Mental Health and Suicide Among Women in Jumla, Nepal: A Qualitative Exploration Open Access
Robkin, Navit Tamar (2012)
Abstract
Despite an increased awareness of the growing burden of disease
attributable to mental health issues, mental health and suicide
remain low priorities in most low and middle-income countries
(LMIC). A recent study from Nepal found that suicide was the
leading cause of death among women of childbearing age. While
researchers have demonstrated a strong relationship between mental
health disorders and suicide in upper income countries, this
association is weaker in LMIC, where many suggest cultural
stressors play a more significant role in suicidal behavior. The
current study explored how different cultural stressors affect
mental health and lead to suicidal ideation/behavior among women in
Nepal. Women were selected to participate in in-depth interviews
based on previous participation in a related mental health study.
They were asked about their general mental well being, daily lives,
and attitudes toward suicide. Six dominant themes emerged as most
relevant to the women's lives and views on suicide: 1) mental
health issues (including depression/sadness and anxiety/worry); 2)
economics; 3) education; 4) domestic issues (including domestic
strife and alcohol abuse and love vs. arranged/captured marriage);
5) differential gender impacts (including personal attitudes and
community response toward child gender and male vs. female work
balance); and 6) suicide (including reasons for committing suicide,
impulsivity in suicide, speculation of family involvement in
suicide, and reactions toward suicide). This study suggests that
cultural stressors negatively impact female mental health and
eventual suicidal ideation and/or decision to attempt suicide.
These cultural stressors are related to differential gender impacts
of modernization that lead to repression of women and shifts in
male roles in society. The study also suggests that most suicides
are committed impulsively, without true intention to die.
Interventions for mental health issues and suicide in Nepal should
address cultural stressors such as domestic violence, alcoholism,
and women's access to income and education. Particular emphasis
should be placed on incorporating men into intervention planning
and dissemination. Additionally, findings about the role of
impulsive behavior in suicide suggest that those with suicidal
ideation would best be treated with Dialectical Behavior Therapy,
which uses techniques that would be familiar to the local
community.
Table of Contents
Table of Contents 1. Chapter 1: Introduction...1
Background on Nepal...4
Background on the People's War in Nepal...6
2. Chapter 2: Comprehensive Review of the Literature...8Mental Health and Suicide in Lower and Middle Income Countries...12
Mental Health and Suicide in Asia...15
Mental Health and Suicide in Nepal...25
Current Study...31 3. Chapter 3: Methods...332000 Study...33
2007 Study...33Current Study (2011)...34
4. Chapter 4: Results...41 Case Studies of Suicidal Ideation...41 In-Depth Interviews...46 Mental Health Issues...48 Depression/sadness...48 Anxiety/worry...51 Economics...53 Education...55 Domestic Issues...58 Domestic strife and alcohol abuse...58 Love vs. arranged/captured marriages...62 Differential Gender Impact...66Personal attitudes & community response toward child gender...66
Male vs. female work balance...69 Suicide...72 Reasons for committing suicide...73 Impulsivity in suicide...77 Speculation of family involvement in suicide...79 Reactions toward suicide...80 5. Chapter 4: Discussion/Conclusion/Recommendations...82 Discussion...82 Strengths/Limitations...94 Conclusion...94 Implications/Recommendations...95 6. References...98 7. Appendix Acronyms...116 Glossary...117 8. Tables and FiguresFigure 1. Map of Nepal...5
Table 1. Main and sub-themes identified in in-depth interviews...46
Table 2. Characteristics of Women in Case Studies/In-depth Interviews...47
Figure 2. The effects of societal factors on female mental health and suicide in Jumla, Nepal...92
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