Suicide in Nepal: Difference between revisions

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m I changed the introduction section describing the suicide burden in Nepal and why it remains a largely neglected issue despite the public health burden. Due to the lack of systematic reviews conducted in Nepal, I have cited individual articles to give more context to the problem of suicide in the country
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{{Suicide sidebar}}
{{Suicide sidebar}}


'''Globally,''' it is estimated that more than 800,000 people die by suicide each year.<ref name=":0">{{Cite web |title=Suicide |url=https://www.who.int/news-room/fact-sheets/detail/suicide |access-date=2023-11-22 |website=www.who.int |language=en}}</ref>According to the World Health Organization (WHO) suicide can occur throughout the lifespan of an individual and is the fourth leading cause of death among 15–29-year-olds globally.<ref name=":0" /> This corresponds to a global suicide rate of 10.4 suicides per 100,000. While the global suicide rates have remained relatively stable over the past decade, there is significant variation in the rates between high and low resource countries. It estimated more than 77 percent global suicides occur <ref>{{Cite journal |last=Jordans |first=Mark JD |last2=Kaufman |first2=Anne |last3=Brenman |first3=Natassia F. |last4=Adhikari |first4=Ramesh P. |last5=Luitel |first5=Nagendra P. |last6=Tol |first6=Wietse A. |last7=Komproe |first7=Ivan |date=2014-12-24 |title=Suicide in South Asia: a scoping review |url=https://doi.org/10.1186/s12888-014-0358-9 |journal=BMC Psychiatry |volume=14 |issue=1 |pages=358 |doi=10.1186/s12888-014-0358-9 |issn=1471-244X |pmc=PMC4299381 |pmid=25539951}}</ref><ref name=":0" /> in the low resource settings. Moreover, it is estimated that for every death by suicide there are as many as 20 more suicide attempts which places the burden much higher than is reported.<ref>{{Cite web |title=Suicide |url=https://www.who.int/health-topics/suicide |access-date=2023-11-22 |website=www.who.int |language=en}}</ref><ref>{{Cite web |title=Preventing suicide: A global imperative |url=https://www.who.int/publications-detail-redirect/9789241564779 |access-date=2023-11-22 |website=www.who.int |language=en}}</ref>
'''Suicide in Nepal''' ({{lang-ne|नेपालमा आत्महत्या}}) has become a major national issue highlighted by a series of high-profile suicides in recent years.<ref name="ekantipur">{{Cite news|url=http://www.ekantipur.com/2015/05/25/top-story/former-sc-justice-uprety-commits-suicide/405657.html|title=Former SC Justice Upreti commits suicide|date=25 May 2015|publisher=[[ekantipur]]|accessdate=29 June 2015}}</ref><ref name="seattleglobalist">{{Cite news|url=http://seattleglobalist.com/2014/07/11/girls-education-nepal-suicide/27430|title=Nepalese student's suicide reveals dark side of 'globalization lottery'|date=11 July 2014|publisher=[[The Seattle Globalist]]|accessdate=29 June 2015}}</ref><ref name="nydailynews">{{Cite news|url=http://www.nydailynews.com/sports/soccer/reports-young-brazil-fan-nepal-commits-suicide-world-cup-loss-article-1.1860190|title=Reports: Brazil soccer fan in Nepal commits suicide after being teased by friends over World Cup loss to Germany|date=9 July 2014|work=[[Daily News (New York)|Daily News]]|accessdate=29 June 2015}}</ref> Ranked 126th by suicide rate globally by the 2015 World Health Organization report, Nepal has an estimated 6,840 suicides annually, or 8.2 suicides per 100,000 people.<ref name="Suicide rates Data by country">{{cite web |url=http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en |title=Suicide rates Data by country |publisher=[[World Health Organization]] |year=2015|accessdate=13 June 2015}}</ref> Suicide is currently the leading cause of death for Nepalese women aged 15–49.<ref name="Irin News">{{cite web |url=http://www.irinnews.org/report/87823/nepal-why-are-so-many-women-killing-themselves|title=NEPAL: Why are so many women killing themselves?|publisher=[[Irin News]] |date= 11 January 2010|accessdate=29 June 2015}}</ref><ref name="SUICIDE AMONG WOMEN IN NEPAL">{{cite web |url=http://www.nhssp.org.np/pulse/Suicide%20Among%20Women%20Pulse%20Update%204.pdf|title=SUICIDE AMONG WOMEN IN NEPAL|publisher=[[Nepal Health Sector Support Programme]] |date=May 2012|accessdate=29 June 2015}}</ref>

