Social connectedness (SC) is “how one views oneself with the external world.” (Lee & Robbins, 1995). It includes all dimensions of social relations, including domestic, peer networks, and the community in general. Daily interactions are also included in one’s sense of SC (Townsend & McWhirter, 2005). It can be defined as having a lasting and pervasive sense of relational intimacy with the social world (Lee & Robbins, 1995). This sense of connectedness matures from adolescence to adulthood as one gradually builds trust in social relationships and gets comfortable in roles like a partner, parent, or colleague. Alternatively, a person who does not feel connected most likely struggles in social relationships (Lee et al., 2001).

The STS relates suicide to social integration, as excessive social integration may lead to deprivation strain. Frequent social interactions can stimulate comparison, where one may feel less than others or relatively deprived. Contrarily, the inadequacy of social integration can lead to coping strain, as facing ordeals may seem more taxing when facing them alone rather than with social or personal relations (Zhang, 2019).

To our knowledge, the role of SC as a moderator in the relationship between PS and SI has not been previously addressed. A moderated mediation model was tested in which psychological pain mediated the association of bullying and SI. Family togetherness and peer support moderated the mediation among middle and high school students (Bao et al., 2020). Another study provided evidence for social support mitigating the effects of PS on suicidal behavior among professionals in China (Lew et al., 2020). This study aims to address SC as an overarching construct of connectedness (Williams & Galliher, 2006).

An individual’s level of SC guides their feelings, thinking, and behavior in various social settings. The perception of low-connected people of their environment might be cold and negative, as opposed to that of high-connected people, which might be positive and welcoming (Lee et al., 2001). Perceived low levels of connectedness may lead to frustration and loss of sense of belongingness, resulting in chronic loneliness, lower self-worth, and social mistrust (Lee & Robbins, 1998). Problems with SC elucidate a more tenacious, global incapacity to connect with the social world (Williams & Galliher, 2006). Chronic isolation can be traumatic, affecting areas of functioning and development (Lee & Robbins, 1995). It directly leads to feelings of loneliness, which has been a strong predictor of SI in both men and women (McClelland et al., 2020; Stravynski & Boyer, 2001).

As mentioned earlier, a large body of literature on suicide focuses on reactivity rather than prevention. The primary focus is on risk elements when, in fact, protective elements, if powerful enough, can mitigate the impact of risk factors (Sánchez-Teruel & Robles-Bello, 2014). As protective elements against SI, both SC and social support (SS) have significance in the literature. In terms of relative importance, SC (17.6% variance) has a far greater protective role than SS (0.5% variance) against SI (Reyes, 2020). Empirical evidence exists to support that teacher, peer, familial, and school connectedness are protective factors against suicide (Whitlock et al., 2014). Parental connectedness significantly predicted a decrease in suicide (Gunn et al., 2018). School connectedness and community connectedness negatively predicted SI in cross-sectional studies and meta-analyses (Foster et al., 2017; Marraccini & Brier, 2017). Social connectedness was positively related to self-esteem, especially among females in Pakistan (Fatima et al., 2017). Respondents hailing from single-parent families had persistently higher rates of SI (68.3%) than those from two-parent families (33.3%) (Ghazanfar et al., 2015). These studies have indirectly alluded to SS and its constituents, but no study has addressed SC as a construct in Pakistan or its mitigating effects upon SI.

Religious orientation is “the degree of one’s involvement and personal significance attached to a sacred system” (Bjarnason, 2007). Extrinsic religious orientation (ERO) is a way of acquiring some self-serving end, where religion is utilized as an instrument that endorses social support, comfort, and self-esteem. Intrinsic religious orientation (IRO) is described as religion being an ultimate end in itself. Intrinsically religious people are exhilarated by a promise for personal spiritual development and a deeper, more meaningful relationship with God. (Bjarnason, 2007; Darvyri et al., 2014). People with IRO internalize their beliefs and use them as a framework to view their life, its purpose, and their contributions to it (King et al., 2020; Liang & Ketcham, 2017).

