110 Suicide prevention in Pakistan

Pakistan is a developing country located in South Asia, with a population of approximately 162 million, 97 per cent of which are Muslims. Suicide is a condemned act in Islam. Historically, suicide was rare, but over the last decade or so has become a major public health problem in Pakistan (Khan and Prince 2003).

Despite this, there are no official statistics from Pakistan. National rates are neither known nor reported to the World Health Organization (WHO) (World Health Organization 2001).

Under Pakistani law (based on the tenets of Islam), both suicide and deliberate self-harm (DSH) are illegal acts, which are punishable with a term in jail and a financial penalty. People avoid going to government hospitals, where suicidal acts are registered. Many seek treatment from private hospitals that neither diagnose suicide nor report them to police. Suicide and DSH are, therefore, under-reported in Pakistan (Khan and Reza 1998).

Information on suicide in Pakistan comes from newspapers, non-governmental organizations (NGOs), volunteer and human rights organizations, and police departments of various cities (Khan and Prince 2003). Further information is available from hospital-based studies on acute intentional poisoning (Waseem et al. 2004), DSH (Kermani et al. 2006) and autopsies carried out by forensic medicine departments (Sultana 2002; Bashir et al. 2003).

Suicide cuts across all ethnic, provincial and rural/urban boundaries. It has been reported from all major cities, including Karachi (Sultana 2002; Ahmed et al. 2003; Farooqi et al. 2004), Larkana (Aziz et al. 2006), Lahore (Aziz and Awan 1999), Multan (Ahmed et al. 2002), Bahawalpur (Suliman et al. 2006), Faisalabad (Saeed et al.2002), Rawalpindi (Khattak 2006) and Peshawar (Bashir et al. 2003). Suicide has been reported from the remote Ghizer District, in the northern areas of Pakistan (Ahmad and Khan 2005).

While official rates of suicide are lacking, it is possible to calculate rates in some cities and districts of Pakistan.

Crude rates vary from a low of 0.43/100,000 per year (average for 1991–2000) in Peshawar, to a high of 2.86/100,000 for Rawalpindi (in 2006), with other cities falling in between: Karachi, 2.1/100,000 (1995–2001); Lahore, 1.08/100,000 (1993–95); Faisalabad, 1.12/100,000 (1998–2001) and Larkana, 2.6/100,000 (2003–2004).

Gender differences show that in all studies men outnumber women. Gender-specific rates show that for men, highest rates are 5.2/100,000 in Rawalpindi and Haripur, while for women the highest rates are 16.7/100,000 in the Ghizer District, located in northern areas of Pakistan.

In Pakistan, most suicides are committed by young people. The highest age- and gender-specific rates for both genders in the age group 20–40 years are: 7.03/100,000 in Larkana for men; and for women, 32/100,000 in the Ghizer District, northern Pakistan.

A review of seven studies, which list methods used in suicide (N = 5394), showed that poisoning (34 per cent) and hanging (26 per cent) to be the two most common methods, followed by firearms (16 per cent), drowning (11 per cent), self-immolation (5 per cent) and jumping from height or in front of trains or moving vehicles (1 per cent each) (Aziz and Awan 1999; Khalid 2001; Saeed et al. 2002; Ahmed et al. 2003; Bashir et al. 2003; Aziz et al. 2006; Khan and Hyder 2006). Use of medications for suicide featured in only four cases (one male and three female).

A multisectoral approach is needed to address suicide prevention in Pakistan

The traditional low suicide rate, and the protective influence of Islam, has undergone a radical change, and suicide has become a major public health problem in Pakistan. Lack of resources, poorly established primary and mental health services, and weak political processes make suicide prevention a formidable challenge in Pakistan. Public and mental health professionals need to work with government and non-governmental organizations to take up this challenge.