In The Name of ALLAH The Almighty
Suicide among Young Adults
“When people kill themselves, they think they're ending the pain,
but all they're doing is passing it on to those they leave behind”
Suicide is the act of deliberately or intentionally taking one's
own life (Center for Disease Control and Prevention, 2010). Most
suicides occur among young adults i.e. over the age of 25 (Beautrais,
2000). Erikson’s stages of human development describe the young
adult age group between 20 to 40 years. Suicide is a common cause
of unnatural death and is significant as a major public health
problem in Pakistan.
It is considered that the act of suicide is started to increase
more in human life from 1970’s. In this year, the rise in
depression as well as suicide attempts and deaths were first
reported among adolescents and young adults. It seems that the
'baby boomers', which were born after World War II, had increased
rates of depression and other illnesses, including drug abuse and
alcoholism (Klerman, 1988). On contrary, many countries have
experienced an increase rate of suicides over the years 1960-64 to
1990-94 (Beautrais, 2000).
Worldwide, approximately 900,000 suicides reported each year,
including 200,000 adolescents and young adults (Ahmad &Rizwan,
2010). In a descriptive data, four ethnic groups including South
Asia (Pakistan) indicates that risk of suicide among adolescents
and young adults were reported to be rising. Moreover, suicide is
the 8th leading cause of death in males and 16th leading cause
among females worldwide (Bhui& McKenzie, 2008). According to CDC
(2010) fact sheets report, males are more likely to commit suicide
at a rate of five times than females whereas females are more
likely to attempt suicide than males. Whereas, in 2003, American
Indian/Alaskan Native, non-Hispanics have the highest suicide rate
in which males were two to four times that of same-age males in
other racial/ethnic groups and eleven times that of same-age
females ("2006 fact sheet," 2006). Likewise, a study presented by
Bhui& McKenzie (2008) shows that in South Asia (Pakistan) 50% out
of 166 are among young adults who commit suicide among which 68%
were males. Whereas, in the Ghizar District, the remote area of
Northern Areas of Pakistan, 49 women committed suicide during the
year 2000 to 2004. Suicide rates of women were undertaken among
15-24 years and crude specific rates were found to be 61.07/100,000
per year by taking average mean population for women for 5 years as
65,783 (Khan, Ahmed & Khan, 2008). In disparity to this, according
to Human Rights Commission of Pakistan (HRCP) 98 men and 40 women
committed suicide between December 26, 2008 and January 25, 2009
out of the 138 people. (138 committed suicide, 2009). Hence, this
empirical statistics shows that in some areas of Pakistan women are
more prone to commit suicide and in other areas men are more prone
to commit suicide.
In Pakistan, the existence of suicidal behavior is considered as a
social taboo which makes Pakistani population more vulnerable to
suicide. Family also hides suicidal behavior of individual to avoid
legal actions, religious humiliation and social disgrace due to
which it becomes difficult to identify suicidal cases. Regardless
of highly underreported suicides in Pakistan, its cases are raising
very rapidly which are based on empirical research studies that
have explored only the reasons and risk factors of suicides in
Pakistan (Ayub, 2008).
Recently researchers have begun to investigate the effects of
suicide. Cited in a study of Goode, (2003), Dr. John Jordan, the
author of Review of Research on Suicide (2001) said that the health
of survivors is physically, emotionally and psychologically
affected badly because some people pass through a normal grief
process and heal quickly; but others go in depression feel guilt,
rejection, shame, and adopt isolation. Their health is also
affected because sometimes they are viewed negatively by others. In
addition, the family members of the person are affected, as stated
in a study of Goode, (2003) wives who had lost their husbands are
viewed more blameworthy than wives whose husbands had died from
heart attacks or in accidents. Due to this factor they are also
vulnerable to depression; this is the worse effect of suicide and a
major risk factor for family members that they are prone to commit
There are several methods to commit suicide including hanging,
poisoning, jumping, gunshot and self-fire etc. In California
females more likely poison themselves and males shoot themselves (Otsuki,
Kim & Peterson, 2010) whereas in Pakistan hanging, poisoning and
firearms are common methods (Khan, 2007). The broader perspective
of causes includes psychopathology, stressful life events, suicide
contagion, interpersonal conflicts, and socioeconomic and political
Psychopathology describes the relationship between mental illnesses
and suicidal ideations. People with depression, personality
changes, phobias, obsessive compulsive disorder, somatoform
disorder, and substance abuse and anxiety disorders are susceptible
to suicide. At least 90% of the youth suicide victims had
psychiatric disorders at the time of death (Liu &Tein, 2005,
p.196). Depression is now more prevalent among people who aged
between 20 to 30 years. Among young women, depression is high and
at its peak in their mid-30s (Stillion& McDowell, 1996). In
contrast, almost 34% of Pakistani youth suffers from common mental
disorders among them 90% suffersfrom depression (Khan, 2007).