The STS regards excess or inadequacy of social integration and moral regulation as predictors of suicide. Excessive moral regulation can lead to value strain, whereas inadequate moral regulation can lead to aspiration strain (Zhang, 2019). Psychological strain is not studied with religious orientation, despite being an important determinant of depression and SI (Zhang et al., 2016, 2017; Zhao & Zhang, 2018). In a few studies, psychological distress and pressure were assessed with RO among Muslim students, elucidating a significant negative association (Butt, 2014; Kidwai et al., 2014) . However, these studies referred to unidirectional stress and not strain. For it to be considered a strain, two contradicting social facts need to be pulling an individual in the opposite directions, making it more detrimental, exacerbating, and frightening for an individual (Zhang, 2019).

Religious orientation was addressed with PS among studies conducted in rural China, but the inquiry remained limited to a single question of individuals being either religious or not religious (Zhang & Lv, 2014; Zhao & Zhang, 2018). Contrary to the Western sample, among Chinese students, those reported to believe in religion or were religious had higher levels of depression and SI as compared to those who were not. Among the Chinese sample, RO was a risk factor for SI (Zhang et al., 2016). Non-religious students were less likely to be depressed (Lew et al., 2020), though a single item limits the reliability of the findings. Overcoming this limitation in a psychological autopsy study, RO was studied using four items with dichotomous responses. The comparison was made between completed suicides and living controls, where religious orientation was found to be stronger for suicides as compared to controls (Zhang et al., 2011). As most of these studies were conducted in China, which is declared an atheist country, where prayer or going to church is considered to be deviant behavior (Zhang et al., 2011), religion may not be a protective factor against psychopathology, mental disorder, and suicidality (Zhang et al., 2024). Psychological strain in these cases may be experienced as a result of going against the norm (Zhang et al., 2011).

The protective role of religion against suicide has been a frequent debate in the literature across many religions (Cook, 2014). Although religion can play a protective role against suicide, the role might be conditional on culture-related implications and on association with a specific religion (Lawrence et al., 2016). Similarly, religious attendance significantly predicted decreased suicide attempts among those suffering from mental illnesses, even after controlling for social support (Rasic et al., 2009). A meta-analysis indicated that religion played a significant defensive role against suicide in both Western and old cultures, but not in Eastern countries (Wu et al., 2015). Likewise, in a cross-cultural study, religiosity was strong in Brazil and South Africa, but not in India and Vietnam (Sisask et al., 2010). This posits that the association between RO and suicide can vary based on cultural settings and affiliation with a particular religion. The available empirical evidence for suicidal behavior underscores the exclusive importance of SI, and the number of studies discretely focusing on ideation is rare. The levels of SI were found to be higher among depressed patients who regarded religion as more important and those who attended religious services (Lawrence et al., 2016).

In a country like Pakistan, where 96% of the population is Muslim (USCIRF, 2022), there is a need to explore whether RO acts as a risk or protective element regarding SI, by studying the moderating role of RO between PS and SI among young Muslim students.

This study extends previous research in several aspects. First, it focused exclusively on SI among young Muslim students aged 18 to 30. Second, the process-oriented approach was used to explore the moderating mechanisms between PS and SI. As shown in Figure 1, this study explored the moderating role of SC and RO in the association between PS and SI. In addition, it explored the moderated mediation of SC between PS and SI among students.

To collect data from a large sample during the lockdown, the survey method was deemed appropriate. A convenience sampling technique was used to collect data from different universities in Rawalpindi and Islamabad, Pakistan. Four hundred undergraduate, graduate, and doctoral students aged 18 to 30 years participated in the study. The data collection process commenced after formal approval from the Institutional Review Board. The data was collected online using a convenience sampling technique, during the COVID-19 lockdown between May 2020 and August 2020. The sampling population was students of the age range of 18 to 30 years from universities in Rawalpindi and Islamabad. The sample size was calculated using a sample size calculator. Informed consent was obtained from all participants. They were debriefed on the rationale of the study, their prospective inputs, and their right to withdraw from the study at any point. The survey information was kept confidential, and the personal information of participants was concealed. The survey was conducted using a self-report questionnaire comprising five categories: a socio-demographic section followed by scales to assess SI, PS, SC, depression, and RO.

