BACKGROUND: Suicide deaths are significantly under-reported in Pakistan due, in part, to the absence of a national registry of suicide and stigma resulting from its illegal status until recently. Past studies of suicide by forensic autopsy have focused on larger cities. We aimed to identify the pattern of suicidal deaths in five rural districts in Punjab Province of Pakistan. METHODS: The data included all autopsies performed for suspected suicide in five districts of Punjab province (Bhakkar, Okara, Nankana Sahib, Khanewal and Khushab) over five years between January 2018 and December 2022, identified through collaboration with the Surgeon Medicolegal Punjab Office and district medico-legal officers. Demographic information and post-mortem toxicological findings were collected through a pre-designed proforma based on previous research. RESULTS: A total of 205 autopsies due to suspected suicides were identified. Most were aged under 30 years (133/205, 64.9%) and the male-to-female ratio was observed as 1.1:1. The most common methods overall were ingestion of poisonous substances (80/205, 39%; 18.5% of men and 61.9% of women) and hanging (75/205, 36.6%; 46.3% of men and 25.8% of women). Kala-pathar (paraphenylenediamine hair dye) was the most common ingested poison (41/80, 51.3%) followed by aluminium phosphide (formulated as 56% of 3 g fumigant wheat pills). Domestic conflict was the most common motive identified. CONCLUSIONS: This retrospective review of suicide autopsy cases in five districts of the Pakistan Punjab showed that poisoning was the most common means of suicide, particularly with paraphenylenediamine hair dye. There is need for systematic collection of such data from all districts across Pakistan, which can lead to the development of a national suicide registry. This will allow official reporting of suicide deaths on a national level to help guide development and monitoring of an effective suicide prevention strategy.