure and childhood sexual abuse (CSA). 

The first clinical theme related to symptoms consistent with a depressive disorder or a co-morbid depressive disorder with anxiety symptoms examples of individuals who exhibited depressive symptoms prior to their death. The study suggested that the efforts to reduce the ease of access to firearms and pesticides would have beneficial effects in reducing the suicide rate in the region. The study also suggests that greater community based mental health programmes for the detection and treatment of mental disorders and strategies are required to reduce lethal means of suicide including pesticides.

The availability of pesticides, including those of a particularly toxic nature in markets and small shops (“Khodas”) with transportation of pesticides into this region (often illegally) from Afghanistan and Central Asia require strict enforcement of laws. The KP Directorate General of Health Services (DGHS) has also recently formed a four-member committee to look into the causes of growing suicide cases and conduct psychotherapy of those with suicidal tendency and submit a report as soon as possible in Chitral district of the province also identified significant clinical, psycho-social and environmental factors that were present prior to the individuals' death including factors noted as easy access to firearms and limited mental health support services.


The Author is Journalist and Freelance Columnist based in Islamabad.