Evidence on Deliberate Self-Harm, Suicidal Ideation, and Suicides in Pakistan: A Scoping Review of Methods, Contributing Factors, and Associated Mental Disorders

BACKGROUND: Suicide is a major global public health problem, responsible for over 1 in 100 deaths worldwide, with South Asian countries bearing a particularly high burden. In Pakistan, the absence of a national suicide surveillance system obscures the true scale of the issue. This review aims to systematically map the existing literature on suicide in Pakistan, with a focus on identifying key contributing factors, commonly used methods, and the role of underlying mental health conditions associated with suicidal ideation, deliberate self-harm, and suicidal attempts. SUMMARY: This scoping review followed methodological approach outlined by Arksey and O'Malley, integrating the evidence from both peer-reviewed sources and gray literature. We searched National library of medicine MEDLINE (PUBMED), Directory of open access Journals (DOAJ), Cochrane trial registers (CRG), Pakistan Medical Research Council (PMRC) Publications, Pakmedinet.com , Google scholar, PubMed Central (PMC) from year 2010 to 2025 using a combination of key terms. A total of 61 studies were included, including a thesis from the gray literature. Most of the included studies were cross-sectional and urban-based, with limited focus on rural areas, indicating a significant data gap. Females showed higher rates of deliberate self-harm and suicide. At-risk groups included young adults and transgender individuals. The key contributing factors were domestic violence, academic pressure, emotional strain, and low socioeconomic status. Self-poisoning was the most common method, with increasing cases involving paraphenylenediamine. Emerging trends also include suicide related to online gaming (e.g., PUBG). Hanging and firearm use remain prevalent methods. Although formal psychiatric diagnoses were rarely reported, depression and anxiety were frequently associated with suicide. KEY MESSAGES: Suicide remains a critical yet underreported issue in Pakistan, driven by easy access to lethal means, weak regulation, and evolving risk factors such as online gaming. Vulnerable groups include women, transgender individuals, and youth, often affected by violence, academic pressure, and untreated mental health conditions. Addressing this crisis requires improved surveillance, restricted access to means, early mental health intervention, and coordinated prevention efforts across sectors.