• Ajmal Shah Khyber Teaching Hospital, Peshawar, Pakistan
  • Imran Khan Khyber teaching hospital, Peshawer, Pakistan
  • Aamir Aziz Hayatabad Medical Complex, Peshawar, Pakistan
  • Irfan Ullah Khyber Teaching Hospital, Peshawar, Pakistan
  • Muhammad Asim Khyber Medical University, Peshawar, Pakistan
Keywords: severe depression, suicide, protective factors



The aim of this study is to find out “factors that prohibit those suffering from severe depression with suicidal ideation of committing suicide”, admitted to the psychiatric unit of a tertiary care hospital in Khyber Pakhtunkhwa, Peshawar.


Cross sectional study


This study was conducted in psychiatry department of Khyber Teaching Hospital, Peshawar from May 2023 till November 2023.


We conducted this study on 230 admitted patients, and they were diagnosed with severe depression according to ICD-10 and beck scale for suicidal ideation was applied and a score of ≥ 8 was considered positive for the presence of suicidal ideations and then a “modified version of reasons for living scale” to identify protective factors against suicide. Data was analyzed using SPSS version 22.0.  


The most common protective factor found in our study was religious and moral objections in 37.4% patients followed by fear of social disapproval in 17.4%, hopefulness and fear of suicide in 15.7% each and responsibility towards family was present in 13.9% patients. Data stratification for protective factors and other demographic characteristics including gender, residential, socioeconomic, marital, educational statuses and family system were statistically significant with their P-values of <0.001.


This study demonstrated that religious and moral objections were the most common protective factors in prevention of suicide, followed by fear of social disapproval, hopefulness, fear of suicide and responsibility towards family. Gender, residential, socioeconomic, marital, and educational statuses along with family system were significantly associated with the presence of protective factors against suicide.