In 2014, the WHO ranked Nepal as the 7<sup>th</sup>on the suicide rate globally. The estimated annual suicides annually are 6,840 or 24.9 suicides per 100,000 people.<ref name=":1">{{Cite journal |last=Thapaliya |first=Suresh |last2=Sharma |first2=Pawan |last3=Upadhyaya |first3=Kapil |date=2018-02-01 |title=Suicide and self harm in Nepal: A scoping review |url=https://www.sciencedirect.com/science/article/pii/S1876201817302885 |journal=Asian Journal of Psychiatry |volume=32 |pages=20–26 |doi=10.1016/j.ajp.2017.11.018 |issn=1876-2018}}</ref>According to data obtained from the Nepal police the average annual increase in suicide over the past five year is 7% which increased to 14% in 2021. Data on suicide in Nepal are primarily based on police reports and therefore rely on mortality statistics. Due to the lack of community-based screening, national suicide surveillance systems and integrated network, there is discrepancy in suicide reporting.<ref>{{Cite journal |last=Jordans |first=Mark JD |last2=Kaufman |first2=Anne |last3=Brenman |first3=Natassia F. |last4=Adhikari |first4=Ramesh P. |last5=Luitel |first5=Nagendra P. |last6=Tol |first6=Wietse A. |last7=Komproe |first7=Ivan |date=2014-12-24 |title=Suicide in South Asia: a scoping review |url=https://doi.org/10.1186/s12888-014-0358-9 |journal=BMC Psychiatry |volume=14 |issue=1 |pages=358 |doi=10.1186/s12888-014-0358-9 |issn=1471-244X |pmc=PMC4299381 |pmid=25539951}}</ref> As such, burden of suicide in communities is likely to be higher particularly among women, migrant workers and population affected by disasters.<ref name=":1" />


