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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Original Article 

Prevalence of Suicidal Ideation and Suicidal Cognition 

among the Local Population of Karachi, Pakistan 
Rakhshanda Bakht1, Tasmeena Saeed1, Sadaf Ahmed1&2& Shamoon Noushad2&3 

1.  Psychophysiology Research Lab, Department of Physiology, University of Karachi.                                                                                                                                                      

2. Advance Educational institute and research center (AEIRC), 

3. Dadabhoy Institute of Higher Education. 

Corresponding Author: bakht.rakshanda@yahoo.com 

 

Abstract 

Objective Suicide has become a leading cause of death worldwide, thus it has become a public 

health problem for every country in the world and thereby in Pakistan too. The aim of present 

study was to find out the prevalence of suicidal thoughts among the local population of Karachi. 

Correlations were also assessed among suicidal thoughts and demographic characteristics. Method 

A survey was conducted to fill out a pre-structured questionnaire from the participants between 

the age group of 18-30. The questionnaire contains Beck’s scale of suicide cognition, Modified 

scale of suicide ideation and a detailed demographic profile. Subjects were taken from different 

universities, medical colleges, offices and business schools. Mentally ill patients were not included 

in the study. Result Severe Suicide ideation and suicidal cognitions are prevalent in the population 

to about 4% and 3% respectively. Also in the study, demographic variations exist in subjects with 

respect to suicidal thoughts; male, non-working, unhappy, in-pain subjects, unmarried, being in 

the 18-21 age brackets and undergraduate reported higher suicidal thoughts as compared to their 

correspondent parameters. Conclusion It has been concluded that severe suicidal thoughts are 

prevalent among youngsters. And certain demographic characters are strongly correlated with 

amplified suicidal thoughts among youth of Karachi. 

 

Keywords 

Suicide, imagination, Beck’s scale, suicidal cognitions 

 

Introduction 

According to the recent report of World 

Health Organization of 2006, about a million 

people, commit suicide every year in the 

whole wide world, which is far more than the 

deaths occurred in wars (WHO, 2006; 

Kessler et al, 2005 & Mann, 2003). Thus 

suicide has become a public health problem 

affecting entire world at every level with 

devastating socio-economic cost and 

consequences (WHO, 2013 & Mann, 2003). 

It is also revealed that after every 40 seconds 

a person takes his or her life somewhere in 

the world (WHO, 2006).  In general, rates are 

highest in Eastern Europe and lowest in 

Central and South America, with the United 

States, Western Europe, and Asia falling in 

the middle (Bertolote & Fleischman., 2009 & 

Nock, et al., 2008). 

 

Previously researchers define suicide as “an 

outcome of deliberate obliteration or killing 

of oneself” (Kaplan, et al., 1998). Similarly, 

Krug in 2002 defined suicide as “an outcome 

of deliberate acts of the person with 

considerable initiation and performance of a 

pattern to knowingly kill oneself” (Krug, 

2002). Meanwhile, the word suicide is 

etymologically derived from a Latin word, 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

suicidium (Sui=oneself and Cidium=killing) 

(Jans, et al., 2012).  

However, the notion, thought and 

imagination of self-harm comes under the 

umbrella of suicide ideation (Jacobs, et al., 

2003 & Kaplan, et al., 1998), which is way 

more common than the actual suicide 

attempts. Further, it was specified that the 

ratio of suicide ideation to suicide attempts is 

about 8 to 10 times higher, which means that 

people ideate suicide 8 to 10 time more than 

they actually attempt it (Frierson, et al., 2003 

& Andreason, et al., 1995).  On the other 

hand, attempted suicides are 10 to 40 times 

more frequent than lethal suicides 

(Schmidtke, et al., 2004 & Platt, et al., 1992). 

Therefore, each suicide (whether attempted 

or completed) is an individual’s own 

catastrophe who takes his or her life 

captivating under the dilemmas of life. And 

this tragic act will unceasingly and vividly 

influence the lives of his or her family and 

companions till the very end (WHO, 2013). 

Similarly, Redfield Jamison described the 

sentiments of suicidal mind as,  

 

“Suicide carries in its aftermath a level of 

confusion and devastation that is, for the 

most part, beyond description” (Redfield 

Jamison, 2000). 