Problem in intimate personal relationships is another cause as
young adults are working to establish the intimacy in their
relationship. A difficulty in interpersonal relationship leads to
separations and divorces and is associated with depression in both
the genders (Stillion& McDowell, 1996). Most of the people who
commit or attempt suicides have experienced failure or rejection in
love which leads to suicide (Richards, 2003).
The socioeconomic and political factors describe relation of
poverty and unemployment to suicide. “The Nation” (2011) reports
that a mother committed suicide in Lahore due to severe financial
constraints. Samaa news channel (2011) reports about a 35 year old
man who took poison from the frustration of losing his job.
Political matters grounds the rich to be richer and the poor to be
entangled in poverty. The unemployed youth is brainwashed to
attempt suicide bombing. This affects the country’s socio-economic
and political conditions in a negative way.
Several negative life events also lead to suicide completion among
young adults. These events may consist of ignorance during
childhood, physical or sexual abuse, past suicide attempts,
hopelessness and disconnection from family and peers. According to
Websdale (2003) a significant number of 6,000 women commit suicide
in the United States each year because they are abused by intimate
male partners. Due to the above reasons, the victims are unable to
cope with the stress and commit suicide.
Stories shown by media, newspaper articles, and the factious and
non-factious performance have a positive impact on young adults to
attempt suicide as they find the stories similar to their life
stressors and choose suicide as the last solution to get rid of
them (Gould, Jamieson &Romer, 2003).
Awareness and knowledge about suicidal prevention and management is
less identified in comparison to cause and effects. Suicide can be
prevented in four phase’s i.e. primordial, primary, secondary and
The primordial prevention includes mass education as a main
approach to prevent suicide among healthy individuals when there is
no presence of risk factors. Population health is viewed as a broad
emphasis rather than individual’s perspective. Public health’s long
term goal is the lasting change in factors that place people at
risk by social ecology modification that will reduce suicidal rates
(Strategic Direction for the Prevention of Suicidal Behavior, CDC).
Different workshops and media plays important role in primordial
prevention. Gould, Jamieson and Romer (2003) report that media
plays a powerful role in educating people about suicide prevention,
its warning signs, trends, causes and recent treatment modalities.
Stories about the harmful effects of suicide are portrayed by media
and reduce the prevalence of suicide.
Unemployment is another prevalent cause, uneducated youth are less
selective but have low economic opportunities whereas educated
youth are particular and they are in search of better jobs, thus
constituted a major part of frictional unemployment. One of the
reasons of unemployment among educated people is lack of training
and skills which is needed in labor market especially in Pakistan.
The needs of youth must be addressed at country level keeping in
view the educational, social and labor market employments. To
create youth employment opportunities, there is need of integrated
approach which comprises of supportive economic policies belonging
to labor demand and supply (Ahmed &Azim, 2010).
The word primary prevention shows prevention before the occurrence
of suicide in conditions as depression, impulsive behavior, or
alcohol and drug abuse (National Center for Injury Prevention and
Control, n.d.). To deal with these disorders first of all health
care providers should be well skilled, able to manage depression
and other chaos. Likewise, many people with depression and related
disorders visit primary care providers where they report physical
complaints rather than psychological symptoms (WHO, 2008).
This shows that how the knowledge of health care provider is
necessary in these situations. A cross sectional study displays
that individuals or group of people can be taught about the
self-appraisal strategy. There are three ways of self-appraisal;
social support, emotional coping and situational coping. All the
three appraisals lie under the umbrella of resilience appraisals.
Social support includes assistance from other people including
family and friends in terms of emotional support, financial support
and advisory. Emotional coping consist of purposeful use of
distraction techniques to deal with one’s emotional needs.
