Tagged / suicide

Nepal publication: Smoking & suicide ideation

Published earlier this week in the Nepal Journal of Epidemiology a BU co-authored paper on ‘Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study’ [1].   The authors conducted a cross-sectional questionnaire-based survey with 452 young people in Nepal’s second largest city Pokhara.  The study matched participants by age and smoking status. The mean age was 21.6 years and 58.8% were males. The overall rate of suicidal ideation in our cohort was 8.9%. Smokers were slightly more likely to report suicidal ideation than non-smokers (aOR 1.12). The risk of developing suicidal ideation was 3.56 (95% CI 1.26-10.09) times more in individuals who smoked greater than 3.5 cigarettes per week (p=0.01).
The paper concludes that the rate of suicidal ideation was slightly higher among smokers and a dose-response relationship  existed linked with the number of cigarettes smoked per week. Being aware of the link between smoking and
suicidal ideation may help health care professionals working with young people to address more effectively the issues of mental well-being and thoughts about suicide.  The Nepal Journal of Epidemiology is an Open Access journal hence this public health  paper is freely available to readers across the globe.

Reference:

  1. Sathian, B., Menezes, R.G., Asim, M., Mekkodathil, A., Sreedharan, J., Banerjee, I., van Teijlingen, E.R., Roy, B., Subramanya, S.H., .Kharoshah, M.A., Rajesh, E., Shetty, U., Arun, M., Ram, P., Srivastava, V.K. (2020) Cigarette smoking dose-response and suicidal ideation among young people in Nepal: a cross-sectional study, Nepal Journal of Epidemiology 10 (1): 821-829 https://www.nepjol.info/index.php/NJE/article/view/28277

Why suicide rates among pregnant women in Nepal are rising

File 20180308 30989 ov7dje.jpg?ixlib=rb 1.1

Shutterstock/By KristinaSophie

By Bibha Simkhada, Liverpool John Moores University and Edwin van Teijlingen, Bournemouth University

Huge numbers of pregnant women and new mothers are taking their own lives in Nepal as they deal with extreme poverty, natural disasters, domestic violence and oppression. Research shows suicide represents 16% of all deaths in women of reproductive age. The rate is higher than previously recorded and there has been a considerable increase over the past few years. But a new project which trained midwives about mental health issues might hold the key to turning this around.

Suicide is primarily associated with unwanted pregnancy or the feeling of being trapped in poverty or situations of sexual and physical abuse. A study of 202 pregnant women (carried out between September and December 2014) found that 91% of them experienced some kind of physical, emotional or sexual abuse – mostly at the hands of their husbands and/or mother-in-laws.

The sad fact is that almost 40% of suicides in the world occur in South-East Asia. And one in three pregnant woman and new mothers are taking their own lives in low-income countries. In Nepal, 21% of the suicides among women aged 15-49 were in girls under 18 due to violence and being powerless in their families and communities.

Pregnancy is a known trigger for mental health problems. But gender discrimination and domestic violence are making matters worse. In addition to these issues, natural disasters are also a huge contributing factor to the spiralling mental health problems of young mothers.

A woman on a collapsed building in Kathmandu after the earthquake in May, 2015. Shutterstock/Somjin Klong-ugkara

Lack of control

In Nepal, making decisions about seeking maternity care is not in the hands of the pregnant woman but usually lies with her mother-in-law or husband. When young women marry they move in with their husbands’ family and their lives are ruled by their in-laws. These women often have little say in seeking health care during pregnancy, childbirth and the postnatal period.

In many poor families, husbands migrate for work leaving their young wives with family. Nepal has a real migrant workers economy with close to 50% of Nepalis relying on financial help from relatives abroad. Mental health problems can worsen for women who have been taken away from their own families. In other cases, young women face domestic violence due to their husbands’ drinking leading to mental health issues and suicide.

There is also a lack of understanding of pregnancy and childbirth-related mental health issues and husbands and mothers-in-law often fail to support these vulnerable young women. They in turn are reluctant to seek help due to the stigma associated with mental illness.

Cultural and social norms

Cultural practices and social norms, like gender inequalities and early marriage, hinder women who have a lack of choice when it comes to their role as mothers. There is also a preference for sons rather than daughters, who are seen as an “economic burden” in many families. If a woman is expecting a daughter, especially for the second or third time, this can also trigger mental health issues.

Depression and anxiety are common and affect ten to 15 out of every 100 pregnant women in the country. Postnatal depression is often reported, but less attention is given to more common and less obvious mental health issues.

Natural disasters and midwives

Recurrent earthquakes and floods exacerbate issues of depression and helplessness as women are forced to live in temporary shelters and have the burden of increased poverty.

For many rural Nepali women, the most qualified birth attendant they can expect to look after them is the Nepali Auxiliary Nurse Midwives (ANMs). But a study found that they received little or no formal training on perinatal mental health issues. Although there have been gradual improvements in health care for women during pregnancy, mental health support is leaving many women feeling that suicide is their only option.

As part of a Tropical Health and Education Trust project, funded by DFID, around 80 ANMs were trained on perinatal mental health issues. The project used UK-based volunteers in Nepal over two years.

The training helped raise awareness of mental health well-being and improved access to mental health care for pregnant women and new mothers. This is a vital first step towards improving community-based services for pregnant women in rural Nepal. But to offer hope to more young women there needs to be a significant increase in this type of training and awareness raising.

Bibha Simkhada, Postdoctoral Researcher in School of Nursing and Allied Health, Liverpool John Moores University and Edwin van Teijlingen, Professor of Reproductive Health Research, Bournemouth University

This article was originally published on The Conversation. Read the original article.

Suicide in India: Modelling data

The latest BU research publication used a modelling approach to suicide in India [1].  The paper ‘Time Trend of the Suicide Incidence in India: a Statistical Modelling’ is now online and freely available as it was published in an Open Access journal.  The first author of this paper is BU Visiting Faculty Dr. Brijesh Sathian.  The modelling resulted in some useful predictions of future risk of suicide at a population level, see for example: 10.12691.ajphr-3-5A-17.fig_1

 

Prof. Edwin van Teijlingen

Reference:

Sathian, B. , De, A. , Teijlingen, E. V. , Simkhada, P. et al. (2015). Time Trend of the Suicide Incidence in India: a Statistical Modelling. American Journal of Public Health Research, 3(5A), 80-87.  Online at:  http://pubs.sciepub.com/ajphr/3/5A/17/