'''Suicide in Nepal''' ({{lang-ne|नेपालमा आत्महत्या}}) The increasing trend in suicide is a major public health concern in Nepal. <ref name=":2">{{Cite journal |last=Silwal |first=Bhagabati Sedain |last2=Pant |first2=Puspa Raj |last3=Gurung |first3=Yogendra Bahadur |date=2021-03-01 |title=2E.003 Burden of suicide in Nepal: an analysis of police records |url=https://injuryprevention.bmj.com/content/27/Suppl_2/A17.2 |journal=Injury Prevention |language=en |volume=27 |issue=Suppl 2 |pages=A17–A17 |doi=10.1136/injuryprev-2021-safety.51 |issn=1353-8047}}</ref><ref>{{Cite journal |last=Marahatta |first=Kedar |last2=Samuel |first2=Reuben |last3=Sharma |first3=Pawan |last4=Dixit |first4=Lonim |last5=Shrestha |first5=Bhola Ram |date=2017-04 |title=Suicide burden and prevention in Nepal: The need for a national strategy |url=https://pubmed.ncbi.nlm.nih.gov/28597859/ |journal=WHO South-East Asia journal of public health |volume=6 |issue=1 |pages=45–49 |doi=10.4103/2224-3151.206164 |issn=2304-5272 |pmid=28597859}}</ref><ref name=":3">{{Cite journal |last=Hagaman |first=Ashley K. |last2=Maharjan |first2=Uden |last3=Kohrt |first3=Brandon A. |date=2016-06-06 |title=Suicide surveillance and health systems in Nepal: a qualitative and social network analysis |url=https://doi.org/10.1186/s13033-016-0073-7 |journal=International Journal of Mental Health Systems |volume=10 |issue=1 |pages=46 |doi=10.1186/s13033-016-0073-7 |issn=1752-4458 |pmc=PMC4895957 |pmid=27274355}}</ref> Often suicide indicates an underlying mental health problem or acute stress.<ref>{{Cite journal |last=Brådvik |first=Louise |date=17 September 2018 |title=Suicide Risk and Mental Disorders |url=https://www.mdpi.com/1660-4601/15/9/2028 |journal=International Journal of Environmental Research and Public Health |language=en |volume=15 |issue=9 |pages=2028 |doi=10.3390/ijerph15092028 |issn=1660-4601}}</ref><ref>{{Cite web |date=2023-07-06 |title=Risk and Protective Factors {{!}} Suicide {{!}} CDC |url=https://www.cdc.gov/suicide/factors/index.html |access-date=2023-11-22 |website=www.cdc.gov |language=en-us}}</ref> Increased access to timely and effective mental health services are often associated with decreased risk of suicide <ref>{{Cite web |title=A Comprehensive Approach to Suicide Prevention – Suicide Prevention Resource Center |url=https://sprc.org/effective-prevention/comprehensive-approach |access-date=2023-11-22 |language=en-US}}</ref><ref>{{Cite web |title=Suicide Prevention: Evidence-Informed Interventions for the Health Care Workforce Guide {{!}} AHA |url=https://www.aha.org/suicideprevention/health-care-workforce/suicide-prevention-guide |access-date=2023-11-22 |website=www.aha.org |language=en}}</ref><ref>{{Cite journal |last=Ahmedani |first=Brian K. |last2=Vannoy |first2=Steven |date=2014-09 |title=National Pathways for Suicide Prevention and Health Services Research |url=https://doi.org/10.1016/j.amepre.2014.05.038 |journal=American Journal of Preventive Medicine |volume=47 |issue=3 |pages=S222–S228 |doi=10.1016/j.amepre.2014.05.038 |issn=0749-3797 |pmc=PMC4143796 |pmid=25145743}}</ref>. However, there are several barriers to access high quality mental health services in Nepal including stigma, lack of human resources as well as infrastructure to provide care.<ref>{{Cite journal |last=Atreya |first=Alok |last2=Upreti |first2=Manish |last3=Nepal |first3=Samata |date=2023-03 |title=Barriers to mental health care access in Nepal |url=http://journals.sagepub.com/doi/10.1177/00258172221141293 |journal=Medico-Legal Journal |language=en |volume=91 |issue=1 |pages=54–55 |doi=10.1177/00258172221141293 |issn=0025-8172}}</ref><ref>{{Cite journal |last=Luitel |first=Nagendra P |last2=Jordans |first2=Mark JD |last3=Adhikari |first3=Anup |last4=Upadhaya |first4=Nawaraj |last5=Hanlon |first5=Charlotte |last6=Lund |first6=Crick |last7=Komproe |first7=Ivan H |date=2015-12 |title=Mental health care in Nepal: current situation and challenges for development of a district mental health care plan |url=https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-014-0030-5 |journal=Conflict and Health |language=en |volume=9 |issue=1 |doi=10.1186/s13031-014-0030-5 |issn=1752-1505 |pmc=PMC4331482 |pmid=25694792}}</ref><ref>{{Cite journal |last=Luitel |first=Nagendra P. |last2=Jordans |first2=Mark J. D. |last3=Kohrt |first3=Brandon A. |last4=Rathod |first4=Sujit D. |last5=Komproe |first5=Ivan H. |date=2017-08-17 |editor-last=Abe |editor-first=Takeru |title=Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal |url=https://dx.plos.org/10.1371/journal.pone.0183223 |journal=PLOS ONE |language=en |volume=12 |issue=8 |pages=e0183223 |doi=10.1371/journal.pone.0183223 |issn=1932-6203 |pmc=PMC5560728 |pmid=28817734}}</ref><ref>{{Cite journal |last=Gurung |first=Dristy |last2=Poudyal |first2=Anubhuti |last3=Wang |first3=Yixue Lily |last4=Neupane |first4=Mani |last5=Bhattarai |first5=Kalpana |last6=Wahid |first6=Syed Shabab |last7=Aryal |first7=Susmeera |last8=Heim |first8=Eva |last9=Gronholm |first9=Petra |last10=Thornicroft |first10=Graham |last11=Kohrt |first11=Brandon |date=2022 |title=Stigma against mental health disorders in Nepal conceptualised with a ‘what matters most’ framework: a scoping review |url=https://www.cambridge.org/core/product/identifier/S2045796021000809/type/journal_article |journal=Epidemiology and Psychiatric Sciences |language=en |volume=31 |doi=10.1017/S2045796021000809 |issn=2045-7960 |pmc=PMC8851063 |pmid=35086602}}</ref> The government of Nepal spends less than 1% of its total healthcare budget on mental health. <ref>{{Cite journal |last=Singh |first=Rakesh |last2=Khadka |first2=Seema |date=2022-02 |title=Mental health law in Nepal |url=https://www.cambridge.org/core/product/identifier/S2056474021000520/type/journal_article |journal=BJPsych International |language=en |volume=19 |issue=1 |pages=24–26 |doi=10.1192/bji.2021.52 |issn=2056-4740 |pmc=PMC9811380 |pmid=36622651}}</ref> Nepal has a rural population of over 78% population<ref>{{Cite web |title=Nepal: share of rural population 2022 |url=https://www.statista.com/statistics/761008/nepal-share-of-rural-population/ |access-date=2023-11-22 |website=Statista |language=en}}</ref><ref>{{Cite web |last=Bureau |first=US Census |title=Nepal: Population Vulnerability and Resilience Profile |url=https://www.census.gov/programs-surveys/international-programs/data/population-vulnerability/nepal.html |access-date=2023-11-22 |website=Census.gov}}</ref>, but the mental health resources are highly concentrated in larger urban areas.<ref>{{Cite journal |last=Luitel |first=Nagendra P |last2=Jordans |first2=Mark JD |last3=Adhikari |first3=Anup |last4=Upadhaya |first4=Nawaraj |last5=Hanlon |first5=Charlotte |last6=Lund |first6=Crick |last7=Komproe |first7=Ivan H |date=2015-12 |title=Mental health care in Nepal: current situation and challenges for development of a district mental health care plan |url=https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-014-0030-5 |journal=Conflict and Health |language=en |volume=9 |issue=1 |doi=10.1186/s13031-014-0030-5 |issn=1752-1505 |pmc=PMC4331482 |pmid=25694792}}</ref> While there have been some improvements in increasing awareness and access to mental health care through non profit organizations, government initiatives and telehealth, over 90% of people with mental health problems do not receive any access to treatment.<ref>{{Cite journal |last=Luitel |first=Nagendra P. |last2=Garman |first2=Emily C. |last3=Jordans |first3=Mark J. D. |last4=Lund |first4=Crick |date=2019-10-22 |title=Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal |url=https://doi.org/10.1186/s12889-019-7663-7 |journal=BMC Public Health |volume=19 |issue=1 |pages=1350 |doi=10.1186/s12889-019-7663-7 |issn=1471-2458}}</ref><ref>{{Cite journal |last=Luitel |first=Nagendra P. |last2=Jordans |first2=Mark J. D. |last3=Kohrt |first3=Brandon A. |last4=Rathod |first4=Sujit D. |last5=Komproe |first5=Ivan H. |date=2017-08-17 |editor-last=Abe |editor-first=Takeru |title=Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal |url=https://dx.plos.org/10.1371/journal.pone.0183223 |journal=PLOS ONE |language=en |volume=12 |issue=8 |pages=e0183223 |doi=10.1371/journal.pone.0183223 |issn=1932-6203 |pmc=PMC5560728 |pmid=28817734}}</ref>. As a result, despite the significant public health burden, suicide remains largely neglected and underreported in Nepal.<ref name=":2" /><ref name=":3" />


==Underreporting==
==Underreporting==
The rate of suicide in [[Nepal]] has been reported to be as low as 3.7/100,000 as a result of under reporting caused by issues of legality, social stigma, and logistical problems.<ref name="ncbi.nlm.nih.gov">{{cite journal |title = Suicide prevention in Nepal: a comparison to Australia – a personal view|journal=[[Mental Health in Family Medicine]]|date = 2008|pmc=2777576|pmid=22477866|volume=5|issue = 3|pages=177–82 | last1 = Benson | first1 = J | last2 = Shakya | first2 = R}}</ref>
The rate of suicide in [[Nepal]] has been reported to be as low as 3.7/100,000 as a result of under reporting caused by issues of legality, social stigma, and logistical problems.<ref name="ncbi.nlm.nih.gov">{{cite journal |title = Suicide prevention in Nepal: a comparison to Australia – a personal view|journal=[[Mental Health in Family Medicine]]|date = 2008|pmc=2777576|pmid=22477866|volume=5|issue = 3|pages=177–82 | last1 = Benson | first1 = J | last2 = Shakya | first2 = R}}</ref>


Suicide was decriminalized in Nepal 2018. Before that it was punishable by fines and imprisonment (requires citation). According to the director of Samanta, a Nepalese organization for women’s rights, "most families would never report suicide cases as they are afraid of being entangled in police cases."<ref name="Irin News"/> In attempts to avoid legal trouble, suicidal patients and their families may avoid going to hospitals for treatment. Even after death, victims of suicide may have their deaths misattributed to avoid legal problems for their families.<ref name="ncbi.nlm.nih.gov"/>
Suicide was decriminalized in Nepal 2018. Before that it was punishable by fines and imprisonment (requires citation). According to the director of Samanta, a Nepalese organization for women’s rights, "most families would never report suicide cases as they are afraid of being entangled in police cases."<ref name="Irin News">{{cite web |date=11 January 2010 |title=NEPAL: Why are so many women killing themselves? |url=http://www.irinnews.org/report/87823/nepal-why-are-so-many-women-killing-themselves |accessdate=29 June 2015 |publisher=[[Irin News]]}}</ref> In attempts to avoid legal trouble, suicidal patients and their families may avoid going to hospitals for treatment. Even after death, victims of suicide may have their deaths misattributed to avoid legal problems for their families.<ref name="ncbi.nlm.nih.gov"/>


Families may also avoid reporting suicides due to social stigma and discrimination against people with mental health problems.<ref name="ncbi.nlm.nih.gov"/> Despite the recent abundance of articles discussing suicide in Nepal, issues related to suicide are largely avoided, both as the result and perpetuation of a powerful social stigma against mental illness.<ref>{{cite journal |title = Nepal mental health country profile|journal=[[International Review of Psychiatry]]|volume = 16|issue = 1–2|pages = 142–149|date = 2004|doi = 10.1080/09540260310001635186|pmid = 15276946|last1 = Regmi|first1 = S. K.|last2 = Pokharel|first2 = A.|last3 = Ojha|first3 = S. P.|last4 = Pradhan|first4 = S. N.|last5 = Chapagain|first5 = G.|s2cid=37998108}}</ref> For women in particular, the under reporting of suicides and suicide-attempts may be caused in part by a "culture of silence", especially in cases related to domestic abuse.<ref name="Peace Voice">{{cite web |url = http://www.peacevoice.info/2013/08/30/female-suicides-in-nepal%E2%80%95and-in-the-usa/|title = Female Suicides in Nepal and in the USA|publisher=[[Peace Voice]]|date = 30 August 2013|accessdate=29 June 2015}}</ref>
Families may also avoid reporting suicides due to social stigma and discrimination against people with mental health problems.<ref name="ncbi.nlm.nih.gov"/> Despite the recent abundance of articles discussing suicide in Nepal, issues related to suicide are largely avoided, both as the result and perpetuation of a powerful social stigma against mental illness.<ref>{{cite journal |title = Nepal mental health country profile|journal=[[International Review of Psychiatry]]|volume = 16|issue = 1–2|pages = 142–149|date = 2004|doi = 10.1080/09540260310001635186|pmid = 15276946|last1 = Regmi|first1 = S. K.|last2 = Pokharel|first2 = A.|last3 = Ojha|first3 = S. P.|last4 = Pradhan|first4 = S. N.|last5 = Chapagain|first5 = G.|s2cid=37998108}}</ref> For women in particular, the under reporting of suicides and suicide-attempts may be caused in part by a "culture of silence", especially in cases related to domestic abuse.<ref name="Peace Voice">{{cite web |url = http://www.peacevoice.info/2013/08/30/female-suicides-in-nepal%E2%80%95and-in-the-usa/|title = Female Suicides in Nepal and in the USA|publisher=[[Peace Voice]]|date = 30 August 2013|accessdate=29 June 2015}}</ref>


Finally, logistical issues pose a threat to accurate reporting and record keeping. According to the Nepal Health Sector Support Programme, due to "poor record keeping by police and hospitals" as well as the fact that "registration systems are inaccurate and of poor quality," suicide may continue to be under reported even if social and legal issues were to be resolved.<ref name="SUICIDE AMONG WOMEN IN NEPAL"/>
Finally, logistical issues pose a threat to accurate reporting and record keeping. According to the Nepal Health Sector Support Programme, due to "poor record keeping by police and hospitals" as well as the fact that "registration systems are inaccurate and of poor quality," suicide may continue to be under reported even if social and legal issues were to be resolved.<ref name="SUICIDE AMONG WOMEN IN NEPAL">{{cite web |date=May 2012 |title=SUICIDE AMONG WOMEN IN NEPAL |url=http://www.nhssp.org.np/pulse/Suicide%20Among%20Women%20Pulse%20Update%204.pdf |accessdate=29 June 2015 |publisher=[[Nepal Health Sector Support Programme]]}}</ref>


==Gender==
==Gender==
In 2009, the Nepalese Family Health Division's Maternal Mortality and Morbidity Study published the "shocking finding" that suicide was the leading cause of death for women of reproductive age (15-49). According to the report, "analysis of verbal autopsy data indicates mental health problems, relationships, marriage and family issues are key factors" with 21% of suicides among women of reproductive age consisting of women 18 or younger, "indicating that youth is a factor to be investigated."<ref name="Family Health Division">{{cite web |url=http://www.dpiap.org/resources/pdf/nepal_maternal_mortality_2011_04_22.pdf|title=Maternal Mortality and Morbidity Study|publisher=[[Family Health Division]] |year=2009|accessdate=29 June 2015}}</ref> Although the suicide rate for men remains higher almost universally as well as in Nepal (30.1/100,000 for men, 20.0/100,000 for women),<ref name="Suicide rates Data by country"/> Nepal has a relatively high ratio of female:male suicides and stands out as being ranked 17th for male suicide rates but 3rd for female suicide rates. It's worth noting that while male suicide rates are higher, it is estimated that Nepalese women attempt suicide three times more than men do.<ref>{{cite web |url=http://www.ekantipur.com/the-kathmandu-post/2010/09/10/top-story/youth-more-prone-to-suicide/212596/ |title=Youth more prone to suicide |publisher=[[Kathmandu Post]] |date = 11 September 2010|accessdate=13 June 2015}}</ref> Additionally, the tie ins to maternal health, domestic violence, and youth have made female suicide a prominent issue. A case study published in the same mortality report exemplifies the type of problems that women may face:
In 2009, the Nepalese Family Health Division's Maternal Mortality and Morbidity Study published the "shocking finding" that suicide was the leading cause of death for women of reproductive age (15-49). According to the report, "analysis of verbal autopsy data indicates mental health problems, relationships, marriage and family issues are key factors" with 21% of suicides among women of reproductive age consisting of women 18 or younger, "indicating that youth is a factor to be investigated."<ref name="Family Health Division">{{cite web |url=http://www.dpiap.org/resources/pdf/nepal_maternal_mortality_2011_04_22.pdf|title=Maternal Mortality and Morbidity Study|publisher=[[Family Health Division]] |year=2009|accessdate=29 June 2015}}</ref> Although the suicide rate for men remains higher almost universally as well as in Nepal (30.1/100,000 for men, 20.0/100,000 for women),<ref name="Suicide rates Data by country">{{cite web |year=2015 |title=Suicide rates Data by country |url=http://apps.who.int/gho/data/node.main.MHSUICIDE?lang=en |accessdate=13 June 2015 |publisher=[[World Health Organization]]}}</ref> Nepal has a relatively high ratio of female:male suicides and stands out as being ranked 17th for male suicide rates but 3rd for female suicide rates. It's worth noting that while male suicide rates are higher, it is estimated that Nepalese women attempt suicide three times more than men do.<ref>{{cite web |url=http://www.ekantipur.com/the-kathmandu-post/2010/09/10/top-story/youth-more-prone-to-suicide/212596/ |title=Youth more prone to suicide |publisher=[[Kathmandu Post]] |date = 11 September 2010|accessdate=13 June 2015}}</ref> Additionally, the tie ins to maternal health, domestic violence, and youth have made female suicide a prominent issue. A case study published in the same mortality report exemplifies the type of problems that women may face:


<blockquote>Sanju was a 21 years old, illiterate and mother of two children. By her third pregnancy she was anaemic and malnourished, feeling dizzy and weak, but she received no antenatal care. In her third month of pregnancy she was about to travel to her maternal home with her husband, but her relatives stopped her as there was a flood. She went to her room to rest, but when her mother-in-law went to her room an hour later she said she had eaten some medicine for killing lice. Her husband, mother-in-law and neighbour took her to the local medicine shop in their cart, and the pharmacist immediately referred her to the district hospital. The family borrowed money and took her to hospital in a private van, a 25 minute journey. She was admitted to the emergency ward and attended to by the doctor immediately, but died within a few hours. The above account was given by her mother-in-law. However, the female community health volunteer said Sanju suffered from hysteria and was being forced to have an illicit relationship with her father-in-law. She was treated for her hysteria but forced to continue the relationship, and therefore was tense. The FCHV and VHW felt this may have been the reason she committed suicide.<ref name="Family Health Division"/></blockquote>
<blockquote>Sanju was a 21 years old, illiterate and mother of two children. By her third pregnancy she was anaemic and malnourished, feeling dizzy and weak, but she received no antenatal care. In her third month of pregnancy she was about to travel to her maternal home with her husband, but her relatives stopped her as there was a flood. She went to her room to rest, but when her mother-in-law went to her room an hour later she said she had eaten some medicine for killing lice. Her husband, mother-in-law and neighbour took her to the local medicine shop in their cart, and the pharmacist immediately referred her to the district hospital. The family borrowed money and took her to hospital in a private van, a 25 minute journey. She was admitted to the emergency ward and attended to by the doctor immediately, but died within a few hours. The above account was given by her mother-in-law. However, the female community health volunteer said Sanju suffered from hysteria and was being forced to have an illicit relationship with her father-in-law. She was treated for her hysteria but forced to continue the relationship, and therefore was tense. The FCHV and VHW felt this may have been the reason she committed suicide.<ref name="Family Health Division"/></blockquote>

Revision as of 20:37, 22 November 2023

Suicide
Social aspects
Crisis
Types
Epidemiology
History
In warfare
Related phenomena
By country
Organizations

Globally, it is estimated that more than 800,000 people die by suicide each year.[1]According to the World Health Organization (WHO) suicide can occur throughout the lifespan of an individual and is the fourth leading cause of death among 15–29-year-olds globally.[1] This corresponds to a global suicide rate of 10.4 suicides per 100,000. While the global suicide rates have remained relatively stable over the past decade, there is significant variation in the rates between high and low resource countries. It estimated more than 77 percent global suicides occur [2][1] in the low resource settings. Moreover, it is estimated that for every death by suicide there are as many as 20 more suicide attempts which places the burden much higher than is reported.[3][4]

In 2014, the WHO ranked Nepal as the 7thon the suicide rate globally. The estimated annual suicides annually are 6,840 or 24.9 suicides per 100,000 people.[5]According to data obtained from the Nepal police the average annual increase in suicide over the past five year is 7% which increased to 14% in 2021. Data on suicide in Nepal are primarily based on police reports and therefore rely on mortality statistics. Due to the lack of community-based screening, national suicide surveillance systems and integrated network, there is discrepancy in suicide reporting.[6] As such, burden of suicide in communities is likely to be higher particularly among women, migrant workers and population affected by disasters.[5]


Suicide in Nepal (Nepali: नेपालमा आत्महत्या) The increasing trend in suicide is a major public health concern in Nepal. [7][8][9] Often suicide indicates an underlying mental health problem or acute stress.[10][11] Increased access to timely and effective mental health services are often associated with decreased risk of suicide [12][13][14]. However, there are several barriers to access high quality mental health services in Nepal including stigma, lack of human resources as well as infrastructure to provide care.[15][16][17][18] The government of Nepal spends less than 1% of its total healthcare budget on mental health. [19] Nepal has a rural population of over 78% population[20][21], but the mental health resources are highly concentrated in larger urban areas.[22] While there have been some improvements in increasing awareness and access to mental health care through non profit organizations, government initiatives and telehealth, over 90% of people with mental health problems do not receive any access to treatment.[23][24]. As a result, despite the significant public health burden, suicide remains largely neglected and underreported in Nepal.[7][9]

Underreporting

The rate of suicide in Nepal has been reported to be as low as 3.7/100,000 as a result of under reporting caused by issues of legality, social stigma, and logistical problems.[25]

Suicide was decriminalized in Nepal 2018. Before that it was punishable by fines and imprisonment (requires citation). According to the director of Samanta, a Nepalese organization for women’s rights, "most families would never report suicide cases as they are afraid of being entangled in police cases."[26] In attempts to avoid legal trouble, suicidal patients and their families may avoid going to hospitals for treatment. Even after death, victims of suicide may have their deaths misattributed to avoid legal problems for their families.[25]

Families may also avoid reporting suicides due to social stigma and discrimination against people with mental health problems.[25] Despite the recent abundance of articles discussing suicide in Nepal, issues related to suicide are largely avoided, both as the result and perpetuation of a powerful social stigma against mental illness.[27] For women in particular, the under reporting of suicides and suicide-attempts may be caused in part by a "culture of silence", especially in cases related to domestic abuse.[28]

Finally, logistical issues pose a threat to accurate reporting and record keeping. According to the Nepal Health Sector Support Programme, due to "poor record keeping by police and hospitals" as well as the fact that "registration systems are inaccurate and of poor quality," suicide may continue to be under reported even if social and legal issues were to be resolved.[29]

