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Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world’s burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample.

Methods

Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal.

Results

In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide.

Conclusions

Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.

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Acknowledgements

The authors are deeply grateful for the valuable support and mentorship of Transcultural Psychosocial Organization (TPO) Nepal, particularly Mr. Nandaraj Acharya, Mr. Safar Bikram Adhikari, Mr. Nagendra Luitel, and Mr. Suraj Koirala. We are also gracious for the assistance of Jumla District and Kathmandu District police officers as well as Action Works Nepal staff and community leaders.

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Authors and Affiliations

  1. Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Ashley K. Hagaman

  2. Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal

    S. Khadka

  3. Nobel College, Pokhara University, Kathmandu, Nepal

    S. Lohani

  4. Department of Psychiatry, George Washington University, Washington, DC, USA

    B. Kohrt

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  1. Ashley K. Hagaman
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  2. S. Khadka
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Corresponding author

Correspondence to Ashley K. Hagaman.

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Financial support

AH was supported by US Fulbright Student Research Program and the National Science Foundation Cultural Anthropology Doctoral Dissertation Research Improvement Grant (Award 1459811). BAK was supported by the U.S. National Institute of Mental Health (K01MH104310).

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Availability of data and materials

Quantitative data resulting from the psychological autopsies and qualitative coding queries and code book information may be requested from the first author. Institutional suicide surveillance and reporting data are not available from the authors. For this information, researchers are encouraged to directly contact law enforcement and health institutions in Nepal.

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Hagaman, A.K., Khadka, S., Lohani, S. et al. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 52, 1483–1494 (2017). https://doi.org/10.1007/s00127-017-1433-6

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