Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems
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ORIGINAL PAPER
Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems H. M. Garrison‑Desany1,2 · M. E. Lasater3 · N. P. Luitel4 · D. Rimal4 · D. Pun5 · S. Shrestha5 · W. Tol3 · P. J. Surkan2,3 Received: 20 January 2020 / Accepted: 7 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Suicide · Transcultural psychiatry · Depression · Women’s health
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01932-7) contains supplementary material, which is available to authorized users. * H. M. Garrison‑Desany [email protected] 1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
2
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3
Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
4
Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
5
Women for Human Rights, Single Women’s Group, Kathmandu, Nepal
Globally nearly 800,000 people die b
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