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Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Suicide is a leading cause of death among Nepali women of reproductive age. Suicidal ideation has known associations with stressful life events, which Nepali widows disproportionately experience. We aimed to identify risk and protective factors that could lead to effective interventions for this population.

Methods

To study suicidal ideation in Nepali widows, we collected data from 204 women in urban, semi-urban, and rural areas whose husbands died at least one year prior. The questionnaire included sociodemographic information, the Hopkins Symptom Checklist-25, PTSD Checklist—Civilian Version, Somatic Symptom Scale–8, and the Multidimensional Scale of Perceived Social Support. Overall severity of prolonged grief was assessed by a counselor after completing a structured clinical interview. Using multivariate regression models, we assessed associations of sociodemographic and psychosocial indicators with past-year suicidal ideation. Latent profile analysis was also performed to estimate profiles of comorbidities.

Results

Past-year suicidality was high, with 16.2% (N = 33). Each year increase since husband's death was protective and reduced odds of ideation 8% (95% CI 0.85–0.98) and being educated and of older age also reduced the odds of ideation by 0.21 (95% CI 0.06–0.70), and 0.09 (95% CI 0.01–0.64), respectively. Depression (OR = 6.37, 95% CI 2.78–14.59), PTSD (OR = 3.84, 95% CI 2.15–6.86), prolonged grief (OR = 6.04, 95% CI 3.04–12.00) and anxiety (OR = 6.52, 95% CI 2.96–14.38) were highly associated with suicidality, and mapped onto the three profiles of increasing mental distress severity.

Conclusion

Suicide remains a major issue among Nepali widows, showing high comorbidity with other mental disorders. Screening for depression, anxiety, and prolonged grief, may aid in identifying widows at increased risk of suicidal ideation.

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Acknowledgements

This work was supported by a grant from the Center for Public Health and Human Rights and the Center for Global Health at the Johns Hopkins Bloomberg School of Public Health.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    H. M. Garrison-Desany

  2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    H. M. Garrison-Desany & P. J. Surkan

  3. Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    M. E. Lasater, W. Tol & P. J. Surkan

  4. Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal

    N. P. Luitel & D. Rimal

  5. Women for Human Rights, Single Women’s Group, Kathmandu, Nepal

    D. Pun & S. Shrestha

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  1. H. M. Garrison-Desany
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Correspondence to H. M. Garrison-Desany.

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Ethical approval for this study was obtained from the Nepal Health Research Council (NHRC) and the Institutional Review Board of Johns Hopkins Bloomberg School of Public Health. Participants provided oral informed consent. 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.

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Garrison-Desany, H.M., Lasater, M.E., Luitel, N.P. et al. Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems. Soc Psychiatry Psychiatr Epidemiol 55, 1535–1545 (2020). https://doi.org/10.1007/s00127-020-01932-7

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