Gender

In 2009, the Nepalese Family Health Division's Maternal Mortality and Morbidity Study published the "shocking finding" that suicide was the leading cause of death for women of reproductive age (15-49). According to the report, "analysis of verbal autopsy data indicates mental health problems, relationships, marriage and family issues are key factors" with 21% of suicides among women of reproductive age consisting of women 18 or younger, "indicating that youth is a factor to be investigated."[30] Although the suicide rate for men remains higher almost universally as well as in Nepal (30.1/100,000 for men, 20.0/100,000 for women),[31] Nepal has a relatively high ratio of female:male suicides and stands out as being ranked 17th for male suicide rates but 3rd for female suicide rates. It's worth noting that while male suicide rates are higher, it is estimated that Nepalese women attempt suicide three times more than men do.[32] Additionally, the tie ins to maternal health, domestic violence, and youth have made female suicide a prominent issue. A case study published in the same mortality report exemplifies the type of problems that women may face:

Sanju was a 21 years old, illiterate and mother of two children. By her third pregnancy she was anaemic and malnourished, feeling dizzy and weak, but she received no antenatal care. In her third month of pregnancy she was about to travel to her maternal home with her husband, but her relatives stopped her as there was a flood. She went to her room to rest, but when her mother-in-law went to her room an hour later she said she had eaten some medicine for killing lice. Her husband, mother-in-law and neighbour took her to the local medicine shop in their cart, and the pharmacist immediately referred her to the district hospital. The family borrowed money and took her to hospital in a private van, a 25 minute journey. She was admitted to the emergency ward and attended to by the doctor immediately, but died within a few hours. The above account was given by her mother-in-law. However, the female community health volunteer said Sanju suffered from hysteria and was being forced to have an illicit relationship with her father-in-law. She was treated for her hysteria but forced to continue the relationship, and therefore was tense. The FCHV and VHW felt this may have been the reason she committed suicide.[30]

More indirectly, gender based inequality in Nepal has been suggested as the cause of female suicide in Nepal. The prominence of suicide among women of reproductive age may be as a result of unwanted pregnancies and early marriages.[28] For Nepalese women, being married can come with the cost of leaving one's family and friends,[33] creating a "perennial cycle of dependence, which may lead some to view suicide as their only option.[34]