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Author Biographies

Ajmal Shah, Khyber Teaching Hospital, Peshawar, Pakistan

Department of Psychiatry

Imran Khan, Khyber teaching hospital, Peshawer, Pakistan

Department of Psychiatry , Associate Professor

Irfan Ullah, Khyber Teaching Hospital, Peshawar, Pakistan

Department of Medicine


1. Preventing suicide: A global imperative. Published 2014. Accessed February 22, 2024.
2. Bifftu BB, Tiruneh BT, Dachew BA, Guracho YD. Prevalence of suicidal ideation and attempted suicide in the general population of Ethiopia: a systematic review and meta-analysis. Int J Ment Health Syst. 2021;15(1):27. doi:10.1186/s13033-021-00449-z
3. Have M ten, de Graaf R, van Dorsselaer S, et al. Incidence and Course of Suicidal Ideation and Suicide Attempts in the General Population. Can J Psychiatry. 2009;54(12):824-833. doi:10.1177/070674370905401205
4. Song Y, Rhee SJ, Lee H, Kim MJ, Shin D, Ahn YM. Comparison of Suicide Risk by Mental Illness: a Retrospective Review of 14-Year Electronic Medical Records. J Korean Med Sci. 2020;35(47). doi:10.3346/jkms.2020.35.e402
5. Stack SJ. Mental Illness and Suicide. In: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Wiley; 2014:1618-1623. doi:10.1002/9781118410868.wbehibs067
6. Crump C, Sundquist K, Sundquist J, Winkleby MA. Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study. Psychol Med. 2014;44(2):279-289. doi:10.1017/S0033291713000810
7. Olgiati P, Fanelli G, Serretti A. Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder. Int Clin Psychopharmacol. 2023;38(4):201-208. doi:10.1097/YIC.0000000000000461
8. Belsiyal Cx, Rentala S, Das A. Frequency of suicide ideation and attempts and its correlates among inpatients with depressive disorders at a tertiary care center in North India. J Fam Med Prim Care. 2022;11(6):2537. doi:10.4103/jfmpc.jfmpc_2013_21
9. Sokero TP, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET. Suicidal Ideation and Attempts Among Psychiatric Patients With Major Depressive Disorder. J Clin Psychiatry. 2003;64(9):1094-1100. doi:10.4088/JCP.v64n0916
10. Naeem F, Taj R, Khan A, Ayub M. Can watching traumatic events on TV cause PTSD symptoms? Evidence from Pakistan. Acta Psychiatr Scand. 2012;126(1):79-80. doi:10.1111/j.1600-0447.2012.01876.x
11. Owais SS, Horner RD, Khan MA, Kenison K, Probst JC. Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis. Front Glob Women’s Heal. 2023;4. doi:10.3389/fgwh.2023.1091485
12. Farooq R, Afsar S, Mehdi M, Jaffar MA, Ashfaq S, Hotiana UA. Factors of Depression and its Prevalence among Pregnant Females Attending Antenatal Clinics in Pakistan. Pakistan J Med Heal Sci. 2022;16(6):995-997. doi:10.53350/pjmhs22166995
13. Zaman Afridi M, Akhtar P, Naeem Khan M. A Systematic Review and Meta-Analysis of Prevalence of Depressive Symptoms among Healthcare Workers in Pakistan during Covid Pandemic. Pakistan J Med Heal Sci. 2022;16(2):2-5. doi:10.53350/pjmhs221622
14. Shahid H, Hasan MA, Ejaz O, et al. The Severity of Depression, Anxiety, and Stress: Recommendations From Joint Work of Research Center and Psychology Clinics in COVID-19 Pandemic. Front Psychiatry. 2022;13. doi:10.3389/fpsyt.2022.839542
15. Cai H, Xie XM, Zhang Q, et al. Prevalence of Suicidality in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Comparative Studies. Front Psychiatry. 2021;12. doi:10.3389/fpsyt.2021.690130
16. Ariapooran S, Khezeli M, Janjani P, et al. Protective factors against suicide attempt in Iranian Kurdish women: a qualitative content analysis. BMC Psychiatry. 2023;23(1):58. doi:10.1186/s12888-023-04544-y
17. Boydell KM, Nicolopoulos A, Macdonald D, Habak S, Christensen H. Understanding Protective Factors for Men at Risk of Suicide Using the CHIME Framework: The Primacy of Relational Connectedness. Int J Environ Res Public Health. 2023;20(3):2259. doi:10.3390/ijerph20032259
18. Oakey-Frost N, Cowan T, Moscardini EH, et al. Examining the Interrelationships Among Suicide Cognitions, Suicidal Ideation, and Theoretically Derived Protective Factors. Arch Suicide Res. 2023;27(3):984-1001. doi:10.1080/13811118.2022.2096521
19. Ayub N. Validation of the Urdu Translation of the Beck Scale for Suicide Ideation. Assessment. 2008;15(3):287-293. doi:10.1177/1073191107312240
20. Pirani S, Kulhanek C, Wainwright K, Osman A. The Reasons for Living Inventory for Young Adults (RFL-YA-II). Assessment. 2021;28(3):942-954. doi:10.1177/1073191119900242
21. van den Brink B, Schaap H, Braam AW. Moral Objections and Fear of Hell: An Important Barrier to Suicidality. J Relig Health. 2018;57(6):2301-2312. doi:10.1007/s10943-018-0573-7
22. Jongkind M, van den Brink B, Schaap‐Jonker H, van der Velde N, Braam AW. Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed, Religiously Affiliated Patients. Suicide Life-Threatening Behav. 2019;49(2):505-519. doi:10.1111/sltb.12456
23. Hameed A, Garman JC, Gomaa H, White A, Gelenberg AJ. Is Religioness a Protective Factor against Suicide? Evaluating Suicidality and Religiousness in Psychiatric Inpatient Population Utilizing Sheehan Suicide Tracking Scale (S-STS) and Columbia Suicide Severity Rating Scale (C-SSRS). J Psychiatry Psychiatr Disord. 2020;04(06). doi:10.26502/jppd.2572-519X0123
24. An S. Suicide: Stigma. In: The International Encyclopedia of Health Communication. Wiley; 2022:1-6. doi:10.1002/9781119678816.iehc0820
25. Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, Mann JJ. Protective Factors Against Suicidal Acts in Major Depression: Reasons for Living. Am J Psychiatry. 2000;157(7):1084-1088. doi:10.1176/appi.ajp.157.7.1084
26. Ropaj E. Hope and suicidal ideation and behaviour. Curr Opin Psychol. 2023;49:101491. doi:10.1016/j.copsyc.2022.101491
27. Pharris AB, Munoz RT, Kratz J, Hellman CM. Hope As a Buffer to Suicide Attempts Among Adolescents with Depression. J Sch Health. 2023;93(6):494-499. doi:10.1111/josh.13278
28. El-kholy HM, Mubarak AAELR, Elheniedy MA, AL-Deeb FA. Socioeconomic status and psychiatric comorbidity associated with suicidal behavior among a sample of Egyptian patients who attended Tanta University emergency hospital for suicide-related problems. Middle East Curr Psychiatry. 2023;30(1):24. doi:10.1186/s43045-023-00290-9
29. Choi M, Sempungu JK, Lee EH, Chang SS, Lee YH. Single and combined effects of marital status, education attainment, and employment status on suicide among working-age population: A case-control study in South Korea. SSM - Popul Heal. 2022;19:101246. doi:10.1016/j.ssmph.2022.101246
30. Holm AL, Salemonsen E, Severinsson E. Suicide prevention strategies for older persons—An integrative review of empirical and theoretical papers. Nurs Open. 2021;8(5):2175-2193. doi:10.1002/nop2.789
How to Cite
Shah A, Khan I, Aziz A, Ullah I, Asim M. CROSS SECTIONAL STUDY ON PROTECTIVE FACTORS AGAINST SUICIDE IN INDIVIDUALS WITH SEVERE DEPRESSION. J Pak Psychiatr Soc [Internet]. 2024Jun.30 [cited 2024Jul.24];21(02). Available from: