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A Qualitative Analysis of Suicides Committed by the Students in Pakistan.

Byline: Muneeba Shakil

Key words: Suicide, rate, method, reasons, Pakistan students.

Introduction

As declared by World Health Organization, around 800,000 people die every year due to committing suicide i.e. one person in every 40 seconds. Suicide is declared to be the second leading cause of death among 15-29 year old globally. Young population specifically adolescents between the age group 10-19 years often die premature due to suicide according to statistics worldwide.1 According to the statistics from 2016 to 2017, around 34.2 percent of college and university students who received mental health services had also seriously considered to commit suicide.2

Getting educated is a universal right of every child, however, over the years; standard for academics in Pakistan is getting so alarmingly high that it's doing more harm than good to our students. Increased expectations and competition leads to academic stress, depression and other psychological illnesses among students nowadays. Students have been committing suicide in Pakistan since quite a few years. Some motives that act as contributing factors in provoking students to end their own lives are examination stress, fear of failure, verbal and physical abuse by parents, teachers or peers, feelings of loneliness, hopelessness, and of being worthless. Low academic grades resulting in feelings of guilt, high personal or academic expectations leading to stress in turn leading in some cases to alcohol and drugs.3

When comparing the rising trend student suicide in Pakistan to other countries around the world, the situation is not much different except the fact that Pakistan has no official statistics regarding student suicide. According to Indian's statistics, their suicide rate is 10.3 which have increased by 43% from the last three decades. Their studies revealed that most of the suicide behaviors are not officially reported. Physical and mental illness, disturbed interpersonal relationships and economic difficulties were the most common reasons for suicide and the vulnerable population was women, students and farmers.4

With respect to the alarming rise of teenage suicides in Pakistan, Mr. laghari a renowned psychiatrist reported to media that there has been a drastic increase in the number of suicides committed by teenagers in Pakistan.5 Murad Musa, Head of psychiatry department, Aga khan University Hospital, Karachi (AKUH) expressed his views to a news reporter. According to him adults are the ones to be blamed directly as they could not provide a positive, safe and secure environment to their youngsters. Similarly a Karachi based psychiatrist, Shifa Naeem, believes that our teenagers are exposed to numerous stresses that our older generation was unaware of.6 A number of professionals have given their opinion on the increasing rate of suicide among Pakistani students.

In this context Muhammad Iqbal (Dean, Faculty of Education, University of Punjab) said that the contributing factors are examination stress, performance pressure from parents and their aspirations, difficulty in covering curriculum and teacher's incompetence and harsh attitude towards students. According to his analysis, the current curriculum is intellectually very demanding and students usually come under pressure when it is coupled with parental pressure to secure high marks. Due to such pressures, students feel frustrated and dissatisfied with life in general. The circumstances become more unfavorable when parents as well as teachers verbally and physically abuse, ridicule and punish the children".7 Our society overburden the children with their expectations which can be life threatening for them. Neglecting their talent, society imposes its own wishes for something they believe is better for them.

Instead of realizing that every child comes to world with a different set of talent, there is constant pressure on children to get good grades to seek admission in top most medical and engineering institutes and universities of the country. To meet societal standards, parents have eliminated the word enjoy from their children's life causing mental and physical instability with their constant hogging.8

The World Bank in its report published in 2011 has warned Pakistan for a rising trend of suicides within last few years. Approximately 7000 cases of suicide were reported in 2008, considering different psychiatric illnesses to be the contributing factor. According to the report it was alarming that even the students had started taking their lives in Pakistan. Cases of student suicide have been reported in past as well and were mostly attributed to poor academic performance and low grades in exams.3 According to annual report of the Human Rights Commission of Pakistan (HRCP) published in 2012, there has been increasing trend of suicide among teenage girls in Karachi.5 According to a report of 2011 published in National Poison Control Centre, at Jinnah Post Graduate Medical Centre, in Karachi, (HRCP), five or six teenagers attempt suicide every day in Karachi. Of them, 60% are teenage girls whose families did not register the case as attempted suicide.