 

The estimated ratio of attempted suicides to 

completed suicides among adolescents to be 

50:1 to 100:1 respectively; at which each 

adult already had 20 other suicide attempts 

before he or she could actually die by suicide 

(WHO, 2013). If 2003 report of WHO is 

assessed solely, it shows that about 877,000 

deaths occurred only due to suicide in the 

year, 2002 (WHO, 2003). Whereas, the most 

recent report of WHO suggested that 804,000 

people took their lives in 2012 (WHO, 2013). 

Moreover, on the other aspect, these suicidal 

attempts reflect about 1.4% of the disease 

burden on the entire globe in 2002 (WHO, 

2003) and are predicted to be increased as 

much as 2.4% in 2020 (WHO, 2013).  

 

Though there is a plenty of data regarding 

attempted suicide and completed suicide 

throughout the world, but little has been 

researched in relative to the suicidal thoughts, 

including suicide ideation and suicide 

cognition; which has proven to be the basic 

markers of suicidal activities. The present 

study is thereby conducted to shed some 

lights on the ground scenarios and milieu on 

suicidal thoughts, which are the root causes 

of these increased suicidal acts. 

The prevalence of suicidal ideation and 

suicidal cognition has been pondered among 

the local population of Karachi, Pakistan. 

Also in this study, different demographic 

components, like age-group, gender, marital 

status, life style etc. has been correlated with 

suicidal ideation and cognition. 

 

Methodology 

Subjects Participants were recruited from 

different universities and medical colleges of 

Karachi. Subjects of this study were mostly 

undergraduates, however, pre-graduates and 

post graduates were also included. Moreover, 

the age criterion was set to be 18-30 years 

who did not have any disorder or any kind of 

mental illness, whether acute or chronic.  

 

Tools A pre-structured questionnaire was 

interviewed from the participants who 

showed their interest in the present study and 

voluntarily agreed to give their concerned 

information regarding this study. The 

questionnaire included three parts in which 

the first portion has a detailed demographic 

information, the second one comprised of a 

universally recognized scale for suicide 

cognition, the suicide cognition scale (M.D. 

Rudd, et al., 2007) the remaining third part 

included The Modified Scale for Suicidal 

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Rakhshanda Bakht 25 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Ideation (MSSI) (Miller, et al., 1986) 

respectively. Consent is also attached for 

ethical purpose in which individual is asked 

to read out some details about the study and 

if he or she agrees to take out 10-15 minutes 

to fill it out; then an agreeable signature is 

taken and the interview is started. 

Meanwhile, a free space was also given in the 

questionnaire so as to provide participants 

with liberty to express their trauma and 

suicidal thoughts.  The personal information 

however remains confidential and not shared 

at any level with individual’s specificities.   

 

Data analysis The collected data was 

compiled from 519 subjects, of which 247 

were female participants and 272 were males. 

The data was sorted into different groups, 

according to the severity of parameters been 

analyzed. The variables are then correlated to 

each other to evaluate the possible 

relationships among them. Moreover, 

frequencies of some variables are also 

assessed. The data is initially analyzed 

through standardized scoring schemes of 

scales along with the demographic profile 

using MS Excel 2010. Later the data was 

shifted to SPSS version 2.0, for graphical 

analysis and correlations of different 

variables altogether.  

 

Results 

The results of this study are showing in the 

graphical manner under this heading. 

 

 

Figure 1.0 represents the prevalence of suicide ideation among the sample population. Less 

than half of the population reflects low suicide ideation by scoring 42% at this range. 

Similarly mild suicide ideation is prevalent to 41% of the total sample. 

 

 

 
 

 

 

 

 

 

42%

41%

13%

4%

Suicidal_scoring Low suicide ideation Suicidal_scoring Mild

Suicidal_scoring Moderate Suicidal_scoring Severe

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Rakhshanda Bakht 26 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 1.1 shows the prevalence of suicide cognition with the greater proportion of the 

sample is found to be lying in mild suicide cognition scoring.  Whereas only 2% of the 

sample had severe suicide cognition with respect to 10 % of the population which showed 

moderate suicide cognition. 

 

 

 
 

Figure 1.2 shows the comparison of gender in suicidal ideation. Here females show higher 

frequency in suicide ideation at normal and mild level whereas both genders are equally 

populated at severe suicide ideation score. 