Statistical Package for the Social Sciences software (version 23) and Hayes’ PROCESS macro (version 3.5.2) were used for data analysis. Pearson’s Product-Moment Correlation was conducted for bivariate analysis. The statistical significance level was set at p <.05. For moderation analysis, model 1 was used while model 58 was used for moderated mediation, with a bootstrap method with 5000 replications (Hayes, 2017).

Pearson product-moment correlation, means, standard deviations, and internal reliability for the scale scores were computed. PS (r = .57, p < .01) and depression (r = .58, p < .01) are significantly and positively related to SI, whereas social connectedness (r = –.25, p < .01) and intrinsic religious orientation (r = –.25, p < .01) are significantly and negatively related to SI. There is no significant relationship between ERO and SI (r = –.033, n = 372, p = .52).

As shown in Table 2, the interaction between PS and SC was negative and statistically significant (β = –.002, p < 0.05). This identified SC as a moderator in the association between PS and SI, though the interaction value is small (See Figure 2). The conditional direct effect showed corresponding results, being positively and significantly different from zero. The subsequent slope analysis is shown in Figure 3.

As shown in Table 2, after controlling for covariates, PS positively predicted depression (β = .27, p < 0.001). In addition, PS (β = 0.10, p < 0.001) and depression (β = 0.81, p < 0.001) positively predicted SI. The paths between PS and depression (β = –.002, p < 0.001) and between depression and SI (β = –.0053, p < 0.05) were significantly moderated by SC. All three conditional direct effects were positively and significantly different from zero, indicating significant moderation of SC on SI. Subsequent simple slope analyses are shown (see Figure 4). No index of moderated mediation is produced in Model 58, but the pairwise contrasts of indirect effect were all significant, indicating that the indirect effects were conditional on the level of the moderator.

As shown in Table 3a, the interaction between PS and IRO was negative and statistically significant (β = –.002, p < 0.05). This identified IRO as a moderator in the association between PS and SI, though the interaction value is small (See Figure 5a). The conditional direct effect showed corresponding results (See Table 3b), positively and significantly different from zero. The subsequent slope analysis is shown in Figure 5b.

Social determinants, like SC, play a significant role in preventing suicidal thoughts and behavior. Our findings reveal that SC was negatively and significantly related to SI, indicating that an increase in connectedness is associated with a decrease in suicidal thoughts. As the perception of connectedness increases in a young individual, the chance of thinking about ending one’s life decreases. Hence, the hypothesis is supported. Loss of sense of connectedness and chronic isolation can be traumatic (Lee & Robbins, 1995, 1998; Wickramaratne et al., 2022), facilitating an individual toward suicidal thoughts (Zhang, 2019). The findings are empirically supported by related studies conducted in Pakistan, as disrupted social networks (Shekhani et al., 2018) and poor interaction with family (Ghazanfar et al., 2015) played a critical role in predicting SI. Similarly, social isolation, exposure to family violence, and loss or separation of parents were found as significant risk factors for suicide (Tharwani et al., 2023). Hence, SC significantly influences an individual’s intent to live, be it with peers, parents, or school.

Another noteworthy social determinant of SI, in the context of Pakistan being a Muslim-majority country, is IRO. Findings reveal that IRO has a significant negative but small association with SI, supporting our hypothesis that an increase in IRO is related to a decrease in SI. Young adults who find meaning in religion and follow it as an ultimate end are less likely to think about ending their lives. The findings of the study are in line with the literature and theory that people who are religiously involved are more likely to be protected from suicide (De Berardis et al., 2020; Lawrence et al., 2016).