According to an estimate of World Health Organization (2002), over 15,000 suicides were committed in Pakistan. According to Murad Musa Khan, majority of victims in such incidences are people under age 30 years. He further stated that of these approximately 25% of the cases were in their teenage. Thus, these figures are the only estimates one can establish from the studies available on suicide from Pakistan.6

Pakistan is not the only country where students commit suicide, it is not uncommon for students around the world to commit suicide or at least have suicidal ideation. According to the 2015 Youth Risk Behaviors Survey, 8.6 percent of youth in grades 9-12 reported that they had made at least one suicide attempt in the past 12 months. Girls attempted twice as often as boys (11.6% vs. 5.5%) and teens of Hispanic origin reported the highest rate of attempt (11.3%), especially Hispanic females (15.1%) when compared with white students (6.8%) and White females (9.8%) and approximately 2.8 percent reported making a suicide attempt that required treatment by a doctor.9

With respect to incidents of suicide by students in Pakistan, a few studies have been conducted. A study was conducted on information about suicidal behavior and prevalence of suicidal ideation in Pakistani college students. Results indicated that the overall rate of suicidal ideation was 31.4% where 33% were females and 29.2% were males. Higher rates of suicidal ideation were reported by students using hostel facilities. It was suggested by researchers to collect more information regarding suicidal behavior, including feelings in school going children as well to contribute to our understanding of the suicidal process in the Pakistani youth in order to address it at various levels.10 Suicidal ideation among medical students was investigated in another study conducted in a private medical college of Karachi.

Findings of the study revealed that 13.9% of all the students had made a plan in their life time to commit suicide, while 4.8% of the 331 students tried to commit suicide at some point of time in their life. Reasons were considered to be substance abuse followed by parental neglect and previous psychiatric disorder.11

Literature suggest that the exact figure of suicide by Pakistani students could not be determined as most of the cases were not reported and mortality statistics on suicides could not have been collected through a standard system of registration, recording and diagnosis of suicides at town, district and provincial levels. Studies on suicidal attempts, tendencies and mental health in college students are carried out, however, this issue is still understudied with reference to gender basis ratio, age, and reason with mortality statistics at country level. There are only rough estimates of incidences reported in newspaper articles or by health professionals. Therefore, this exploratory study is carried out with the aim to determine the rate, patterns, reasons and methods of suicide used by Pakistani students over a period of 8 years (i.e. 2010-2017).

The objectives of the study were to determine (1) the exact figure of reported suicide cases attempted by students all over Pakistan, (2) risk factor in terms of gender, age and field of studies, (3) common methods of suicide used in all the reported incidences, (4) prominent reasons behind comitting suicide.

Methodology

Retrospective study design was used in this paper as the outcome of interest has already occurred before the time present study was initiated. The researcher used suicide incidents published in newspapers of Pakistan.

Sixty seven reported cases suicide attempted by students in Pakistan were collected from renowned online Pakistani newspapers. As electronic archival data was collected incidences happened in past 8 years (i.e. 2010-2017), all over Pakistan were collected through Google search engine. The age range of deceased students was between 11 to 27 years. Of them 52 were males and 16 were female students. Cases were not included in the study if (a) the incidence happened before 2010 (b) the student was murdered (c) did not belong to Pakistan, (d) there was confusion between suicide and murder.

Electronic archival data was collected through renowned e-newspapers of Pakistan. The newspapers were namely (a) DAWN (b) The Express Tribune (c) The Nation (d) Samaa News (e) Pakistan Today (f) The News International (g) Pakistan Observer (h) Daily Times (i) Pakistan Times (j) Daily News International and (k) Geo news.

Finding and gaining access to electronic archives was the first step in this archival research. Once access was obtained to online Pakistani newspapers in English through Google search engine, the archives were searched. The Electronic archives collected were all public and were collected through purposive sampling based on characteristics of population and objectives of the study. While collecting the cases of students who committed suicide within past 8 years i.e. 2010-2017, their demographic details were taken including: age, gender, area of residence, field of study, city, reason and method through which suicide was committed. Records on the topic were identified, categorized, and converted into data which was then analyzed with both quantitative and qualitative methods of analysis.

