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January 2014, Volume 64, Issue 1

Letter to the Editor

Prevalence and correlates of suicidal expression among school attending adolescents in Pakistan

Masood Ali Shaikh  ( Independent Consultant, Gulshan-e-Iqbal, Karachi, Pakistan. )

Madam, suicide is a serious global public health problem among adolescents. There are no nationally representative, population based surveys on suicide-expression among school attending adolescents in Pakistan. A recent study based on 90 countries reported a suicide rate of 7.4/100,000 adolescents aged 15-19 years old.1 Suicide-expression has been reported to be associated with poverty, having been bullied, poor mental health, poor parental monitoring and involvement, and tobacco use.1-4
To describe these factors association with self-reported suicide-expression in the past 12-months in Pakistani students of class 8-10 and its prevalence; I used data from the two-stage cluster sample-based nationally representative Global School-Based Health Survey (GSHS) for Pakistan, conducted by the Ministry of Health in collaboration with the World Health Organization and Centers of Disease Control and Prevention, United States, in 2009.5 Design-based analysis using STATA-12 was done using bivariate analysis and multinomial logistic regression; factors found statistically significant at p<0.05 level on Chi-square test were used for multinomial logistic regression. Responses to GSHS question "During the past 12 months, did you ever seriously consider attempting suicide?", and "During the past 12 months, did you make a plan about how you would attempt suicide?" were used to determine suicide-expression. Suicide-expression was defined as either having 'suicide-ideation' or 'suicide-planning' in the past 12 months.
The overall prevalence of suicide-ideation alone was 3.3% [95% confidence interval (CI): 2.6%, 4.0%] (n = 5095), while prevalence of suicide-planning (with or without suicide-ideation) was 7.6% (95% CI: 6.4%, 8.8%).

Table-1 provides the description of respondent's demographics, tobacco use and food deprivation, anxiety, having close friends, truancy, bullying, parental involvement, loneliness, and tobacco use; as well as their association with suicide-expression in bivariate and multivariate analyses.
Age, sex, and parental involvement in terms of their knowledge about use of free time by the respondent were not found to be statistically significant in bivariate analysis with suicide expression. Multivariate analysis found anxiety, number of close friends, parental involvement in terms of checking respondents' homework, and use of tobacco were found to be statistically significantly associated with suicide ideation. While anxiety, number of close friends, being bullied, and tobacco use were found to be statistically significantly associated with suicide plan.
Results augur the need for identifying those students who are at increased risk of attempting suicide and targeting suicide prevention health education campaigns in schools towards them in concert with teachers, parents, and general practitioners.


1. Wong SS, Zhou B, Goebert D, Hishinuma ES. The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 1611-20.
2. Wilson ML. Dunlavy AC, Viswanathan B. Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-saharan country. Int J Environ Res Public Health 2012; 9: 4122-34.
3. Alaimo K, Olson CM, Frongillo EA, Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. J Nutr 2002; 132: 719-25.
4. Whitley E, Gunnell G, Dorling D, Smith GD. Ecological study of social gragmentation, poverty, and suicide. BMJ 1999; 319: 1034-7.
5. Global School-based Student Health Survey (GSHS). (Online) 2013 (Cited 2013 March 1). Aavailable from URL:

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: