Assessment and management of suicidality in a mental health survey among poverty affected adolescents in Nepal

Authors

Rakesh Singh, Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal. rakesh.singh@kcl.ac.uk.
Karuna Chhetri, Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal.
Parinati Khanal, Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal.
Sabina Maharjan, Clinical Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal.
Emily Garman, Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
Mark J. Jordans, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 18 De Crespigny Park, London, SE5 8AF, UK.
Crick Lund, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 18 De Crespigny Park, London, SE5 8AF, UK.
Nagendra Luitel, Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal.
Kamal Gautam, Research Department, Transcultural Psychosocial Organization Nepal (TPO Nepal), Baluwatar, Kathmandu, Nepal.

Document Type

Journal Article

Publication Date

10-27-2025

Journal

BMC public health

Volume

25

Issue

1

DOI

10.1186/s12889-025-24943-y

Keywords

Adolescent suicidality; Mental health survey; Suicidality assessment; Suicidality management; Suicide management protocol

Abstract

BACKGROUND: Adolescent suicidality currently ranks as the third leading cause of death among adolescents, affecting global adolescent population, particularly in low- and middle-income countries (LMICs) like Nepal. This study explores the assessment of suicidality as an adverse event in adolescent mental health research in Nepal and outlines practical strategies for integrating suicide management protocols into mental health surveys in LMICs. It offers guidance on suicide risk assessment and referral pathways for vulnerable adolescents and contribute to suicide prevention efforts. METHODS: This study, a part of a cross-sectional survey with 490 adolescents aged 13-15 in public secondary schools in Kathmandu valley, used a three step approach of the Suicide Management Protocol (SMP) to identify and manage participants at risk of suicidality. Using the specific item under the measurement of mental health among adolescents and young people at the population level (MMAPP) tool followed by administering the suicide screening tool, those at risk of suicidality were identified by the researchers. Clinical assessments were then conducted by the psychosocial counsellor to categorize risk levels using Beck Suicide Intent Scale (BSIS) and provided appropriate management according to the severity. RESULTS: Of total 490 participants, while the single item under the MMAPP assessment identified 33 (6.7%) participants at risk, further screening using the suicide screening tool confirmed 25(5.1%) as positives, by the researchers. The psychosocial counsellor clinically assessed the 25 participants screened as suicide risk positive and found that 10 (40%) as high risk, 8 (32%) as moderate, and 7 (28%) as low risk. The clinical management of the cases at a differing level of risk was then managed as per the designated clinical pathways by developing protective behavior and reducing suicide related risk factors. All the participants were found to be safe and functioning normally through the course of clinical management, ranging from 2 to 6 sessions. CONCLUSIONS: Overall, integrating suicidality measures in mental health surveys was found to be effective suicide assessment and preventive strategy for adolescents in Nepal. Developing suicide management protocols within mental health surveys is essential and feasible for real-time monitoring and response to suicidal behavior among at-risk populations in LMICs, including Nepal.

APA Citation

Singh, Rakesh; Chhetri, Karuna; Khanal, Parinati; Maharjan, Sabina; Garman, Emily; Jordans, Mark J.; Lund, Crick; Luitel, Nagendra; and Gautam, Kamal, "Assessment and management of suicidality in a mental health survey among poverty affected adolescents in Nepal" (2025). GW Authored Works. Paper 8224.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8224

Department

Psychiatry and Behavioral Sciences