Mental Health and Suicide Among Women in Jumla, Nepal: A Qualitative Exploration 公开

Robkin, Navit Tamar (2012)

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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...8

Mental 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...33

2000 Study...33

2007 Study...33

Current 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...66

Personal 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 Figures

Figure 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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