Contrarily, there is no significant relationship between ERO and SI, and the hypothesis was not supported. Findings suggest that changes in the level of ERO will not be related to SI. The nature of RO might be the reason behind the relationship. When RO is intended to serve as an instrument for social recognition or self-esteem, it might not be related to a decrease in SI. In literature, ERO is seen as less indicative of mental health as compared to the IRO due to their nature and intention (Allport & Ross, 1967; García-Alandete & Bernabé-Valero, 2013). Even in China, university students with high IRO and low personality-oriented ERO intend to have lower suicidality (Lew et al., 2018). IRO embodied positive outcomes, whereas ERO embodied negative outcomes. Findings are supported by similar conclusions, where religious attendance only mitigated distress when experiencing high spirituality (Kidwai et al., 2014). Empirical and theoretical evidence reinforces the above-stated results that intrinsically oriented religious people have better mental health as compared to extrinsically oriented religious, and are less likely to suffer from suicidal thoughts (Allport & Ross, 1967; García-Alandete & Bernabé-Valero, 2013).

A moderation analysis was carried out to study the role of SC in the association between PS and SI. A moderated mediation model was tested to explore the role of SC as a moderator in the mediation of depression between PS and SI. Also, a moderation analysis was carried out to study the role of IRO in the association between PS and SI. The findings revealed that SC and IRO buffer the effect of PS on SI. Also, depression may not mediate between PS and SI when a young person has a high sense of connectedness.

With more than 64% of the population of Pakistan highly vulnerable to suicide, a poor mental healthcare system, and the impacts of the COVID-19 outbreak, interventions against SI are crucial to prevent ideation. Without timely intervention, our young students might succumb to SI.

Unfortunately, the country does not have an integrated strategic policy framework for suicide prevention at the national, provincial, or local levels. Mental health action plans are available, but implementation is lacking at both the national and provincial levels, with mere replication of mental health acts. This study underscores the importance of preventive strategies at the national level, with radical steps for policy change and implementation.

Mental health awareness campaigns must be introduced to educate youth, encourage help-seeking behavior, and mitigate the societal stigma and discrimination against mental disorders and suicidality. Public health initiatives can prevent SI by implementing multifaceted interventions. State and humanitarian agencies must facilitate digital services after COVID-19 to ensure scalable and accessible mental health care. Institutions must establish online platforms to provide counseling and SS for students’ mental and social well-being. Services like internet-based cognitive behavioral therapy might be introduced with data protection protocols to ensure help-seeking against depression and suicide without worrying about the associated stigma.

The present study has clinical implications for suicide prevention among young Muslim students. Historically, religion and psychotherapy were segregated, and psychotherapists were not considered prepared to address spiritual issues in psychotherapy (Pargament & Saunders, 2007). In the Islamic Republic of Pakistan, religion guides the way of life and IRO has a protective role against SI among university students. The Royal College of Psychiatrists (Cook, 2013) upholds the significance of addressing religion in clinical practice. A psychologist cannot inculcate religion, but for someone whose lifestyle is guided by religion, their religious conflicts and strains need to be addressed. If patients report being religious during history-taking and are comfortable in discussing their religious concerns, mental health practitioners must be open to addressing such issues or refer the patient to another practitioner who is equipped to meet their needs (VanderWeele et al., 2017). In the last two decades, there has been a shift in the realm of psychotherapy, where psychotherapists are prepared to address religious concerns in treatment (Post & Wade, 2009). Hence, therapy must be tailored to fit the client’s spiritual and social needs without imposing any practice (Worthington & Aten, 2009), to facilitate well-being by using these resources in their favor (Ghafoor et al., 2022) with the help of professionals.

This study aimed to address SI while suicide attempts and suicidal behavior remained unaddressed. Future studies can aim to study the mechanisms that lead to suicide ideation, attempt, and behavior. Since self-report measures were administered, social desirability and biases in reporting could be observed. Future studies can employ other methods for data collection, such as interviews, focus group discussions, etc. The correlational design of the study prevents causal inferences; hence, definitive conclusions must therefore be avoided. This study only offers one exploration of the pathway to SI, presenting the plausible association between variables. In the future, prospective studies may help to determine causal inferences and suggest comprehensive insight into other pathways. As the study employed a convenience sampling technique, it mandates a cautious interpretation of the findings. Though the study addressed certain psychosocial factors regarding SI, other pathways are yet to be explored. Lastly, as this study was carried out during the COVID-19 outbreak among Muslim students, and the findings must be assessed against other samples without the impact of the pandemic.