Many of the ethical issues of informed consent did not apply to this study because cases already reported in newspapers have been collected. However, the confidentiality of participants was protected as none of the details revealing their identity are mentioned in the study. Full caution was exercised while handling privacy issues before accessing archives. To avoid privacy related issues researcher did not access the names, addresses, or telephone number of victims. The archives accessed were not enclosed by any copyright law.

The cases collected through electronic archives were identified, categorized, and converted into data to carry out descriptive statistical analysis through IBM SPSS: Version 20. Mean age, standard deviation, frequency and percentages were calculated to carry out analysis.

Results

Figure-1 shows the percentage of reported suicide cases by students in Pakistan from 2010 to 2017. The incidences started rising from 2012 with 27.9%, no cases reported in 2013 and are maintained at 26.5% in 2016 and 25% in 2017.

The distribution of suicide among male students was found to be 76.5% and 23.5% among females. Mean age was found to be 12.10 years. Of them 42.6% were from school, 23.5% from college and 22.1% from university. Suicide methods used were hanging (33.8%), shooting self with gun (27.9%), chemical poison (13.2%), jumping from height (5.9%), suicide burn (4.4%), and wrist cutting (1.5%). Most of the reported cases were from Punjab (52.9%) than Sindh (23.6%) and Khyber Pakhtunkhwa (8.9%).

Table 1: Demographic characteristics.

Variables###(n)###%

Gender

Male###52###76.5

Female###16###23.5

Age

Teenage Students (11-18 years)###23###30.9

Adult Students (19-27 years)###24###33.9

Not reported###21###30.9

Provinces/City

Punjab

(Islamabad)###18###26.4

(Lahore)###10###14.7

(Faisalabad)###2###2.9

(Rawalpindi)###3###4.4

(Gujranwala)###1###1.5

(Multan)###1###1.5

(Rahim Yar Khan)###3###4.4

Khyber Pakhtunkhwa

(Abbotabad)###1###1.5

(Mardan)###1###1.5

(Chitral)###1###1.5

(Peshawar)###14###20.6

Sindh

(Karachi)###10###14.7

(Hyderabad)###1###1.5

(Khairpur)###1###1.5

Education Level

School###29###42.6

College###16###23.5

University###15###22.1

Not Reported###8###11.8

Among the reasons of suicide, most common was failure in exams (23.6%), 11.8% committed suicide after being scolded by parents over concerns related to academic performance, 8.8% after failure in love, 5.9% due to their family issues, 5.9% due to harsh attitude of teachers and administration, 4.4% took their life due to dissatisfaction with life, 2.9% due to pressure of studies, 2.9% due to ragging by seniors and one student committed suicide due to poverty.

Discussion

Growing trend of suicide among young students is an area of major concern among mental health experts as this growing suicidal tendency is a serious threat to our educational system and raise questions to both parents and teachers. Previously studies have been conducted but all the literature available addresses suicidal attempts and ideation in general population with an overall mortality rate. Despite of an alarmingly rising rate of suicide by students in Pakistan, mental health experts and governments has not addressed this issue. This should also have served as a wake-up call for the government plan to remedy the situation.

This study explored the rate, patterns, reasons and methods of suicide committed by students all over Pakistan over a period of 8 years i.e. 2010-2017. According to results of descriptive analysis, mean age was found to be 12.10 years. Suicide rate was higher among male (76.5%) than female students (23.5%). Of them 42.6% were from school, 23.5% from college and 22.1% from university. Suicide methods used were hanging (33.8%), shooting self with gun (27.9%), chemical poison (13.2%), jumping from height (5.9%), suicide burn (4.4%), and wrist cutting (1.5%). Most of the reported cases were from Punjab (52.9%) than Sindh (23.6%) and Khyber Pakhtunkhwa (8.9).

