NGO workers’ perspectives on suicide risk factors for Nepalese women of reproductive age, responses to suicide attempts, and challenges in suicide prevention.

Abstract

Background: Suicide is a global public health priority, with over 800,000 people ending their lives every year. A study conducted in 2008/09 in Nepal found it to be the leading cause of death in women of reproductive age, yet it is still under-researched and under-prioritised. Suicide risk factors amongst women are still not fully understood in the Nepalese context, with many studies assuming causes will be the same as in other South Asian countries such as India. Few studies explore risk factors and responses to suicide from an NGO’s perspective. WHO (2014) and Cramer and Kapusta (2017) use social-ecological models to explain suicide risk factors, placing them in levels moving from macro to micro. The research combined these two models to identify key suicide risk factors that fell into four categories: Society, Community, Relationship, and Individual. Methodology: Nine semi-structured interviews were conducted between August 10th and September 1st, 2017, with individuals working at a mental health NGO in Kathmandu. Participants worked in a range of positions within the NGO, from management level positions through to frontline staff working directly with beneficiaries. Interviews lasted on average 45 minutes and explored participants views on suicide risk factors amongst Nepalese women of reproductive age, responses from the NGO and on a wider scale, and the challenges the NGO face when supporting women. Findings: Many suicide risk factors were identified by participants, falling into all four categories of the social-ecological model. Gender inequality was found to be a crosscutting factor, influencing risk factors at all levels of the model. Stigma and relationship factors were also frequently mentioned. The NGO currently do not have a specific suicide prevention programme and their responses mainly focus on mental illness and stigma-related issues, but they are hoping to expand their programmes to include suicide prevention interventions. The main challenges identified were lack of political will, stigma, and lack of resources. Conclusion: The NGO could integrate some suicide prevention initiatives into current programmes (such as incorporating discussions on suicide into their stigma-reduction programme and gatekeeper training) without placing too much strain on resources. On a wider level, more research and lobbying about suicide, awareness-raising, and stigma-reduction interventions need to be implemented to increase political will, reduce stigma and improve resources.