Implementation Strategies for Suicide Prevention among Youth in Nepal

PROJECT SUMMARY / ABSTRACT
Suicide is a major public health concern. Globally, over 700,000 people die of suicide each year. It is the 4th
leading cause of death among youth throughout the world. The World Health Organization (WHO) recently set
a goal to reduce global suicides by 1/3rd by 2030. One major area of opportunity is within low- and middle-
income countries (LMICs), where over 77% of all suicides occur. Throughout the world, health systems have
begun implementing prevention and intervention approaches that have demonstrated effectiveness to reduce
suicide in numerous studies. This collection of evidence-based approaches make-up the Zero Suicide (ZS)
model, which has now penetrated the national health systems in >20 countries worldwide along with hundreds
of United States (US) health systems. Despite this success, this full model may be challenging to implement in
LMICs due to limited mental health infrastructures. However, several studies support the effectiveness of brief,
pragmatic approaches that may be adapted and implemented in LMICs. Nepal, a small country in South Asia,
serves as an optimal location to adapt and test these suicide prevention approaches. The suicide rate in Nepal
is more than double the US rate, and young people are disproportionately affected. In October 2022, a
National Suicide Prevention Symposium was cohosted by the Nepalese Government Ministry of Health and
Population, the GTA Foundation, and Henry Ford Health. In the meeting, youth were identified as the highest
priority sub-population. There was consensus that very little suicide prevention is being implemented, but there
was clear support for new research and program implementation. The established research and community
partnership between Henry Ford Health and the GTA Foundation in Nepal provides an ideal infrastructure to
learn from stakeholders about the feasibility of suicide prevention approaches and how best to implement them
in Nepal. The overall goal of the proposed R21 project is to work in partnership with stakeholders to develop
implementation strategies for adopting suicide prevention approaches among youth in Nepal. The specific aims
are to 1) Examine the feasibility of evidence-based suicide prevention approaches for youth in Nepal via
stakeholder surveys and interviews, and 2) Develop and evaluate implementation strategies for prevention and
intervention among youth at risk for suicide through a multi-step process informed by focus groups with key
stakeholders. Stakeholders will include national and local government leaders, community organization staff,
administrators and clinicians at hospitals and health clinics, school personnel, parents and youth. The
proposed project will generate data to inform a future hybrid trial of the proposed implementation strategies
and the design of a national suicide prevention strategy in Nepal.

Grant Number: 1R21MH135272-01
NIH Institute/Center: NIH
Principal Investigator: Brian Ahmedani