Most common reasons behind suicide were found to be failure in exams (23.6%), scolded by parents (11.8%) harsh attitude of teachers or administration (5.9%) and academic stress (2.9). Relating to the results it is very disturbing to know that most of the students before taking their life held their teachers' and parents harsh and unacceptable behavior responsible for committing suicide. Both parents and teachers need to change their attitude towards their children. They need to have frequent conversations with them regarding their hopes and what outcome they should expect from them. The role of teachers is very important to prevent suicides in educational setup. Caution must be exercised while teaching to protect the self esteem of students and they should be treated with concern, kindness and respect. Our education system, society, teachers and parents must acknowledge that every student does not have high caliber as every individual has different potential.

Therefore, every student should be treated differently and individually. Most important, a complain cells should also be established and psychological services must be available to students in every educational institute, school, college and university. Academic stress and peer pressure is another risk factor for student suicides in Pakistan. The elevated costs of educating oneself, the competition of getting in and fitting one in the demanding environment of academic institutions and the lack of social support system are the significant contributors to the elevated levels of academic stress. Students in academic institutions came from diverse cultural and socio-economic backgrounds. So, competition does not only exist at academic level but also on socio-economic grounds.12 Other reasons behind committing suicide were failure in love (8.8%) and domestic issues (5.9%), ragging (2.9%) and poverty (1.9%).

Abuse by loved one in the form of rejection in love and family issues have been one of the common issues found in the reported cases which many young students have suffered from. The reason behind the issues are unknown, however, it might be victim of severe violence at home or a disturbing house environment characterized by rigid parental control and sadness, ongoing exposure to physical violence or bullying, sexual abuse, cyber- bullying and blackmailing. Another contributing factor was life dissatisfaction (4.4%). A clinical psychologist, Asha Bedar, in a newspaper interview reported teen suicide to be the result of either mental illness or emotional disturbance caused by circumstances. She pointed out that many youngsters suffer from mental illness which is often undiagnosed and untreated in our country, in turn leading to consistently increasing suicide rate among student population.3

Moreover, among the deceased cases, most of the students were enrolled in MBBS, engineering and A- levels. Suicidal ideation among medical students was investigated in a private medical college of Karachi by Osama et al. in 2014. Findings suggested that 13.9% of all the students had made a plan in their life time to commit suicide, while 4.8% of the 331 students tried to commit suicide at some point of time in their life. Reasons were considered to be substance abuse followed by parental neglect and previous psychiatric disorder. Quite a few studies have been conducted in Pakistan on suicide including a study that was carried to find out the suicide patterns and methods involved in Pakistan and according to them suicide was the leading cause of death in Pakistan. They reported that suicidal rates were higher among males than females (Mage = 27.12+-10.11 years) and peak age of suicide to be in 20-30 years.

Suicide rate was reported to be high in working women and was found to be 10.0% among housewives 9.8% in non-working women and 46.9% among female. Common suicide methods used were 40% overdose of drug, 20% wrist cutting, 10% hanging from ceiling, 10% jumping from heights, 10% chemical poising and 10% suicidal burns.13 With respect to incidents of suicide by students in Pakistan Khokher and Khan in 2005-10, reported an overall rate of suicidal ideation among college students to be 31.4% where 33% were females and 29.2% were males. Higher rates of suicidal ideation were reported by students using hostel facilities. A number of educationists, parents and psychiatrists in many parts of the world have devised counseling techniques for students to ensure that they do not take their own lives out of stress. Parental management training needs to be provided to parents to reduce communication gap and encourage children to share their problems with them.

It is obvious that the parents should have friendly relation with their children to openly discuss the issues confronting them and allow them to easily express their feelings. Pakistani parents also keep high expectations from their children with respect to their grades without even realizing their potential for a particular subject of study they force them to enroll in, causing frustration to both parties.3

Suicide deaths by students have never been included in the National mortality statistics as official statistics from Pakistan are unknown. Furthermore, student suicide rates at national level are also not reported to the World Health Organization (WHO). Most of the suicide cases are not reported due to stigma and strict Pakistani law. Under Pakistani law based on Islam principle suicide is an illegal act and is punishable with a jail term and financial penalty.

