Assessment of suicide and risk factors in Ilam district of Nepal, 2015/16
Suicide is a major public health problem worldwide. Suicide was the 14th leading cause of death and accounted for 1.48 % (95% UI: 1.34%-1.55%) of all deaths globally in 2015. There is a dearth of systematic, reliable, and nationally representative data on suicide in Nepal. The objective of this study is to estimate the prevalence of suicidal ideation, plan, and attempt in the Ilam district of Nepal.
A cross-sectional, descriptive study was conducted in the Ilam district using mixed methods (qualitative and quantitative). For the quantitative study, 20 Village Development Committee (VDCs) were chosen using probability proportionate to size (PPS) sampling. We used PPS sampling to select three wards within each selected VDC and then used systematic random sampling to select 24 households from each ward. A total of 1440 respondents age 10 or older were selected to be interviewed. Of the 1440 selected, 1387 were interviewed using a semi-structured questionnaire. For the qualitative study, five VDCs (Soyang, Sangrumba, Chamaita, Ebaang and Mahamai) were chosen purposively. Within the five selected VDCs, we conducted 42 interviews (28 key informant interviews and 14 in-depth interviews). Teachers, health workers, police, social workers, and a VDC secretary were key informant interviewees. Indepth interviews (IDI) were conducted among family members of individuals who attempted or committed suicide.
About 4.5% of all respondents are suicidal ideators; we define suicidal ideators as people that have seriously considered commiting suicide at some point in their lifetime. About 18% of suicidal ideators are suicidal planners; we define suicidal planners as people that have made a plan to commit suicide in the past 12 months. About 5% of suicidal ideators have attempted suicide in their lifetime. An estimated 15.4% and 21.5% of suicidal ideators aged 18-29 and 30-49, respectively, made a plan to commit suicide within 12 months prior to the survey. An estimated 7.7% of suicidal ideators aged 18-29 years old have attempted suicide in their lifetime. Suicidal plan and attempt is prevalent among female suicidal ideators (22.2% and 6.2%, respectively). The prevalence of suicidal ideation is 5.5% in Janajatis, followed by Dalit (5.0%), and the Upper Caste (2.7%). Suicidal plan is 22.6% among Janajatis who are suicidal ideators. Suicidal attempt is 17.5% among Dalit suicidal ideators. Suicidal ideation is 6.3% among Non-Hindus. Among Non-Hindus who are suicidal ideators, 22.6% are suicidal planners. The prevalence of attempted suicide is 8.1% among Hindus who are suicidal ideators. The prevalence of suicidal ideation is 6.3% among those who have no formal schooling. Suicidal plan and attempt are 24.6% and 8.4% respectively among suicidal ideators with only a primary education. Suicidal ideation is 7.4% among widowed or divorced respondents and 5.2% among the respondents living in a nuclear family. The prevalence of suicidal planning is 43.0% among unmarried suicidal ideators and 22.4% among suicidal ideators living in nuclear family. About 15% of unmarried suicidal ideators attempted suicide in their lifetime; this proportion is 6.9% among suicidal ideators living in a nuclear family.
The prevalence of suicidal ideation is 7.9% among those with a family history of disability and 11.5% among those with a personal history of disability. This proportion is 14.1% among those with a family history of suicide. Suicidal ideation prevalence is 22.3% among those with severe depression. Among those who are alcohol dependent, 10.5% are suicidal ideators. Suicidal plan is prevalent among suicidal ideators with severe depression (43.8%). Among suicidal ideators who are alcohol dependent, 23.4% made a suicidal plan within the 12 months prior to the survey. About 8% of suicidal ideators with severe depression have attempted suicide. This proportion is 7.6% among alcohol dependents who are suicidal ideators.
This study identifies several risk factors for suicidal ideation, such as family disputes, academic failure, financial hardship, alcohol use, physical illness, mental disorders, family history of suicide, anger issues, and low coping skills. Suicide was reported to have psychological effects on families and friends.
Though the incidence of suicide is rising in Ilam, suicide prevention programs have been limited to education classes for school children in Ilam as of July 2017. We propose community awareness programs and psychological support for high-risk populations as possible measures for preventing suicide in Ilam district.
Karki KB, Aryak KK, Ojha SP, Sapkota DR, Koirala S, Adhikari R, Shakya S, Thapa A, Pandit A, Mehta R, Shrestha N, Chalise B, Bista B, Jha BK, Jha AK. Assessment of Suicide and Risk Factors in Ilam District of Nepal, 2015/16. Kathmandu, Nepal: Nepal Health Research Council, TPO Nepal, Karuna Foundation Nepal, 2017.