 
 

41%

47%

10%

2%

suicide_cognition_scoring normal cognition suicide_cognition_scoring mild

suicide_cognition_scoring modeate suicide_cognition_scoring severe

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

108 101

27
11

111 110

41

10

gender male

gender female

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 1.3 shows the comparison of suicidal cognition among genders in which females 

show higher frequency in suicide cognition at moderate and severe level. 

 

 
 

Figure 1.4 shows the ratio of suicidal ideation with respect to their social status. The 

majority of the sample population is found to be normally social comparative to that of 

anti-social or being a social butterfly. 

 
 

0

50

100

150

200

250

normal
cognition

mild modeate severe

suicide_cognition_scoring

106 106

28
7

110
136

24
2

gender male

gender female

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

16
39

12 3

170
146

51

14

33 26

5

4

social_status
social_butterfly

social_status normal

social_status Antisocial

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 1.5 shows the ratio of suicidal cognition in relation to their social status. Mild 

suicidal cognition is most prevalent at every social status, either in anti-social, normally 

social or social butterfly. 

 
Figure 1.6 shows the prevalence of suicidal ideation in different marital statuses. Single 

people ideate suicide more frequently and intensely as compared to committed and  

married ones. 

 

 

0

50

100

150

200

250

normal
cognition

mild modeate severe

suicide_cognition_scoring

23 31
12 4

160

185

33
3

33

26

7

2

social_status
social_butterfly

social_status normal

social_status Antisocial

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

178 172

57

18

27 28

7

3

14 11

2

0
0

2

0

marital_status divorced

marital_status married

marital_status commited

marital_status single

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Rakhshanda Bakht 29 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

 

Figure 1.7 shows the prevalence of suicidal cognition in different marital statuses. Single 

subjects have the high fraction of mild to moderate suicide cognition as compared to 

engaged, in related and married population. However, divorced subjects show high rate of 

severe suicide cognition. 

 

 
 

 

Figure 1.8 shows the abundance of suicidal ideation in different age groups. Age group of 

18-21 is more prone to suicide ideation at every level of severity. 

 
 

 

0

50

100

150

200

250

normal cognition mild modeate severe

suicide_cognition_scoring

176
202

42

5

26

30

9

0

14

9

1

3

0

1

0

1

marital_status
divorced

marital_status
married

marital_status
commited

marital_status single

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

211 204

66
21

8 6

2

0

Count age_groups 22-25

Count age_groups 18-21

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Rakhshanda Bakht 30 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

 

Figure 1.9 shows the abundance of suicidal ideation in different age groups. Age group of 

22-25 scores more in severe suicide cognition degree as compared to that of  

Lower age group. 

 

 
 

 

 

Figure 2.0 shows the prevalence of suicidal ideation in which non-working subject than 

working individuals. 

 

 
 

0

50

100

150

200

250

normal
cognition

mild modeate severe

suicide_cognition_scoring

213 231

51
7

3
10

1

2

age_groups 22-25

age_groups 18-21

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

160 166

58

17

59 45

10

4

work working

work non_working

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Rakhshanda Bakht 31 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 2.1 shows the prevalence of suicidal cognition in subjects with suicide cognition at 

every level is more frequent in the non-working individuals with respect to that of  

Working individuals. 

 
 

Figure 2.2 indicate the prevalence of suicidal ideation in the population. The graph reveals 

that people who are spending an active life-style showed more suicidal ideation as 

compared to those who live with a lazy life-style. 

 

 

0

50

100

150

200

250

normal cognition mild modeate severe

suicide_cognition_scoring

159
193

44

5

57

49

8

4

work working

work non_working

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

31
50

16 4

188 161

52

17

life_style active

life_style sedentary

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Rakhshanda Bakht 32 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 2.3 shows the prevalence of suicidal cognition with respect to the life-style activities 

of the individual.  Here active subjects showed higher suicide cognition as 

compared to the lazy ones. 

 

 
 

Figure 2.4 shows he relation of suicidal ideation with that of education level. The figure 

reveals that the subjects pursuing their graduation are seen to ideate suicide more as 

compared to any other educational level. It means that undergraduate students are more 

prone towards suicidal thoughts as compared to their correspondant pre-graduates  

and post graduates. 