Notable cases

References

  1. ^ a b c "Suicide". www.who.int. Retrieved 2023-11-22.
  2. ^ Jordans, Mark JD; Kaufman, Anne; Brenman, Natassia F.; Adhikari, Ramesh P.; Luitel, Nagendra P.; Tol, Wietse A.; Komproe, Ivan (2014-12-24). "Suicide in South Asia: a scoping review". BMC Psychiatry. 14 (1): 358. doi:10.1186/s12888-014-0358-9. ISSN 1471-244X. PMC 4299381. PMID 25539951.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  3. ^ "Suicide". www.who.int. Retrieved 2023-11-22.
  4. ^ "Preventing suicide: A global imperative". www.who.int. Retrieved 2023-11-22.
  5. ^ a b Thapaliya, Suresh; Sharma, Pawan; Upadhyaya, Kapil (2018-02-01). "Suicide and self harm in Nepal: A scoping review". Asian Journal of Psychiatry. 32: 20–26. doi:10.1016/j.ajp.2017.11.018. ISSN 1876-2018.
  6. ^ Jordans, Mark JD; Kaufman, Anne; Brenman, Natassia F.; Adhikari, Ramesh P.; Luitel, Nagendra P.; Tol, Wietse A.; Komproe, Ivan (2014-12-24). "Suicide in South Asia: a scoping review". BMC Psychiatry. 14 (1): 358. doi:10.1186/s12888-014-0358-9. ISSN 1471-244X. PMC 4299381. PMID 25539951.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  7. ^ a b Silwal, Bhagabati Sedain; Pant, Puspa Raj; Gurung, Yogendra Bahadur (2021-03-01). "2E.003 Burden of suicide in Nepal: an analysis of police records". Injury Prevention. 27 (Suppl 2): A17–A17. doi:10.1136/injuryprev-2021-safety.51. ISSN 1353-8047.
  8. ^ Marahatta, Kedar; Samuel, Reuben; Sharma, Pawan; Dixit, Lonim; Shrestha, Bhola Ram (2017-04). "Suicide burden and prevention in Nepal: The need for a national strategy". WHO South-East Asia journal of public health. 6 (1): 45–49. doi:10.4103/2224-3151.206164. ISSN 2304-5272. PMID 28597859. {{cite journal}}: Check date values in: |date= (help)CS1 maint: unflagged free DOI (link)
  9. ^ a b Hagaman, Ashley K.; Maharjan, Uden; Kohrt, Brandon A. (2016-06-06). "Suicide surveillance and health systems in Nepal: a qualitative and social network analysis". International Journal of Mental Health Systems. 10 (1): 46. doi:10.1186/s13033-016-0073-7. ISSN 1752-4458. PMC 4895957. PMID 27274355.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  10. ^ Brådvik, Louise (17 September 2018). "Suicide Risk and Mental Disorders". International Journal of Environmental Research and Public Health. 15 (9): 2028. doi:10.3390/ijerph15092028. ISSN 1660-4601.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ^ "Risk and Protective Factors | Suicide | CDC". www.cdc.gov. 2023-07-06. Retrieved 2023-11-22.
  12. ^ "A Comprehensive Approach to Suicide Prevention – Suicide Prevention Resource Center". Retrieved 2023-11-22.
  13. ^ "Suicide Prevention: Evidence-Informed Interventions for the Health Care Workforce Guide | AHA". www.aha.org. Retrieved 2023-11-22.
  14. ^ Ahmedani, Brian K.; Vannoy, Steven (2014-09). "National Pathways for Suicide Prevention and Health Services Research". American Journal of Preventive Medicine. 47 (3): S222–S228. doi:10.1016/j.amepre.2014.05.038. ISSN 0749-3797. PMC 4143796. PMID 25145743. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  15. ^ Atreya, Alok; Upreti, Manish; Nepal, Samata (2023-03). "Barriers to mental health care access in Nepal". Medico-Legal Journal. 91 (1): 54–55. doi:10.1177/00258172221141293. ISSN 0025-8172. {{cite journal}}: Check date values in: |date= (help)
  16. ^ Luitel, Nagendra P; Jordans, Mark JD; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H (2015-12). "Mental health care in Nepal: current situation and challenges for development of a district mental health care plan". Conflict and Health. 9 (1). doi:10.1186/s13031-014-0030-5. ISSN 1752-1505. PMC 4331482. PMID 25694792. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  17. ^ Luitel, Nagendra P.; Jordans, Mark J. D.; Kohrt, Brandon A.; Rathod, Sujit D.; Komproe, Ivan H. (2017-08-17). Abe, Takeru (ed.). "Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal". PLOS ONE. 12 (8): e0183223. doi:10.1371/journal.pone.0183223. ISSN 1932-6203. PMC 5560728. PMID 28817734.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  18. ^ Gurung, Dristy; Poudyal, Anubhuti; Wang, Yixue Lily; Neupane, Mani; Bhattarai, Kalpana; Wahid, Syed Shabab; Aryal, Susmeera; Heim, Eva; Gronholm, Petra; Thornicroft, Graham; Kohrt, Brandon (2022). "Stigma against mental health disorders in Nepal conceptualised with a 'what matters most' framework: a scoping review". Epidemiology and Psychiatric Sciences. 31. doi:10.1017/S2045796021000809. ISSN 2045-7960. PMC 8851063. PMID 35086602.{{cite journal}}: CS1 maint: PMC format (link)
  19. ^ Singh, Rakesh; Khadka, Seema (2022-02). "Mental health law in Nepal". BJPsych International. 19 (1): 24–26. doi:10.1192/bji.2021.52. ISSN 2056-4740. PMC 9811380. PMID 36622651. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  20. ^ "Nepal: share of rural population 2022". Statista. Retrieved 2023-11-22.
  21. ^ Bureau, US Census. "Nepal: Population Vulnerability and Resilience Profile". Census.gov. Retrieved 2023-11-22.
  22. ^ Luitel, Nagendra P; Jordans, Mark JD; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H (2015-12). "Mental health care in Nepal: current situation and challenges for development of a district mental health care plan". Conflict and Health. 9 (1). doi:10.1186/s13031-014-0030-5. ISSN 1752-1505. PMC 4331482. PMID 25694792. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  23. ^ Luitel, Nagendra P.; Garman, Emily C.; Jordans, Mark J. D.; Lund, Crick (2019-10-22). "Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal". BMC Public Health. 19 (1): 1350. doi:10.1186/s12889-019-7663-7. ISSN 1471-2458.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  24. ^ Luitel, Nagendra P.; Jordans, Mark J. D.; Kohrt, Brandon A.; Rathod, Sujit D.; Komproe, Ivan H. (2017-08-17). Abe, Takeru (ed.). "Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal". PLOS ONE. 12 (8): e0183223. doi:10.1371/journal.pone.0183223. ISSN 1932-6203. PMC 5560728. PMID 28817734.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  25. ^ a b c Benson, J; Shakya, R (2008). "Suicide prevention in Nepal: a comparison to Australia – a personal view". Mental Health in Family Medicine. 5 (3): 177–82. PMC 2777576. PMID 22477866.
  26. ^ "NEPAL: Why are so many women killing themselves?". Irin News. 11 January 2010. Retrieved 29 June 2015.
  27. ^ Regmi, S. K.; Pokharel, A.; Ojha, S. P.; Pradhan, S. N.; Chapagain, G. (2004). "Nepal mental health country profile". International Review of Psychiatry. 16 (1–2): 142–149. doi:10.1080/09540260310001635186. PMID 15276946. S2CID 37998108.
  28. ^ a b "Female Suicides in Nepal and in the USA". Peace Voice. 30 August 2013. Retrieved 29 June 2015.
  29. ^ "SUICIDE AMONG WOMEN IN NEPAL" (PDF). Nepal Health Sector Support Programme. May 2012. Retrieved 29 June 2015.
  30. ^ a b "Maternal Mortality and Morbidity Study" (PDF). Family Health Division. 2009. Retrieved 29 June 2015.
  31. ^ "Suicide rates Data by country". World Health Organization. 2015. Retrieved 13 June 2015.
  32. ^ "Youth more prone to suicide". Kathmandu Post. 11 September 2010. Retrieved 13 June 2015.
  33. ^ "A Silent Killer of Women — Suicide". The New York Times. 6 March 2014. Retrieved 29 June 2015.
  34. ^ "A review of the evidence: suicide among women in Nepal" (PDF). Nepal Health Sector Support Programme. Archived from the original (PDF) on 8 June 2015. Retrieved 29 June 2015.
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