‘80pc suicides are due to depression’

By Shahid Husain

KARACHI: Suicide is a multi-dimensional disorder, which results from a complex interaction of biological, genetic, psychological and environmental factors, according to a study conducted by Murad M Khan, an associate professor at Aga Khan University, Karachi.

According to World Health Organisation (WHO) statistics, Mr Murad said that worldwide more than a million people commit suicide each year, while the suicide attempt is successful 10-20 times. “Suicide is among the top 10 causes of death in every country, and one of the three leading causes of death in the 15 to 35-year age group” he said. “It is not only a global tragedy but a major public health problem as well. The psychological and social impact of suicide on the family and society is immeasurable. On an average, single suicide intimately affects at least six other people” he said.

Mr Murad further said that there were no official statistics for suicide in Pakistan. However, there was compelling evidence (NGOs, newspaper reports, police) that the suicide ratio has gradually been increasing in Pakistan over the last few years. The upward trend has been very dramatic with almost 3,000 cases of suicide being reported in 2001 nationally, he said. “Even this is considered to be an underestimation, as it is well known that in many developing countries suicide tends to be grossly under-reported.”

He said that research has shown that between 40 percent and 60 percent of people who commit suicide had been to a physician in the month prior to suicide: of these, many had seen a general physician rather than a psychiatrist. In countries such as Pakistan where mental health services are not developed, the proportion of people in suicidal crisis consulting a general or family physician is likely to be higher, he said.

He said the relationship between suicide and depression was well known, with more than 80 percent of people who commit suicide suffering from depression. Population-based prevalence studies from Pakistan give high figures for depression. In a recent study, 44.4 percent (males: 25.5 percent, females 57.5 percent) of the cohort were found to be depressed for more than a year, he said. It would appear that mental illnesses (especially depression) are under-recognised and not treated properly in Pakistan and could be a major factor responsible for suicidal tendencies.

Prof Khan said there was compelling evidence indicating that adequate prevention and treatment of some mental disorders could reduce suicide rates, whether such interventions were directed towards individuals, families, schools or other sections of the general community. “With such high rates of depression, undiagnosed mental disorders and interpersonal problems in Pakistan, innovative treatment modalities need to be developed,” he said.

He said studies suggest that lifetime risk of suicide in people with depression was 15 percent, with alcoholism 7-15 percent and with schizophrenia, 4-10 percent. However, a substantial proportion of people who commit suicide die without having seen a mental health professional. Hence improved detection, referral and management of psychiatric disorders in primary care was an important step in suicide prevention, according to Prof Khan. “As family physicians may be the first point of contact for many depressed and suicidal patients, their role becomes crucial in suicide prevention.”

Closer collaboration between family physicians and psychiatrists was important so that timely referrals of difficult to treat patients or those at high risk of suicide could be managed, he said.

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