 
 

0

50

100

150

200

250

normal
cognition

mild modeate severe

suicide_cognition_scoring

33
48

17 3

183

194

35
6

life_style active

life_style sedentary

0

50

100

150

200

250

Low suicide
ideation

Mild Moderate Severe

Suicidal_scoring

9 6 2 0

44
77

22
5

149
118

39

16

17 9

4

0

0
1

1

0

qualification PG

qualification graduate

qualification
undergraduate

qualification inter

qualification matric

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Rakhshanda Bakht 33 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Figure 2.5 shows that severe suicide cognition is highest among undergraduate students as 

compared to other educational level. 

 

 
 

 

 

Discussion 

The prime objective of the study was to 

measure the prevalence of suicide ideation 

and suicide cognition among the local 

population of Karachi. Though, results 

summarized that about 42% of the population 

is having low suicidal ideation and an 

approximately same ratio of the populace 

have mild suicide ideation, which is prone 

towards severity as shown in Figure 1.0. The 

shocking revelation was that 4 in every 100 

persons are severely ideating suicide in this 

population which is an alarming call for the 

whole country. Similarly, 3 individuals in 

every 100 subjects are having severe suicide 

cognition ratio as shown in Figure 1.1. 

Previous studies quoted that suicidal ratio 

among Muslim countries and other Asian 

countries are lowest as compared to non-

Muslim countries (Bertolote & Fleischman, 

2009 & Nock, et al., 2008). But these rising 

suicidal ideation and suicidal cognition 

among Karachi, Pakistan are leading us 

among those highly suicidal countries.  

 

The current study also shows the intensity 

and frequency of suicidal thoughts with 

respect to different demographic 

characteristics of the population. The 

reported results of the survey and analytical 

measures reflect that some gender variations 

are present with respect to suicide ideation. 

Males ideate suicide more than females 

which is in the line of previous studies, who 

concluded that males are more supportive of 

the idea of suicide as compared to female 

(Domino & Leenaars., 1989; Domino, 

MacGregor, Hannah, 1988-89; Limbacher & 

Domino, 1985-86.) as it can be seen in Figure 

1.2 and Figure 1.3. Similarly, another 

account of studies suggested similar resulted 

in a way that men are more likely than 

women to kill themselves (American 

Foundation for Suicide Prevention, 2007. 

Sejong, et al., 2005; Canetto & Lester, 1995). 

0

50

100

150

200

250

normal
cognition

mild modeate severe

suicide_cognition_scoring

5 6 5 1

54 74

20

143

147

25

6

13

14

1

2

qualification PG

qualification graduate

qualification
undergraduate

qualification inter

qualification matric

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Rakhshanda Bakht 34 

  

Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

However, Peter, et al. in 1996 reported that 

females tend to have significantly more 

suicide ideation in the course of their life time 

than males.  

 

With respect to social status, it is estimated 

that a major ratio of the sample was found to 

be normally social thereby suicidal ratings 

are condensed at this level, as it can be seen 

in Figure 1.4. However, it is observed that 

severe suicidal ideation is found more in 

people who are socially active. In the 

meantime, mild suicide cognition exists in 

every social status, shown in Figure 1.5. This 

may be due to the fact that youth is more 

socialized now, no matter what they feel and 

think; they tend to express it to as many 

people as they can. Nonetheless, the results 

are contrary to previous studies that 

suggested that strong social relations likely to 

decrease suicidal risks (Meadows, 2005).  

 

Relationship commitments have always been 

a protective factor for any kind of risky 

behavior including suicide. The study 

concluded similar results by showing high 

suicide ideation and suicide cognition among 

single and divorced ones while lowest rates 

among engaged and married ones; which 

shows that the committed ones are not likely 

supportive with the idea of suicide as 

compared to the loners or singles shown in 

Figure 1.6 and Figure 1.7. Justifiable 

researches include (Lorant, et al., 2005), who 

stated that marriage has a buffering effect on 

suicidal risk in the population. Similarly, 

(Agerbo, 2005; Gove, 1979; Qin, Agerbo, & 

Mortensen, 2003 & Jans, et al., 2012) are 

further studies summarized in the same array.  

