Pakistan faces a significant suicide problem, with a mortality rate of 9.77 per 100,000. Several interconnected factors contribute to this, including:
The article suggests several interventions to address the issue:
Pakistan is the sixth most populous country in the world with a suicide mortality rate of 9.77 per 100,000 population1. Since its independence, the nation has faced numerous barriers due to volatile governance, and resultant continuous low socioeconomic and health indicators. Pakistan is a country with communities of many languages, cultures, and religious factions. Whereas Islam, which continues to be the commonly practiced religion; has a significant influence on the legal and medical systems. Therefore, the actual suicide rate and underlying psychosocial conditions remain largely unreported in Pakistan surrounding its potential legal and religious repercussions2,3. Evidence suggests on suicidal conduct, which includes completed suicide, deliberate self-harm (DSH), and suicide ideation indicating that in South Asian cultures like Pakistani, interpersonal relationships seem to play a more significant role in suicidal ideation4. Suicidal ideation and behavior are actively being stigmatized in society which may be a factor in the paucity of qualitative studies on the topic. Currently, the country does not have any integrated strategic policy framework for suicide prevention at the national, provincial, or local levels. In order to facilitate policy and future research for suicide prevention programs for the nation, the study intends to raise a concern about the social stigmatization and nonexistence of national suicide policy in Pakistan.
Nearly 34% of Pakistanis suffer from a common mental disorder, and depression is thought to be a factor in more than 90% of suicides5. One of the most marginalized groups in society are adults with psychiatric problems, and social isolation being a significant risk factor for both declining mental health and suicide6. Other psychosocial factors include childhood traumas such as exposure to family violence, the loss or separation of parents, childhood sexual abuse7, and early marriage age with little autonomy in choice of partner8. For Pakistani women, marriage also appears to be a substantial cause of stress. Marital and family strife, particularly with in-laws, seem to be significant risk factors9. Pakistan also has a relatively high rate of psychoactive drug use, with Khyber Pakhtunkhwa (KPK) province having the highest rates of cannabis (4.7%), opiate analgesics (4.4%), tranquilizers/sedatives (2.4%), heroin (1.0%), and opium usage (0.6%). The psychoactive substance abuse is also associated with an increased risk of suicide, as people tend to overdose on it7.
According to estimates, there are at least 10–20 DSH actions for every suicide. DSH has become stigmatized as a result of its “criminalization”5, and religious judgment10. This leads to avoidance of obtaining medical assistance, a lack of professional engagement, and restrictions on the formation of creative initiatives to prevent suicide5. According to a study, the follow-up rate after contact with psychiatric care following a suicide attempt was just 27%10. Pakistan is also uncompetitive in establishing effective mental health policies. This is in concordance with the fact that as of 2021, the Mental Health Ordinance of 2001 was Pakistan’s last comprehensive component of mental health law with no updates thereafter. This suggests that Pakistan fails to take mental disease into account9. This is further supplemented by the fact that the total health budget is <4% of the GDP and incorporates no specific funding for mental health care11.
Mental illness was also rendered severe during the COVID-19 pandemic, as reported in an article, Pakistan observed 29 cases of suicides and attempted suicides since the lockdown began12. This is attributed to self-isolation, physical distance, and fear of contagion. Social exclusion and prejudice toward people with COVID-19 and their families have further raised the risk of suicide. Other factors that have also contributed to suicide in Pakistan amidst the pandemic include rising domestic violence, alcohol use, lockdown-related unemployment, and economic recession12,13.
Moreover, the recent flooding in Pakistan resulted in substantial loss of human and material resources, as well as psychological stress and depression that could lead to suicidal tendencies among survivors14. According to a growing body of research, the climate disruption has direct effects on mental health that vary from a rise in suicides and worsening outcomes for those with diagnosable mental health illnesses to a decline in population mental health and wellbeing15.
Suicide and DSH also seem to be substantially linked with unemployment and prevailing poverty in Pakistan7,8. It was reported by the government in September 2021 that 22% of Pakistanis live below the poverty line16. In addition, mental illnesses have a disproportionately negative impact on people living in poverty. Numerous indices of poverty and common mental diseases have a substantial correlation, according to a recent systematic review of epidemiological studies in low- middle-income countries6. As of recent reports, the inflation crisis in Pakistan hit a huge spike of 40% during February, 202317. This highlights the current economical instability and the crucial debts that Pakistan is dealing with. The high inflation rates coupled with minimal salary increment makes it arduous for the prevailing lower- and middle-class community to afford basic necessities, such as food, for themselves and their families17. This not only creates a huge mental distress but also serves as a motive for committing suicide.
Drugs, insecticides, and toxic chemicals are the most often utilized items by suicide victims6. The prevalence of incidents of medicinal self-poisoning is largely due to the “over the counter” availability of psychotropic medications, particularly benzodiazepines18. Pills have been linked to suicide more frequently than any other substance in Pakistan, and of the ones mentioned, wheat pills and Kala Pathar are the most frequently utilized due to their accessible nature, minimal cost, absence of regulation, and high toxicity19,20. In addition, Pakistan is an agriculture-based country, and pesticides are often accessible in virtually every family6. Accessibility to weapons and other potentially violent techniques like firearms has also been linked to an increased risk of suicide. This is especially relevant for Pakistan’s Northwest region, including KPK, where the young generation frequently acquires weapons without an official permit7. According to a recent systematic study, gaming platforms like PUBG also have a significant impact on the presence of violent, suicidal, and self-harming behaviors21.
In order to reduce the suicide rates in Pakistan it is first necessary to deal with the current mental health situation. According to the American Psychiatric Association (APA), recommended psychiatrist to population ratio should be 1:8,000, however, in Pakistan there are only 500 well-trained psychiatrists and around 3–4 decent child psychiatrists22. Keeping this in mind, the first step toward reducing suicide rates should be to promote the field of psychiatry by influencing future doctors to pursue this field, and the government should hire more psychiatrists in different parts of the country, especially the rural areas where the strict culture has a negative influence over the mental health of many. Secondly, as poverty is a major concern in Pakistan, the government must regulate policies which can promote accessible donations and foreign funding which can be allocated to the betterment of the low-esteemed and poor communities of Pakistan. In addition, job opportunities must be provided to those in need, this way a major factor influencing mental health of Pakistanis can be dealt with, lowering the incidence of suicide. Moreover, nearly one-third of Pakistan’s population is between ages 10 and 14, and as DSH is relatively common in Pakistan, this puts a majority at the risk of suicide23. To counter this issue schools and colleges must intervene to educate their students and provide proper counselling which teaches them the harms of such actions and also provide the mental support that they may require. Furthermore, as many poisons and drugs are available openly in the market, which can potentially be used as a suicidal substance, the authorities must implement a strict checking system regulating the dispensing of these items openly in the market. In addition, establishment of new rehabilitation centers should be promoted to prevent suicide due to overdosing24. Lastly, since criminalization of suicide limits people from seeking mental health which adds to the incidents of DSH and suicide, decriminalization of suicide in Pakistan can prove to be helpful in lowering the risk of suicide. Such efforts await results as the decriminalization bill passed by the senate received approval by the president and is now being implemented in Pakistan25.
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All authors contributed equally.
The authors declare that they have no financial conflict of interest with regard to the content of this report.
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