Self harm and suicide cases are to be taken to government hospitals or medico-legal centers (MLC) which family of victim usually due to fear of harassment by the police and stigma. Instead treatment is taken from private hospitals that neither diagnose suicide nor report them to police. Due to the discussed factors incidences of student suicide are hideously underestimated in Pakistan. Despite this information on suicide in Pakistan can be obtained from a number of sources including newspapers, reports of nongovernmental organizations (NGOs), voluntary and human rights organizations, police departments of different cities and from hospital based studies.14

This paper will prove to be beneficial as it may add sufficient information to the literature. Results have been specifically discussed with reference to suicide among students. However, the figures collected through newspaper reports are believed to be an underestimate due to lack of reporting, socio-cultural and religious stigma. Thus, to determine the epidemiology of suicide by students in Pakistan, a standard system of recording should be established to help design effective suicide prevention programs. Information obtained through the system can be used for carrying out further analysis of the issue.

The consistently increasing rate of suicide among students calls for attention and our government needs to address the issue and steps should be taken at national and provincial level including public education campaigns to control the occurrence of such incidences. There is a dire need to start school based interventions and prevention strategies to reduce suicide among students should also be initiated including disaster management, handling self esteem issues and social skills training to reduce such incidences among students. Government should also give priority and start increased spending on mental health of student population through proper utilization of psychological services in educational setups.

Conflict of interest: None declared.

References

1. World Health Organization. Adolescent Health, 2018. (Accessed on 12th February 2016) Available from URL: http://www.who.int/topics/adolescenthealth/en/

2. Statista, the Statistics Portal. 2018. Percentage of college students in the U.S. that were receiving mental health services and had seriously considered suicide from 2010 to 2017. (Accessed on 12th February 2016) Available from URL: https://www.statista.com/statistics/827344/suicidal-thoughts-among-college-students- receiving-mental-health-services-us-by-year/

3. Khan FZ. Growing trend of suicide in students. (Accessed on 18th June 2010) Available from URL: http://nation.com.pk/18-Jun-2012/growing-trend- of-suicide-in-students/

4. Kumar LV. Indian research on suicide. Ind J Psy 2010; 52 (Suppl1): S291-S6.

5. One million people commit suicide every year. (Accessed on 23rd June 2010) Available from URL: https://tribune.com.pk/story/23240/one-million-people- commit-suicide-every-year/

6. Ebrahim ZT. The alarming rise of teenage suicides in Pakistan. (Accessed on 8th June 2012) Available from URL: https://www.dawn.com/news/724902/

7. Students committing suicides due to exam stress. (Accessed on 11th June 2012) Available from URL: http://nation.com.pk/11-Jun-2012/-students- committing-suicides-due-to-exam-stress/

8. Naveed S. Due to Pressure from parents, a girl tried to commit suicide because of her A-level grades. (Accessed on 11th June 2017) Available from URL: https://www.parhlo.com/a-girl-tried-to-commit-suicide- because-of-her-a-level-grades/

9. Suicide statistics. 2018. American foundation for suicide prevention. (Accessed on 11th June 2017) Available from URL: https://afsp.org/about- suicide/suicide-statistics/

10. Khokher S, Khan MM. Suicidal ideation in Pakistani college students. Crisis 2005; 26(3): 125-7.

11. Osamaa M, Islama MY, Hussaina SA, Masroora SMZ, Burneya MU, Masood MA, et al. Suicidal ideation among medical students of Pakistan: A cross-sectional study. J Foren Legal Med 2014; 27, 65-8

12. Pachani N. Suicidal behaviors among youth in Pakistan and prevention. J Pioneer Med Sci (Accessed on 26th May 2014) Available from URL: http://blogs.jpmsonline.com/2014/05/26/Suicidal- behaviors-among-youth-in-pakistan-and-prevention/

13. Liaqat A, Barlas A, Barlas T, Adnan M, Anwar I. An alarming situation of suicide patterns and methods involved in Pakistan. Am J Psy Neuros 2017; 5(3): 37-39.

14. Khan MM. Suicide prevention in Pakistan: an impossible challenge. J Pak Med Assoc 2007; 57(10): 478-80.
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Publication:Pakistan Journal of Medical Research
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2019
Words:4087
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