 

The age group in which suicidal ideation and 

cognition is more prevalent is found to be 18-

21, agreeable by a range of past researches 

including (WHO, 2013; National center of 

health statistics,  2009; McKeown, et 

al.,2006; Kaplan, et al., 1998; Jacobs, et al., 

2003; Watkins, 2006; Quin, 2005, 

Department of health statistics, 2000; 

National Youth Violence Prevention 

Resource Centre, 2006;  Masango, et al., 

2008 & Waldvogel, et al., 2008).  Department 

of health statistics notes, 2000, see Figure 1.8 

and Figure 1.9. The age group which is 

generally considered to be young adult age 

has higher suicidal prevalence which may be 

due to the fact that the maturity has not yet hit 

these individuals. Researches claimed that 

human brain has not developed completely 

till this age bracket as prefrontal cortex is still 

in developing stage. This immaturity reflects 

in their behavior and they end up ideating and 

even attempting suicide for few minor invalid 

reasons.  

 

Further, in this study, suicide cognition is 

shown to be associated with employment. 

Generally, where there is un-employment; 

there comes depression, anxiety, 

hopelessness and thereby suicide ideation. 

The results are similar here; unemployed 

subjects reflect high suicide ideation and 

suicide cognition, when compared to 

employed ones, see Figure 2.0 and Figure 

2.1. In 2000, Platt and Hawton found similar 

results and they concluded that suicidal risks 

are increased among un-employed people 

(Platt & Hawton, 2000). Similarly, Kraut and 

Walld in 2003 showed association of un-

employment with higher likelihood of 

suicidal behaviors. Though, they compared 

unemployment with part time job and full 

time job in their study (Kraut A. & Walld R, 

2003). 

 

When life-style was compared with respect to 

the suicidal thoughts, it was seen that people 

with active life-style tend to have intensified 

suicidal ideation and suicidal cognition as 

compared to those who have sedentary life-

style, consider Figure 2.2 and Figure 2.3. One 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

of the possible reasons behind these results 

would be the hyper secretion of epinephrine 

and nor-epinephrine in these individuals. 

This hyper-secretion would let them stay 

active, and sometime very active, but suicidal 

are occupied their place in their minds.  

 

In addition to it, the level of qualification 

influences suicidal behavior as well. 

Subjects, who are pursuing graduation show 

high rates of suicidal ideation, consider 

Figure 2.4. The results are in the line of 

Minear and Brush (1980-81). This may be 

due to the peer pressures they are 

experiencing in their graduation life. Further 

participants who did matriculation and 

intermediate and also post-graduated ones 

reflect comparatively lower suicidal ideation 

and cognition, consider Figure 2.5.  

 

Conclusion 

The present study concluded that suicidal 

thoughts, including suicidal ideation and 

suicide cognition are widespread among the 

younger population of Karachi. And these 

prevalent self-harming thoughts are 

simultaneously linked with the demographic 

characteristics. Mild to moderate suicidal 

thoughts exist dominantly in males but the 

severity cases are almost equally prevalent 

among both genders. Similarly, being single 

and, aged 18-21, increases the risk of suicidal 

thoughts among youth. It is also analyzed that 

undergraduate students perceive suicidal 

thoughts more than any other educational 

level. Similarly, non-working subjects think 

about suicide more as compared to working 

individuals. 

 

Recommendations 

The future recommendations in regards to 

suicidal behavior, in general mental health, 

are more pronounced towards research area 

and awareness sessions on mental well-

being. Thus, in every country, there should be 

launched some educational and awareness 

campaigns for the locals in order to spread the 

words on mental health. For this to happen, 

the main goal is to treat barriers in treatment 

and care by increasing awareness of the 

frequency of mental disorders, their 

treatability, their recovery process and the 

human rights of people with mental health. 

Ultimately, well planned public awareness 

and educational campaigns can reduce stigma 

and discrimination, increase the use of mental 

health service, and bring mental health and 

physical health come closer to each other. 

 

Furthermore, new researches into biological 

and psycho-social aspects of mental health 

are needed in order to increase the 

understanding of mental disorders and to 

develop more effective interventions. 

 

Conclusively, the study suggest that, through 

educational forum we can spread the 

awareness of significance of mental health in 

correspondence with the physical well-being; 

because one has to maintain a balance 

between the two in order to enjoy a complete 

circle of life.  

 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
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ISSN 2412 - 3188 
 

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Annals of Psychophysiology                                                                                                                Volume 4, July 2017 
©Advance Educational Institute & Research Centre                                                                    www.aeirc-edu.com 

ISSN 2412 - 3188 
 

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