I thank Drs Mushtaq & Mushtaq for their comments. Regarding their queries of marital status and age groups, 25% of the victims were engaged, divorced or widowed, and the age groups of the victims were: 15–20 years (24%); 21–30 (41%); 31–40 (17%); 41–50 (7%); and >51 (3%). From our and other studies, it appears that in Pakistan the majority of people dying by suicide are young – under the age of 30 years. This is a massive loss to society and contributes to high years-of-life-lost. On the other hand, suicide is rare in the elderly in Pakistan, which is in contrast to findings in the West. This may be due to the status afforded to the elderly in the family-centered Pakistani society. The elderly continue to live with family members after retirement and rarely have to fend for themselves.

I agree with the other comments made by the authors: mental illness, especially depression, is underrecognised and undertreated in Pakistan; most suicide victims used violent methods such as hanging, firearms, burning and poisoning, while few used medications as a method, and none of the victims were in contact with health services in the month before the suicide. Although these findings have important implications for suicide prevention in Pakistan, we do not see the situation changing on the ground, as far as mental health or suicide prevention are concerned. Successive governments in Pakistan (military as well as civilian) have failed to address the basic health needs of the population; mental health does not have a separate budget but it is believed that less than 1% of the annual health budget is allocated to mental health. Unfortunately, what little is available is eaten up by massive corruption, mismanagement and poor governance. Until these fundamental issues are addressed, the population of the country will continue to suffer from high levels of distress and many of those affected will die by suicide.