Situational coping refers to deal with problem or stressor itself.
The schematic appraisal model of suicide suggests that positive
self-appraisals might provide a source of resilience (Johnson,
Gooding, Wood &Tarrier, 2009).
Correspondingly, the main goals of secondary and tertiary
prevention is early detection of suicidal ideation, planning, and
appropriate referral and treatment for suicide risk along with the
rehabilitation for the people who have attempted suicide (National
Center for Injury Prevention and Control, n.d.). Therefore, it is
needed to arrange sessions or trainings for gatekeepers (teachers,
counselors, coaches, police, merchants, and recreation staff,
trained volunteers, social workers, peers).At Hong Kong the
gatekeepers programs were done on supermarket staff because
charcoal is commonly used in suicide. The successful completion of
program was only because of reducing availability of charcoal from
the supermarkets (WHO, 2008).
Japan’s Ministry of Health, Labor and Welfare in collaboration with
Akita University initiated a community-based public health suicide
prevention program which ran in six towns in Akita (high suicides
rates in Akita). The project offered much training in suicide
prevention, screening for depression and counseling. After running
this project, there was a significant reduction in suicidal cases
in town (WHO, 2008).
Furthermore, counseling and psychotherapy is another solution of
suicide. Many young adult have a great difficulty in problem
solving, managing stress and expressing their feelings. After
counseling, several therapies could be helpful to prevent suicide.
One is Cognitive Behavioral Therapy (CBT), according to U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES (2009) in a randomized
controlled trial using CBT reports that this therapy has reduced
50% suicide attempt in adults who had made an earlier attempt as
contrast to those similar groups who receive treatment as usual.
Similarly, a study was done in group of women who took Dialectical
Behavioral Therapy (DBT); they had fewer hospitalizations for
suicide ideation, lower medical risk, and were less likely to drop
out of treatment.
Moreover, mindfulness is also a therapy which assists anxious and
depressed people by paying attention towards some stimuli through
their senses. WHO (2008) states that Thailand is participating with
other Asian countries in strategies to prevent suicide (STOP) by
taking guidelines of media from World Health Organization. As a
result, in Thailand practice of reporting suicides on the front
page of newspapers has reduced because of fulfilling those
To overcome this issue at grass root level, we recommend that there
should be tele-help lines for people experiencing stressful events.
This is done by using catharsis which helps them in ventilating
their feelings and finding out ways to solve their problems with
different coping strategies; this will reduce suicides related to
traumatic events. Secondly, the help lines will generate income
opportunities for unemployed and will further reduce suicides
related to unemployment. Moreover, medications must not be given
without prescription in order to reduce means of suicide. Policies
should be followed to cancel the license of pharmacist along with
the payment of penalty if he/she provides lethal medications
without prescription. In Pakistan, there are laws present against
suicides i.e. Rs. 50,000 penalty but unfortunately are not being
followed; the policies should be strictly followed to reduce the
suicide rates. Furthermore, support groups must be present for
people with depression, stressors and suicide attempts to help
people out of problems and reduce consequences. Hospitals should
report strictly the cases of self-injuries so that the institutes
have exact data of people committing or attempting suicides which
will help in prevention and control of issue. People should
practice their religion regularly as all the religions in the world
forbid self-injuries and suicides and ensures life as a precious
In Pakistan there is less data obtainable on suicide than other
parts of the world. Researches should be conducted on analytical
based studies including case control studies and cohort studies.
Furthermore, randomized experimental studies should be conducted on
this issue all over the world. In Pakistan, the descriptive and
empirical data are available whereas cross sectional studies are
less to none presented. Due to unavailability of these studies, the
prevalence is also less existing in Pakistan. The experiments
should be conducted related to cognitive and dialectal based
therapies as they have shown remarkable results in other
researches. Moreover, projects on prevention at large scale should
be conducted at different areas so that more people can get benefit
and will add onto the research studies.
“Suicide is the sinerest form of criticism life gets.” (Wilfred
Sheed, The Good Word, 1978) so we should take measures to stop this
sin and to save and give meaning to precious lives.
Sunita Lalani, Zainish Zafarullah Hajiani,
Sajid Khan, Ina Abdul Majeed and Jasmin Zahid
Students of BScN (undergraduate nursing program) at
Aga Khan University School Of Nursing and Midwifery