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Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths.

Publication ,  Journal Article
Hagaman, AK; Khadka, S; Wutich, A; Lohani, S; Kohrt, BA
Published in: Cult Med Psychiatry
September 2018

South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.

Duke Scholars

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Published In

Cult Med Psychiatry

DOI

EISSN

1573-076X

Publication Date

September 2018

Volume

42

Issue

3

Start / End Page

704 / 734

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Suicide
  • Qualitative Research
  • Psychiatry
  • Poverty
  • Nepal
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hagaman, A. K., Khadka, S., Wutich, A., Lohani, S., & Kohrt, B. A. (2018). Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry, 42(3), 704–734. https://doi.org/10.1007/s11013-018-9585-8
Hagaman, Ashley K., Seema Khadka, Amber Wutich, Shyam Lohani, and Brandon A. Kohrt. “Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths.Cult Med Psychiatry 42, no. 3 (September 2018): 704–34. https://doi.org/10.1007/s11013-018-9585-8.
Hagaman AK, Khadka S, Wutich A, Lohani S, Kohrt BA. Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry. 2018 Sep;42(3):704–34.
Hagaman, Ashley K., et al. “Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths.Cult Med Psychiatry, vol. 42, no. 3, Sept. 2018, pp. 704–34. Pubmed, doi:10.1007/s11013-018-9585-8.
Hagaman AK, Khadka S, Wutich A, Lohani S, Kohrt BA. Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry. 2018 Sep;42(3):704–734.
Journal cover image

Published In

Cult Med Psychiatry

DOI

EISSN

1573-076X

Publication Date

September 2018

Volume

42

Issue

3

Start / End Page

704 / 734

Location

Netherlands

Related Subject Headings

  • Young Adult
  • Suicide
  • Qualitative Research
  • Psychiatry
  • Poverty
  • Nepal
  • Middle Aged
  • Male
  • Humans
  • Female